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Southeast Asian (SEA) refugee children tend to have numerous mental health problems such as trauma symptoms, depression, and low self-esteem. Yet, many SEA refugee children do not receive the couns...

Women in resource-constrained, postdisaster, urban enclaves, such as Haiti’s Cité Soleil, are at risk for nonpartner sexual violence (NPSV) by multiple perpetrators, and subsequently, psychological trauma and sexually transmitted infections (STIs), including HIV/AIDS. These biopsychosocial risks suggest that NPSV victims may benefit from an adapted evidence-based intervention for sexually transmitted infection (EBI-STI) that includes a trauma component. Yet there is a dearth of knowledge on trauma symptoms experienced by victims in Haiti. We administered a Haitian Kreyòl version of Trauma Symptom Checklist (TSC-40), including its subscales (depression, dissociation, anxiety, sexual problems, sleep disturbance, sexual abuse trauma) to women in Cité Soleil, comparing victims’ scores ( n = 54) with those of nonvictims ( n = 179). After controlling for child sexual abuse, arrest, transactional sex, and sociodemographics, being a victim was associated with higher scores on the full TSC-40, and subscales of anxiety and sexual abuse trauma index. These increased scores of victims underscore the need to incorporate trauma in adaptation of EBI-STI for Haitian NPSV victims like our sample.

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.

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.

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.

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.

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.

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.

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: Prescription drug–related overdose deaths have increased dramatically in recent years. Women in the justice system experience high rates of drug use, victimization, trauma symptoms, and other health problems and would appear to be at high risk for nonmedical use of prescription drugs (NMUPD). This study will be among the first to describe prevalence and correlates of NMUPD among this population. Methods: This cross-sectional study collected data from 406 victimized women on probation and parole between 2010 and 2012. In a multiple logistic regression model, we differentiated women who reported past-year NMUPD from those who did not using demographic, health, other drug use, substance use treatment, and trauma symptom severity variables. Results: Past-year NMUPD was reported by 26.8% ( n = 109) of the overall sample. Women reporting NMUPD were significantly younger and more likely to be white. Past-year use of alcohol (adjusted odds ratio [AOR]: 3.3; 95% confidence interval [CI]: 1.8–6.1), marijuana (AOR: 3.6; 95% CI: 1.8–7.0), methamphetamines (AOR: 6.1; 95% CI: 1.7–21.3), and heroin (AOR: 8.4; 95% CI: 2.0–35.2) were significantly associated with NMUPD. Additionally, each unit increase in the measure assessing bodily pain was associated with a 40% increase (AOR: 1.4; 95% CI: 1.1–1.7) in the odds of NMUPD. Finally, meeting diagnostic criteria for posttraumatic stress disorder almost doubled (AOR: 1.9; 95% CI: 1.1–3.4) the odds of reporting past-year NMUPD. Conclusions: Victimized women on probation and parole report high rates of NMUPD, and this behavior intersects with other complex social, behavioral, psychological, and physical needs. The authors recommend increased access to trauma-informed correctional care among women in the justice system.

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with women’s trauma symptoms. Participants were 95 women recruited from domestic violence shelters. Women reported on their trauma symptoms, the frequency of IPV victimization, the use of a weapon during IPV, and police involvement over the year following shelter departure. Police involvement in IPV was associated with higher levels of reexperiencing trauma symptoms 1 year after shelter departure, even after controlling for baseline trauma symptoms, the frequency of IPV, and the use of a weapon during IPV. Women’s race and ethnicity did not moderate the results. These findings suggest police involvement in IPV incidents may be associated with higher levels of trauma symptoms experienced by women. Further investigation into law enforcement practices and policies to help reduce women’s distress is needed.

Background A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. Methods A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. Results Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. Limitations Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. Conclusions Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.

Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, βrange = .15 to .33, and for those who participated in fewer treatment sessions, βrange = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.

