International Society for Traumatic Stress Studies

Child Trauma

The ISTSS 34th Annual Meeting is the largest gathering of professionals dedicated to trauma treatment, education, research and prevention. There will be several workshops, symposia and expert trainings on child trauma. 


Concurrent Session One: Multi-Media Presentation

Thursday, November 8 | 9:45 AM to 11:00 AM

Integrating Research, Training, and Resource Development to Improve Trauma-informed Services for Transition Age Youth: A Multi-media Workshop

Kisiel, Cassandra, PhD1; Habib, Mandy, PsyD2; Stokes, Chaney, BSW, MA3; Spinelli, Tawny, PhD Student1; Riley, Tracey, BA1; Spinazzola, Joseph, PhD4

1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
2Adelphi University, Garden City, New York, USA
3Strong Able Youth Speaking Out (SaySo), Durham, North Carolina, USA
4The Foundation Trust, Melrose, Massachusetts, USA

Transition Age Youth (TAY) impacted by trauma are at-risk for poor outcomes across many areas of functioning. As these emerging adults transition out of child systems, they no longer have access to these supports, and resources that exist are often inadequate in addressing their complex, trauma-related needs.This multi-media session will set the stage with research and needs assessment data on a range of trauma-related needs for TAY. Provider and youth feedback highlight trauma training and service needs, leading to the development of targeted resources to address gaps in partnership with youth. This session integrates youth voices and reflects the bidirectional nature of the process. It features a set of fact sheets (Trauma-Informed Guiding Principles for Working with TAY) and a youth-led film developed through the National Child Traumatic Stress Network. The film Never Give Up: A Complex Trauma Film by Youth, For Youth examines the challenges and growth of 7 youth/young adults as they transcend developmental trauma. Both are designed to help providers and youth understand the impact of trauma; offer trauma-informed strategies for working with TAY; and support TAY in building strengths and skills. Discussion will emphasize the integration of research with resource development and training, and ways to use resources to support trauma-informed practices with TAY across systems. 

Concurrent Session Two: Symposium

Thursday, November 8 | 11:15 AM to 12:30 PM

Transforming Research into Trauma-informed Interventions for Vulnerable High-risk Traumatized Youth: Getting Kids Safer, Self-regulated, and Engaged in Services

Chair: Ford, Julian, PhD

Increasing recognition of the prevalence of trauma exposure amongst high risk youth has led to a call for trauma-informed services and systems. However, the translation of research-based knowledge on traumatic stress into interventions in community, mental health and juvenile justice systems is still in its infancy. This symposium brings together investigators from 4 independent projects devoted to translating trauma-informed research into trauma-informed services in real-world contexts involving vulnerable youth. The first introduces the risk-needs-responsivity conceptual model and describes the results of a study investigating the contributions of trauma-informed assessment to case planning and services outcomes for justice-involved youth.  The second examines predictors of multiple-systems service utilization in a large national database of trauma-exposed adolescents, comparing justice-involved versus other youth. The third describes the implementation, including challenges and lessons learned, of an affective neuroscience-based psychosocial intervention targeting affect regulation among traumatized youth and staff in a variety of juvenile justice settings. . The fourth presents process and outcome evaluation results from a federally funded grant to integrate trauma recovery services into gang intervention programming in East and South Los Angeles. Collectively, these papers offer valuable insights into how trauma-informed research can be translated into effective trauma-informed interventions for high-risk vulnerable youth.

Race/Ethnicity, Trauma, and Service Utilization among Justice Involved and Uninvolved Youth

Pickens, Isaiah, PhD
National Center for Child Traumatic Stress at UCLA, Los Angeles, California, USA

Data from the National Child Traumatic Stress Network on the service utilization of trauma-exposed youth who were (N=680) or were not (N=3561) recently involved in juvenile justice were used to test associations with race/ethnicity and cumulative exposure to relational trauma (CRT). Logistic regression analyses were used to assess involvement in intensive (ISU; e.g., residential or inpatient treatment) or non-intensive (NISU; e.g., outpatient treatment or counseling) as outcome variables. Race/ethnicity and CRT were unrelated to intensive service utilization except that Hispanic justice-involved and non-involved youth had lower ISU levels than White youth (b=-.98-1.25, SE=.32-.46).  When non-involved Hispanic youth had higher CRT, they received more ISU (interaction b=.18, SE=.07). CRT was associated with higher NISU levels for both justice-involved and non-involved youth (b=.09-.19, SE=.05-.06). Race/ethnicity and cumulative relational trauma were associated with NISU, but only for youth not involved in juvenile justice: Black (b=-.75, SE=.27), Hispanic (b=-.54, SE=.25), and other ethnicity (b=-1.07, SE=.52) youth had lower NISU levels than Whites, but Black and other ethnicity youths with higher CRT levels had higher NISU levels. Implications for understanding juvenile justice as a de facto service system for traumatized under-served ethno-racial minority youth are discussed.

