National Child Traumatic Stress Network Research Articles

Implementation and program evaluation of trauma-informed care training across state child advocacy centers: An exploratory study

Awareness of Trauma-Informed Care (TIC) is essential for all professionals employed at child advocacy centers (CAC). This study evaluated the effectiveness of a training program that utilized a modified version of a TIC curriculum accessible through the National Child Traumatic Stress Network (NCTSN) among CAC workers in Florida. The workers' TIC knowledge level (n=203) was examined prior to the training, immediately thereafter, and in a 12-month follow-up. Participants in general had similar levels of TIC knowledge before the training although the knowledge level was significantly affected by race/ethnicity, years of working experience, and educational degree. The results also indicated that participants' TIC knowledge significantly increased after training, with an effect size of 0.71. This increase appeared to be universal among participants. Further, the significant increase still maintained in the 12-month follow-up test. The analysis of participants' responses to two open-ended questions suggested that most participants were satisfied with the program. It is suggested that training efforts need to be conducted frequently to ensure that CAC employees get repeated exposure to the information in order to ultimately improve the services they provide to victims.

Trauma exposure and sleep disturbance in a sample of youth from the National Child Traumatic Stress Network Core Data Set

ObjectiveAdverse childhood experiences are prevalent and have been associated with sleep disturbance. However, there are limited data examining factors that influence this relationship. The purpose of this study was to extend the current literature by characterizing the relationship between adverse childhood experiences and sleep disturbance in a sample of trauma-exposed youth and to identify factors that may influence this relationship. Study designData were collected from 56 mental health centers across the National Child Traumatic Stress Network. For the current study, secondary data analysis was conducted using de-identified data from the National Child Traumatic Stress Network Core Data Set. The present study included 4043 children and adolescents who met eligibility criteria. ResultsSixteen percent of the sample (n=634) met criteria for a sleep disturbance as determined through clinician assessment and collateral report. Posttraumatic stress disorder (PTSD) symptom severity influenced the risk of disturbed sleep (ages 7-12: t=−4.33, ages 13-18: t=−7.12, P≤.001 for both analyses), with those meeting full criteria for PTSD at greatest risk (age 7-12: odds ratio [OR]=1.95; 95% confidence interval [CI], 1.17-3.24; age 13-18: OR=3.18; 95% CI, 1.87-5.43). Exposure to sexual assault and community violence also contributed independently to the risk of disturbed sleep (age 7-12, sexual assault: OR=1.76; 95% CI, 1.21-2.57; age 13-18, community violence: OR=1.61; 95% CI, 1.19-2.18). ConclusionsComprehensive treatment strategies should include assessment of disturbed sleep in youth exposed to trauma, particularly those with elevated PTSD symptoms and exposure to sexual trauma or community violence.

Positive Psychology and Disaster Mental Health: Strategies for Working with Children and Adolescents.

Positive psychology concepts and principles can be incorporated into preparedness, crisis response, and recovery phases of disaster mental health efforts to address the needs of children, adolescents, and families. This article articulates general developmental considerations for applying positive psychology in disaster mental health contexts and discusses how 5 essential elements of immediate and midterm mass trauma intervention identified by Hobfoll etal. (2007) may be infused in applications of positive psychology for children and adolescents. Specific strategies for working with children, adolescents, and their families in home, community, and school contexts are drawn in part from disaster mental health resources developed jointly by the National Child Traumatic Stress Network and National Center for Posttraumatic Stress Disorder, including the Psychological First Aid Field Operations Guide (Brymer etal., 2006), the Skills for Psychological Recovery Field Operations Guide (Berkowitz etal., 2010), and the Psychological First Aid for Schools Field Operations Manual (Brymer etal., 2012). Two case examples illustrate the use of positive psychology principles.

Polyvictimization: Latent profiles and mental health outcomes in a clinical sample of adolescents.

