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Lyons JS, Fernando AD. Creating the necessary infrastructure for a trauma-informed system of care for children and youth. Front Psychol 2023; 14:1129197. [PMID: 37496789 PMCID: PMC10366599 DOI: 10.3389/fpsyg.2023.1129197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Understanding and addressing the impact of adverse life events is an important priority in the design of helping systems. However, creating trauma-informed systems requires efforts to embed effective trauma-informed work in routine practice. This article discusses a model for developing trauma-informed systems using the Transformational Collaborative Outcomes Management (TCOM) framework, a strategy for engineering person-centered care. Person-centered care is naturally congruent with trauma-informed care. We describe the initial stages of implementation of a trauma-informed standardized assessment process to support the sustained evolution of trauma-informed care. Distinguishing between traumatic experiences and traumatic stress is fundamental to an effective trauma-informed system. We describe two sets of analyses-one in a statewide child welfare system and the other in a statewide behavioral health system. These projects found opportunities in the analysis of the detection of traumatic stress based on traumatic experiences to inform practice and policy. Being trauma-informed in child welfare is distinct from being trauma-informed in behavioral health. In child welfare, it appears that a number of children are resilient in the face of traumatic experiences and do not require trauma treatment interventions. However, delayed and missed traumatic stress responses are common. In behavioral health, misses often occur among adolescents, particularly boys, who engage in acting out behavior. Opportunities for the ongoing development of trauma-informed systems using the TCOM framework are discussed.
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Kagan R, Pressley J, Espinoza R, Lanktree C, Henry J, Knoverek A, Duffy S, Labruna V, Habib M, Blaustein ME, Spinazzola J. Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:145-159. [PMID: 36776636 PMCID: PMC9908809 DOI: 10.1007/s40653-022-00479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 06/18/2023]
Abstract
Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.
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Affiliation(s)
- Richard Kagan
- Training Programs on Traumatic Stress, Family Treatment Center Foundation, The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | - Jana Pressley
- The Foundation Trust, Richmont Graduate University, Chattanooga, USA
| | - Rosa Espinoza
- The Foundation Trust, Children’s Hospital Los Angeles/USC UCEDD, Los Angeles, USA
| | - Cheryl Lanktree
- Department of Psychiatry & Behavioral Sciences, Keck Medical School, University of Southern California Adolescent Trauma Training Center, University of Southern California, Los Angeles, USA
| | - Jim Henry
- School of Social Work and Children’s Trauma Assessment Center, Western Michigan University, Kalamazoo, USA
| | - Angel Knoverek
- School of Counselor Education, Culver-Stockton College, Adams State University, Alamosa, USA
| | | | - Victor Labruna
- The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | - Mandy Habib
- The Institute for Adolescent Trauma Treatment and Training at Adelphi University, Garden City, USA
| | | | - Joseph Spinazzola
- The Foundation Trust, Richmont Graduate University, Chattanooga, USA
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Ascienzo S, Sprang G, Royse D. "My Bad Experiences Are Not the Only Things Shaping Me Anymore": Thematic Analysis of Youth Trauma Narratives. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:741-753. [PMID: 35958719 PMCID: PMC9360376 DOI: 10.1007/s40653-021-00431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to better understand how youth with poly-trauma histories appraise and make meaning of their traumatic experiences within the trauma narrative and processing components of Trauma-focused Cognitive Behavioral Therapy (TF-CBT), and to explore the results of the meaning-making process. Thematic analysis was employed to explore the trauma narratives of youth (N = 16) ages 8 - 16 that were created during TF-CBT. Participants experienced a mean of 5.38 types of trauma that predominantly included various forms of child maltreatment. With regard to how youth appraise and interpret their traumatic experiences, four themes emerged, including I Am Not Safe, which denotes a lack of physical and psychological safety; It's My Fault, which symbolizes misattributions of responsibility; I Am Changed, which captures alterations in systems of meaning; and Why Did This Happen to Me?, which denotes the struggle to comprehend why the traumatic events occurred and their significance. With regard to the products of the meaning-making process, three themes emerged, including Now I Know, which denotes reappraisals; I Am Safe/r, which signifies increases in perceptions of safety, and I Can Do It, which includes the participant's perceptions of growth. Results from this study provide a deeper understanding of youth's experiences during these components of treatment, and illuminate the meaning-making process. Findings can help guide clinical-decision making, and highlight the importance of explicitly attending to specific components of the meaning-making process during trauma narration and processing.
