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OBJECTIVE In this study, we tested direct pathways from trauma exposure to trauma symptomatology and risky and self-destructive behavior and indirect pathways through two cognitive and affective mechanisms: (a) world assumptions and (b) emotion dysregulation. METHOD A sample of 270 undergraduate students with an average age of 20.02 years participated in the study (204 women, 65 men, and one participant choosing not to disclose). Participants completed self-report measures assessing trauma exposure, trauma symptoms, emotion dysregulation, world assumptions, and lifetime and past-month engagement in any of 38 risky and self-destructive behaviors. RESULTS The direct path from trauma exposure to trauma symptoms was significant, and so was the indirect effect of self-worth assumptions on this association. The indirect pathway between trauma symptoms and risky and self-destructive behavior in the past month was significant through difficulties with impulse control when distressed. Trauma symptoms had an indirect effect on the association between trauma exposure and lifetime and past-month engagement in risky and self-destructive behavior, while the direct pathway from trauma exposure to lifetime engagement remained significant. CONCLUSION We offer theoretically and empirically supported integrative pathways that explicate some aspects of trauma exposure's negative sequelae with potential areas for intervention. Clinical Impact Statement: Trauma exposure is widespread and is associated with negative views about oneself and the world and with difficulties in managing one's emotions, which in part is associated with individuals' risk for developing psychopathology and engaging in risky and self-destructive behaviors. The findings inform optimal time for intervention and prevention efforts targeting trauma exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Patients with complex medical conditions may have a medical history that includes multiple negative/traumatic experiences with the health care system over the course of their diagnosis and treatment. The BITTEN (Betrayal history by health-related institutions; Indicator for health care engagement; Trauma symptoms related to health care; Trust in health care providers; Expectation of patient; Needs of patient) model posits that health care providers can recognize and respond in a way that encourages resisting patient retraumatization. We present a hypothetical case study applying the BITTEN model as a patient-centered framework to include in a standard visit. Increased awareness of the patient’s risk for institutional betrayal, trauma, and overall negative past health care experiences can help the NP better understand the patient’s current and future health care needs and expectations.

Most out-of-home placed children have experienced early adversities, including maltreatment and neglect. A challenge for caregivers is to adequately interpret their foster child’s internal mental states and behavior. We examined caregivers’ mind-mindedness in out-of-home care, and the association among caregivers’ mind-mindedness (and its positive, neutral, and negative valence), recognition of the child’s trauma symptoms, and behavior problems. Participants (N = 138) were foster parents, family-home parents, and residential care workers. Caregivers’ mind-mindedness was assessed with the describe-your-child measure. Caregivers’ recognition of the child’s trauma symptoms, their child’s emotional symptoms, conduct problems, prosocial behavior, and quality of the caregiver-child relationship were assessed using caregivers’ reports. Foster parents produced more mental-state descriptors than did residential care workers. General mind-mindedness, as well as neutral and positive mind-mindedness, related negatively to conduct problems. Besides, positive mind-mindedness was associated with prosocial behavior and neutral mind-mindedness with a better quality of the caregiver-child relationship and fewer child conduct problems. Negative mind-mindedness related positively to the caregiver’s recognition of the child’s trauma symptoms, and indirectly, to emotional symptoms. In conclusion, mind-mindedness seems to be an essential characteristic of out-of-home caregivers, connected to the understanding of their child’s behavior problems and trauma symptoms, as well as to the relationship with the child. The findings suggest a possible use of mind-mindedness in out-of-home care evaluation and intervention.

Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion (such as hair cortisol concentrations; HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth ( Mage = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-months follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.

The current study used a person-oriented approach to investigate (a) potential distinctive groups of women survivors of IPV based on their posttraumatic growth (PTG), centrality of event, resilience, and posttraumatic stress symptoms (PTSS) patterns, and (b) examine the role of sociodemographic (age, education, work status) and violence related (physical and emotional violence, time since last violence episode, psychological help) factors in distinguishing these groups. The study sample consisted of 421 women survivors of IPV, and latent profile analysis revealed four profiles: “negative impact” (11% of the sample), “positive growth” (46%), “low impact” (18%), and “distressed growth” (25%). Women age, education, received psychological help, frequency of physical and emotional violence, and time since last violence incident significantly distinguished some of the indicated profiles from each other. Findings of this study contribute to the existing literature by identifying different responses to IPV and investigating some of the theoretical assumptions that had not been comprehensively analyzed in the IPV literature. Limitations of the study and implications for future research are discussed.