Exposure to multiple traumatic events (polyvictimization) is a reliable predictor of deleterious health outcomes and risk behaviors in adolescence. The current study extends the literature on the prevalence and consequences of adolescent trauma exposure by (a) empirically identifying and characterizing trauma exposure profiles in a large, ethnically diverse, multi-site, clinical sample of adolescents, and (b) evaluating relations among identified profiles with demographic characteristics and clinical correlates. Data from the National Child Traumatic Stress Network Core Data Set were used to identify and characterize victimization profiles using latent class analysis in a sample of 3,485 adolescents (ages 13-18, 63% female, 35.7% White, 23.2% Black/African American, 35.0% Hispanic/Latino). Multiple measures of psychological distress and risk behaviors were evaluated as covariates of trauma exposure classes. Five trauma exposure classes, or profiles, were identified. Four classes-representing approximately half the sample-were characterized by polyvictimization. Polyvictimization classes were differentiated on number of trauma types, whether emotional abuse occurred, and whether emotional abuse occurred over single or multiple developmental epochs. Unique relations with demographic characteristics and mental health outcomes were observed. Results suggest polyvictimization is not a unidimensional phenomenon but a diverse set of trauma exposure experiences with unique correlates among youth. Further research on prevention of polyvictimization and mechanisms linking chronic trauma exposure, gender, and ethnicity to negative outcomes is warranted.

Behavioral Problems and Service Utilization in Children with Chronic Illnesses Referred for Trauma-Related Mental Health Services.

Given its prevalence and impact on health and well-being, children's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers. Little is known, however, about the traumatic experiences profiles, trauma-related sequelae, and service use patterns of youth with chronic or recurrent medical problems/disabilities. This study aimed to fill this research gap. Participants were children less than 18 years of age who were referred for assessment and/or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s) (n = 9885; mean = 11 years, SD = 4.3; 52.3% girls). Generalized linear mixed models were used to examine associations among types of trauma, emotional and behavioral problems, and rates of service utilization adjusting for treatment center-level random effects, demographic characteristics, and the total number of types of trauma exposures. Among children seeking treatment for traumatic stress, those with comorbid medical problems/disabilities had different demographic characteristics, different types of trauma exposure, and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities. Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures, associated symptoms, and higher levels of behavioral problems at home, school, or day care. Those with medical disorders/disabilities were at 30% to 40% higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms, used more medical and mental health services for trauma, and had more emotional and behavioral concerns. Given that pediatricians are more likely to see children with medical disabilities and concerns than those without, there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience. Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions.

Trauma-Informed Care for Children in the Child Welfare System: An Initial Evaluation of a Trauma-Informed Parenting Workshop.

An essential but often overlooked component to promoting trauma-informed care within the child welfare system is educating and empowering foster, adoptive, and kinship caregivers (resource parents) with a trauma-informed perspective to use in their parenting as well as when advocating for services for their child. In this first evaluation of the National Child Traumatic Stress Network's trauma-informed parenting workshop (Caring for Children who Have Experienced Trauma, also known as the Resource Parent Curriculum), participant acceptance and satisfaction and changes in caregiver knowledge and beliefs related to trauma-informed parenting were examined. Data from 159 ethnically diverse resource parents were collected before and after they participated in the workshop. Results demonstrate that kinship and nonkinship caregivers showed significant increases in their knowledge of trauma-informed parenting and their perceived self-efficacy parenting a child who experienced trauma. Nonkinship caregivers increased on their willingness to tolerate difficult child behaviors, whereas kinship caregivers did not show a significant change. Participants also demonstrated high levels of satisfaction with the workshop. Although these preliminary results are important as the first empirical study supporting the workshop's effectiveness, the limitations of this study and the directions for future research are discussed.

Think Trauma Evaluation Questionnaire: Factor Structure and Feasibility of Large Scale Administration

The majority of individuals working with justice-involved youth receive limited training addressing the impact of childhood trauma. There is a need for trauma-related training for staff, as well as valid measures to evaluate the effectiveness of training. The National Child Traumatic Stress Network designed a training curriculum, Think Trauma, which educates staff about the impact of trauma on justice-involved youth. A 45-item Think Trauma Evaluation Questionnaire (TTEQ) was developed to assess participants’ changes in knowledge and attitudes. This article examines the factor structure and internal consistency of this questionnaire. Two-hundred and ninety-six employees at two secure juvenile detention centers completed the TTEQ. The results suggest that the questionnaire is feasible to administer to a large group and has a factor structure corresponding to areas covered in the curriculum. A reliable and valid measure of trauma knowledge and attitudes is important to identifying the training needs for a particular facility.

