Translating Traumatic Stress Science and Practice for Policymakers: Promoting the Needs of Underserved Communities Through Public Policy
Diane Elmore Borbon, PhD, MPH
Policy Program Director, UCLA/Duke University National Center for Child Traumatic Stress
Adjunct Professor, School of Public Affairs, American University
Wednesday, November 4, 5pm – 6:15pm
Trauma is a pervasive and serious global public health problem. Its consequences are experienced by individuals across the lifespan and are disproportionately felt among underserved and vulnerable subpopulations, including communities of color and people from a variety of minority and historically marginalized identity groups. Over the last several decades, significant investments have been made in the scientific understanding of traumatic stress. In addition, important strides have occurred in increasing public awareness regarding trauma, investing in prevention, and developing and disseminating trauma-informed treatments and interventions. As the traumatic stress field has advanced, so have efforts to establish and implement trauma-informed public policies. This presentation will focus on several important public policy efforts in the US to promote recovery and resilience among underserved and vulnerable survivor communities. In addition, strategies for global trauma professionals to effectively disseminate and translate their scientific and clinical knowledge to inform the policymaking process will be discussed.
Diane Elmore Borbon, PhD, MPH, is a psychologist and the Washington, DC-based Director of the Policy Program for the UCLA-Duke University National Center for Child Traumatic Stress, the coordinating center for the National Child Traumatic Stress Network (NCTSN). She is also an Adjunct Professor in the School of Public Affairs at the American University. Previously she served as Director of the American Psychological Association’s (APA) Public Interest Government Relations Office; Director of the APA Congressional Fellowship Program; coordinator of APA activities related to military service members, veterans, and their families; and worked on health care issues in the United States Senate. Dr. Elmore Borbon earned her PhD in Counseling Psychology from the University of Houston, MA and BA in Psychology from Pepperdine University, and MPH from Johns Hopkins University with a dual concentration in health policy and public health preparedness. She completed her predoctoral residency at the Honolulu Veterans Affairs Medical Center/National Center for PTSD, Pacific Islands Division. Dr. Elmore Borbon is a Past-President of the International Society for Traumatic Stress Studies (ISTSS), Chair of the ISTSS Public Health and Policy Committee, Chair of the Public Policy Committee for the APA Division 56: Trauma Psychology, a member of the Board of the International Center for the Study, Prevention, and Treatment of Multigenerational Legacies of Trauma, and an Associate Editor for Psychological Trauma: Theory, Research, Practice, and Policy. In 2019, she received the University of Houston Distinguished Alumni Award; in 2016, she received the ISTSS Public Advocacy Award; and in 2007, she received the ISTSS Chaim Danieli Young Professional Award. Her work focuses on the translation and dissemination of scientific and clinical knowledge to policymakers, government leaders, and key decision makers on public health and trauma policy issues to address the needs of underserved populations.
Providing Trauma-Focused Cognitive Behavioral Therapy via Telehealth Before, During and After the COVID-19 Pandemic
Michael Andrew de Arellano, PhD
Senior Associate Dean for Diversity, College of Medicine
Professor and Licensed Clinical Psychologist, National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Friday, November 6, 10am – 11:15am
While there are numerous evidence-based treatments that have been found to be effective to treat trauma-exposed youth, only a small percentage of youth and families receive needed treatment interventions. Even among those who are able to access these services, fewer still complete a full course of treatment and instead prematurely drop out. A number of strategies have been successfully utilized to improve access to and completion of treatment—including treatment through telehealth. The use of telehealth to provide evidence-based treatments has become much more commonplace in recent months due to the COVID-19 pandemic, but telehealth has been used for many years to help to increase access to mental health services for trauma-exposed youth and families. This presentation will discuss lessons learned providing trauma-focused cognitive behavioral therapy through telehealth in a variety of service settings for trauma-exposed youth over the past 10 years, including considerations to create a safe, therapeutic environment remotely.
