Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for children impacted by trauma. Despite decades of empirical support for its efficacy, many children do not complete the full course of TF-CBT as designed. Up to 27% of children do not receive the full dose of treatment, limiting treatment effectiveness. Number of traumatic experiences, avoidance, post-traumatic stress symptoms, and foster care show mixed associations with treatment completion across evidence-based treatments overall, and it remains unknown if these same factors contribute to early termination of TF-CBT. Given documented barriers to participation (e.g., lack of parental involvement), further analysis using TF-CBT data is warranted. Thus, this study sought to identify client characteristics (e.g., residence status [living with parents versus not], number of trauma types [not including number of experiences], UCLA PTSD RI-5 scores and symptomology, and demographics [white, male, age]) associated with premature dropout or treatment transfer compared with treatment completion. The study used secondary baseline data from a statewide implementation of TF-CBT (N = 562 children). Multinomial logistic regression analyses revelated that children with a greater number of trauma types were significantly more likely to drop out of treatment or have their treatment transferred than complete TF-CBT. Under PTSD symptoms, children with higher arousal were more likely to transfer but children with higher re-experiencing symptoms were more likely to complete. This suggests that TF-CBT treatment may not be as accomplishable for children with multiple trauma types and tailoring based on these symptoms early may lead to less treatment transfer or dropout.

Military service can have a profound impact on families, particularly in relation to parental mental health. These factors can make the parent’s ability to provide stability and emotional support to other family members, especially children, extremely difficult. While the parent plays an important role in a child's life, teachers also play a critical role in understanding and supporting children’s behavior and performance in school. There seems to be a notable lack of studies exploring their perceptions of military student behaviors. Military families often experience unique challenges due to moving frequently, parental deployments, and the potential impact of military life on children’s emotional well-being (Briggs et al., 2019). Understanding how teachers perceive and respond to these specific challenges is crucial in providing appropriate support to military students. By exploring teacher perceptions, researchers could gain insights into how military life influences classroom dynamics, academic performance, and social interactions. The current study aims to investigate what child, parent, family, and deployment-related factors are associated with teachers’ perceptions of externalizing and internalizing behaviors in military-connected children.

Military sexual trauma (MST) is a risk factor for suicide among service members/veterans. Research reported that 41.79% of male and 63.58% female MST survivors were exposed to pre-military sexual trauma, making MST a revictimization experience. Unfortunately, little is known about mechanisms of the association between revictimization and suicide risk among MST survivors. One possible mechanism is posttraumatic cognitions (PTCs), which include the survivor’s (1) negative thoughts and beliefs about themselves, (2) negative thoughts and beliefs about the world, and (3) self-blame. The current study examined each of the PTC subscales as mediators of the association between sexual revictimization and suicide risk. Participants were 383 service members/veterans reporting a history of MST that involved assault (50.65% female), recruited via Qualtrics., Inc. in 2021. Participants completed self-report questionnaires assessing demographics, suicide risk, history of sexual victimization (MST only, MST and pre-military sexual victimization), and PTCs. Of these, 340 (88.8%) reported a history of MST and pre-military victimization and comprised the revictimization group. Parallel mediation analysis with suicide risk regressed on each of the PTCs subscales and covariates accounted for 43.48% of the variance, and revealed that negative cognitions about the self had a significant indirect effect on the association between revictimization and higher suicide risk, above and beyond negative cognitions about world and self-blame. Targeting negative cognitions about the self among sexual revictimization survivors may be an effective therapeutic strategy to most effectively reduce suicide risk. Cognitive Processing Therapy may be particularly useful among revictimization survivors given the focus on altering posttraumatic cognitions.

Depression is associated with job fatigue, social isolation, and suicide risk in US service members and veterans (SM/Vs). Risk for depression is particularly heightened among male SM/Vs relative to civilians, impacting 23% and 6%, respectively. Research suggests social support may protect SM/Vs from depressive symptoms, but most studies focus on positive social support (PSS). Negative social support (NSS) could be more impactful on depressive symptoms than positive support; however, this has not been examined in military samples. Given heightened risk for depression in SM/Vs, it is critical to better understand these associations. The present study addressed this literature gap in a convenience sample (N=508) of male SM/Vs. Participants completed measures of depression, PSS, NSS, and a demographic questionnaire. A correlation comparison calculation was used to compare the strength of bivariate associations of PSS and NSS with depression. Linear regression was employed to test the simultaneous effects of PSS and NSS as correlates of depression after accounting for age, race, and marital status. The association of NSS and depression was statistically stronger than the association of PSS and depression (t[301]=-11.55, p<0.05). Linear regression revealed that higher NSS (partial r=.40, p<.001) was positively associated with depression and high PSS (partial r=-.32, p<.001) was negatively associated with depression with medium-to-large effect sizes after accounting for covariates. Decreasing the frequency of negative social support may reduce depression in men SM/Vs. Findings also suggest the utility of focusing studies on both dimensions of social support in place of focusing on positive elements of social support.

Family engagement in child and family service systems can be influenced by the quality of the relationship between service system, provider, and family. Knowledge surrounding how relationships are mechanisms through which family engagement can be enhanced to promote equity in service accessibility remains scant, as such family engagement continues to be studied as a family-centric behavior and attitudinal construct. Thus, limited attention has been given to exploring structural factors influencing family engagement. In response and drawing from the socio-ecological model, this dissertation combines two qualitative studies to discuss the importance of and mechanisms for building relationships in two different contexts. The first study, “Factors Influencing Family Engagement for Immigrant Latina Mothers Participating in Trauma-Informed Child and Family Behavioral Health Services”, explores qualitatively the in-depth experiences of immigrant Latina mothers in trauma-informed services to understand multilevel factors and patterns of interconnection between these factors in the social ecology that impede or foster engagement in such services. Culturally responsive strategies to trauma-informed behavioral health services employed by providers and service agencies that lower immigrant Latina mothers’ barriers are also discussed. The second paper, “Sociocultural Responsive Frameworks to Increase Family Engagement in Child Serving Systems through a Peer-to-Peer Model for Families Experiencing Trauma”, uses multimodal qualitative methodology to comprehensively examine the value of a peer-to-peer support model in the context of trauma-informed and culturally responsive approaches in order to enhance family engagement for communities at higher risk for social exclusion. Together, these studies will shed light on the importance of studying family engagement as a function of intertwined structural factors and capitalizing on meaningful relationships to overcome barriers to community-based service engagement to address health disparities.