Developmental Patterns of Adverse Childhood Experiences and Current Symptoms and Impairment in Youth Referred For Trauma-Specific Services.

By the time children reach adolescence, most have experienced at least one type of severe adversity and many have been exposed to multiple types. However, whether patterns of adverse childhood experiences are consistent or change across developmental epochs in childhood is not known. Retrospective reports of adverse potentially traumatic childhood experiences in 3 distinct developmental epochs (early childhood, 0- to 5-years-old; middle childhood, 6- to 12-years-old; and adolescence, 13- to 18-years-old) were obtained from adolescents (N = 3485) referred to providers in the National Child Traumatic Stress Network (NCTSN) for trauma-focused assessment and treatment. Results from latent class analysis (LCA) revealed increasingly complex patterns of adverse/traumatic experiences in middle childhood and adolescence compared to early childhood. Depending upon the specific developmental epoch assessed, different patterns of adverse/traumatic experiences were associated with gender and with adolescent psychopathology (e.g., internalizing/externalizing behavior problems), and juvenile justice involvement. A multiply exposed subgroup that had severe problems in adolescence was evident in each of the 3 epochs, but their specific types of adverse/traumatic experiences differed depending upon the developmental epoch. Implications for research and clinical practice are identified.

Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS): Psychometric Testing of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool

Post disaster psychosocial surveillance procedures are important for guiding effective and efficient recovery. The Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS) is a model designed with the goal of assisting recovering communities in understanding the needs of and targeting services toward children and adolescents. As a critical, yet understudied, component to the KIDS model, the objective of this study is to test the psychometric properties of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool for Children and Adolescents. Exploratory factor analysis (EFA) was used to investigate the factor structure of the NCTSN Hurricane Assessment and Referral Tool. The convenience sample included 7530, 9–18 years old students who completed the school initiated screener in Southeastern Louisiana schools from December 2005 to December 2006. On a small treatment seeking population (N = 62), associations among the referral tool and the PTSD Reaction Index were also explored. EFA of the referral tool revealed a two factor solution, anxious and depressive reactions, that accounted for 45.8 % of model variance. Internal consistency was high and symptom scores were moderately associated with the PTSD Reaction Index. The cutoff score was also confirmed with scores ≥4 suggesting the need for referral. This study allows for the recommendation of the NCTSN Hurricane Assessment and Referral Tool as a reliable and valid part of the KIDS model; together they provide an initial step toward addressing the needs of child and adolescent disaster survivors.

Trauma and Treatment in Early Childhood: A Review of the Historical and Emerging Literature for Counselors