Does PTSD Symptom Severity Impact the Association Between Delinquency Risk Ratings and Legal Outcomes in Detained Adolescents?

Feingold, Zoe, BA1; Kaufman, Holly, MA2; Cruise, Keith, PhD3; Ford, Julian, PhD4

1VA Boston Healthcare System, National Center for PTSD, Boston, Massachusetts, USA
2Fordham University, Bronx, New York, USA
3Fordham University, New York, New York, USA
4University of Connecticut Health Center, Farmington, Connecticut, USA

Prior research has demonstrated that PTSD symptomology is associated with negative outcomes such as increased anger (Ford et al., 2012), substance use (Adams et al., 2013), and reactive aggression (Stimmel et al., 2014) in justice-involved adolescents. Given these associations, a key question for delinquency risk reduction efforts is whether PTSD symptom severity moderates the relationship between known delinquency risk factors and negative outcomes (e.g., recidivism) in justice-involved adolescents. To test this question, this study utilized risk ratings (SAVRY; Borum, Bartel, & Forth, 2006) and PTSD symptom severity (STRESS; Grasso, Felton, & Reid-Quiñones, 2015) collected at detention intake as predictors of new juvenile court referrals over a 12-month time period in a sample of 187 detained adolescents. Negative binomial regression analyses indicated that SAVRY total risk scores were a significant predictor of new juvenile court referrals, ß = 0.03, Exp(ß) = 1.03, p < .05, while the interaction between total risk and PTSD symptom severity was not significant in predicting re-offending outcomes, ß = -0.01, Exp(ß) = 0.99, p > .05. Implications of these results for assessment, treatment, and risk reduction strategies are discussed specifically in relation to key tenets of the Risk-Needs-Responsivity model (Hoge & Andrews, 2011).

Creating Trauma-informed Juvenile Justice Agencies: Lessons Learned from Multiple Projects

Baetz, Carly, PhD; Branson, Christopher, PhD
New York University Langone Medical Center, New York, New York, USA

Exposure to trauma is extremely prevalent among youth in the juvenile justice system (70-90%) and linked to worse legal outcomes and psychosocial impairment. Direct-care staff who work with justice-involved youth also experience secondary trauma exposure at rates higher than the general public, placing them at risk for impairments in health and job performance. The high rates of trauma-related impairment among youth and line staff contribute to dangerous environments of care and rampant staff turnover. Consequently, agency-wide training for staff in specific skills for working with traumatized youth is widely recognized as a core component of trauma-informed care. However, only a handful of studies have evaluated the impact of staff training and little is known about the most effective approaches for training and ongoing consultation. For the proposed presentation, the presenters will share practical and detailed lessons learned from five grant-funded projects in state or county juvenile justice systems. These projects were designed to increase knowledge and improve affect regulation among youth and staff, thus enabling staff to manage their own stress while modeling and reinforcing skills for youth. By utilizing an evidence-based intervention (TARGET), these projects translate research into practice at multiple levels of the system.

Integrating Trauma-informed Care Into Community-based Gang Intervention Programming

Dierkhising, Carly, PhD1; McCloud, Alfred (A.J.), MSW2; Gutierrez, Luis, MS1

1California State University Los Angeles, Los Angeles, California, USA
2Los Angeles Mayor’s Office of Gang Reduction and Youth Development, Los Angeles, California, USA

