Clifford Beers Clinic

BackgroundWe describe the rationale and study design for “TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN),” a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma.Design:TRUE HAVEN is a multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome.DiscussionResults from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence.Trial registrationClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023.

Relationship-defining memories represent enduring themes in a marriage and can provide insight in to marital satisfaction (Alea & Vick, 2010). The purpose of the study presented in this chapter was to examine whether “we-ness,” compared to “I-ness,” expressed in positive and negative relationship-defining memories, were linked to martial satisfaction. Men (n = 99) and women (n = 168) in long-term marital relationships wrote about their most defining positive and negative relationship events. First-person plural (“we-ness”) and singular (“I-ness”) pronouns expressed in the narratives were counted. “We-ness” was less likely to be expressed in negative compared to positive memories. “We-ness” in negative relationship-defining memories was associated with higher martial satisfaction. The effect was particularly for women, who also had a positive association between “we-ness” in positive memories and marital satisfaction. The discussion highlights the role of relationship-defining memories, and “we-ness,” in exploring resiliency in marriage and clinical work with couples.

Sustainability is a major challenge to mental health work in schools, and many initiatives started by well-meaning individuals and agencies fade quickly. This paper outlines some key actions that can be taken to ensure that mental health work is sustained, as well as introduced, in schools. These actions include demonstrating that mental health work meets educational goals such as learning and the management of behaviour, using a positive model of mental well-being to which it is easy for those who work in schools to relate, using mental health experts as part of a team, forging alliances with other agencies and working with a whole-school approach. Such approaches are more likely to meet the needs of people with more severe mental problems and provide a more stable platform for specialist interventions than targeted programmes. The paper goes on to suggest some practical steps to sustain work at the school level. These steps include assessing the current position, developing the vision, identifying the g...