Young children are especially susceptible to exposure to trauma. Rates of abuse and neglect among this population are staggering. This article presents a review of relevant literature, including research findings specific to early childhood vulnerability to trauma, symptoms associated with traumatic events, diagnostic validity of early childhood trauma, and treatments for young children. In the past, misconceptions about the mental health of young children have hindered accurate diagnosis and treatment of trauma-related mental illness. Due to the prevalence of trauma exposure in early childhood, counselors are encouraged to become familiar with ways that clients and families are impacted and methods for treatment. Implications for future research also are presented.Keywords: early childhood, trauma, treatment, mental health, mental illnessChildren from birth to age 5 are at a particularly high risk for exposure to potentially traumatic events due to their dependence on parents and caregivers (Lieberman & Van Horn, 2009; National Child Traumatic Stress Network, 2010). Traumatic events are incidents that involve the threat of bodily injury, death or harm to the physical integrity of self or others and often lead to feelings of terror or helplessness (National Library of Medicine, 2013). The American Psychological Association (APA) Presidential Task Force on Posttraumatic Stress Disorder (PTSD) and Trauma in Children and Adolescents (2008) indicated that traumatic events include suicides and other deaths or losses, domestic or sexual violence, community violence, medical trauma, vehicle accidents, war experiences, and natural and manmade disasters. With more than half of young children experiencing a severe stressor, they are especially susceptible to accidents, physical trauma, abuse and neglect, as well as exposure to domestic or community violence (National Child Traumatic Stress Network, 2010).Over 20 years ago, Straus & Gelles (1990) estimated that three million couples per year engage in severe in-home violence toward each other in the presence of young children. The Administration on Children, Youth, and Families (2003) reported that in 2001, 85% of abuse fatalities occurred among children younger than 6 years of age, and half of all child victims of maltreatment are younger than 7. More recently, the Child Welfare Information Gateway (2014) indicated that 88% of child abuse and neglect fatalities occurred among children 7 years of age and younger. Often, there is an overlap between domestic violence and child physical and sexual abuse (Osofsky, 2003). In addition to domestic violence, young children also are vulnerable to community violence.A study conducted by Shahinfar, Fox, and Leavitt (2000) suggested that the majority of young children enrolled in Head Start experienced violence in their communities. Young children also are exposed to traumatic Stressors such as accidental bums or falls resulting in hospitalization or death (Grossman, 2000). It is common for children to experience more than one traumatic event (APA Presidential Task Force on PTSD and Trauma in Children and Adolescents, 2008).Young children birth to age 5 are especially vulnerable to adverse effects of trauma due to rapid developmental growth, dependence on caregivers and limited coping skills. However, despite decades of statistical data, counselors generally have limited knowledge of the impact of traumatic events on younger children in comparison to older children and adolescents (De Young, Kenardy, & Cobham, 2011). Reasons for this disparity in knowledge include a historical resistance to the notion that early childhood mental health is important and concerns about diagnosing young children with mental disorders.Research in early childhood mental health has developed rapidly over the past 20 years. Practitioners and researchers who work with this population continue to contribute to the understanding of trauma and early childhood mental health. …

Children With Special Needs and Circumstances: Conceptualization Through a Complex Trauma Lens

When conceptualizing this special issue, we had a basic idea of what might be included; however, as submissions arrived, it was evident that our basic definition of special needs was limited and could include much more when broadened. Therefore, the issue was reconceptualized as Children with Special Needs and Circumstances. It is my hope that when practitioners, researchers and faculty read this issue, each begins to see that the term special needs encompasses more than we think, because anything that hinders the optimal growth and development of a child constitutes a special need. In this issue, readers will find articles concerning fears, trauma, sensory processing disorder, foreign adoption, cystic fibrosis, spina bifida, homelessness, special education and parent-child interaction therapy.Keywords: counseling, children, special needs, complex traumaTo set the stage for this special issue, to provide a foundation for understanding and to link the various articles, I encourage readers to conceptualize the impact of a special need through a complex trauma or developmental lens. Over the past 15 years, countless articles have reported and described the impact of chronic stress and adverse childhood experiences (Anda et al., 2006; Edwards et al., 2005) and the subsequent development of complex trauma.Complex and Developmental TraumaThe National Child Traumatic Stress Network (n.d.-a) has defined complex trauma as a series of traumatic experiences that are usually interpersonal in nature and lead to numerous long-term adverse effects on health and well-being. Similarly, van der Kolk, Roth, Pelcovitz, Sunday and Spinazzola (2005) described experiencing repeated traumatic events during childhood as developmental trauma. The duration and intensity of the traumatic experiences, as well as the age of onset of these experiences, can determine the outcome of both complex trauma and developmental trauma. Neuroscience research provides ample evidence of neurochemical and brain structural changes caused by complex trauma that result in affective and behavioral dysregulation (Lanius, Bluhm, & Frewen, 2011).Though the terms developmental trauma and complex trauma were originally used to represent repeated abuse or an accumulation of traumatic experiences, recent neuroscience research has extended these terms to other conditions and experiences. Copeland, Keeler, Angold, and Costello (2007) noted that a long-term physical illness may lead to complex trauma, while D'Andrea, Ford, Stolbach, Spinazzola, and van der Kolk (2012) and Finkelhor, Ormrod, and Turner (2007) reported that bullying also may lead to similar outcomes.Courtois (n.d.), as well as Ford and Courtois (2009), Vogt, King, and King (2007), and the National Child Traumatic Stress Network (n.d.-b), offered a more descriptive explanation and extensive list when they stated the following:Cumulative adversities faced by many persons, communities, ethno-cultural, religious, political, and sexual minority groups, and societies around the globe can also constitute forms of complex trauma. Some occur over the life course beginning in childhood and have some of the same developmental impacts described above. Others, occurring later in life, are often traumatic or potentially traumatic and can worsen the impact of early life complex trauma and cause the development of complex traumatic stress reactions. These adversities can include but are not limited to:* Poverty and ongoing economic challenge and lack of essentials or other resources* Community violence and the inability to escape/relocate* Homelessness* Disenfranchised ethno-racial, religious, and/or sexual minority status and repercussions* Incarceration and residential placement and ongoing threat and assault* Ongoing sexual and physical re-victimization and re-traumatization in the family or other contexts, including prostitution and sexual slavery* Human rights violations including political repression, genocide/ethnic cleansing, and torture* Displacement, refugee status, and relocation* War and combat involvement or exposure* Developmental, intellectual, physical health, mental health/psychiatric, and age-related limitations, impairments, and challenges* Exposure to death, dying, and the grotesque in emergency response work (para. …