Gang-involved youth are at greater risk for trauma exposure and posttraumatic stress compared to non-gang involved youth. Their experiences have been likened to child soldiers (Kerig et al., 2013). Despite the need for trauma-specific services, gang-involved youth are extremely difficult to engage in services. This presentation describes attempts to reach those whose voices are rarely heard. It will describe a federally-funded project to integrate trauma-specific services into gang intervention programming operated by the Los Angeles Mayor’s Office of Gang Reduction and Youth Development. Goals of the project are to increase awareness of trauma among gang intervention workers and clients, promote recovery, and improve access to trauma-specific treatment and resources in L.A.’s most disenfranchised communities. Preliminary findings indicate the most common posttraumatic stress symptoms among gang intervention clients (n = 67) are negative thoughts or emotions (39%) and avoidance of trauma reminders (31%); however, only 51% of youth reported trauma exposure. These results highlight the desensitization of gang-involved youth to their environments which will be discussed. Process and outcome evaluation results will be described, with an emphasis on implementation successes and challenges associated with reaching some of our nation’s most vulnerable and victimized youth.

Concurrent Session Three: Symposium

Thursday, November 8 | 3:00 PM to 4:15 PM


Translating Evidence-Based Treatments from Research to Practice for Child Traumatic Stress

Chair: Lang, Jason, PhD
Discussant: Berliner, Lucy, MSW

Significant resources are being put towards dissemination of evidence-based treatments (EBTs) across state systems, particularly for vulnerable populations of children exposed to trauma.  Despite these efforts, widespread uptake of EBTs remains limited and EBTs still represent a very small minority of behavioral health services provided in community settings (Bruns et al., 2015). Further, significant disparities in access to and utilization of children’s mental health services among culturally diverse populations persist (Alegria et al., 2005). This symposium includes four papers that address several emerging research and practice questions about translating EBTs into practice and policy, with a focus on improving efficient dissemination and sustainment of EBTs for underserved populations.

Specifically, these presentations include data about (1) the relationships between interprofessional collaboration and EBT service utilization when considering poverty, rurality, and cultural diversity; (2) clinician perspectives about readiness and barriers to implementing a school-based EBT; (3) a comparison between EBTs and usual care and the impact on racial/ethnic disparities in a state children’s behavioral health system; and (4) barriers and facilitators to EBT sustainability from a statewide survey of EBT-trained clinicians. Recommendations for research, practice, and policy change to support dissemination of EBTs for vulnerable populations will be made.

Are We Failing our State's Most Vulnerable Children? The South Carolina(SC) Corridor of Shame

Hanson, Rochelle, PhD; Saunders, Benjamin, PhD; Peer, Samuel, MS
Medical University of South Carolina, Charleston, South Carolina, USA

Ongoing barriers limit access and availability to trauma-focused EBPs, particularly for traditionally underserved youth, such as those from the Corridor of Shame, a region of rural, impoverished communities in SC. Interprofessional collaboration (IPC) can identify at-risk youth, facilitate referrals, and improve outcomes. The Community-Based Learning Collaborative (CBLC), a training/implementation model designed to promote IPC, disseminate trauma-focused EBPs and reduce service access barriers, may be especially relevant for underserved, vulnerable populations. Participants (n = 572) from 5 CBLCs across SC completed surveys pre/post CBLC to examine changes in IPC, barriers to trauma services, and service utilization. Repeated measures ANOVAs indicated significant pre/post-CBLC increases in IPC and service utilization, and decreased barriers to services (F[1, 303]=98.48, p < .001, ηp2 =.25). Mediational analyses indicated that IPC had a significant direct (c′1 = 1.11, p < .001, 95% CI [0.65, 1.57]) and indirect effect (a1b1 = 0.14, 95% CI [0.03, 0.27]) on service utilization. While poverty was associated with greater pre-CBLC barriers and significantly greater reductions in barriers pre to post CBLC, other risk factors (rurality, high percentages of ethnic/racial minorities) were not related to any of the measured variables. We will discuss implications and future directions.

The Effects of Evidence-based Treatments on Disparities among Children in a Statewide System of Care

Lang, Jason, PhD1; Lee, Phyllis, PhD2

1Child Health and Development Institute, Farmington, Connecticut, USA
2Eastern Connecticut State University, Willimantic, Connecticut, USA

