Trauma and posttraumatic stress disorder symptomatology: patterns among American Indian adolescents in substance abuse treatment.

In this study the authors examined the prevalence and correlates of posttraumatic stress disorder (PTSD) and trauma symptomatology among a sample of 89 American Indian adolescents in a residential substance abuse treatment program. These youths reported an average of 4.1 lifetime traumas, with threat of injury and witnessing injury being most common; molestation, rape, and sexual attack were least common. Approximately 10% of participants met the Diagnostic and Statistical Manual IV Text Revision (DSM-IV-TR) criteria for full PTSD, and about 14% met the criteria for subthreshold PTSD. Molestation (including rape and sexual attack), experiencing 6 or more traumas, and a diagnosis of abuse of or dependence on stimulants were significantly associated with PTSD. Findings indicated that trauma was a pervasive phenomenon among this population, with sexual traumas being particularly stigmatizing, resulting in high rates of posttraumatic symptomatology, specifically PTSD.

Does writing reduce posttraumatic stress disorder symptoms?

To see if writing about their trauma lessened PTSD and related symptoms, 57 undergraduates, previously screened for traumatic experiences, wrote for 15 minutes on 4 days across 2 weeks about either their trauma or a trivial topic. They reported PTSD, impact, suicide ideas, dissociation, and depression pre-, post-, and at 6-week follow-up testing. Trauma and trivial writers were not different. Surprisingly, at follow-up everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression. On PTSD symptoms and impact, the pattern of improvement was different: Those writing about trauma got worse at posttesting, but improved to better than their initial state by follow-up. Those writing about a trivial topic got better by posttesting, and held that position at follow-up. In this project, writing seemed to reduce PTSD symptoms regardless of whether it concerned the trauma or what they ate for lunch.

The evaluation life cycle: a retrospective assessment of stages and phases of the circles of care initiative.

A life cycle metaphor characterizes the evolving relationship between the evaluator and program staff. This framework suggests that common developmental dynamics occur in roughly the same order across groups and settings. There are stage-specific dynamics that begin with Pre-History, which characterize the relationship between the grantees and evaluator. The stages are: (a) Pre-History, (b) Process, (c) Development, (d) Action, (e) Findings-Compilation, and (f) Transition. The common dynamics, expectations, and activities for each stage are discussed.

Mapping pathways to services: description of local service systems for American Indian and Alaska Native children by Circles of Care.

The process of describing existing services for American Indian and Alaska Native children with serious emotional disturbance by the Circles of Care strategic planning initiative is overviewed. We explain why service system description is important and how it helped define the role of evaluation within the initiative. Primary goals and methodologies of the service system description are described. Key findings, challenges and opportunities presented by the findings, and impact on the planning process are described.

The Circles of Care evaluation: doing participatory evaluation with American Indian and Alaska Native communities.

Little information exists regarding mental health and special needs related to American Indian and Alaska Native (AI-AN) families. In this paper we emphasize the use of oral tradition during the Circles of Care initiative, which was essential in understanding cultural history and historical trauma of AI-ANs while giving a greater understanding of an AI-AN-based definition of severe emotional disturbance (SED). The success of these methods serves as a template for improving systems of care and may be useful in evaluation among a wide range of ethnic communities.