Objectives To assess symptoms of post-traumatic stress disorder (PTSD) in children with severe epilepsy and the associations of trauma symptoms across age, comorbid symptoms, epilepsy-specific factors, parental resources, and psychopathology. Methods Fifty children with severe epilepsy across three different age groups (0–5 yrs., 6–12 yrs., 13–18 yrs.) were assessed with developmental-sensitive and standardized PTSD assessment tools when hospitalized at the tertiary epilepsy center Filadelfia, Denmark. The Diagnostic Infant and Preschool Assessment (DIPA), the Darryl test, and the ITQ questionnaire were used to assess the three age groups, respectively. Results Twenty-two percent of the overall sample met the criteria for PTSD, with a prevalence of symptoms increasing with age (6%, 28%, and 40%). Comorbid psychiatric symptoms in preschoolers were present in 81% of the children witnessing a high level of distress in this group. Behavioral difficulties were elevated across all three age groups, and 40% of the children with trauma symptoms had a parent with concurrent psychopathology. Conclusion To the authors’ knowledge, this study is the first to assess trauma symptoms with standardized tests in children with more complicated epilepsies. Trauma symptoms in the group are high; however, there is a need for larger scale studies and research into trauma symptoms in children with more severe epilepsy than those assessable with the included assessment tools. The trauma perspective in severe childhood epilepsy might further clarify the complex associations of biological and contextual variables that affect the children’s life quality and enable better preventative treatment options for this group.

Background Police officers are frequently exposed to distressing and dangerous situations, increasing their risk of posttraumatic stress disorder (PTSD) and complex PTSD (C-PTSD). Research examining C-PTSD in police officers is sparse, particularly examination of the occupational risk factors for trauma symptoms. Aims This study aimed to examine the prevalence and risk factors for PTSD and C-PTSD in UK police officers. Methods A cross-sectional study was conducted using psychological health surveillance data from the UK National Police Wellbeing Service. Police officers were either from high-risk areas of work or had been referred for screening by occupational health practitioners regarding psychological distress. The primary outcome for this study was a positive screening of either PTSD or C-PTSD, measured using the International Trauma Questionnaire. A range of occupational, clinical and lifestyle factors was examined to establish their role as potential risk factors for PTSD and C-PTSD. Results In total, 2444 UK police officers were included, with 89% from high-risk areas of work. A prevalence of 3% for PTSD and 2% for C-PTSD was found in police officers from high-risk areas of work. Higher work stress and lower manager support were found to increase the odds of C-PTSD but not PTSD. Higher personal trauma history increased the risk for PTSD and C-PTSD equally. Conclusions Work-related occupational factors increased the odds of PTSD and C-PTSD in police officers, which could be important risk factors for trauma symptoms within police officers. Efforts should be made to improve the working environment of police officers to help improve their psychological well-being.

Nurse practitioners regularly treat primary care patients with trauma histories. By incorporating trauma-informed care into practice, nurse practitioners can enhance the provision of clinical care and, ultimately, improve patient health outcomes. This brief report demonstrates how to actively incorporate the principles and practices of the 4R framework of trauma-informed care into primary care to realize the prevalence of trauma, recognize patients’ trauma signs and symptoms, and respond to patients in a manner that resists retraumatization. Through early identification of trauma symptoms and referral to appropriate follow-up treatment, nurse practitioners can significantly improve the life course of their trauma survivor patients.