While examples of successful EBT implementation initiatives are emerging, little is known about the effects of EBTs in state systems of care, particularly in comparison to usual care and for underserved populations. This paper includes four years of data from a statewide children’s behavioral health administrative data system collected while several EBTs were being disseminated across the system.  Data from more than 48,030 children (55% male, 40% Latino, 36% White, 15% Black) receiving outpatient treatment are described, including characteristics of children served, type of services received (including several EBTs and usual care), pre- and post-treatment measures of problem behavior and functioning (Ohio Scales), and treatment satisfaction.  Results indicate overall disparities in outcomes such that Black and Latino youth showed less improvement than White youth. Children receiving EBTs showed significantly more improvement than children not receiving EBTs, and the use of EBTs, particularly TF-CBT and MATCH, reduced or eliminated disparities in outcomes by race/ethnicity (F=2.53, p=.002). Overall rates of EBT delivery (compared to usual care) were larger than recently published estimates of EBT penetration, but still modest. Recommendations for scaling up EBTs in large systems of care and implications for reducing disparities among underserved populations will be made.

Clinician Readiness, Attitudes, and Perceived Barriers for Implementing a School-based Trauma Intervention

Nadeem, Erum, PhD; Rojas, Monica, MS; Miller, Sarah, MS; Hoschander, Avital, MS
Yeshiva University, Bronx, New York, USA

Agency leadership enroll their staff in EBP training programs. However, clinician perceptions about their relevance and capacity to implement may not be considered. The current study examined clinician readiness, attitudes, and workloads related to uptake of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants included 60 clinicians from 26 agencies (87% female, 75% social workers). Clinicians indicated that the primary reason to attend the training was the strong fit of the intervention (45%), followed by general interest in CBT (25%). In comparison to web-based training, in-person training increased comfort level with CBT for trauma and each component of CBITS. Despite increased comfort, clinicians reported significant barriers, such as lack of time for groups (60%) and consultation calls (70%).  Many felt that they lacked a plan for selecting students (70%), group space (27%), school buy-in (52%), a supportive contact at the school (45%), or implementing colleagues (47%). With respect to training outcomes, less than 50% of clinicians consistently attended consultation calls, and less than 30% implemented. Additional analyses focus on predictors of clinician implementation, engagement, and attitudes.  Results suggest the importance of communication between clinicians and agency leadership, who may be eager to capitalize on EBP training programs

Sustainability of Trauma-focused EBTs in North Carolina

Ake, George, PhD1; Pane, Heather, PhD2; Blythe, Mellicent, MSW3; Glienke, Beverly, MA4

1Duke University School of Medicine, Durham, North Carolina, USA
2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
3University of North Carolina at Chapel-Hill, Durham, North Carolina, USA
4NC Child Treatment Program, Durham, North Carolina, USA

This presentation will highlight the process and results of a National Child Traumatic Stress Network (NCTSN) measure review and Senior Leader (SL) survey of evidence-based treatment (EBT) sustainability. The sustainability of trauma-focused EBTs has been an area of focus through efforts of the NCTSN with a goal to increase the quality of and access to treatments available to families. These efforts in combination with lessons learned from the implementation science field, including overall low rates of EBT sustainment (Wiltsey Stirman et al., 2012) demonstrate a substantial interest and need to understand the mechanisms of sustaining EBTs in community settings to assist in the spread of other EBTs across the country. Since 2006, the North Carolina Child Treatment Program has focused its work on development of a training and implementation platform to spread trauma-focused treatments across the state. This presentation summarizes the process and results of an NCTSN review of sustainability measures. Standardized measures of the degree to which SL reported sustained EBP use after implementation and the barriers and facilitators to sustainment were sent to approximately 190 SL. Results of these sustainability measures, barriers, and facilitators will be provided and recommendations made for further research and practice change to improve sustainability of EBTs.

Concurrent Session Four: Symposium

Thursday, November 8 | 4:30 PM to 5:45 PM

Trauma Training for Foster Parents: Evaluation of Three Models Implemented in the Child Welfare System

Chair: Dym Bartlett, Jessica, PhD

Children involved with child welfare display a range of emotions and behaviors in response to the trauma they have experienced (Dovran et al., 2012). Foster parents are an often-ignored resource with considerable potential to help mitigate the negative effects of childhood trauma through trauma-informed care (TIC). Unfortunately, typical training efforts are inadequate to prepare them for the challenges of caring for children exposed to trauma. While most states require foster parents to participate in pre-service training and continuing education, the content varies widely (Grimm, 2003). This symposium brings together trauma experts from four institutions to discuss studies of three trauma training models for foster parents that show potential to improve the quality of caregiving by foster parents and, in turn, children’s safety, stability, and well-being.