This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers two years following Israeli offensives against Gaza Strip in 2014. Methodology: A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip who worked with victims of the 2014 war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. Results: The results showed that 291 (89.3%) out of 2444 participants had scores more than 35 (threshold cut-off point) on Impact Event Scale-Revised. Scores ranged from eight to 80 with a mean of 52.71. Females had higher levels of stress (55.33) than males (50.82) and nurses (52.67) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was “Intrusion” (mean=19.99), followed by “Avoidance” (mean=17.60), and then “Hyper-arousal” (mean=14.12). Level of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. Conclusion: The findings showed that health care providers still suffer from severe posttraumatic symptoms two years after exposure to a prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war. This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers two years following Israeli offensives against Gaza Strip in 2014. Methodology: A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip who worked with victims of the 2014 war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. Results: The results showed that 291 (89.3%) out of 2444 participants had scores more than 35 (threshold cut-off point) on Impact Event Scale-Revised. Scores ranged from eight to 80 with a mean of 52.71. Females had higher levels of stress (55.33) than males (50.82) and nurses (52.67) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was “Intrusion” (mean=19.99), followed by “Avoidance” (mean=17.60), and then “Hyper-arousal” (mean=14.12). Level of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. Conclusion: The findings showed that health care providers still suffer from severe posttraumatic symptoms two years after exposure to a prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war.

This paper presents findings from research investigating trauma symptomization in children with prior trauma experiences from intact families (n = 32) compared with those from non-intact families (n = 32). Using a mixed method approach, a file audit of an Australian child/youth mental health service database was undertaken. Statistical analysis identified a significant relationship (p = < 0.05) of high numbers of trauma symptoms (NTS) for children from non-intact families, and low NTS for children from intact families. This finding indicates that children from intact families manage trauma better in terms of reduced symptomization. Other key patterns of relationship were identified and implications for systemic practice explored.

The Calgary Counselling Centre offers therapy groups for both women whose partners abuse them, “You’re Not Alone” (YNA) and women who abuse partners, “Responsible Choices for Women” (RCW). The study examines 262 group members (157 RCW & 105 YNA), comparing their demographics and scores on measures of physical and non-physical partner abuse, and mental health symptoms. At pretest, women in YNA reported significantly more problematic depression, anxiety, general distress and trauma symptoms than women in the RCW program. Nevertheless, the factorial repeated measures analysis of variance on pretest/posttest data from 177 women found statistically significant improvements on all four outcomes measures for women in both groups, although women in the YNA survivor groups made the most improvements on depression, stress and general distress. Clinical implications are described.

Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8-16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 ), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, & Griffin, 2002 ), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 ) and a case study is used to demonstrate its application.

This article presents an overview of complex trauma and a case study describing the evidence-informed treatment of a 25-year-old woman with chronic complex trauma symptoms resulting from childhood sexual, physical, and psychological abuse from a caregiver. Treatment followed a relationship-based, cognitive behavior therapy model across 3 treatment phases. Significant reductions in trauma and general distress symptoms occurred from pre- to posttreatment, although firm conclusions about cause cannot be drawn from case studies. Verbatim vignettes illustrate specific interactions.

Children in the child welfare system experience high rates of exposure to potentially traumatic events, which are associated with significant impairments in safety, permanency, and well-being. However, child welfare systems have not routinely screened children for trauma, and little is known about such efforts. This paper describes five statewide and tribal projects to implement trauma screening for children in the child welfare system as part of broader, trauma informed care initiatives. Findings indicate that implementation strategies varied considerably but that screening generally resulted in identification of high rates of trauma exposure, trauma symptoms and service referrals. Further, screening was generally perceived favorably by child welfare workers and mental health professionals. However, wide variations were observed in the number of children screened, suggesting that more research is needed to identify optimal strategies. Lessons learned are described and recommendations made for implementing trauma screening in state or tribal child welfare systems.

Objective: The present study aimed to (a) identify what mental health profiles exist among emerging adults with a history of childhood contact with Child Protective Services (CPS), and (b) examine whether the level of young-adult functioning varies across the profiles. Method: Latent profile analysis was conducted with a nationally representative sample of youths (mean age = 18.99, N = 1,179) who were tracked for an extended time following CPS investigation. Results: A five-profile solution—minimal symptoms, midlevel symptoms, multimorbid, trauma symptoms, and substance problems—provides the best fit for the data. Young-adult functioning levels vary across the profiles with the members of the minimal-symptoms profile functioning better in many domains compared with members of other profiles. Members of the minimal symptoms, the midlevel symptoms, and the multimorbid profiles scored the lowest, the midlevel, and the highest, respectively, across all mental health symptoms. These three profiles were...

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3-18; M=9.97, SD=3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children's caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.