Michael A. de Arellano, PhD, serves as the Senior Associate Dean for Diversity at the Medical University of South Carolina College of Medicine, and he is also a professor and a Licensed Clinical Psychologist at the National Crime Victims Research and Treatment Center in the Department of Psychiatry and Behavioral Sciences. He directs the Mental Health Disparities and Diversity Program, which facilitates the development of research, clinical work and educational programs to enhance culturally competent and linguistically appropriate care. Dr. de Arellano and his team are involved in research, clinical services and training to increase access to evidence-based mental health services for trauma-exposed youth from traditionally underserved backgrounds (e.g., rural, economically disadvantaged, ethnic minority) though a variety of in-person (e.g., school-based) and virtual (e.g., telehealth) programs. In recent years, he and his team have broadened their work to include projects outside the US mainland and international projects, including collaborations to support children recovering from Hurricane Maria and disseminating evidence-based treatments for trauma-exposed youth in Central America.
The Ebb and Flow of Suicide Risk: Implications for Treatment
Craig J. Bryan, PsyD, ABPP
Stress, Trauma, and Resilience (STAR) Professor of Psychiatry and Behavioral Health
Director, Division of Recovery and Resilience
The Ohio State University Wexner Medical Center
Saturday, November 7, 2pm – 3:15pm
Q&A: Tuesday, November 10, 4:15pm – 4:45pm
Although PTSD is a well-established risk factor for suicidal thoughts and behaviors, little is understood about the processes that underlie these associations. Accumulating evidence informed by complex systems thinking suggests that the examination of nonlinear patterns of change over time can provide new insights regarding the emergence of complex and seemingly unpredictable phenomena like suicide. This presentation will introduce the concept of emergence, discuss its applicability to suicide, consider how this framework could advance our understanding of suicide risk among individuals experiencing traumatic stress, and reveal clues about novel suicide risk assessment and intervention strategies that could yield meaningful reductions in suicidal thoughts and behaviors among vulnerable individuals.
Dr. Craig J. Bryan, PsyD, ABPP, is a board-certified clinical psychologist in cognitive behavioral psychology. He is the Stress, Trauma, and Resilience (STAR) Professor of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center, and is the Division Director for Recovery and Resilience. Dr. Bryan received his PsyD in clinical psychology in 2006 from Baylor University and completed his clinical psychology residency at the Wilford Hall Medical Center, Lackland Air Force Base, TX. Dr. Bryan deployed to Balad, Iraq, in 2009, where he served as the Director of the Traumatic Brain Injury Clinic at the Air Force Theater Hospital. He separated from active duty service shortly after his deployment, and started researching PTSD, suicidal behaviors and suicide prevention strategies, and psychological health and resiliency. He has held faculty appointments at the University of Texas Health San Antonio, the University of Utah, and the Ohio State University, and has managed numerous federally-funded projects in excess of $30 million focused on testing treatments for reducing suicidal behaviors, developing innovative methods to identify and detect high-risk individuals, and facilitating recovery after trauma. His research has been funded by a wide range of agencies including the Department of Defense, the National Institutes of Health, the Boeing Company, and the Bob Woodruff Foundation, and has been featured in media outlets including Scientific American, CNN, Fox News, NPR, USA Today, the LA Times, the New York Times, and the Washington Post. Dr. Bryan has published over 200 scientific articles and multiple books including Brief Cognitive Behavioral Therapy for Suicide Prevention, and is considered an international expert on suicide prevention and trauma.
Dr. Bryan has served as the lead risk management consultant for the $25 million STRONG STAR Research Consortium and the $45 million Consortium to Alleviate PTSD, which investigates treatments for combat-related PTSD among military personnel. Dr. Bryan has served on the Board of Directors of the American Association for Suicidology, the Scientific Advisory Board for the Navy SEAL Foundation, and the Educational Advisory Board of the National Center for PTSD. He has served as a consultant to the Department of Defense, Department of Veterans Affairs, Federal Bureau of Prisons, Avera Health, and Aurora Health Care. For his contributions to mental health and suicide prevention, Dr. Bryan has received numerous awards and recognitions including the Arthur W. Melton Award for Early Career Achievement, the Peter J.N. Linnerooth National Service Award, and the Charles S. Gersoni Military Psychology Award from the American Psychological Association; and the Edwin S Shneidman Award for outstanding contributions to research in suicide from the American Association of Suicidology.