The chair will offer an overview of current knowledge on trauma training for foster parents, situating findings in the broader literature on TIC, highlighting core components of effective trauma training, and identify gaps in current research, policy, and practice.

The first presentation will examine the implementation of Trauma Systems Therapy-Foster Care (TST-FC) in two public child welfare settings. The evaluation included trained child welfare staff, mental health providers, foster parents, and children in trained foster homes. The study examines model fidelity, foster parents’ trauma related knowledge and skills in caring for children placed in their homes, placement stability, and foster parent retention.

The second presentation will discuss the implementation of Attachment, Self-Regulation, and Competency in foster care (ARC Reflections). ARC is a clinical trauma treatment adapted for foster parents in public child welfare settings. Using mixed methods, ARC Reflections was evaluated in two states to determine model fidelity, changes in foster parent's knowledge of trauma and trauma-informed parenting, children’s placement stability, and foster home retention.

The third presentation assesses the implementation of the Resource Parent Curriculum (RPC), developed by the National Child Traumatic Stress Network. The evaluation investigated multiple implementation sites using a pre-/post-workshop design. The authors report on improvements in trauma-informed parenting, tolerance of children’s misbehavior, and parenting efficacy related to the RPC, as well as application of skills they learned.

Collectively, the presentations will contribute to participants’ understanding of how implementation of TIC through foster parent training can improve care for children who experience abuse, neglect, and other forms of trauma. Audience participation will be encouraged throughout the symposium.

An Evaluation of Trauma Systems Therapy-Foster Care in Public Child Welfare Settings

Brown, Adam, PsyD
New York University Langone Medical Center, New York, New York, USA

Many children in foster care have been exposed to trauma, and their resulting disruptive behaviors can cause difficulties for foster parents and lead to placement instability. Trauma Systems Therapy-Foster Care (TST-FC) is an adaptation of an evidence-informed treatment model designed for implementation in the child welfare system. Results of an initial implementation evaluation of TST-FC in two public child welfare agencies suggest that it is a promising model for placement stability and reducing disruptive behaviors. This study used a mixed method, multi-informant approach: researchers administered surveys with standardized measures at three time points with staff and foster parents; analyzed clinical fidelity checklists; observed and reviewed notes from team meetings; conducted focus groups and interviews with each group; and reviewed foster parent recruitment and retention data.  Results indicated significant improvement in agency policies, agency practices and individual trauma-informed practices. Foster parents’ trauma-informed parenting, tolerance of misbehavior and parenting efficacy all improved. Additionally, administrative data findings suggested increased placement stability and retention of foster homes. Results suggest TST-FC is associated with significant gains in knowledge in trauma-informed care systemically and among child welfare staff and foster parents.

ARC Reflections: Pilot Evaluation of Implementation Process and Outcomes for a Trauma-focused Child Welfare Skill-building Curriculum

Blaustein, Margaret, PhD1; Kinniburgh, Kristine, LICSW2

1Trauma Center at Justice Resource Institute, Brookline, Massachusetts, USA
2Justice Resource Institute, Brookline, Massachusetts, USA

This study examines implementation of ARC Reflections (AECF, 2015), a 9-week foster parent training adapted from the ARC intervention model (Blaustein & Kinniburgh, 2010). Designed for public child welfare systems, Reflections was piloted in 2 states from 2016 - 2017. An independent, mixed method evaluation conducted by Child Trends assessed implementation fidelity; impact on foster parents’ trauma knowledge; and impact on placement stability. In North Carolina, 115 foster parents were trained. Findings showed significant increases on all scales of the RPKBS [Sullivan et al., 2014], including knowledge of trauma-informed parenting (TIP), t(67) = -11.77; p=0.000, tolerance of misbehavior (TOM), t(80) = -6.72; p=0.000, and parenting efficacy (EFF), t(78) = -9.75; p=0.00. These gains remained significant from pre-training to follow-up, although not from post-training to follow-up. Pre-/post-data available from 33 of the 48 foster parents trained in Virginia had similar results, with significant increases from in TIP, TOM, and EFF. Data from both projects suggested that placement stability and foster parent recruitment and retention improved during implementation. Description of the curriculum, challenges and benefits of implementation, and key findings from both projects will be presented along with implications for trauma-informed child welfare policy and practice.