The Trauma of Commercial Sexual Exploitation of Youth: A Comparison of CSE Victims to Sexual Abuse Victims in a Clinical Sample.

This study examined the demographic features, trauma profiles, clinical severity indicators, problem behaviors, and service utilization characteristics of youth victims of commercial sexual exploitation (CSE) compared with a matched sample of sexually abused/assaulted youth who were not exploited in commercial sex. Secondary data analysis and propensity score matching were used to select a sample of 215 help-seeking youth who were exploited in prostitution (n = 43) or who were sexually abused/assaulted but not exploited in prostitution (n = 172) from the National Child Traumatic Stress Network Core Data Set (NCTSN CDS). Propensity Score Matching was used to select a comparison sample based on age, race, ethnicity, and primary residence. Statistically significant differences were noted between the groups on standardized (e.g., UCLA Posttraumatic Stress Disorder Reaction Index [PTSD-RI], Child Behavior Checklist [CBCL]) and other measures of emotional and behavioral problems (e.g., avoidance and hyperarousal symptoms, dissociation, truancy, running away, conduct disorder, sexualized behaviors, and substance abuse). This study provides useful insight into the symptom and service utilization profiles of youth exploited in commercial sex as compared with youth with other types of sexually exploitive experiences. Targeted screening and event-sensitive measures are recommended to more accurately identify youth exploited in commercial sex. More research is needed to determine if and what modifications to trauma therapies may be required to address the more severe symptomatology and behavior problems associated with youth exploited in commercial sex.

IS-040 Critical Illness: Early Recognition Of Stress And Its Long-term Impact On The Child And Family Is Important To Offer The Right Interventions

<h3></h3> Children and their parents who are exposed to medical life-threat due to illness or injury are at risk for developing symptoms of posttraumatic stress of psychosocial problems which should be monitored during follow up and treated. Several initiatives which can be used during follow-up using the internet are presented. A set of material that could be used is the Paediatric Traumatic Stress Toolkit (http://www.nctsnet.org/). This toolkit is created by the National Child Traumatic Stress Network (NCTSN) and comprises both practical tools and training materials to health care professionals to enhance trauma-informed practice. After considering the A-B-C’s (airway-breathing-circulation), professionals should consider the D-E-F’s (distress-emotional support-family) we modified the material for Dutch families and health care professionals www.nahetziekenhuis.nl and evaluated this material. Health Related Quality of Life (HRQOL) questionnaires are increasingly used in clinical practice. These Patient Reported Outcomes (PROs) are provided to the paediatrician to facilitate communication with patients during a consultation. Currently, the use of PROs in daily clinical practice is very time consuming and often has logistical problems. The use of a web-based programme can overcome these problems and contributes to an improved use of PROs in clinical practice. We therefore developed an easily accessible website (www.hetklikt.nu) for outpatient treatment and a training programme for paediatricians to maximise the effectiveness and the practical use of PROs (for demonstration: username PRO and password: KLIK).

