VA Montana Health Care System

Individuals residing in more socioeconomically disadvantaged neighborhoods experience greater uncertainty through insecurity of basic needs such as food, employment, and housing, compared with more advantaged neighborhoods. Although the neurobiology of uncertainty has been less frequently examined in relation to neighborhood disadvantage, there is evidence that neighborhood disadvantage is associated with widespread neural alterations. Recently traumatically injured participants (n = 90) completed a picture anticipation task in the magnetic resonance imaging scanner, in which they viewed images presented in a temporally predictable or unpredictable manner. We investigated how neighborhood disadvantage (via area deprivation index [ADI]) was related to neural activation during anticipation and presentation of negative and neutral images after accounting for individual factors (i.e., age, gender, income, acute posttraumatic stress symptoms). There was a significant interaction during the anticipation period such that higher ADI rankings were related to greater activation of the right anterior cingulate cortex to predictable versus unpredictable neutral stimuli. Although no other robust interactions emerged related to ADI, we note several novel simple effects of ADI during anticipation and presentation periods in the hippocampus and prefrontal, cingulate, and occipital cortices. Together, these results may represent an adaptive response to predictable and/or negative stimuli, stemming from chronic exposure to socioeconomic-based uncertainties. Although effects were modest, future work should continue to examine pretrauma context on posttrauma outcomes. To better understand trauma outcomes, it is imperative that researchers consider the broader context in which trauma survivors reside.

Background: Little is known about what distinguishes those who are resilient after trauma from those at risk for developing posttraumatic stress disorder (PTSD). Previous work indicates white matter integrity may be a useful biomarker in predicting PTSD. Research has shown changes in the integrity of three white matter tracts—the cingulum bundle, corpus callosum (CC), and uncinate fasciculus (UNC)—in the aftermath of trauma relate to PTSD symptoms. However, few have examined the predictive utility of white matter integrity in the acute aftermath of trauma to predict prospective PTSD symptom severity in a mixed traumatic injury sample. Method: Thus, the current study investigated acute brain structural integrity in 148 individuals being treated for traumatic injuries in the Emergency Department of a Level 1 trauma center. Participants underwent diffusion-weighted magnetic resonance imaging 2 weeks post-trauma and completed several self-report measures at 2-weeks (T1) and 6 months (T2), including the Clinician Administered PTSD Scale for DSM-V (CAPS-5), post-injury. Results: Consistent with previous work, T1 lesser anterior cingulum fractional anisotropy (FA) was marginally related to greater T2 total PTSD symptoms. No other white matter tracts were related to PTSD symptoms. Conclusions: Results demonstrate that in a traumatically injured sample with predominantly subclinical PTSD symptoms at T2, acute white matter integrity after trauma is not robustly related to the development of chronic PTSD symptoms. These findings suggest the timing of evaluating white matter integrity and PTSD is important as white matter differences may not be apparent in the acute period after injury.