Study of the Resource Parent Curriculum with a Diverse Range of Resource Parents

Sullivan, Kelly, PhD1; Murray, Kate, PhD2; Ake III, George, PhD1

1Duke University Medical Center, Durham, North Carolina, USA
2Center for Child and Family Health, Durham, North Carolina, USA

Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents (Grillo et al., 2010; a.k.a. Resource Parent Curriculum or RPC) is designed to promote trauma-informed parenting among foster, adoptive, and kinship caregivers (resource parents) developed by the National Child Traumatic Stress Network. The study examined pre- versus post-workshop data from multiple RPC implementation sites with 311 resource parents to assess improvement on trauma-informed parenting (TIP), perceived self-efficacy for parenting a child who experienced trauma (EFF), and tolerance of misbehavior (TOM) and whether parent characteristics (age, gender, years of experience as resource parent, race/ethnicity, and resource parent type) moderated the impact of RPC on these outcomes. Improvement was found on TIP F(1, 295) = 330.99, p = .000,  Eta-squared= .59; TOM F(1, 298) = 229.21, p = .000, Eta-squared= .44; and EFF F(1, 295) = 125.55, p = .000, Eta-squared= .29 regardless of parent characteristics. A 3-month follow-up survey was conducted on a subsample indicating that most resource parents reported that RPC positively impacted their parenting, applied what they learned, and reported high levels of placement stability of children in their care. The results support prior work showing the effectiveness of RPC. Key findings and current dissemination efforts will be presented.

Concurrent Session Five: Symposium

Friday, November 9 | 9:45 AM to 11:00 AM


Innovative Strategies to Address the Unique Needs of Court-Involved Youth: Training, Access, Treatment, and Special Populations

Chair: Pickens, Isaiah, PhD 

Research indicates that court-involved youth (e.g., juvenile justice involved; youth involved in dependency courts; youth as victims of crime and often Commercially Sexually Exploited Youth) have higher rates of trauma exposure and are thus at higher risk for mental health problems, substance abuse, and delinquent behaviors (Ford et al., 2007; Tuell, 2008). These events can trigger a plethora of negative mental health and functional outcomes during adolescence and adulthood. Most youth in juvenile detention have been exposed to community and family violence or have even been victims of human trafficking (Ford et al., 2012; Cisler et al., 2012). Despite this, there are still significant gaps in terms of access to treatment for this vulnerable population, and until recently, little attention has been paid in the justice sector to the early identification of trauma. Additionally, there are significant behavioral health disparities within the court-involved youth population with disproportionate rates of youth of color, youth with developmental disabilities, and LGBTQ youth. Youth are not properly identified or screened for trauma; access issues plague systems; and treatments historically have not been tailored to meet the unique needs of court-involved youth.

This symposium will start with an overview of the specific needs of this population, provided by the Chair of this symposium, Dr. Isaiah Pickens, the Assistant Director of Service Systems for the National Child Traumatic Stress Network, followed by a series of presentations on innovative strategies to address these needs. Presenters will discuss unique ways in which service and treatment gaps among court-involved youth have been addressed, including: 1) trauma-informed trainings in the legal system, boosting front-line legal professionals’ capacity to identify, screen and assess for childhood trauma; 2) improved access to evidence-based treatment via an innovative access program (e.g., LINK-KID) and widespread training in Trauma-Focused Cognitive-Behavioral Therapy among mental health professionals; and 3) increased coordination, training initiatives, access solutions, and treatment applications for court-involved youth seen through Children’s Advocacy Centers, including a multi-tiered effort to train clinicians statewide in a module: "TF-CBT for Court-Involved Youth." Utilizing multiple methodological approaches, each presentation will provide data on the efficacy of methods used to improve trauma screening and identification, training efforts, and/or access to treatment among court-involved youth.  Presenters will engage in a discussion of unique ways treatment and services are tailored to court-involved youth as well as limitations and barriers to implementation. 