This research examined contributions of loss events to loss distress and trauma symptoms (accounting for trauma events) for refugee women at risk. Participants (N = 104) responded to the Multidimensional Loss Scale (loss events and distress) and Harvard Trauma Questionnaire (trauma events and symptoms). Loss events contributed uniquely to loss distress (explaining additional 50.8% variance), and made a unique contribution to trauma symptoms (explaining additional 5.2% variance) approximately equal to trauma events. Appropriate response to psychic distress in refugee women at risk requires assessment of both loss and trauma and consideration of cultural differences in ways loss is expressed and meaning ascribed to symptoms.

The competency to stand trial evaluation has long been identified as the most important inquiry in the area of criminal mental health (American Bar Association, Judicial Administration Division, in Standards Relating to Appellate Courts, Vol. 3, 1994; Perlin, Behav Sci Law 21:297–310, 2003; Stone, 1975) as it is part of the bedrock of the commitment to the right to a fair trial. Certainly, it is the most frequently ordered and performed criminal evaluation with an estimated 90,000 (Fuller et al., Emptying the ‘new asylums’: A beds capacity model to reduce mental illness behind bars. Arlington, VA: Treatment Advocacy Center, 2017. http://www.treatmentadvocacycenter.org/storage/documents/emptying-new-asylums.pdf) up from the oft-cited 60,000 per year in the United States in 2000 (Bonnie and Grisso, Adjudicative competence and youthful offenders. In T. Grisso and R. Schwartz (Eds.), Youth on trial: A developmental perspective on juvenile justice (pp. 73–103). Chicago, IL: University of Chicago Press, 2000). This chapter provides an overview of competency to proceed to trial evaluations (CST) and examines how assessing trauma during these evaluations is an important, if often overlooked, area, which could impact competency decisions and thus fair resolutions (typically not at trial) of criminal cases. While psychotic symptoms are the most often-cited issues related to impairments in CST, trauma symptoms have also been found to play a role. Case examples are included to illustrate some ways that the presence of trauma symptoms informed competency to stand trial evaluations and their outcomes. Trauma symptoms are only now coming to be recognized as possibly important factors in competency to proceed evaluations, as they include alterations in attention, concentration, interpersonal relationships, and, at times, reality testing. All too often, competency evaluators focus solely on the presence or absence of psychotic symptoms. Trauma symptoms can be quite similar to those seen in psychosis, specifically dissociation, disruptive thought and emotional processes, and hallucination-like flashbacks but may not be queried if prominent psychotic symptoms are not present. While it is true that psychotic symptoms are the primary reason defendants are found not competent, to overlook the role trauma may play on an individual’s functioning is a disservice to the defendant, the forensic evaluator, the courts, and ultimately, the criminal justice system.

Background: Young children may be adversely impacted by separation from and loss of caregivers and other loved ones. Such experiences often co-occur with interpersonal violence, unpredictability and other traumas. Whether separation/loss has unique effects independent of those other adversities is not known. Objective: This study aimed to establish whether separation/loss is associated with trauma-related symptoms, psychiatric disorders, and functional impairment in 18- to 48-month-old children independent of other adversities. Methods: Data from a cross-sectional community and clinical cohort were analyzed. Recruitment occurred in pediatric primary care, mental health, and developmental services sites. Children (33% female) were heterogeneous in ethnic background (55% minority) and family socioeconomic status (40% living in poverty). Results: Separation/loss was common (30.9% single type, 15.0% multiple types) and frequent amongst violence-exposed children (84.4% of violence-exposed children had experienced separation/loss from a loved one). However, violence exposure was uncommon amongst children with separation/loss experiences (only 23.9% were violence-exposed). Separation/loss was significantly associated with symptoms of posttraumatic stress and reactive attachment, as well as impairment and psychiatric disorders in models that controlled for sociodemographic and contextual risks, including other traumas. Psychiatric disorders were approximately 2.5 times more likely in children who had experienced multiple separations/losses, after accounting for interpersonal violence which was also significant. Conclusion: Professionals working with young children, policy-makers and caregivers should be aware that an accumulation of caregiver separations/losses, irrespective of violence and other traumatic exposure, may have detrimental effects on young children especially in the context of prior separations/losses or disruptions in their lives.

There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD.

According to the Office of Juvenile Justice and Delinquency Prevention (Puzzachera, 2013), there were approximately 1.47 million arrests of juveniles in the United States reported in 2011, including 68,150 serious violent crimes and 190,000 simple assaults. These data demonstrate that violent crimes are a significant national issue. Past studies have indicated that court-involved and delinquent adolescents frequently report a history of trauma symptoms and exposure to violence. The goal of this article is to present a framework for practice with court-involved youth that reflects the intersection of literature on adolescent development, trauma, and court-involved youth. Improving our understanding of the influence that trauma has on court-involved adolescents will support our ability to better understand the needs of this population in terms of treatment and crime prevention. This article presents a trauma-specific context for addressing the needs of court-involved youth from developmental, neurob...

