Service utilization among adolescents seeking trauma-related care: Differences by risk for suicide and ethnoracial background.

Adolescents from ethnoracially minoritized backgrounds increasingly report high rates of attempted suicide, trauma exposure, and limited access to mental healthcare services. However, less is known regarding their use of services across different youth-serving systems. This study examines the associations and interactions between self-injurious thoughts and behaviors (SITBs), race/ethnicity, and service sector utilization (mental healthcare, general healthcare, school, and social services) among a sample of trauma-exposed and treatment-seeking adolescents. Participants were treatment-seeking adolescents (N = 4406) ages 12-17 from the National Child Traumatic Stress Network Core Data Set who had available data for SITBs, race/ethnicity, services utilized, and other key variables. Mixed effects logistic regression was used to examine main and interactive effects for whether adolescents' race/ethnicity and SITBs were associated with service utilization in each of the identified service sectors. SITBs were associated with adolescents' utilization of mental healthcare (OR = 1.38 p < 0.001), general healthcare (OR = 2.30; p < 0.001), and school services (OR = 1.38 p < 0.001). NH Black adolescents reporting SITBs were less likely to use mental health services than other NH Black youths (OR = 0.53; p = 0.004). Hispanic adolescents reporting SITBs were more likely to utilize healthcare services than other Hispanic youths (OR = 1.51; p = 0.039). Trauma-exposed adolescents reporting SITBs are more likely to utilize mental healthcare, general healthcare, and school-based services than other trauma-exposed adolescents. However, NH Black adolescents experiencing SITBs may face additional barriers to utilizing mental healthcare services. Findings can be used to develop nursing practices and policies to address barriers faced by adolescents reporting SITBs.

Addressing Systemic Racism in the American Professional Society on the Abuse of Children Publications.

The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.

Predictors of symptom severity and change among youth in trauma-informed residential care.

BACKGROUND: Trauma-informed residential care is an intensive intervention setting for youth, but research on its effectiveness is limited and yields mixed findings. OBJECTIVES: The study aims were to; 1) evaluate change over time of mental health (MH) symptoms over 21 months of trauma-informed residential care, and 2) examine the influence of demographic and risk factor variables (e.g. age, gender, trauma and placement history) on baseline symptoms and treatment response. PARTICIPANTS: A sample of 547 youth ages 12 to18 in trauma-informed residential care (M age = 15.84 (SD = 1.56), 43.2 % male) were examined, with notable attrition over the study period. METHOD: Latent curve analysis (LCA) was used to estimate MH symptom severity at intake and change during 21 months (8 assessments total, intake and every 3 months) of care. RESULTS: Trauma-informed residential care was associated with significant reductions in symptoms of PTSD (d = -0.76), depression (d = -0.59), dissociation (d = -0.60), psychological dysregulation (d = -0.94), and externalizing (d = -0.31), but not internalizing (d = 0.01) problems. Females had greater symptoms at intake across multiple indicators and showed equivalent or greater treatment response than males, although both groups improved. Neither cumulative trauma nor previous placement were associated with attenuated treatment response, but trauma history was positively associated with severity of multiple clinical measures at intake. CONCLUSIONS: Trauma-informed residential treatment can lead to reductions in clinical symptoms, even among multiply trauma-impacted youth. The extent of youth's trauma history did not negatively influence treatment response.

Polyvictimization and Psychosocial Outcomes Among Trauma-Exposed, Clinic-Referred Youth Involved in the Juvenile Justice System.

Polyvictimization is a robust predictor of emotional and behavioral problems and is linked to involvement in juvenile justice and other public sector systems. This study extends prior research by employing person-centered methods for identifying polyvictimization patterns among trauma-exposed, clinic-referred, justice-involved youth (n = 689; ages 12-18 years) and how identified classes differ on psychosocial outcomes and demographic characteristics. Most participants had experienced multiple traumatic event (TE) types. Latent class analyses identified three classes: mixed trauma/bereavement exposure group (55.1%; Mean = 3.0 TE types); maltreatment polyvictimized group (29.3%; Mean = 5.7 TE types); and maltreatment plus extreme violence polyvictimized group (15.7%; Mean = 9.3 TE types). Polyvictimized youth were more likely to be female, in out-of-home placements, and experiencing negative psychosocial outcomes (e.g., Posttraumatic Stress Disorder). Hispanic/Latino youth were overrepresented in the extreme polyvictimized subgroup. Results underscore the need for cross-system coordination of trauma-informed, comprehensive services for clinic-referred, justice-involved youth.

Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder.

Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect ß = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect ß = .15, 95% CI [.11, .18], and aggressive behaviors, total effect ß = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.

All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores.

The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self-reported ACEs increase from 0 to 4 or more (4+), most studies find a roughly stepwise progression in risk for a wide range of negative medical and mental health outcomes. A score of 4+ ACEs, has become a de facto cutpoint, increasingly used clinically to define "high risk" status for a myriad of outcomes. Comparisons across studies using a 4+ cutpoint, however, find considerable heterogeneity in the degree of risk for the same outcomes. In addition to sample and methodological differences, certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome. This article reviews the empirical literature on synergistic ACEs including results from a general population adult and a mixed trauma, youth sample both sufficiently powered to examine over 20 different ACE pairings for possible synergy. Synergistic pairs of ACEs vary by gender and age group. About 30-40% of the variance in outcomes is accounted for by additive synergistic interactions between certain pairs of ACEs. Across studies, sexual abuse is the most synergistically reactive ACE. The article concludes with a discussion of the implications of synergistic ACE pairings for psychologists and other allied professionals across clinical practice, prevention, research, and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Translating cultural assets research into action to mitigate adverse childhood experience-related health disparities among African American youth.

Adverse childhood experiences (ACEs) including trauma exposure, parent mental health problems, family dysfunction, and community-level adversities put individuals at risk for a host of negative health outcomes. The effects of cumulative ACEs are numerous, diverse, and can predispose an individual to cognitive, emotional, behavioral, and physical health problems as well as premature death. African American youth experience disproportionate exposure to ACEs in the context of racism that increases risk for allostatic load and hinders systems of care responses resulting in physical and mental health disparities. To maximize efforts to mitigate these disparities it is imperative that we translate research into action to respond to ACEs in the context of racism. This article synthesizes African American cultural assets research within a resilience after trauma framework to provide a foundation for translating research into action to mitigate ACE-related disparities among African American youth. We present task shifting and youth-partnered advocacy as two strategies supported by this framework and describe their application to responding to ACEs in the context of racism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Identifying Bereavement-Related Markers of Mental and Behavioral Health Problems Among Clinic-Referred Adolescents.

Objective: This study examined bereavement-related risk markers (number of deaths, cause of death, and relationship to deceased) of mental and behavioral health problems (suicidal thoughts or behaviors, self-injury, depression, posttraumatic stress, and substance use) in a national sample of clinic-referred bereaved adolescents. Method: Participants included 1281 bereaved youth aged 12-21 years (M=15, SD=1.8; 62.1% female), from the National Child Traumatic Stress Network Core Data Set. Results: Generalized linear mixed-effects regression models controlling for demographics and other traumas revealed that youth bereaved by multiple deaths had higher posttraumatic stress scores than youth bereaved by a single death (Estimated difference ±SE=3.36 ± 1.11, p=0.003). Youth bereaved by suicide were more likely to report experiencing suicidal thoughts or behaviors (AOR=1.68, p=0.049) and alcohol use (AOR=2.33, p<0.001) than youth bereaved by natural causes. Youth bereaved by homicide were at greater risk for substance use than youth bereaved by natural death (AOR=1.76, p=0.02). Compared to parentally bereaved youth, youth who lost a peer were more likely to use alcohol (AOR=2.32, p=0.02) or other substances (AOR=2.41, p=0.01); in contrast, parentally bereaved youth were more likely to experience depression compared to those who experienced the death of an adult relative or unrelated adult (range of AOR: 0.40 to 0.64, p-values<0.05). Conclusion: These bereavement-related contextual factors can serve as early markers of mental and behavioral health problems among bereaved youth.

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child-parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Synergistic adversities and behavioral problems in traumatized children and adolescents.

OBJECTIVE: This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive. METHODS: A sample of 10,355 clinic-referred youth (1.5-18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5-5 years, 6-12 years, and 13-18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL. RESULTS: Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6-12 and 13-18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9). CONCLUSION: Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.

Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Trauma-informed measurement-based care for children: Implementation in diverse treatment settings.

Ongoing and comprehensive assessment is a critical part of the implementation of evidence-based care; yet, most providers fail to routinely incorporate measurement into their clinical practice. Few studies have focused on the complex application of routine assessment or measurement-based care (MBC) with children. This pilot examined the acceptability, appropriateness, adoptability, and feasibility of an MBC effort, the Clinical Improvement through Measurement Initiative (CIMI), across several child-serving settings (e.g., community mental health center, residential treatment facility). CIMI includes a comprehensive mental health assessment protocol and combines a mobile technology platform with implementation support. Survey and focus group information, assessing implementation constructs and outcomes, was collected from 44 clinicians and staff. Overall, participants agreed that the implementation process and technology were acceptable, appropriate, and feasible for use in child mental health and that CIMI can be used to guide case conceptualization, facilitate treatment planning, and monitor outcomes. Strategies that supported the implementation process were identified as were recommendations to enhance adoption. Significant differences were observed by Community versus Specialized settings with respect to feasibility and appropriateness, likely because of factors associated with inner setting (climate, compatibility), outer setting (patient needs), and the phase of implementation achieved by sites. Implications and recommendations for tailoring MBC implementation by characteristics related to setting are discussed. MBC across child service settings are discussed in the context of implementation frameworks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Network analysis of exposure to trauma and childhood adversities in a clinical sample of youth.

Categorizing and quantifying exposure to trauma and childhood adversities (CAs) presents a significant measurement and analytic challenge. The current study examined the co-occurrence of trauma and CA types using network analyses, an alternative to traditional measurement models. The Trauma History Profile, assessing lifetime exposure to 20 different trauma and CA types, was administered to 618 treatment-seeking children and youth ages 4 to 18 years (52.8% female). The generalized similarity model (Kovács, 2010) was used to construct a network of trauma/CA types to visualize relationships and detect cohesive groups. Four clusters of trauma/CA types emerged: overt forms occurring at the individual level (e.g., physical, sexual, and psychological maltreatment), environmental forms at the family level (e.g., neglect, impaired caregiving), environmental forms occurring at the community level (e.g., community and school violence), and acute forms (e.g., loss, medical trauma). Age of onset data indicated that neglect and psychological maltreatment were most predictive of later occurrences of other trauma and CAs. Structural equation modeling indicated that trauma/CA clusters displayed specific associations with posttraumatic stress, internalizing, and externalizing symptoms. Results demonstrate the potential utility of network analysis to understand the co-occurrence and temporal ordering of multiple types of trauma and CAs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Benefits of Treatment Completion Over Premature Termination: Findings from the National Child Traumatic Stress Network.

Objective: To evaluate potential differences in therapeutic outcomes between youths who completed a full course of treatment as planned compared to youths who terminated treatment prematurely. Method: Using longitudinal data from the National Child Traumatic Stress Network (NCTSN) Core Data Set, the present study examined demographic characteristics, trauma history, scores on standardized measures, and ratings of functional impairment and behavior problems in a large clinical sample of children and adolescents exposed to trauma who received treatment at NCTSN centers across the United States. Baseline and follow-up data were used to compare treatment completers (n= 3,108) and noncompleters (n = 4,029). Results: Both treatment completers and noncompleters received benefits from treatment by NCTSN mental health providers in that both groups showed significant decreases in mean scores from baseline to follow-up on all standardized measures. However, compared to noncompleters, treatment completers showed three types of significantly greater benefit at follow-up. These included: (a) greater rates of decline (i.e., steeper slopes) on all outcome measures; (b) greater reductions in the odds of falling within the clinical range on standardized measures; and (c) greater reductions in the odds of exhibiting functional impairment and behavior problems at follow-up. In contrast, compared to treatment completers, noncompleters reported significantly higher rates of lifetime exposure to community violence, psychological maltreatment, physical abuse, neglect, sexual abuse, and sexual assault. Conclusion: These findings underscore the value of incorporating engagement and retention strategies in treatments for traumatized youths to maximize therapeutic benefit and raise the standard of care.