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Affiliation(s)
- Sarah Ascienzo
- School of Social Work, North Carolina State University, Raleigh, NC 27695 USA
| | - Ginny Sprang
- Department of Psychiatry and Executive Director, Center On Trauma and Children, University of Kentucky, Lexington, KY 40506 USA
| | - David Royse
- College of Social Work, University of Kentucky, Lexington, KY 40506 USA
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Cox A, Frederico M, Mosse H, Radford L, Ambry D, Ryan C. Australian Maltreated Infants and Young Children Can Achieve Positive Relational Health With Neurodevelopmentally- and Trauma-Informed Interventions Provided Within Relationally-Positive and Stable Environments. Front Psychiatry 2021; 12:680343. [PMID: 34393846 PMCID: PMC8355362 DOI: 10.3389/fpsyt.2021.680343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Childhood maltreatment such as abuse, neglect and family violence has a profound impact on children's psychological and relational functioning and their lifelong trajectory, with associated adverse physical and mental health outcomes, higher mortality rates and reduced socioeconomic opportunities. The aim of the study was to explore the impact of neurodevelopmentally- and trauma-informed interventions on the relational health of children who have experienced maltreatment. Context: The study was conducted at Berry Street Take Two, an Australian therapeutic service. Take Two provides services to Victorian children aged 0-18 years, to address the impact of the trauma they have experienced from maltreatment. Take Two clinicians use relational and ecological frameworks, neurodevelopmental research and evidence-informed approaches to repair family relationships and develop networks of caring adults that focus on meeting the child's needs. Take Two uses the NMT approach as a framework for clinical intervention-planning and is site-certified in the use of the NMT Clinical Practice tools. Method: The mixed methods study had two components. A cross sectional study of baseline and repeat clinical measure data (HoNOSCA and SDQ) with a cohort of children aged 2-11 years (n = 91), who were clients of Berry Street Take Two between 2014 and 2019, was conducted utilizing SPSS. The quantitative data analysis was supplemented by three case studies of Berry Street Take Two clients, which explored the process of intervention, including intervention type, timing and dosage. The case studies drew on the full case record for each child to illustrate the impact of NMT-informed interventions on the relational health, psychological and behavioral functioning of children. Results: The study found that Take Two intervention was associated with improved relational health, measured by the NMT metric and supported by significant positive changes on the SDQ and HoNOSCA with medium effect sizes (cohen's d). The case study analysis highlighted the importance of intervention addressing individual, family and systems elements to bring about positive change. Conclusions: This study illustrates the value of neurodevelopmental trauma-informed interventions in positively impacting on the relational health and current functioning of maltreated children and the potential to reduce the lifelong impact of maltreatment.