OBJECTIVE: To develop a typology of criminal defendants found incompetent to stand trial using data-driven classification techniques and validate it against forensically relevant outcomes. HYPOTHESES: We hypothesized that discrete groups of defendants determined to be incompetent exist that can be identified in the structure of observed clinical, demographic, and criminological data. We also expected that class membership would be differentially associated with competency restoration. METHOD: We coded hospital records for 492 consecutive male criminal defendants committed to a secure hospital for competency restoration between 2013 and 2017 (mean [M] age = 38.7 years, standard deviation [SD] = 14.2; 61.0% White, 34.2% Black, 2.6% Hispanic, 2.2% "Other"). Clinical, demographic, and criminological data were analyzed using latent class analysis. Validation analyses modeled competency restoration outcomes as a function of class membership. RESULTS: An 8-class solution best fit the data and included 3 discrete classes of patients with psychotic disorders (Class 2, n = 74; Class 3, n = 78; Class 6, n = 68), as well as classes characterized by intellectual limitations without comorbid psychosis (Class 4, n = 54), comorbid psychosis and intellectual limitations (Class 1, n = 41), mood disorders (Class 5, n = 80), older adults with neurocognitive disorders (Class 8, n = 59), and chronic instability (Class 7, n = 38). The restoration rate in the overall sample was 87.8%, and Classes 1-7 showed restoration rates similar to the overall sample, ranging from 82.9% to 100%. The restoration rate of Class 8 was 66.1%, and this was the only class to show significantly lower odds (odds ratio [OR] = 0.181, 95% confidence interval [CI: 0.093, 0.353], p < .001) and hazards (hazard ratio [HR] = 0.511, 95% CI [0.361, 0.724], p < .001) of restoration. CONCLUSION: Older adults with neurocognitive disorders admitted for competency restoration are at increased risk of failed restoration. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Abstract The presence of a Gender and Sexuality Alliance (GSA) reduces risk for sexual and gender minority (SGM) youth across a variety of domains, but little is known about the adult advisor‐level variables contributing to these observed benefits. This study explored relationships between advisors' tenure, receipt of professional development, self‐efficacy, and social emotional competencies (SECs). Participants ( N = 167) completed an online survey measuring their own social‐emotional competencies and their perceived self‐efficacy as a GSA advisor. As hypothesized, results demonstrated relationships between advisor tenure and self‐efficacy and between advisor receipt of professional development and self‐efficacy. Further, advisor SEC significantly predicted self‐efficacy, and both receipt of professional development and SEC positively predicted perceived self‐efficacy, as well. Findings point to opportunities for providing training to GSA advisors, with a focus on SEC to increase their efficacy in working with SGM youth. Implications for school psychologists are discussed.

Accelerated Transcranial Magnetic Stimulation (TMS) is a novel adaptation of TMS designed for faster symptomatic relief compared to standard TMS (1). Traditional TMS involves one session per day over 6 weeks, while accelerated TMS condenses multiple sessions into a single day. One of the first uses of accelerated TMS described in 2010 (2) provided a high dose of TMS over three days with improvements occurring rapidly; a more recent example is the SAINT protocol for MDD, which combines high dose TMS with proprietary functional targeting to yield robust outcomes (3).

OBJECTIVE: To improve knowledge, skills, and confidence in mass casualty management through design and im-plementation of a formal educational curriculum. DESIGN: Observational study using a mixed-methods formal educational training curriculum. SETTING: Rural Emergency Medical Services (EMS) system in Pennsylvania. Subjects/participants: Convenience sample of 141 licensed EMS providers. INTERVENTIONS: Formal educational curriculum using a computerized mass casualty scenario, lectures, hands-on skill stations, post-intervention participant satisfaction survey, knowledge retention at three- and six-month post curriculum. RESULTS: The formal curriculum resulted in an improvement in scene size-up, incident command system (ICS) set-up, and medical management of 12 percent, 27 percent, and 26 percent, respectively. Average scores on the written component evaluating mass casualty incident (MCI) management and knowledge of test patient triage were 84 percent and 74 percent, respectively. Knowledge recall at three- and six-month post-training was highly retained as test scores were generally unchanged from the time of the educational session. Course and instructor evaluations by participants reflected a high degree of satisfaction (scoring five on a five-point Likert scale). CONCLUSIONS: The formal curriculum was effective in improving the knowledge, skills, and confidence of mass casualty management. Although traditional educational methods tend to show decreases in long-term knowledge retention, the mixed active learning strategies used in this curriculum resulted in high level retention since short and long-term test scores were similar and unchanged over time. Additionally, this curriculum was perceived by participants as highly satisfactory toward their knowledge and skill development.

