Julian D. Ford’s research while affiliated with University of Connecticut and other places

Background Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is crucial for enhancing treatment outcomes. Objective Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD. Methods A comprehensive systematic literature search was undertaken to identify randomised controlled trials comparing CBT-TF with waitlist control, treatment-as-usual or another therapy. Academic databases were screened from conception until 11 January 2021. Eligible interventions were required to be individual and in-person delivered. Participants were considered dropouts if they did not complete the post-treatment assessment. Findings The systematic literature search identified 81 eligible studies (n=3330). Data were pooled from 25 available CBT-TF studies comprising 823 participants. Overall, 221 (27%) of the 823 dropped out. Of 581 civilians, 133 (23%) dropped out, as did 75 (42%) of 178 military personnel/veterans. Bivariate and multivariate analyses indicated that military personnel/veterans (RR 2.37) had a significantly greater risk of dropout than civilians. Furthermore, the chance of dropping out significantly decreased with advancing age (continuous; RR 0.98). Conclusions These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel. Clinical implication Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes.

Objective: As a result of the coronavirus pandemic, mental health professionals have faced the challenge of helping their clients cope with pandemic-related distress on top of ongoing therapeutic issues. This article describes a telehealth-delivered peer/mutual support program for mental health professionals during the pandemic and the key themes identified by participants. Method: An interdivisional American Psychological Association task force formed a working group to identify practical ways to provide mental health professionals with direct support during the pandemic. A mutual support program, the Clinician Support Collaborative, was initiated using virtual video technology. This article describes the program and themes that emerged, including the challenges and benefits of using virtual video technology to host mutual support meetings. Results: Mutual support meetings were conducted on a weekly basis in 2020 and 2021, with mental health professionals and trainees in the Americas, Australasia, and India participating. Key themes identified included the logistical, therapeutic, and privacy concerns participants faced when shifting to telehealth, professional isolation, compassion fatigue, moral injury, burnout, stigma, disparities, and the intersection of personal/family stressors and work stressors. Conclusions: Recommendations for future use of virtual video technology to provide mutual support by and for mental health professionals are provided.

Objective: Youth who have been exposed to potentially traumatic events are at risk of developing chronic and severe adjustment problems. However, some youth exposed to potentially traumatic events exhibit better-than-expected adaptation. Person-centered analyses, based on multiple criteria for adaptive behavior and adversity, are well-suited to empirically identifying different patterns of adaptation among high-risk youth. Method: Data from 381 youth from three at-risk subgroups in Portugal were collected using self-reported measures of trauma history, trauma-related symptomatology, coping skills, and perceived social support. Distinct classes of adaptation after traumatic experiences were examined with latent class analysis. Results: Four classes were identified: (a) trauma-related psychopathology class (13.6%), (b) adaptive resilience class (36.8%), (c) low resources class (11.4%), and (d) high resources class (38.2%). Trauma-related psychopathology class and low resources class were characterized by high levels of maladjustment. Similarly to the low resources class, the trauma-related psychopathology class reported a significantly higher likelihood of trauma-related psychopathology and higher levels of problem-solving skills. The adaptive resilience class and high resources class also reported lower levels of maladjustment, and the high resources class reported higher levels of coping skills and lower levels of externalizing problems than any other class. Conclusion: Clinicians treating children’s internalizing mental health or externalizing behavior problems should assess trauma history and trauma-related psychopathology, as well as protective resources that may enhance resilience such as skills for problem solving and social support seeking.

Recognition of the high prevalence of trauma exposure and posttraumatic stress reactions among young offenders has led to calls for a shift toward the implementation of trauma-informed approaches in juvenile justice systems. However, meeting the clinical needs of youth in this population not only requires comprehending the profound effects of polyvictimization, developmental trauma, and complex PTSD but also an appreciation of the ways in which traumatic experiences and posttraumatic sequela intersect with diverse youth identities, including ethnicity and race, gender, sexual minority status, developmental stage, and gang involvement, which in turn may affect engagement in treatment. Ethical, legal, and clinical challenges specific to providing services in the context of the juvenile justice system also must be considered, including complications related to confidentiality, protection from self-incrimination, threats to psychological safety, and the potential for secondary traumatic stress among service providers delivering trauma-focused interventions in forensic contexts. This paper reviews those issues and goes on to describe the existing evidence base for interventions for posttraumatic reactions among justice-involved youth, as well as its limitations, and points toward future directions for research and clinical developments that could to expand the precision and reach of mental health services for youth at risk or already involved in the legal system.