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Affiliation(s)
- Allison Cox
- Berry Street Take Two Program, Eaglemont, VIC, Australia
| | - Margarita Frederico
- Department of Occupational Therapy and Social Work and Social Policy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering LaTrobe University, Bundoora, VIC, Australia
| | - Holly Mosse
- Berry Street Take Two Program, Eaglemont, VIC, Australia
| | - Lyn Radford
- Berry Street Take Two Program, Eaglemont, VIC, Australia
| | - Dallas Ambry
- Berry Street Take Two Program, Eaglemont, VIC, Australia
| | - Clare Ryan
- Berry Street Take Two Program, Eaglemont, VIC, Australia
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Racine N, Dimitropoulos G, Hartwick C, Eirich R, van Roessel L, Madigan S. Characteristics and Service Needs of Maltreated Children Referred for Mental Health Services at a Child Advocacy Centre in Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:92-103. [PMID: 33953761 PMCID: PMC8056957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There is a dearth of Canadian-based literature on children referred to treatment services following maltreatment exposure. In order to inform assessment, intervention, and program development to improve outcomes, insight into the demographics and mental health needs of this population is required. METHODS A retrospective file review of 176 children and youth who were referred for assessment and treatment at a mental health partner agency within a Canadian Child Advocacy Centre was conducted from January 2016 to June 2017. A standardized protocol was developed to extract data on family and child demographic characteristics, type of maltreatment, other adversity exposure, presenting concerns of the child, and mental health service utilization. RESULTS The majority of children were female (66.5%), 4.5% were 0 to <5 years, 66.5% were 5 to <13 years, and 29.0% were 13 to <18 years of age. More than half of the children (53.4%) had multiple forms of maltreatment, with 67% exposed to sexual abuse. Exposure to other forms of adversity was also common, including domestic violence (53.4%) and parental mental health difficulties (52.3%). Most children had more than five presenting concerns at the time of referral, and most went on to receive intervention services. Sixty-nine percent of families had not previously received child mental health treatment, although 41.5% had prior child welfare involvement. Thirty percent of families ended treatment prematurely. CONCLUSIONS The current study illustrates the complex profile and mental health needs of children referred for treatment following maltreatment exposure. Results may have implications for clinical care improvement that support maltreated children.
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Affiliation(s)
- Nicole Racine
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, The Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta
| | - Cailey Hartwick
- Child Abuse Service, Alberta Health Services, Calgary, Alberta
| | | | | | - Sheri Madigan
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute
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Mance GA, Rodgers CRR, Roberts D, Terry A. Deeply Rooted: Maximizing the Strengths of a Historically Black University and Community-based Participatory Research to Understand Environmental Stressors and Trauma among Black Youth. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:256-266. [PMID: 32783253 DOI: 10.1002/ajcp.12452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper explores a partnership between an HBCU (Historically Black Colleges and Universities) and a community to understand trauma given the high rates of reported violence among youth locally. The accumulative stress of living in high-stress, high-poverty environments coupled with the normative developmental tasks of adolescence is thought to place these youths at risk for negative mental and physical outcomes (Murry et al., 2011). The current research uses a community-based participatory research (CBPR) approach and developmental lens to better understand environmental stressors and subsequent trauma among Black youth. Specifically, the paper describes the recruitment, engagement, and equitable partnership between a youth advisory board (YAB), university research team, and community agencies advisory board (CAB). The current work is part of a larger research study designed to explore environmental stressors, coping, and social supports for Black youth residing in low-resource urban communities. The broad objective of the research is to develop a trauma-informed community intervention to improve adolescent mental health. The initial phase of this university-community research, which entails the YAB, CAB, and university discussion groups, is outlined in this paper. Community engagement and trust are key factors described in the literature when collaborating with communities of color. These themes were reiterated by research partners in this study. The research team created coding terms to identify themes from YAB and CAB transcript data, respectively. YAB themes regarding stressors centered around financial strain, anger, and loss/violence. CAB themes regarding adolescent mental health and resources centered around trauma, trust, and sustainability. Initial steps to utilize the themes identified thus far are described. The unique advantages of an HBCU and CBPR to address mental health disparities in ethnic minority communities are also highlighted.