Genetic Influences on Posttrauma Risk and Resilience
Ananda B. Amstadter, PhD
Associate Professor, Virginia Institute for Psychiatric and Behavioral Genetics
Departments of Psychiatry, Psychology, and Human and Molecular Genetics
Virginia Commonwealth University
Monday, November 9, 10am – 11:15am
The notion that genetic factors play a role in response to exposure to traumatic events was made over 75 years ago. Great progress has been made since this early inception in understanding the role of genetic liability on traumatic stress phenotypes. This presentation will begin by discussing the behavioral genetic studies that have highlighted the role of latent genetic risk in understanding liability to posttraumatic stress disorder (PTSD), as well as those that have informed the role of genetic etiology in resilience phenotypes. The field has recently undergone tremendous growth in the area of molecular genetic investigations utilizing agnostic genome wide association study (GWAS) designs of traumatic stress-related outcomes, largely due to team science efforts such as the Psychiatric Genomics Consortia (PGC). The PGC PTSD workgroup sample size is now greater than 100,000. In this era of "big data," innovations in statistical genetics have proliferated, offering tools to understand molecular heritability, molecular correlations across traits and aggregate genetic risk, as well as to the causal role of genetic loci on traits. An overview of these statistical genetic approaches will be provided, and key findings resulting from their application to traumatic stress phenotypes will be highlighted. The presentation will end with discussion of a novel cross-species approach that can further shed light on the genetic influences on posttrauma outcomes.
Dr. Amstadter is an Associate Professor of Psychiatry, Psychology, and Human and Molecular Genetics at Virginia Commonwealth University (VCU). Dr. Amstadter completed her clinical internship at the National Crime Victim Center at the Medical University of South Carolina (MUSC) and subsequently served on the faculty at MUSC before joining the faculty at VCU. Dr. Amstadter’s program of research focuses on the understanding of genetic and environmental factors that influence risk and resilience for posttraumatic stress disorder (PTSD) and related comorbidities, with a focus on alcohol use disorder (AUD). Dr. Amstadter is a contributing member to the Psychiatric Genomics Consortia (PGC) for PTSD, and she is the Associate Director of Spit for Science, a genetically informed longitudinal study of behavioral and substance use outcomes in VCU students across their academic careers. Dr. Amstadter also serves as a Co-Director of an NIMH T32 training grant that provides pre and postdoctoral training in psychiatric and statistical genetics. Her funded program of research has yielded over 180 publications, and she has written over 20 book chapters. In addition to her active research, Dr. Amstadter has served in a leadership role for ISTSS as a member of the Board of Directors for two terms, including serving as Vice President and Secretary. She is also a founding member and Co-Chair of the Genomics SIG.
Experimental Designs for Developing Technology-Based Interventions: on Factorial Designs, SMARTs and MRTs
Inbal (Billie) Nahum-Shani, PhD
Co-Director, Data-Science for Dynamic Decision-Making Lab (d3lab)
Research Associate Professor, Survey Research Center
Institute for Social Research
University of Michigan
Wednesday, November 11, 2pm – 3:15pm
Technology-based interventions often include multiple components. A variety of experimental designs can be used to inform the construction of multi-component behavioral interventions. These include factorial designs, sequential multiple assignment randomized trials (SMART), and micro-randomized trials (MRT). This presentation is a non-technical introduction to multi-component interventions, including fixed interventions, adaptive interventions and just-in-time adaptive interventions (JITAI). An organizing framework will be presented to help scientists select an experimental approach to inform intervention development. The connection between several experimental approaches will be discussed and a variety of case studies will be used for illustration.
