Research Roundup |
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March 18, 2014, Volume 60, No. 26 |
Prolonged Exposure Therapy, Beneficial in Treating Adolescent Girls with PTSD
Large-Scale HIV Intervention Project in South Africa
Risk Factors Affecting Some Students Impact Outcomes for All
Prolonged Exposure Therapy, Beneficial in Treating Adolescent Girls with PTSD
Researchers at Penn Medicine reported in JAMA that a modified form of prolonged exposure therapy—in which patients revisit and recount aloud their trauma-related thoughts, feelings and situations—shows greater success than supportive counseling for treating adolescent PTSD patients who have been sexually abused.
Despite a high prevalence of posttraumatic stress disorder (PTSD) in adolescents, evidence-based treatments like prolonged exposure therapy for PTSD in this population have never been established.
“We hypothesized that prolonged exposure therapy could fill this gap and were eager to test its ability to provide benefit for adolescent patients,” said Dr. Edna Foa, professor of clinical psychology in the department of psychiatry in the Perelman School of Medicine, who developed prolonged exposure therapy.
The concern has been that prolonged exposure therapy, while the most established evidence-based treatment for adults with PTSD, could exacerbate PTSD symptoms in adolescent patients who have not mastered the coping skills necessary for this type of exposure to be safely provided.
Adolescence is often a time when children begin to test limits and are in and out of situations, both good and bad—situations that often determine the path their lives take into adulthood.
The six-year (2006-2012) study examined the benefit of a prolonged exposure program called prolonged exposure-A (PE-A), that was modified to meet the developmental stage of adolescents and compared it with supportive counseling in 61 adolescent girls, ages 13-18, with sexual abuse-related PTSD. In the single-blind randomized clinical trial, 31 received prolonged exposure-A and 30 got supportive counseling.
Each received 14 sessions (60- to 90-minute) of therapy in a community mental health setting. The counselors were familiar with supportive counseling but naïve to PE-A before the study; their PE-A training consisted of a 4-day workshop followed by supervision every second week.
Outcomes were assessed before treatment, mid-treatment and after treatment and at three, six and 12-month follow up. During treatment, patients receiving PE-A demonstrated greater decline in PTSD and depression symptom severity and improvement in overall functioning. These differences were maintained throughout the 12-month follow up period.
“Another key finding of this research was that prolonged therapy can be administered in a community setting by professionals with no prior training in evidence-based treatments and can have a positive impact on this population,” Dr. Foa said.
Large-Scale HIV Intervention Project in South Africa
A large-scale human immunodeficiency virus (HIV) intervention/education effort aimed at helping South African men take a proactive role in the prevention of that disease has proven successful, an important development considering that country has the largest number of HIV infections in the world.
Researchers, led by Dr. John B. Jemmott, III, Annenberg School for Communication and the Perelman School of Medicine; and Loretta Sweet Jemmott, director of the Center for Health Equity Research at Penn Nursing, developed an intervention involving nearly 1,200 individuals, who participated in customized and proactive education programs on condom usage and the importance of discussing safe sex in their relationships. The results of their study are reported in the American Journal of Public Health.
Nearly 1,200 individuals in 44 neighborhoods near East London in the Eastern Cape Province of South Africa participated in the program and follow-up surveys conducted over a 12-month period. Approximately half participated in an HIV/STI (sexually transmitted infection) risk reduction intervention and half in a general health information (control) intervention.
The intervention programs, called “Men, Together Making a Difference,” were conducted in native isiXhosa tongue (language using intermittent clicking sounds as part of its lexicon). The intervention sessions involved rituals such as beginning with a “Circle of Men,” which enabled all participants, regardless of age or economic status, to develop stronger bonds. Additional components of the HIV/STI prevention included a video magazine, “The Subject Is: HIV,” addressing the impact of the disease in South Africa; a video drama “Eiyish!,” addressing dangers of multiple partners and the failure to use condoms; take-home assignments; and in-class role-playing to increase the discussion and ultimately the use of condoms.