ABSTRACT IMPACT: Neighborhood disadvantage was significantly associated with brain structure and function in trauma-exposed adults, providing evidence that contextual factors should be assessed in mental health research, particularly in high-risk populations. OBJECTIVES/GOALS: Over 13 percent of Americans live in a socioeconomically disadvantaged neighborhood. Previous work has linked lower individual socioeconomic position to alterations in brain structure and function. However, the neural effects of area-level socioeconomic factors, such as neighborhood disadvantage, are unclear. METHODS/STUDY POPULATION: We recruited two-hundred and fifteen traumatically-injured participants from an Emergency Department in southeastern Wisconsin. An Area Deprivation Index (ADI) score, a national measure of neighborhood socioeconomic disadvantage, was derived from each participant’s home address. Two-weeks post-trauma, participants underwent a battery of self-report measures and functional magnetic resonance imaging (fMRI) scans. Using a multi-modal approach, we investigated the impact of ADI on brain structure as well as neural activation during rest and during an emotional uncertainty task. We sought to disentangle the relationship between neighborhood and individual socioeconomic position and neural activity in the context of trauma. RESULTS/ANTICIPATED RESULTS: We demonstrated that neighborhood disadvantage is associated with decreased volume and alterations of resting state functional connectivity of structures implicated in affect processing, including the hippocampus, amygdala, and ventromedial prefrontal cortex. These results held even after controlling for relevant individual variables, including acute post-traumatic stress symptoms and years of education. Moreover, individuals from disadvantaged neighborhoods exhibited heighted activation of these same structures in response to aversive stimuli. Thus, brain regions critical for recognizing and processing negative stimuli are susceptible to the effects of area-level socioeconomic factors. DISCUSSION/SIGNIFICANCE OF FINDINGS: The results offer additional evidence that neurobiological mechanisms clarify how stress ‘gets under the skin’. Changes to key brain regions may explain why those living in disadvantaged neighborhoods are at a heighted risk of PTSD. Broadly, these findings should inform future policies and community-driven interventions aimed at reducing poverty.

Abstract Older rural Veterans confront greater social isolation and health comorbidities, and have lower access to healthcare than Veterans in urban areas. Additionally, older rural Veterans with posttraumatic stress disorder (PTSD) are at elevated risk for social isolation, loneliness, and low social support. The purpose of this VA Office of Rural Health funded project was to disseminate and evaluate an 8-9 week group intervention “Enhancing Social Function for Older Veterans with PTSD” (ESVP), delivered in-person or virtually. Dissemination proceeded in several steps. (1) We identified potentially interested clinicians via 10-minute presentations at regional VA Geriatric Mental Health Champion-led meetings. (2) We provided 60-minute trainings to six clinicians, offering co-facilitation and consultation. (3) We partnered with behavioral health clinicians serving older rural Veterans at two sites. At the Montana site, our team co-facilitated two virtual ESVP groups (N = 9 Veterans) with Veterans from Montana, South Dakota, and Massachusetts. At the North Carolina site, clinicians co-facilitated one in-person ESVP group (N = 4 Veterans). (4) Leaders provided week by week feedback during consultation calls. Across the three groups, average session attendance was high (79%), despite initial technological difficulties in the virtual groups. Veterans reported modest gains in social function and decreased depressive symptoms pre to post group and provided positive qualitative feedback and suggestions for improvement. Clinicians reported high applicability (M = 4.9/5), feasibility (M = 4.4/5), and helpfulness (M = 4.8/5) of ESVP, and provided valuable feedback to inform future efforts to disseminate ESVP to older Veterans in rural areas.

INTRODUCTION: Native Americans enlist in the military at the highest per capita rate among racial or ethnic groups. Approximately 49% of Native Veterans live in rural areas, facing multiple barriers to health care and a high prevalence of mental health concerns. Video telehealth can improve access to care, and Veterans Health Administration has developed a culturally centered telehealth model for native Veterans. Personalized Implementation of Virtual Treatments for Rural Native Veterans (RNVs), an approach emphasizing cultural safety, helped expand the impact of existing telehealth clinics. METHODS: Recent efforts included a systematic program review and mixed-methods evaluation to identify logistical and administrative considerations for implementation and outreach. RESULTS: Key lessons emphasize protected clinical time for specific regions, building sustained community partnerships, collaborating with leadership, and streamlining messaging to improve patient engagement. CONCLUSIONS: These practices expand care access and quality for RNVs, with potential application to other populations.