The purpose of this study was to describe the perceived barriers to obtaining psychiatric treatment at the Johnson City Community Health Center. The context of the study was a rural area in Eastern Tennessee. Five patients with confirmed DSM-IV mental health diagnoses were recruited during treatment and interviewed at the Johnson City Community Health Center after their scheduled appointments with a Mental Health Nurse Practitioner (MHNP). The semi-structured interview focused on perceived barriers to obtaining treatment, perceptions of treatment received, and perceived availability of treatment. From those interviews, two themes were identified and each of which had two sub-themes identified: Realities of Treatment with the sub-themes of Therapy-Related Realities and Logistics Realities, The Way It Is with the sub-themes of Take Care of It Myself and Don’t Want People to Know. The findings indicate that there is a duality of positive and negative aspects of treatment at Johnson City Community Health Center. Understanding the needs and perceptions of those with psychiatric diagnoses will assist all staff and mental health providers in developing programs that are better suited for those with psychiatric diagnoses receiving treatment from Johnson City Community Health Center.

Book Summary: This volume offers an overview of the latest research on perinatal adaptation among women who have faced trauma, loss and/or adversity, both in childhood and/or as an adult, and describes the varied trajectories of adaptive and maladaptive coping that follow. The range of outcomes considered span from health-limiting (e.g. mental illness, substance use, unhealthy life style behaviours) to health-promoting (e.g. resilience and posttraumatic growth). These outcomes are examined both in relation to mothers’ experience of motherhood and parenting, and with regard to their children’s lives. Interpersonal trauma, experienced in childhood and/or or adulthood, can have a profound effect on how women experience the transition into motherhood – from pregnancy, to childbirth, and postpartum caregiving. Women across the globe are exposed to high rates of interpersonal violence, and face the physical and emotional consequences of such events. The shift into motherhood is an emotionally evocative period in a woman’s life, entailing not only challenges, but also the potential for healing and growth. Individual chapters will present state-of-the-art research, and will also highlight the voices of women who have personally experienced trauma, illustrating the effects on their experiences as mothers. Throughout the book, the consistent emphasis is on clinical implications and on ways that providers can create a context for healing and growth with the help of current evidence-based and promising treatment methods.

Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice–involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-ofhome placements. Implications and future directions are discussed.

Objectives: The process of service intensity (SI) or level of care (LOC) determination regarding mental health services has a problematic history. There is a need for reliable and valid SI/LOC determination tools for youth in the child welfare system. Methods: In 2004 and 2005, the Tennessee Child Program Outcome Review Team (CPORT) reviewed 437 children and youth in the child welfare system (277 in state custody, 160 at risk of custody) of whom 61.6% were male, 64.8% Caucasian and 28.4% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators. Results: All CASII subscales significantly correlated to the CAFAS Total Scores (Pearson coefficients 0.225 to 0.454). The CASII Total Score and the CASII SI determinations were highly correlated to CBCL, YSR, and TRF total and sub-scales. Significant correlations between the CASII SI determinations were found across all of the 13 CPORT Child and Family Indicators, while actual placement significantly correlated with only three of the 13 dimensions. The actual SI/LOC placements were significantly divergent from the placement recommendations derived using the CASII instrument (p < 0.000) with the majority of CASII SI/LOCs recommendations being for less restrictive placements. Conclusions: The CASII SI/LOC tool demonstrates high levels of reliability and validity in multiple care contexts, including child welfare, juvenile justice, and mental health settings. Expanded use of the CASII could potentially result in less restrictive, more appropriate, and less costly services becoming available to youth in these systems.

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The Attachment, Self-Regulation, and Competency (ARC) treatment framework is a “whole-systems” intervention which focuses on children and youth with complex trauma histories and attachment difficulties. ARC encourages intervention in layers to build a safe and secure caregiving system around a child. The layers include the child, caregivers, treatment providers, child welfare workers, teachers, and case managers. We developed an ARC Community Based Learning Collaborative (CBCL) to bring these layers together to create a safe andsupportive group experience and environment in which members of the child’s caregiving system can begin to build a common language and understanding of trauma that results in collaborated and coordinated trauma informed interventions to improve symptoms and decrease disrupted placement for youth in care. The overall goal of the ARC CBLC is to build highly functioning teams whose members have the knowledge and skills to apply the core principles of the ARC framework in accordance with their roles in the child’s caregiving system to promote healing and resiliency. This session will outline the development and implementation of the ARC CBLC, outcomes,and lessons learned.

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