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Affiliation(s)
- GiShawn A Mance
- Department of Psychology, Howard University, Washington, DC, USA
| | - Caryn R R Rodgers
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Debra Roberts
- Department of Psychology, Howard University, Washington, DC, USA
| | - Amanda Terry
- Department of Psychology, Howard University, Washington, DC, USA
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Powell BJ, Patel SV, Haley AD, Haines ER, Knocke KE, Chandler S, Katz CC, Seifert HP, Ake G, Amaya-Jackson L, Aarons GA. Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:705-719. [PMID: 31813066 PMCID: PMC7275881 DOI: 10.1007/s10488-019-01003-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A systematic review was conducted to identify determinants (barriers and facilitators) of implementing evidence-based psychosocial interventions for children and youth who experience emotional or behavioral difficulties due to trauma exposure. Determinants were coded, abstracted, and synthesized using the Exploration, Preparation, Implementation, and Sustainment framework. Twenty-three articles were included, all of which examined implementation of Trauma-Focused Cognitive Behavioral Therapy or Cognitive-Behavioral Intervention for Trauma in Schools. This review identified multilevel and multiphase determinants that can be addressed by implementation strategies to improve implementation and clinical outcomes, and suggests how future studies might address gaps in the evidence base.
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, USA.
| | - Sheila V Patel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Amber D Haley
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Emily R Haines
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Kathleen E Knocke
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Shira Chandler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Colleen Cary Katz
- Silberman School of Social Work, Hunter College, City University of New York, New York, USA
| | | | - George Ake
- Duke University School of Medicine, Durham, USA
| | - Lisa Amaya-Jackson
- Center for Child and Family Health, Durham, USA
- Duke University School of Medicine, Durham, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, University of California at San Diego School of Medicine, San Diego, USA
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Jäderberg L, Goss SP, Graham McBeath A. Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents. COUNSELLING & PSYCHOTHERAPY RESEARCH 2019. [DOI: 10.1002/capr.12279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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9
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Lang CM, Edwards AJ, Mittler MA, Bonavitacola L. Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Sege RD, Amaya-Jackson L, Flaherty EG, Idzerda SM, Legano LA, Leventhal JM, Lukefahr JL, Sege RD. Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment. Pediatrics 2017; 139:peds.2017-0100. [PMID: 28320870 DOI: 10.1542/peds.2017-0100] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children who have suffered early abuse or neglect may later present with significant health and behavior problems that may persist long after the abusive or neglectful environment has been remediated. Neurobiological research suggests that early maltreatment may result in an altered psychological and physiologic response to stressful stimuli, a response that deleteriously affects the child's subsequent development. Pediatricians can assist caregivers by helping them recognize the abused or neglected child's emotional and behavioral responses associated with child maltreatment and guide them in the use of positive parenting strategies, referring the children and families to evidence-based therapeutic treatment and mobilizing available community resources.
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Affiliation(s)
- Robert D. Sege
- Health Resources in Action, Boston, Massachusetts
- Center for the Study of Social Policy, Washington District of Columbia; and
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, UCLA-Duke National Center for Child Traumatic Stress, Center for Child & Family Health, Duke University School of Medicine, Durham, North Carolina
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Cutuli JJ, Ahumada SM, Herbers JE, Lafavor TL, Masten AS, Oberg CN. Adversity and children experiencing family homelessness: Implications for health. JOURNAL OF CHILDREN & POVERTY 2016; 23:41-55. [PMID: 30294200 PMCID: PMC6171526 DOI: 10.1080/10796126.2016.1198753] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health care utilization, and hospitalizations. Parents noted children's experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006-07 (n = 104) and in 2008-09 (n = 138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006-07 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.