Follow-up surveys after one year showed an increase in condom use by participants, regardless of whether they were involved with steady or casual partners for intercourse. (From 54% to 63% for men involved with steady partners and from 77% to 79% for men involved with casual partners.) Also, follow-up surveys showed slight decreases in the occurrences of unprotected sex. Participants also reported a four- to five-percent increase in the number of times men talked to their partners about condom use prior to sex.
“The fact that HIV affects women most severely in regions such as the sub-Saharan Africa where heterosexual exposure is a dominant mode of HIV transmission is well established,” the authors write in the article. “Yet few interventions to change the heterosexual behavior of men have been developed and rigorously evaluated.” They note that not only was this the first large-scale study of its kind, but that South African men demonstrated a willingness to attend multiple intervention sessions, participate in role-play condom use scenarios and return for repeated efficacy assessments. They stressed the need for additional research to strengthen the impact of intervention programs.
Risk Factors Affecting Some Students Impact Outcomes for All
If big-city school systems had a clear picture of the risks that put their students most in danger of falling behind academically, educators and policy makers could build locally targeted solutions for the achievement gap. Educational Researcher published a Penn GSE study that moves that idea closer to reality. Led by Dr. John Fantuzzo, the research team focused on using integrated administrative data to more fully understand complicating factors for children at risk—and the impact of multiple risks on the broader educational environment.
In schools with high concentrations of students with risk factors, such as homelessness and low maternal education, the performance of all students—not just those experiencing these risks—was negatively impacted. The study, which looked at third grade students in Philadelphia, demonstrates that race and poverty are not telling the whole story in examining educational well-being and that problem-solving focused on certain children can benefit the entire school.
In the study, Dr. Fantuzzo and his co-authors used an integrated data system, which they helped to develop. This system, while protecting student privacy, combined records stored by the schools and social service agencies for thousands of third-graders from across Philadelphia to study the relations between risks and educational outcomes.
Third graders were chosen because third grade is the first time that children take state-mandated achievement tests, giving the researchers a consistent measure of academic performance. The data, which had been collected by public agencies over the children’s lifetimes and even extended back before their births to the time of their mothers’ pregnancies, enabled the researchers to use sophisticated analytic techniques to find the association between academic performance and various risks and protective factors over time.
Here is a summary of the peer-reviewed article:
“An Investigation of the Relations Between School Concentrations of Student Risk Factors and Student Educational Well-Being,” by John W. Fantuzzo, Whitney A. LeBoeuf and Heather L. Rouse, investigates the relationship between school concentrations of student risk factors such as homelessness, maltreatment and low maternal education and measures of reading, mathematics and attendance. The authors, examining an entire cohort of third-grade students in the School District of Philadelphia, document the negative impact of high concentrations of students with risk factors on the other children who attend school with these peers but are, themselves, not experiencing these risk factors. Large concentrations of students with low maternal education, homelessness and child maltreatment were found to be among the most harmful to overall student performance, after accounting for student-level risks and demographics. The findings show that poverty and race do not tell the whole story when it comes to educational well-being.
The integrated data system in Philadelphia, which began in 2002, is part of Actionable Intelligence for Social Policy (AISP), an initiative funded by the John D. and Catherine T. MacArthur Foundation through a grant to Penn professors Dennis Culhane, School of Social Policy and Practice and John Fantuzzo, Graduate School of Education.While harnessing the power of large amounts of public data to find solutions to civic problems is a recent trend, AISP has been in the big data field for many years. AISP was ahead of the curve, using research and relationship-building to tackle the complicated challenges of integrating disparate data systems in order to reveal previously unseen patterns, patterns that can teach us about the impact of homelessness on reading skills, send emergency services to those most in need during a crisis or help medical professionals care for rural patients more effectively. AISP is building a nationwide network of agencies that use integrated data systems to answer big questions, create efficiencies and solve the conundrums of technical disparities, legal roadblocks and privacy challenges along the way—essentially, to use data for the common good.
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