Police officers are frequently exposed to traumatic events and therefore are at elevated risk of developing post-traumatic stress disorder (PTSD) and other mental health conditions. While evidence-based treatments for PTSD such as prolonged exposure therapy demonstrate effectiveness, residual symptoms and relapse remain problematic outcomes. Improvements in outcomes may be enhanced by modifying psychotherapy processes based upon recent neuroscientific findings. The present study explored incorporating memory reconsolidation principles into evidence-based exposure therapy for PTSD to create memory reconsolidation therapy (MRT). MRT incorporates memory recall followed by a wait period to make memories liable for modification. Using a case series design, three police officers diagnosed with PTSD participated in a maximum of twelve 90-min sessions of MRT and recorded weekly self-report measures of trauma symptoms and psychological distress. Results indicated participants experienced significantly reduced psychological distress with gains maintained over a 3-month follow-up. A significant reliable reduction in trauma symptoms by post-therapy was identified in two of the three cases with the third narrowly missing the clinically significant cut-off. These significant changes were maintained over the 3-month follow-up in one participant, while the maintenance of these improvements in trauma symptoms approached significance in the other two participants. These findings provide preliminary evidence to justify larger future studies to test the efficacy of MRT with police officers experiencing PTSD.

Research by Robertson, Davies and Nettleingham (2009) suggested a minority of jurors in English and Welsh courts experience significant short‐ and longer‐term distress from undertaking jury service. This study extended the research to jurors in Scottish trials, with their distinct conventions and procedures. Jurors completed web‐based questionnaires measuring juror distress, trauma symptoms, and personal resilience. Results replicated those from England and Wales, showing that some Scottish jurors also experience deterioration in physical and psychological well‐being, with female jurors, those sitting in longer trials, and dealing with crimes against the person, being most affected. Trait resilience did not mitigate such effects.

Trauma is prevalent among children and adolescents, with youth of color generally reporting greater exposure compared to White youth. One factor that may account for this difference is racial stress, which can manifest into trauma symptoms. Although racial stress and trauma (RST) significantly impacts youth of color, most of the research to date has focused on adult populations. In addition, little attention has been given to the impact of the ecological context in how youth encounter and cope with RST. As such, we propose the Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT), a conceptual model of how racial stressors manifest to influence the trauma symptomatology of children and adolescents of color. Within developmental periods, we explore how individual, family, and community processes influence youth’s symptoms and coping. We also discuss challenges to identifying racial trauma in young populations according to clinician limitations and the post-traumatic stress disorder framework within the diagnostic and statistical manual of mental disorders—fifth edition (DSM-5). The article concludes with implications on applying DEMYth-RT in clinical and research settings to address RST for youth of color.

The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (n = 111, ages 7–12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.

In this chapter we bring together three previously unconnected areas of research relating to young men and boys: trauma and prison, trauma and masculinity, and prison masculinities. Within the existing literature there emerges a significant focus on incarcerated young women and trauma, while there is a relative dearth of literature focusing on young men and boys and their trauma experiences prior to, and as a consequence of, incarceration. Furthermore, we consider the ways in which masculinity and trauma interact to reduce the likelihood that young men and boys are able to seek help or benefit from treatment. Consequently, this chapter advocates that there is a pressing need to better understand how prison masculinities interface with trauma-informed care. It is evident that more research is needed with young men and boys about their trauma experiences, the manifestation of their trauma symptoms and how to better support their recovery. Ultimately, through considering these areas and exploring areas of connection and disconnection, we argue for both trauma-informed and gender-sensitive correctional care for incarcerated young men and boys, whose vulnerabilities have tended to be overlooked.

Background Child maltreatment negatively affects the formation of internal schemata of self and other during development, leading to negative adaptations in self-concept and social cognition. Clinical reports suggest the efficacy of psychedelics in treating the psychopathological sequelae of child maltreatment. Altering maladaptive schemata of self and other implicated in negative self-concept and impaired social cognition may be a central mechanism for reducing posttraumatic stress symptoms. Aims This study aims to assess whether psychedelic use moderates the relationships between child maltreatment and self-concept, social cognition, and posttraumatic stress symptoms. Method An online survey was completed by 166 participants and included measures of maltreatment exposure and severity, history of intentional therapeutic psychedelic use, posttraumatic stress symptoms, internalized shame, and facial emotion recognition. Results Child maltreatment significantly correlated with posttraumatic stress symptoms ( r = .26 and r = .20, p Conclusion These findings demonstrate that using psychedelic drugs with therapeutic intent is associated with lower levels of complex trauma symptoms and internalized shame in individuals with histories of child maltreatment. Psychedelic use may have therapeutic benefit in treating the posttraumatic sequelae of child maltreatment.

Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25–32% of the returning military veterans of the 1990–1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. Methods Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. Results Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055–0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. Conclusions Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.