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Affiliation(s)
| | - Sandra M. Ahumada
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Theresa L. Lafavor
- School of Professional Psychology, Pacific University, Hillsboro, OR, USA
| | - Ann S. Masten
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Charles N. Oberg
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Nabors L, Baker-Phibbs C, Woodson K. Community-based counselors’ interventions for elementary school-age children coping with trauma. J Prev Interv Community 2016; 44:79-91. [DOI: 10.1080/10852352.2016.1132820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Holmes C, Levy M, Smith A, Pinne S, Neese P. A Model for Creating a Supportive Trauma-Informed Culture for Children in Preschool Settings. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 24:1650-1659. [PMID: 25972726 PMCID: PMC4419190 DOI: 10.1007/s10826-014-9968-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The all too common exposure of young children to traumatic situations and the life-long consequences that can result underscore the need for effective, developmentally appropriate interventions that address complex trauma. This paper describes Head Start Trauma Smart (HSTS), an early education/mental health cross-systems partnership designed to work within the child's natural setting-in this case, Head Start classrooms. The goal of HSTS is to decrease the stress of chronic trauma, foster age-appropriate social and cognitive development, and create an integrated, trauma-informed culture for young children, parents, and staff. Created from a community perspective, the HSTS program emphasizes tools and skills that can be applied in everyday settings, thereby providing resources to address current and future trauma. Program evaluation findings indicate preliminary support for both the need for identification and intervention and the potential to positively impact key outcomes.
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Affiliation(s)
- Cheryl Holmes
- School of Social Welfare, University of Kansas, Lawrence, KS USA
| | - Michelle Levy
- School of Social Welfare, University of Kansas, Lawrence, KS USA
| | - Avis Smith
- Crittenton Children’s Center, Kansas City, MO 64134 USA
| | - Susan Pinne
- Crittenton Children’s Center, Kansas City, MO 64134 USA
| | - Paula Neese
- Crittenton Children’s Center, Kansas City, MO 64134 USA
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Zilberstein K. Neurocognitive considerations in the treatment of attachment and complex trauma in children. Clin Child Psychol Psychiatry 2014; 19:336-54. [PMID: 23661787 DOI: 10.1177/1359104513486998] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual's understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies.
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Nadeem E, Gleacher A, Beidas RS. Consultation as an implementation strategy for evidence-based practices across multiple contexts: unpacking the black box. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:439-50. [PMID: 23716145 DOI: 10.1007/s10488-013-0502-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.
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Affiliation(s)
- Erum Nadeem
- Department of Child and Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY, 10016, USA,
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16
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Gillies D, Taylor F, Gray C, O'Brien L, D'Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (Review). ACTA ACUST UNITED AC 2014; 8:1004-116. [PMID: 23877914 DOI: 10.1002/ebch.1916] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents. OBJECTIVES To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions. SELECTION CRITERIA All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD. DATA COLLECTION AND ANALYSIS Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team. We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found we used a random-effects model. MAIN RESULTS Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma-related support service. The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy. Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42), anxiety (three studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13) and depression (five studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36) were significantly lower within a month of completing psychological therapy compared to a control group. The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89; up to one year: one study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13) in the CBT group compared to a control. No adverse effects were identified. No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias. AUTHORS' CONCLUSIONS There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others. The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses. More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should also aim to identify the most valid and reliable measures of PTSD symptoms and ensure that all scores, total and sub-scores, are consistently reported.
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Affiliation(s)
- Donna Gillies
- Western Sydney and Nepean Blue Mountains Local Health Districts - Mental Health, Parramatta, Australia.
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Salloum A, Scheeringa MS, Cohen JA, Storch EA. Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:97-108. [PMID: 25411544 PMCID: PMC4233143 DOI: 10.1016/j.cbpra.2013.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.
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Affiliation(s)
| | | | - Judith A Cohen
- Center for Traumatic Stress in Children and Adolescents, Allegheny General Hospital
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18
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A Case Study Approach to Mental Health Recovery: Understanding the Importance of Trauma-Informed Care. ACTA ACUST UNITED AC 2014. [DOI: 10.1891/1559-4343.16.3.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article documents one woman’s experience of mental health recovery using a case study approach. Specifically, qualitative data collected through a semistructured interview were triangulated with the medical record to understand more about how this woman experienced a transition from a period of her life marked by severe psychological and emotional impairment to an extended period of time during which she was thriving and did not experience symptoms consistent with her former diagnosis of severe mental illness. This case study offers important implications regarding the importance of trauma-informed care in the field of mental health.
