The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters.

Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.

When you go low, I go high: Negative coordination of physiological synchrony among parents and children.

The parent-child relationship is an important context for children's emotional development. The current study assessed 43 parent-child dyads while watching a positive film clip and a negative film clip, in order to examine whether partner's physiological reactivity demonstrated dyadic synchrony, and whether this was associated with children's prosocial empathy. Respiratory sinus arrhythmia was measured in both caretakers and children (ages 9-14) and a continuous time series was estimated in order to maximize temporal resolution of physiological dynamics. Dyads varied in both the magnitude and direction of synchrony, with correlation coefficients ranging from moderately negative; r = -.44 (increases in one partner correspond to decreases in the other), to moderately positive; r = .55 (increases in one partner correspond to increases in the other). For both conditions, negative synchrony was correlated with higher child-reported empathy. For the negative mood condition, this effect was moderated by caretaker's emotional acceptance such that positive synchrony was associated with lower levels of empathy among dyads in which caretaker emotional acceptance was lower. These results suggest that positive physiological synchrony during a negative mood condition may not be adaptive for children when their caretaker lacks the skills to appropriately socialize their child's emotional development.

Strengthening family coping resources: the feasibility of a multifamily group intervention for families exposed to trauma.

Families exposed to urban poverty face a disproportionate risk of exposure to repeated trauma. Repeated exposures can lead to severe and chronic reactions in multiple family members with effects that ripple throughout the family system. Interventions for distressed families residing in traumatic contexts, such as low-income, urban settings are desperately needed. This report presents preliminary data in support of Strengthening Family Coping Resources, a trauma-focused, multifamily, skill-building intervention. Strengthening Family Coping Resources is designed for families living in traumatic contexts with the goal of reducing symptoms of posttraumatic stress disorder and other trauma-related disorders in children and caregivers. Results from open trials suggest Strengthening Family Coping Resources is a feasible intervention with positive effects on children's symptoms of trauma-related distress.

Impaired Caregiving, Trauma Exposure, and Psychosocial Functioning in a National Sample of Children and Adolescents.

Impairments in Caregiving (ICG) secondary to mental illness and substance use have been linked to adverse outcomes in children. Little is known, however, about whether outcomes vary by type of ICG, exposure to co-occurring traumas, or mechanisms of maladaptive outcomes. Clinic-referred youth age 7-18 years (n = 3988) were compared on ICG history, demographics, trauma history, and mental health symptoms. Child trauma exposure was tested as a mediator of ICG and child symptoms. Youth with ICG were at heightened risk for trauma exposure, PTSD, internalizing symptoms, total behavioral problems, and attachment problems, particularly youth with multiple types of ICG. Effect sizes were moderate to large for PTSD, internalizing symptoms, and total behavioral problems. Number of trauma types mediated the relationship between ICG and child symptoms. ICG was related to trauma exposure within and outside the family context. Understanding these links has important implications for interrupting intergenerational trauma and psychopathology.

Protecting children from the dangers of urban poverty.

Exposure to the social ecology of poor urban neighborhoods significantly increases the incidence of traumatic stress disorders, placing children growing up in such neighborhoods at disproportionate risk. Although the risk factors for and effects of childhood complex traumatic stress disorders are well documented, there is little intervention research to guide the delivery of services to this population. This paper builds on current knowledge of childhood trauma and related treatments by introducing an intervention model using constructive family ritual functioning as a mechanism for increasing the protective function of the family. The intervention model postulates that use of family rituals as a coping resource will lead to decreased symptoms of chronic traumatic stress and rates of exposure to additional trauma.

The Maryland Resilience Breakthrough Series Collaborative: A Quality Improvement Initiative for Children's Mental Health Services Providers.

The Maryland Resilience Breakthrough Series Collaborative (BSC), a recent quality improvement initiative for children's mental health services providers, is aimed at bridging the gap between resilience theory and mental health service practices. Six provider teams across the state attended resilience training sessions and incrementally implemented practice improvements at their agencies. Group discussions and surveys administered to teams before and after the BSC indicate that the BSC facilitated breakthrough changes in the areas of resilience-enhanced assessment and treatment practices, as well as family and community resilience. This column presents quantitative and anecdotal outcomes and makes recommendations for the provider community.

Effects of the child-perpetrator relationship on mental health outcomes of child abuse: it's (not) all relative.

The present study was conducted to better understand the influence of the child-perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

The Role of Family Processes in Childhood Traumatic Stress Reactions for Youths Living in Urban Poverty.

This article reports findings from a cross-sectional study exploring relationships between trauma exposure, childhood traumatic stress, and family functioning. Data were collected from a sample of 100 mostly African American, 6- to 9-year-old children and their caregivers who were living in low-income, urban neighborhoods and analyzed using hierarchical multiple regressions. The children experienced high levels of exposure and traumatic stress symptoms. Trauma exposure was correlated with reexperiencing, avoidance, and arousal and also with externalizing behavior problems. Reexperiencing and avoidance symptoms were related to lower ratings of the value of family routines reported by caregivers. Higher ratings of family structure, including both organization and support, were related to fewer internalizing and externalizing behavior problems.

Who Are We, But for the Stories We Tell: Family Stories and Healing.

Storytelling is a notable part of family life. Families share stories that illuminate and combine their separate experiences into a meaningful whole. Families narrate both their best and worst life experiences and in this way pass down a heritage of remembrances from one generation to the next. Clinicians working with families who have been impacted by trauma can use family storytelling to aid healing. This article reviews the functions of family storytelling and the skills used by family members in the act of storying to illustrate how therapists can facilitate families' use of their storytelling skills in the healing process.

Family Mealtime Q-Sort: A measure of mealtime practices.

Studies outlining the protective functions of shared family meals suggest that helping families experience successful meals is an important goal. Measuring the effectiveness of family mealtime interventions necessitates the ability to quantify both the frequency and context of shared mealtimes. This article introduces a new instrument, the Family Mealtime Q-Sort, describes its development, and presents preliminary data about its psychometric properties. Data from initial evaluation of the Family Mealtime Q-Sort using family mealtime videos (N = 51) demonstrate acceptable interrater reliability, promising validity, and the ability to compare family mealtimes to an independently derived, culturally appropriate standard. The results suggest that the Q-sort adequately measures important dimensions of a successful mealtime including a positive atmosphere, making use of the shared time to engage in meaningful conversation, and proceeding with a clear plan and minimal distractions. Further research on the tool is warranted.

Understanding the Impact of Trauma on Family Life From the Viewpoint of Female Caregivers Living in Urban Poverty.

Children and their families living in poor, inner-city neighborhoods are at high risk for experiencing multiple traumas. This article describes findings from a qualitative study designed to explore the impact of chronic traumas on family life through the voices of primarily African American caregivers coping with urban poverty. Structured interviews are conducted with 16 caregivers of children ages 6 to 9 years who had been exposed to multiple traumas and had symptoms of posttraumatic stress disorder. Caregivers explain changing daily routines to accommodate child distress and promoting positive family processes such as increased protectiveness. They also describe various roles that religion/spirituality play in their coping with trauma, including finding comfort in the faith that God controls what happens in their lives. These themes are discussed with regard to theory and practical applications for assisting traumatized families.