Background Previous research showed acute psychedelic effects were associated with decreases in racial trauma (RT) symptoms among black, indigenous, and people of color (BIPOC). Among samples comprised primarily of white participants, positive outcomes of psychedelic experiences have been mediated by increases in psychological flexibility. Therefore, we examined whether changes in psychological flexibility from before to after a psychedelic experience mediated the relationship between acute psychedelic effects and changes in RT symptoms among BIPOC. Methods This cross-sectional online survey study included 313 BIPOC (mean age = 33.1; SD = 11.2; female = 57%). A multiple linear regression analysis was used to examine the association between acute psychedelic effects and decreases in RT symptoms in a nonclinical setting; a path analysis was used to explore whether changes in psychological flexibility mediated this relationship. Results Acute insight and challenging effects were significantly ( p Conclusion This research suggests psychedelics confer potential benefits in decreasing RT symptoms among BIPOC and psychological flexibility may be an important mediator of these effects. Future research should test this hypothesis in a longitudinal clinical trial among BIPOC.

Being a victim of abuse in childhood can lead to the development of trauma-related psychopathology, which could affect the testimony of the child victim. Post-traumatic stress disorder (PTSD) is a factor that can increase both the levels of suggestibility and the production of memory errors, such as confabulations, which can be identified in distortions and fabrications. No studies have analyzed the relationship between suggestibility, fabrications, distortions, and PTSD on samples of children and adolescents suspected of being sexually abused. This study aims to verify in a sample of 221 sexually abused children and adolescents the effect of PTSD, measured by Trauma Symptoms Checklist for Children, in increasing the levels of immediate and delayed suggestibility and the production of fabrications and distortions in immediate and delayed memory tasks, obtained by Gudjonsson Suggestibility Scale 2, controlling age and non-verbal intelligence. Our results show that PTSD increases the levels of immediate and delayed suggestibility, but it has no effect on memory recall in immediate recall tasks. Moreover, PTSD leads to a greater number of distorted and fabricated information inserted in delayed memory. Forensic implications of PTSD consequences on memory tasks and suggestibility levels of sexually abused children are discussed.

Background There is a need for effective, low-cost, readily available measures for reducing trauma symptoms so that people exposed to potentially traumatic events can receive help more quickly. A previous study reported that performing an intervention including a visuospatial task shortly after a reminder of a series of unpleasant film clips seen 24 hours earlier reduced the number of intrusive memories over the following week. Objective This study reports a follow-up and extension of the earlier promising finding. The prediction was that participants performing the visuospatial task immediately after the reminder would report fewer intrusions compared to three other groups who 1) performed no task, and novel conditions who 2) performed the task before the reminder, and 3) performed the task 90 minutes after the reminder. Method A trauma-analogue method was used, where students (N = 200) watched a series of short films with unpleasant material. Over the following week, they were asked to write down any intrusive memories they experienced in a diary. On the second day they returned to the lab and saw static reminders of the films. They were then randomly allocated to condition, recorded intrusive memories over the following days and returned to the lab for final testing on Day 8. Results A total of 49 participants did not report any intrusions and were excluded from the analyses. Two more participants were excluded as outliers, leaving a final sample of n = 149. Despite using largely the same materials as the original study there were no significant differences in the number of intrusive memories between the four groups post intervention. Conclusions Possible explanations include the effect not being as robust as expected, a low number of intrusions across groups, baseline differences in attention, and minor but potentially important differences in procedure between this and the original study., HIGHLIGHTS This study followed up James et al.’s (2015) finding that playing a visuospatially demanding game reduced negative intrusive memories.As we did not find a similar pattern of findings the intervention may be less promising than assumed and sensitive to changes in set-up.