Predictors of Treatment Engagement in Ethnically Diverse, Urban Children Receiving Treatment for Trauma Exposure

Keeping traditionally underrepresented children and their families engaged in treatment until completion is a major challenge for many community-based mental health clinics. The current study used data collected as part of the National Child Traumatic Stress Network Core Data Set to examine whether racial/ethnic disparities exist in treatment duration and completion in children seeking treatment for trauma exposure. We then explored whether disparities persist after accounting for other variables associated with children's social contexts and the treatment setting. The sample included 562 ethnically diverse children receiving services from a child abuse prevention and treatment agency in Southern California. The results indicated that African American children had significantly shorter trauma-informed treatment duration and higher rates of premature termination than Spanish-speaking Latino children. These disparities persisted even with other variables associated with treatment duration and completion (e.g., child's age, level of functional impairment, and receipt of group and field services) in the model. Implications and future directions for research and practice are discussed.

Modeling constellations of trauma exposure in the National Child Traumatic Stress Network Core Data Set.

This article describes the features and utility of the Trauma History Profile (THP) component of the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS). The THP, which is derived from the Trauma History section of the University of California PTSD Reaction Index for DSM–IV ,i s a comprehensive tool to assist providers in identifying and characterizing a broad spectrum of 20 types of trauma experienced by children and adolescents. Additional questions assess the age during which each trauma type occurred and capture salient details about each experience. The THP allows for modeling of constellations of trauma history in ways conducive to risk stratification and triage, case conceptualization, treatment planning, and research. This article provides a conceptual background for the companion papers that are included in this special section. Selected illustrative findings from the NCTSN CDS (N 14,088) are presented, including frequencies and mean duration of exposure to specific trauma types; distributions of age of onset by trauma type; frequencies of specific trauma exposure details relating to domestic violence; and a principal component analysis of clusters of co-occurring trauma types during childhood and adolescence. The article concludes with a discussion of implications of the THP for research and practice.

Examining child sexual abuse in relation to complex patterns of trauma exposure: Findings from the National Child Traumatic Stress Network.

Chronic, interpersonal traumas within the caregiving system are associated with a range of symptoms, functional impairments, and trauma history profiles. This study utilized data from the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS) to examine the role of child sexual abuse in combination with other types of caregiver-related trauma (physical abuse, domestic violence, emotional abuse, neglect, and impaired caregiving). These trauma composites were assessed in relation to clinical profiles, including mental health symptoms, risk behaviors, and functional difficulties. Groups included multiply traumatized youth with a documented history of: (a) 3 or more caregiver-related traumas with co-occurring sexual abuse (CR CSA group, N 501); (b) 3 or more caregiver-related traumas without co-occurring sexual abuse (CR group, N 1,108); and (c) 3 or more noncaregiver-related traumas (e.g., medical trauma, natural disaster, physical/sexual assault; non-CR group, N 142). Youth with caregiverrelated traumas had significantly earlier onset and longer duration of traumas compared to other traumatized youth. Child sexual abuse had an additive and potent predictive effect on clinical profiles, even in combination with other caregiver-related traumas. Although youth with caregiver-related traumas exhibited significant attachment problems, youth with sexual abuse in particular had higher levels of posttraumatic stress disorder (PTSD), and received higher ratings for symptoms of depression, suicidality, and sexualized behaviors in comparison with the other 2 groups. Findings suggest that careful mapping of trauma history, including age of onset, duration, and co-occurrence of trauma exposure in childhood, can provide a foundation for a more refined developmental approach to the scientific investigation, clinical assessment, and treatment of children with complex histories of trauma in childhood.

Cumulative trauma exposure and high risk behavior in adolescence: Findings from the National Child Traumatic Stress Network Core Data Set.

