Can Contextual Factors Help Explain Access to, Engagement In, and Effectiveness of Psychological Interventions for Marginalized Adolescents With Trauma Exposure?

Citation

Chodzen, Gia Nora (2024). Can Contextual Factors Help Explain Access to, Engagement In, and Effectiveness of Psychological Interventions for Marginalized Adolescents With Trauma Exposure?.

Abstract

Marginalized adolescents are disproportionately vulnerable to experiencing psychological distress due to trauma exposure but are less likely to access, engage in, and benefit from existing trauma focused evidence based interventions (EBIs). It is hypothesized that one reason for the disparities in EBI access, engagement, and effectiveness is that current trauma focused EBIs do not effectively account for the contextual conditions that contributed to the onset and maintenance of psychological problems following trauma exposure. Therefore, the goal of this dissertation was to utilize an approach informed by socio-ecological model of health to complete three studies to examine the effect of contextual factors on psychological treatment (1) access, (2) engagement, and (3) effectiveness among marginalized adolescents with trauma exposure. Study one utilized data from a large epidemiological dataset to examine the explanatory power of neighborhood level moderators of the relationship between psychological need and likelihood of adolescents accessing psychological services. I found that neighborhood level inequality negatively impacted adolescents’ ability to access care, even when accounting for psychological need and marginalized identity. Study two utilized a mixed methods approach to determine whether contextual barriers to psychological treatment impacted engagement in a small, randomized control trial for a trauma focused EBI. I found modest preliminary evidence that adolescents anticipated that contextual barriers would impact their ability to engage in care. Study three was a qualitative examination of whether content related to contextual stressors in individual therapy sessions impacted adolescent and provider perceptions of EBI effectiveness. I found that contextual stressors were related to psychological distress, difficulty with engaging in treatment, and decreased intervention acceptability. Results from the dissertation have the capacity to inform novel public health and clinical interventions to eliminate disparities and to improve existing EBIs.

Keyword(s)

Contextual factors

Notes

Reference Type

Thesis/Dissertation

Author(s)

Chodzen, Gia Nora

Series Author(s)

Ng, Lauren Christina

Year Published

2024

Pages

134

Publisher

University of California, Los Angeles

City of Publication

United States -- California

ISSN/ISBN

9798383647257

DOI

9798383647257

Reference ID

10488