Background Although the child welfare field has initiated efforts to use standardized screening for trauma and behavioral health needs, research has rarely examined whether these screenings have influenced permanency outcomes. Objective Using data from three states' federal demonstration projects, we examined whether receipt of trauma and behavioral health screening and results of screening were associated with placement stability (i.e., fewer placements). Our inquiry focused on whether similar patterns of statistical associations would be observed in three distinct state settings. Participants and setting Samples comprised children in out-of-home care in three states newly implementing trauma and behavioral health screening. The states included a South Central state, New England state, and a Central Midwestern state. Results In all three states, findings showed children who received screening had a higher number of placements (i.e., placement instability). Likewise, all three states found that children whose screening results indicated greater need, such as higher number of trauma symptoms or lower behavioral health functioning, were more likely to experience a higher number of placements (i.e., placement instability). Conclusion Despite differences in screening tools and state-specific approaches, findings suggest that early screenings may provide important information that could be used to identify children's needs, make appropriate service referrals, establish well-matched placements, and support resource parents and birth parents toward better permanency outcomes. Regardless of potential benefits of early screening, it may be underutilized in the field. Future research is needed to replicate these findings and continue to build an evidence base for trauma and behavioral health screening.

Children’s exposure to intimate partner violence (IPV) and child abuse (CA) is strongly related to later psychological problems. Few studies exist on patients in child and adolescent mental health services (CAMHS) who have been singly or doubly exposed to IPV and/or CA. The overall aim of the current study was to compare self-reported psychiatric symptoms, post-trauma impact, and post-traumatic stress disorder (PTSD) diagnoses among CAMHS patients who had been singly or doubly exposed or had reported no family violence (NoFV). We expected to find more severe symptoms in both singly and doubly exposed patients than in the NoFV group and that double exposure was associated with more severe symptoms than single exposure (to IPV or CA). Finally, we expected to find that higher frequencies of exposure to IPV or CA were related to more psychiatric symptoms, greater post-trauma impact, and a higher likelihood of PTSD diagnosis. We compared psychiatric symptoms, post-trauma impact, and PTSD diagnosis in 578 patients aged 9–17 years with NoFV (n = 287), single exposure (n = 162), and double exposure (n = 129). The influence of gender, age, age of onset, frequency, and traumatic interpersonal events outside the family (IPE) were regressed on psychiatric symptoms, post-trauma impact, and PTSD diagnoses. Patients with double exposure had more severe symptoms than the NoFV group, and patients with single exposure had more trauma-related symptoms than the NoFV group. Double exposure was associated with more severe symptoms than single exposure, and frequency (of exposure to IPV and/or CA) and IPE influenced trauma symptoms and psychiatric symptoms, respectively. Exposure to more than one type of violence is associated with more severe symptoms, but other factors such as frequency of violent acts and IPE are important factors to focus on in future studies and clinical assessment.

Objective: As part of a larger community-based, service driven research project, the purpose of this study was to 1) document the clinical needs of sheltered children (i.e., externalizing behavior problems [EBP], trauma symptoms, and developmental status) and 2) examine the effectiveness of time-limited adaptations of Parent Child Interaction Therapy (PCIT) and Child Parent Psychotherapy (CPP). Method: One hundred and forty-four young children (Mage = 3.48, SD = 1.09; 56.9% male; 78.5% Black/African American) and their mothers were recruited from a women's homeless shelter and randomly assigned to a 12-week course of either PCIT or CPP delivered by shelter clinicians on site. Families completed pre and post intervention assessments including mother-reported measures of child EBP and trauma symptoms, and parenting stress. Observational data on maternal verbalizations during a child-led play session were also collected. Results: High rates of clinically elevated EBP (36%), trauma symptoms (47%), and developmental delays (35%) were found. Time-limited PCIT resulted in greater reductions in maternal negative verbalizations and parenting stress, and greater increases in maternal positive verbalizations relative to time-limited CPP. As it relates to child outcomes, both time-limited PCIT and CPP resulted in similar decreases in children's post-traumatic stress symptoms; however, only time-limited PCIT resulted in significant improvements in EBP. Conclusions: Young sheltered children evidenced high levels of EBP, trauma symptoms and developmental delays. Both time-limited PCIT and CPP offered effective trauma interventions. However, PCIT offered a more comprehensive intervention by more effectively targeting EBP and parenting. Implications of these findings for clinical practice are discussed.

Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel. Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth. Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel. Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association. Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels., HIGHLIGHTS • Emergency room physicians and nurses have same level of secondary trauma and vicarious post-traumatic growth. • In physicians these variables were linked; in nurses they were not. • Different sources for growth in physicians and nurses are discussed.

Background: Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. Methods: This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. Results: Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. Conclusion: Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.