Although links between adverse childhood experiences (ACEs) and problems in adulthood are wellestablished, less is known regarding links between exposure to trauma during childhood and adolescence and high-risk behavior in adolescence. We tested the hypothesis that cumulative exposure to up to 20 different types of trauma and bereavement/loss incrementally predicts high-risk adolescent behavior beyond demographic variables. Adolescents reporting exposure to at least 1 type of trauma (n 3,785; mean age 15.3 years; 62.7% girls) were selected from the National Child Traumatic Stress Network Core Data Set (CDS). Logistic regression analyses tested associations among both demographic variables and number of types of trauma and loss exposure as predictors, and 9 types of high-risk adolescent behavior and functional impairment (attachment difficulties, skipping school, running away from home, substance abuse, suicidality, criminality, self-injury, alcohol use, and victim of sexual exploitation) as criterion variables. As hypothesized, hierarchical logistic regression analyses revealed that each additional type of trauma exposure significantly increased the odds ratios for each problem behavior (range 1.06–1.22) after accounting for demographic variables. Some demographic variables (female gender, public insurance eligibility, and older age) were also associated with increased likelihood for some outcomes. Study findings extend previously identified links between childhood trauma and problems later in life to include high-risk behavior and functional impairment during adolescence. The findings underscore the need for a trauma-informed public health approach to systematic screening, prevention, and early intervention for traumatized and bereaved youth in child service systems.

The National Child Traumatic Stress Network Core Data Set: Emerging findings, future directions, and implications for theory, research, practice, and policy.

The National Child Traumatic Stress Network Core Data Set: Emerging findings, future directions, and implications for theory, research, practice, and policy.

Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes.

For this study, we evaluated the independent and additive predictive effects of psychological maltreatment on an array of behavioral problems, symptoms, and disorders in a large national sample of clinic-referred children and adolescents drawn from the National Child Traumatic Stress Network Core Data Set (CDS; see Layne, Briggs-King, & Courtois, 2014). We analyzed a subsample of 5,616 youth with lifetime histories of 1 or more of 3 forms of maltreatment: psychological maltreatment (emotional abuse or emotional neglect), physical abuse, and sexual abuse. Measures included the University of California, Los Angeles Posttraumatic Stress Disorder–Reaction Index (Steinberg et al., 2004), Child Behavior Checklist (Achenbach & Rescorla, 2004), and 27 diagnostic and CDS-specific clinical severity indicators. Psychologically maltreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms, and disorders compared with physically or sexually abused youth on most indicators. The co-occurrence of psychological maltreatment with physical or sexual abuse was linked to the exacerbation of most outcomes. We found that the clinical profiles of psychologically maltreated youth overlapped with, yet were distinct from, those of physically and/or sexually abused youth. Despite its high prevalence in the CDS, psychological maltreatment was rarely the focus of intervention for youth in this large national sample. We discuss implications for child mental health policy; educational outreach to providers, youth, and families; and the development or adaptation of evidence-based interventions that target the effects of this widespread, harmful, yet often overlooked form of maltreatment.

Traumatic Childhood Experiences in the 21st Century

The study objectives were to (a) examine the association between total number of trauma types experienced and child/adolescent behavioral problems and (b) determine whether the number of trauma types experienced predicted youth behavioral problems above and beyond demographic characteristics, using a diverse set of 20 types of trauma. Data came from the National Child Traumatic Stress Network's (NCTSN) Core Data Set (CDS), which includes youth assessed and treated for trauma across the United States. Participants who experienced at least one type of trauma were included in the sample (N = 11,028; age = 1&frac12;-18 years; 52.3% girls). Random effects models were used to account for possible intraclass correlations given treatment services were provided at different NCTSN centers. Logistic regression analyses were used to investigate associations among demographic characteristics, trauma, and emotional and behavioral problems as measured by the Child Behavior Checklist (CBCL). Significant dose-response relations were found between total number of trauma types and behavior problems for all CBCL scales, except Sleep, one of the subscales only administered to 1&frac12;- to 5-year-olds. Thus, each additional trauma type endorsed significantly increased the odds for scoring above the clinical threshold. Results provide further evidence of strong associations between diverse traumatic childhood experiences and a diverse range of behavior problems, and underscore the need for a trauma-informed public health and social welfare approach to prevention, risk reduction, and early intervention for traumatized youth.