Training Legal Professionals to Identify and Respond Effectively to Child Trauma: Evaluation Findings from the University of Massachusetts Medical School’s Child Trauma Training Center

Kostova, Zlatina, PhD(c)
University of Massachusetts Medical School, Worcester, Massachusetts, USA

Despite high rates of trauma exposure among court-involved youth (CIY), serious gaps remain in terms of identification and accessing services. Addressing disparities requires broad dissemination of quality trauma-informed trainings across the legal system (e.g., judges, attorneys, probation officers, law enforcement, and staff within juvenile justice serving programs) – the first contacts for this vulnerable population. In 2012, the UMASS Medical School’s Child Trauma Training Center (CTTC) was developed to raise the standard of care for youth who have experienced trauma, with a priority population of CIY. CTTC sought to improve the knowledge base of legal professionals and enhance their abilities to identify and screen for child trauma. Data was collected regarding training satisfaction and increased knowledge/skills related to trauma. 14,100 professionals were trained over a 4-year period including 3512 legal professionals. Training significantly boosted legal professionals’ knowledge and skills about child trauma and its impact; data will be presented in this regard (e.g., evaluation findings for law enforcement N=388) showed significant increases in knowledge about child trauma, (p =.000) and a trend for increased confidence in using trauma-informed practices (t (353) -1.67, p = .096).  

Addressing Access and Treatment Issues for Court-involved Youth: An Innovative Access Solution (LINK-KID) and TF-CBT Outcomes in a Community-based Sample

Griffin, Jessica, PsyD1; Dym Bartlett, Jessica, PhD2; Kane-Howse, Genevieve, LMHC1

1University of Massachusetts Medical School, Worcester, Massachusetts, USA
2Child Trends, Acton, Massachusetts, USA

Despite the severe impact of trauma for court-involved youth (CIY), major service gaps exist. The UMMS Child Trauma Training Center (CTTC) is bridging gaps through a highly innovative statewide centralized referral system (LINK-KID) as well as providing training in TF-CBT across the region. LINK-KID will be described, including barriers and strategies to implementation; data will be reported (N=1411 youth) including treatment type (e.g., TF-CBT, ARC, PCIT, CPP, AF-CBT) reduction in waitlists (e.g., 6-12 months for therapy vs approximately 40 days) and system/court involvement (e.g., of N=1411, 899 were child welfare involved; 697 were court-involved). Community-based TF-CBT research outcomes will be presented. Data from youth/caregivers were collected; clinical measures included: Child Behavior Checklist, UCLA PTSD Index, Caregiver Strain Questionnaire, and Youth Report of Functioning Assessment, administered at three different time points. 211 clinicians provided treatment to 830 youth and enrolled 308 youth in the project evaluation, 13% of which were CIY. Regression analysis demonstrated that youth experienced significantly fewer PTSD and behavioral symptoms, improved functioning, and better social connectedness compared to baseline. There were statistically significant improvements among parents (e.g., improved social connectedness & decreased caregiver strain.)

Multi-pronged Efforts to Address the Unique Needs of Court-involved Youth Seen within Children’s Advocacy Centers

Wozniak, Jessica, PsyD1; Griffin, Jessica, PsyD2
1Baystate Medical Center, Springfield, Massachusetts, USA
2University of Massachusetts Medical School, Worcester, Massachusetts, USA

Children’s Advocacy Centers are the gateway to services for child victims of interpersonal crime.  Youth seen within the CACs have various court involvement in addition to criminal court (e.g., dependency/child welfare courts; probate courts; juvenile courts). This presentation will review three separate projects describing issues related to access, treatment, and unique clinical training needs: 1) A CAC with strong collaboration with the District Attorney’s office; 2) a statewide initiative to train CAC-affiliated clinicians across Massachusetts (N=67 clinicians; 140 youth enrolled in TF-CBT); and 3) A hospital-based CAC. Complex referral issues seen across efforts will be discussed (e.g., Dwyer statute which impedes treatment access). Over 1500 clinicians were trained across projects; data will be presented regarding number of youth referred to services as well as data on specialized populations (e.g., Commercially Sexually Exploited Youth (CSEC)) and data on behavioral health disparities. To address disparities and increase engagement, “legal-informed care” trainings were provided to TF-CBT clinicians. 462 clinicians have been trained in these specialized trainings, educating mental health providers on the legal system in order to avoid seeing legal involvement as a barrier impeding treatment.

Concurrent Session Six: Symposium

Friday, November 9 | 11:15 AM to 12:30 PM

Parenting During and After Traumatic Events: Do Different Developmental Stages and Various Cultural Contexts Create Similar Challenges?