This study examines the ability of the Behavior Assessment System for Children, Self Report of Personality-Adolescent, 2nd edition (BASC-2-SRP-A) to predict trauma symptomatology as measured by the Child Report of Post-traumatic Stress among a sample of 59 male and 59 female adjudicated youth. Logistic regression revealed that clinically significant CROPS scores were predicted by BASC-2-SRP Social Stress and Somatization scale scores. A second logistic regression indicated that among youth with significant CROPS scores, gender was predicted by Sensation Seeking and Depression scale scores. Further, 47.4% (n = 56) of juvenile offenders’ CROPS scores were clinically significant, with females scoring significantly higher than males. Results endorse the validity of the CROPS and suggest that with additional analysis the BASC-2-SRP may also have the potential to identify juvenile offenders with a history of trauma.

The main goal of our study was to investigate and compare the relationship between temperament traits postulated by the Regulative Theory of Temperament (RTT) and social support dimensions with the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), in an HIV/AIDS patient sample [HIV+ (n=182) and AIDS (n=128)] and in patients suffering from chronic pain (rheumatoid arthritis; n=150). The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory (PTSD-F), temperament was measured with the Formal Characteristics of Behaviour–Temperament Inventory (FCB-TI), and social support was tested with the Berlin Social Support Scales (BSSS). Significant predictors of trauma symptoms among participants were temperament traits (emotional reactivity, perseveration, and sensory sensitivity), and social support dimensions (perceived support, need for support, support seeking, and actually received support). We also noticed significant differences between the levels of trauma symptoms, temperament, and social support between HIV/AIDS and chronic pain patients. The importance of trauma symptoms, as well as temperament traits and social support, should be taken into account in planning the forms of psychological support that should accompany pharmacotherapy for HIV/AIDS and chronic pain patients.

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients' specific needs.

This study examines the relationship between violence exposure and early substance use as mediated by trauma symptoms. The Assessment of Liability and Exposure to Substance Use and Antisocial Behavior Scale was used to assess violence exposure at age 10 and substance use by age 12. Mediation analysis indicated direct relationships between violence exposure and tobacco or illegal drug use and indirect relationships between violence exposure and girls’ substance use through trauma symptoms. Practitioners should consider violence exposure as a risk factor for early substance use in high-risk youths and potential gender differences in trauma symptom pathways to early substance use.

Military veterans are among those most affected by posttraumatic stress disorder (PTSD) due to combat-related experiences and are often reluctant to seek long-term services. Trauma is commonly associated with distress for veterans as well as their partners, which makes it important for both individuals within a couple to receive mental health care. There are few brief programs, however, that provide these needed services for both active military and veteran couples who may still suffer from the effects of trauma. The authors provide a description and evaluation of a brief couples retreat model program aimed at reducing distress for veterans and their partners. A total of 149 couples (298 individuals) participated in weeklong retreat-style interventions. Results showed that trauma symptoms were significantly reduced for veterans, and partners reported a decrease in distress after the intervention. Although the magnitude of this effect diminished over time, there was evidence of long-term treatment ...

The effectiveness of eye movement desensitization and reprocessing (EMDR) therapy for treating trauma symptoms was examined in a postwar/conflict, developing nation, Timor Leste. Participants were 21 Timorese adults with symptoms of posttraumatic stress disorder (PTSD), assessed as those who scored ≥2 on the Harvard Trauma Questionnaire (HTQ). Participants were treated with EMDR therapy. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist. Symptom changes post-EMDR treatment were compared to a stabilization control intervention period in which participants served as their own waitlist control. Sessions were 60–90 mins. The average number of sessions was 4.15 (SD = 2.06). Despite difficulties providing treatment cross-culturally (i.e., language barriers), EMDR therapy was followed by significant and large reductions in trauma symptoms (Cohen's d = 2.48), depression (d = 2.09), and anxiety (d = 1.77). At posttreatment, 20 (95.2%) participants scored below the HTQ PTSD cutoff of 2. Reliable reductions in trauma symptoms were reported by 18 participants (85.7%) posttreatment and 16 (76.2%) at 3-month follow-up. Symptoms did not improve during the control period. Findings support the use of EMDR therapy for treatment of adults with PTSD in a cross-cultural, postwar/conflict setting, and suggest that structured trauma treatments can be applied in Timor Leste.

