“I love adolescents,” says Dawn Bounds, an assistant professor and psychiatric nursing researcher at the UCI Sue & Bill Gross School of Nursing. “There’s just so much energy and hope.”
She is reflecting on the career that has brought her to California and to GRIT, a pilot intervention that has the hope embodied by young people very much at its heart. Bounds’s aim in designing GRIT is to reduce or delay the well-documented adoption of risky behaviors by adolescents who have experienced adversity. Behind the neutral language of research lies an urgent need: to break the cycle of despair for youths who have experienced the effects of – for example – prejudice, poverty (including homelessness), bereavement, violence, and addiction, by teaching them to cope with the resulting trauma in ways that do not damage them further.
A clear thematic narrative connects Bounds’s current body of work (GRIT is just one of several projects in progress) with her early career as a psychiatric-mental health nurse practitioner in her native Chicago. There, when still a recently qualified nursing practitioner, she worked for a mental health services contractor within the County Juvenile Detention Center. Despite appreciating her excellent colleagues, she soon realized that their collective effort was ultimately part of a system that was, “…not serving our children the way they deserve to be served.”
As she describes that formative experience, “We’d get kids stabilized and decrease meds, or get them to where their symptoms were subacute. They’d leave [the Juvenile Detention Center], their mental health needs were not taken care of, and they’d come back again: rinse and repeat.”
Furthermore, she remembers, she would, “…listen to their stories. Kids who would tell me that a friend or family member had been shot by police – back then, we didn’t have video to corroborate. Girls coming back to the center for status offences – they’d run away from home, or been present at a crime that a boy had committed. The need for them to have people to support and love them was immense.”
The experience stayed with her throughout a subsequent PhD – through which she discovered a transformative passion for research – and a mid-pandemic move to California and the Sue & Bill Gross School of Nursing. In October 2021, she embarked on GRIT (Garnering Resilience In Traumatized youth and families – “I love an acronym,” says Bounds), partly in response to the California Surgeon General’s recommendations encapsulated in the “ACEs Aware” campaign. The Stress Busters advocated by ACEs Aware are all sensible, says Bounds, but it’s a “pet peeve” of hers that medical lifestyle advice is so often given without the guidance to help people put recommendations into practice. Designed from a nursing perspective, GRIT seeks, in part, to bridge that gap for a specifically vulnerable group: the at-risk teens.
The intervention pairs young people between 12 and 17 years of age with a “near-peer” – a college-age student with experience of similar adversity – plus a caregiver identified by participants themselves, often a parent. Screening of all participants, including caregivers, before, during and after the study enables Bounds and her team not only to assess the impact of their work, but to inform participants where they fall above a clinical threshold for any issue of which they may not be aware. Participants are involved in weekly health-coaching sessions and taught to use wearable stress-sensors and a specially designed app that helps them identify their own stress signifiers and deal with them in a healthy way. The resulting self-awareness and self-regulating techniques have the potential to help them negotiate subsequent life events with resilience.
Recruitment and barriers to participation are among the critical aspects Bounds seeks to refine, with a view to making the pilot deliverable at scale.
“The community is my home,” Bounds explains. “Juvenile detention centers, schools, homeless shelters – the people I work with are not coming to the office to see me. I was working in Chicago for over 20 years, and it takes time to build those relationships. We learned very quickly that to overcome barriers to participation, GRIT needed to be completely community-based, that incentives for participation needed to be higher – that’s happening now.”
When it came to finding students to train as health workers for the study – the “near peers” from the nursing school – Bounds deliberately recruited with adversity in mind: “Minoritized backgrounds were encouraged to apply – single-parent background, first generation at college… I listed them all out,” she says. She was determined not only to match mentors with participants but also “to make sure that people who don’t always get these opportunities be exposed to this. I never knew about research as a student in college, and I love it – who knew? It changed my life. We need more people like me who do this work.”
The response to her recruitment appeal was “overwhelming,” she recalls. “Students sharing their stories of adversity and challenge and why they wanted to do this work. They really have a heart for it and not only that – doing it has benefitted them, too.”
Student research, encouraged by Bounds, has analyzed the effect of participation on the near-peer group and identified that they have begun incorporating those same lifestyle changes they are helping engender in the teenage participants. “There’s an expectation that they live it,” says Bounds, and early evidence indicates that they are.
As with the health workers, the wellbeing of caregivers has been an integral aspect of GRIT from the start. As Bounds works to scale up the study, she’s pleased to see early indications of positive impact in the initial, albeit small, sample.
“We know that trauma is intergenerational,” she says. “For the adolescents, there’s a need for co-regulation: to be in a space with someone who’s able to self-regulate. If the parent hasn’t done that before, we are seeing that they can learn now. Before participation begins, we screen for depression and anxiety, PTSD…. One family stands out for me because the mother was above our threshold at that initial screening and now she is subclinical. To see the numbers go down, and be able to share that with her – that’s really exciting.”
For Bounds, GRIT is just one example of her ongoing mission to analyze and ameliorate the effects of adversity on young people and their mental health. She continues to work with teens who have escaped abusive situations and has embarked on a major study of online adolescent risk: Project REVIVE, funded by the Betty Irene Moore Fellowship.
“Adversity looks different following the pandemic,” she points out. “We need to understand that better – what does risk look like now? Resilience? I’m interested in so many different things.”
