Yale University

Culturally Enhanced Trauma Treatment for African American Youth: Integrating Racial Socialization

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period: 07/11/2017 - 07/10/2018
Grant Type: Pilot Project

Abstract Text:

Approximately 30% of youth between the ages of 10 and 17 experience or witness maltreatment; however, upwards of 76% of youth with HIV have histories of trauma [1-3]. Traumatic experiences during childhood are associated with HIV risk behaviors including earlier sexual debut, inconsistent condom use, unstable relationships, multiple sexual partners, and using substances [4-6]. Trauma-related cognitive behavior therapies show empirical support in the reduction of numerous negative sequelae including PTSD, depression, and externalizing problems such as aggression and engagement in HIV risk behaviors [7]. African Americans are significantly less likely to initiate, engage in, complete, and sustain positive outcomes following treatment than youth of other ethnicities [8, 9]. Researchers and clinicians emphasize the importance of culturally competent treatment for ethnic minorities. Cultural modifications to trauma treatments exist for Latino [10] and American Indian and Alaska Native youth [11]; however, no such model has been formalized for African Americans in trauma treatment.
Racial socialization is a critical but underutilized protective process employed by African American parents that helps boost self-esteem, racial identity, and resilience, and helps prevent negative psychological outcomes (e.g., depression), behavior problems (e.g., aggression), and health outcomes (e.g., HIV risk) after stressful life events. Using a Community based participatory research approach following the ADAPT-ITT Model for modifying evidence-based HIV- related interventions [12], the current study will take a secondary prevention approach to HIV prevention. We seek to enhance mechanisms of action (i.e., racial socialization) to reduce health disparities in trauma sequelae (e.g., HIV risk) and to reduce mental health disparities in trauma treatment engagement and outcomes (e.g., PTSD) for at-risk, underserved African Americans.
This study will conduct focus groups with clinicians (n=8) and African American youth (n=12) and caregivers (n=10) in order to develop a culturally enhanced racial socialization integrative component with to be used within (e.g., psychoeducational materials) and between (e.g., in-vivo assignments) trauma treatment sessions. This will involve having key stakeholders in the target population (clinicians and clients) respond to a demonstration of the culturally enhanced treatment components (e.g., psychoeducation materials and in-vivo assignments) and answer questions designed to gauge their reaction to the materials presented. Here, we will consider culture and context in order to gain qualitative feedback from youth, caregivers, and trauma clinicians in order to further refine and finalize the racial socialization integrative component. Focus groups will be transcribed, responses will be coded, and we will create a standardized cultural enhancement component for existing evidence-based trauma treatments wherein racial socialization will be integrated by trauma clinicians both within (e.g., psychoeducation) and between (e.g., in-vivo, “in real life” assignments) sessions with African American youth and caregivers. For our clinician training, we will train 10 clinicians on the use and integration of this component into TF-CBT. Our training will take place over the course of one week wherein clinicians will be trained over 2 sessions (e.g., Monday, Friday) lasting 2 hours each. These sessions will be didactic in nature, and they will provide clinicians with the required theoretical knowledge, involve discussion of the psychoeducation materials and in-vivo assignments, and give clinicians opportunities to role-play the delivery of the content. During the Testing phase, we will assess the acceptability and feasibility of the racial socialization integrative component with 6 sets of clinicians, youth, and caregivers (n=18). African American adolescent boys and girls between the ages of 9 and 18 who have experienced trauma will be recruited from both DNLCC and the NCVC to complete the enhanced treatment. The current preliminary research study is an acceptability and feasibility trial designed to provide the foundation for a randomized controlled trial evaluating the developed Racial Socialization Integrative Component.