An earthquake devastated Haiti in January 2010, killing than over 230,000 and displacing millions. Following this disaster, a culturally specific narrative model was developed for leaders (i.e., teachers, clergy, etc.) to treat trauma symptomatology among Haitians. The Haitian local leaders (n=85) were treated with the narrative model. Data were collected and analyzed, and the results were significant. The leaders’ trauma symptoms decreased following treatment. Following the narrative treatment, they were trained to utilize the model. Recommendations for future research and limitations of the study are discussed.

This chapter discusses the sobering reality that children 10 years and younger frequently sustain significant injuries from dog bites leaving the child and family members to deal with unforeseen difficulties. These challenges include medical bills, legal entanglements, long-term fear of dogs, post trauma symptoms, and caregiver guilt. Suggestions for how to assess and address these issues and provide interventions that enhance coping skills are included.

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.

Effective prevention and intervention for trauma symptoms are still needed, particularly for adolescents, in whom high-risk behavior is common. This pilot study examines how media multitasking may be related to trauma symptoms in a sample of adolescent college students (N = 55). Results indicate that higher media multitasking is uniquely and independently associated with higher trauma symptoms. These results hold even after controlling for alcohol intoxication, which is commonly associated with trauma symptoms. Adolescents may be more forthcoming in revealing information about media multitasking than other behaviors commonly associated with trauma symptoms, such as alcohol and drug use. The present study provides the first evidence that media multitasking could be an additional tool for clinicians treating adolescents with trauma symptoms.

Post traumatic stress disorder (PTSD) is a significant mental health problem which can develop following childbirth (PTSD FC). Partners and staff are also at risk and a larger group of women develop sub-clinical trauma symptoms. PTSD can impact on future childbearing, the wider family, intimate sexual relationships and bonding. The relationship between mothers and health professionals is crucial. Health professionals can

Therapeutic alliance is an influential predictor of successful treatment with transtheoretical capacity. The effectiveness of alliance has been evidenced with adult sex offenders and delinquent youth, but scholarship in this area is only burgeoning with youthful sexual offenders. Client-level variables unique to clinical context may influence the therapeutic alliance and research ought to delineate those factors among youthful sexual offenders. The present study incorporates variables unique to youthful sexual offenders in corrections facilities. Trauma symptoms and attachment patterns are measured among adjudicated male sex offenders (N = 332). The results reveal a significant relationship between youths’ attachment to peers and communication with fathers that positively predicts alliance and that trauma symptoms related to sexual victimization negatively predict alliance. Implications, future research, and treatment suggestions are provided.

The current study investigated a model explaining sexual assault victims’ severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma—cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences.

Differences in trauma symptoms among men and women in two court-involved substance abuse treatment programs were examined using latent transition analysis (LTA). It was hypothesized that women would be more likely to report clinical-level trauma symptoms than would men, but that both groups would show reductions in symptoms over time. Symptom classifications were determined by the LTA. Scores on the Trauma Symptom Inventory (TSI) were obtained on 381 program participants, 112 men and 269 women, at intake and after 6months in treatment. Three ordered classes were obtained for men and women at each time point: non-clinical (no TSI scales elevated), moderate symptoms (1 or 2 scales elevated) and severe symptoms (all scales elevated). Men were more likely to be represented in the non-clinical class at intake, while women had higher representation in the severe symptom s classification. There was a reduction of trauma symptoms for most men and women, but some groupings had symptoms that remained the same or became worse over time. Using gender and trauma-symptoms to help determine interventions is discussed.

Substance use disorders commonly co-occur with posttraumatic stress disorder and are associated with greater impairment. There is some evidence to suggest that different coping strategies, including defence mechanisms and religious forms of coping, may buffer the relationship between trauma and SUDs. The purpose of this study was to evaluate the potential moderating roles of defence mechanisms and religious coping on the already-established relationship between trauma symptoms and substance abuse. Data were gathered from a sample of college students (N = 380). Trauma symptoms were associated with increased substance use and abuse. The use of immature defences was significantly associated with trauma and substance use. Increased substance abuse was also associated with higher rates of negative religious coping. Individuals who endorsed trauma symptoms were also more likely to use positive and negative religious coping. Defences and coping did not moderate the relationship between trauma and substance use.