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19
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Lawson DM, Quinn J. Complex Trauma in Children and Adolescents: Evidence-Based Practice in Clinical Settings. J Clin Psychol 2013; 69:497-509. [DOI: 10.1002/jclp.21990] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Abstract
There has been a recent increase in research focusing on child complex traumatic stress following prolonged or repeated trauma. These traumatic stress reactions often affect many aspects of the child's functioning, including psychological, behavioral, and physical health. In addition, complex traumatic stress experienced by youth with serious medical conditions may influence health issues such as medical adherence, emotional adjustment to illness, and pain management. This article reviews and delineates the current state of the literature on the impact of complex traumatic stress in childhood on mental and physical health as well as on these pediatric health-related issues. To date, few empirical studies have directly addressed this association. Several features associated with complex traumatic stress, such as emotion regulation difficulties, disruptive behavior, and family conflict, have indirectly been demonstrated to interfere with pediatric adherence, medical coping, and pain management. This demonstrates the need for more focused research in this area.
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Affiliation(s)
- Micah S Brosbe
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL 33314, USA.
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21
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Gillies D, Taylor F, Gray C, O'Brien L, D'Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database Syst Rev 2012; 12:CD006726. [PMID: 23235632 DOI: 10.1002/14651858.cd006726.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents. OBJECTIVES To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions. SELECTION CRITERIA All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD. DATA COLLECTION AND ANALYSIS Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team.We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found we used a random-effects model. MAIN RESULTS Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma-related support service.The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy.Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42), anxiety (three studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13) and depression (five studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36) were significantly lower within a month of completing psychological therapy compared to a control group.The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89; up to one year: one study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13) in the CBT group compared to a control. No adverse effects were identified.No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias. AUTHORS' CONCLUSIONS There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others.The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses.More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should also aim to identify the most valid and reliable measures of PTSD symptoms and ensure that all scores, total and sub-scores, are consistently reported.
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Affiliation(s)
- Donna Gillies
- Western Sydney and Nepean Blue Mountains Local Health Districts - Mental Health, Parramatta, Australia.
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Salloum A, Overstreet S. Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration. Behav Res Ther 2012; 50:169-79. [PMID: 22317753 DOI: 10.1016/j.brat.2012.01.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/21/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.
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Affiliation(s)
- Alison Salloum
- University of South Florida, School of Social Work, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL 33612-3870, USA
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Topitzes J, Mersky JP, Reynolds AJ. Child Maltreatment and Offending Behavior: Gender-Specific Effects and Pathways. CRIMINAL JUSTICE AND BEHAVIOR 2011; 38:492-510. [PMID: 27667868 PMCID: PMC5031150 DOI: 10.1177/0093854811398578] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Although expected, distinct gender-specific trajectories from early victimization to later offending have not been well explored. Consequently, this study assessed the association between child maltreatment (ages 0-11) and offending behavior within gender-specific models. Prospectively collected data, including official measures of maltreatment and offending, derived from the Chicago Longitudinal Study, a panel study of 1,539 low-income minority participants, Multivariate probit analyses revealed that maltreatment significantly predicted delinquency for males but not females yet forged a significant relation to adult crime for both genders. Exploratory confirmatory and comparative analyses suggested that mechanisms linking maltreatment to adult crime primarily differed across gender. For males, childhood-era externalizing behavior and school commitment along with adolescent-era socioemotional skills, delinquency, and educational attainment fully explained the maltreatment-crime nexus. For females, childhood-era parent factors along with adolescent indicators of externalizing behavior, cognitive performance, mobility and educational attainment partially mediated the maltreatment-crime relation. Implications of results were explored.
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Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area. Behav Res Ther 2009; 47:980-9. [DOI: 10.1016/j.brat.2009.07.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, Amaya-Jackson L. Evidence-Based Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2008; 37:156-83. [DOI: 10.1080/15374410701818293] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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