Inbal (Billie) Nahum-Shani is Associate Professor in the Institute for Social Research, and a founding member of the Data-science for Dynamic Decision-making lab (d3lab) at the University of Michigan. Her research focuses on conceptual and methodological issues pertaining to the construction of effective Adaptive Interventions -- a treatment design in which ongoing information from the person is used to individualize the type/dose/modality of support (or treatment); and Just-In-Time Adaptive Interventions (JITAIs) -- a special form of adaptive interventions in which mobile devices are used to provide support in a timely and ecological manner. Nahum-Shani collaborates with multiple scientific teams on the development of technology-based interventions that deliver support in real time; these include interventions for engaging individuals in self-monitoring behaviors, emotion-regulation exercises, and mental health treatments. She is providing leadership for three federally funded research projects to inform the development of adaptive interventions and JITAIs targeting substance use (funded by NIH/NIDA), obesity (funded by NIH/NIDDK), and smoking (funded by NIH/NCI).
Wrong Place, Wrong Time: Understanding Violence through the Lens of Racial Trauma
John A. Rich, MD, MPH
Professor of Health Management and Policy, Drexel Dornsife University School of Public Health
Co-Director, Drexel Center for Nonviolence and Justice
Friday, November 13, 10am – 11:15am
Q&A: Friday, November 13, 11:30am – 12pm
Violence and trauma exact a toll the lives of young Black and Brown people across the nation. This inequity is not much different from the way that many chronic diseases disproportionately impact Black and Brown people. Racism is a root cause of inequities in health between Black/Brown people and white people. This racism manifests itself in both overt and subtle ways, often leading Black and Brown people to receive brutal treatment at the hands of law enforcement and inferior care at the hands of medical and behavioral health providers. This inferior care, combined with the wounds of racial trauma, often leads Black and Brown people to avoid systems that inflict these wounds. This presentation will highlight ways for providers to help survivors heal from the wounds of racial trauma by acknowledging of the effects of racism and incorporating trauma-informed, culturally responsive healing practices into care. Building healing approaches requires that we elevate and honor the voices of survivors of violence and engage in a proactive assessment of systems of care to root out structural racism. The presentation will draw from the experiences at the Drexel University Center for Nonviolence and Social Justice where survivors of violence receive physical and behavioral health support and care through Healing Hurt People, a hospital-based trauma-informed intervention.
John A. Rich, MD, MPH is Professor of Health Management and Policy at the Drexel Dornsife University School of Public Health. He is also the Co-Director of the Drexel Center for Nonviolence and Justice, a multidisciplinary effort to address violence and trauma to improve physical and mental health. Dr. Rich’s work has focused on issues of urban violence and trauma, health disparities, particularly as they affect the health of men of color. Dr. Rich is also an expert in qualitative research methods and narrative analysis. In 2006, Dr. Rich was awarded a MacArthur “Genius” Fellowship. In awarding this distinction, the Foundation cited his work to design “new models of health care that stretch across the boundaries of public health, education, social service, and justice systems to engage young men in caring for themselves and their peers.”
Prior to joining Drexel University, Dr. Rich served as the Medical Director of the Boston Public Health Commission where he led the city’s initiatives on Men’s Health, Cancer, Cardiovascular Health and Health Disparities. As a primary care doctor at Boston Medical Center, he created the Young Men’s Health Clinic and initiated the Boston HealthCREW, a program to train inner city young men as peer health educators. His book about urban violence titled Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men (The Johns Hopkins University Press, 2009) shares stories of trauma and healing.
Dr. Rich earned his A.B. degree in English from Dartmouth College, his M.D. from Duke University School of Medicine, and his M.P.H. from the Harvard School of Public Health. He completed his internship and residency in primary care internal medicine at the Massachusetts General Hospital in Boston, and a fellowship in general internal medicine at the Harvard Medical School. In 2009, Dr. Rich was elected to the National Academy of Medicine of the National Academy of Sciences. He currently serves on several boards including the Philadelphia Board of Health, and the Trust for America’s Health. He served on the Board of Trustees for Dartmouth College from 2008-2016.