Relationships Between Maltreatment, Posttraumatic Symptomatology, and the Dissociative Subtype of PTSD Among Adolescents.

The purpose of this study was to explore relationships between maltreatment, posttraumatic stress disorder, and the dissociative subtype of posttraumatic stress disorder among adolescents. This descriptive study used secondary data from the National Child Traumatic Stress Network Core Data Set. A clinical sample of adolescents exposed to potentially traumatizing events ages 12 to 16 was selected (N = 3081) to explore associations between trauma history characteristics, sociodemographic factors, posttraumatic stress disorder, and the dissociative subtype of PTSD which includes depersonalization and derealization. More than half of adolescents who met criteria for posttraumatic stress disorder also met criteria for the posttraumatic stress disorder dissociative subtype with significant depersonalization/derealization symptoms. No particular maltreatment type was associated with increased odds of posttraumatic stress disorder, with or without the dissociative subtype. All posttraumatic stress disorder-affected adolescents, with or without the dissociative subtype, experienced more overall potentially traumatizing events and maltreatment events than those without a posttraumatic stress disorder diagnosis. Girls and adolescents in residential treatment were more likely to have posttraumatic stress disorder with the dissociative subtype. This study provides evidence about the dissociative subtype of posttraumatic stress disorder among adolescents and provides new directions for research on trauma and dissociation. Future research studies should explore the co-occurrence of posttraumatic stress disorder and dissociation with broader range of dissociative symptoms than only depersonalization/derealization to further understand how to diagnose and treat traumatic stress disorders among adolescents.

Examination of Child Placement, Emotional, Behavioral and Attachment Problems Among Children with Caregiver-Perpetrated Trauma Histories.

Caregiver-perpetrated trauma (CPT) is associated with adverse consequences for youth, including out-of-home placement. Although promotion of kinship care placement has recently increased, effects on youth remain unclear. Psychosocial functioning of 1107 CPT-exposed youth ages 2 to 18 was compared across placement types using generalized mixed models. Youth remaining at home had increased Somatization symptoms compared to kinship (OR = .25, CI = 0.07-.88) and foster care (OR = .32, CI = 0.11-.98) youth. Both out-of-home placement types had higher odds of Attachment Problems (OR = 3.61, CI = 2.22-5.87 and 4.41, CI = 2.71-7.18 respectively). PTSD symptoms varied, youth in kinship care had increased self-reported re-experiencing symptoms (OR = 2.66, CI = 1.04-6.8), while youth in foster care had elevated clinician-rated PTSD (OR = 2.07, CI = 1.1.3-3.80). Given the limited differences between kinship and foster care, studies should continue to delineate the impact of child placement type to inform child welfare policy.

The Association between Caregiver Substance Abuse and Mental Health Problems and Outcomes for Trauma-Exposed Youth.

Trauma-exposed youth with impaired caregivers (i.e., due to substance use and/or mental health problems) may be at particular risk for negative outcomes. This study utilized data from the National Child Traumatic Stress Network Core Data Set to examine the impact of caregiver impairment on youth outcomes. Trauma-exposed youth with an impaired caregiver due to either: substance use (n = 498), mental health problems (n = 231), or both substance use and mental health problems (n = 305) were compared to youth without a reported impaired caregiver (n = 2282) to determine if impaired caregiver status is independently associated with increased likelihood of negative behavioral and mental health outcomes and service utilization after accounting for demographics and exposure to traumatic events. Youth with impaired caregivers compared to those without were more likely to display PTSD, emotional and behavioral problems, suicidality, self-injury, and substance abuse and had higher rates of service utilization (p < 0.05). Differential patterns were observed based on the type of caregiver impairment. Findings support the importance of family-centered assessment and intervention approaches for youth affected by trauma.

Mental Health of Children of Deployed and Nondeployed US Military Service Members: The Millennium Cohort Family Study.

OBJECTIVE: Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children. METHOD: This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member- and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years. RESULTS: Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group. CONCLUSION: These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.

Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth.

BACKGROUND: A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice. METHODS: Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression. RESULTS: One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria. CONCLUSION: Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program.

Maltreatment type, exposure characteristics, and mental health outcomes among clinic referred trauma-exposed youth.

Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.