Chair: Dekel, Rachel, PhD
Discussant: Hobfoll, Stevan, PhD

Although it is generally recognized that holding, care, control and distress are challenges of parenting in the aftermath of traumatic events, our understanding of parenting in this context has mostly been derived from studies on families with young children.  The proposed symposium will broaden this perspective and examine parenting – and specifically holding, care, control  and parents' distress– among four cohorts that represent different developmental stages in the life cycle, and different cultural and social contexts, via the use of various research methods. As such, this symposium will raise questions related to the changes in family bonds and the parenting role during times of adversity. It will address the issue of how the pendulum in parenting swings between care and control; it will also address issues related to the parent’s well-being, sense of responsibility, and the quality of the parent/child bond in the different samples. The symposium will help widen our knowledge and understanding of the complexity of trauma and family dynamics throughout the life cycle in a number of different contexts.

Co-parenting with a Veteran Partner Who Has Post-traumatic Stress Disorder

Cramm, Heidi, PhD1; Norris, Deborah, PhD2; Schwartz, Kelly, PhD3; Tam-Seto, Linna, PhD Candidate1; Mahar, Alyson, PhD4; Eichler, Maya, PhD2; Smith-Evans, Kimberley, MA2; Blackburn, David, PhD5

1Queen's University, Kingston, Ontario, Canada
2Mount Saint Vincent University, Halifax, Nova Scotia, Canada
3University of Calgary, Calgary, Alberta, Canada
4University of Manitoba, Winnipeg, Manitoba, Canada
5Universite du Quebece en Outaoais, Saint Jerome, Quebec, Canada

This qualitative study explored the mental health and well-being of family members of Canadian Armed Forces Veterans experiencing mental health issues during the military-to-civilian transition. We conducted, transcribed, and analyzed 27 in-depth, semi-structured interviews and 3 focus groups. Veteran’s mental health problems resulted in changes to family functioning and roles, including parenting. Spouses reported that they maintained primary responsibility for parenting, providing caregiving to the Veteran in collaboration with their children while modifying family life to manage the Veteran’s symptoms. These symptoms interfered with Veterans’ capacity to engage with their children, participate in family activities, and influenced how they responded to perceived threats in their child’s day-to-day activities. Spouses were responsible for interpreting the Veteran’s behaviour to their children, explaining absences or missed family activities, and shielding their children from the impacts of the Veteran’s illness. Many spouses reported their own struggles with depression and anxiety, feelings of isolation, and an inability to access family and social support networks. Targeted services supporting spouses who co-parent with a military partner who has post-traumatic stress disorder are needed, as well as resources for children in these families.

Parenting Young Adults with Post Traumatic Stress Disorder

Dekel, Rachel, PhD1; Levavy, Netta, BA (Hons)1; Lavi, Tamar, PhD2

Bar-Ilan University, Ramat Gan, Israel, Israel
2Natal, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Isreal, Israel

Little is known about the effects of PTSD in young military veterans (between the ages of 20 and 30) and their relationships with their parents. This gap in the literature is unfortunate given that veterans mainly sustain mental injuries during a developmental phase where they are expected to cultivate their independent identities and achieve autonomy through the attainment of higher education, jobs, and family lives. Their PTSD not only impedes their development, but also challenges the parenting of their parents. The study explored Israeli parents’ relationships with their military veteran sons who have PTSD. Method:
Seventeen interviews were conducted, recorded, transcribed and analyzed. Parents reported experiencing severe distress, impaired marital relations (of their own), and physical health problems. The relationships with their children were characterized by a life-long commitment to them alongside deep worries regarding their current and future adjustment. Parents described a constant struggle with their child in regard to his functioning and with the army system in regard to proper recognition of their child’s rehabilitation. This study is one of the first to identify a population that has been deeply affected by the ripple effects of PTSD but has received little attention. Understanding the needs of these parents, will facilitate their sons’, better recovery. 

Multigenerational Families in the Context of War

Nuttman-Shwartz, Orit, PhD
Sapir College, Sha'ar HaNegev, , Israel

Continuous exposure to threat and extreme situations such as terror and war are intensifying the argument between parents and their adult offspring regarding threat-related coping strategies.  As such, the present study examined family relationships in the context of political violence among three focus groups.  Participants were elderly residents in peripheral communities situated near the Israeli border with Gaza, areas which have been exposed for over a decade to intense security threats and several wars.

In this presentation, based on content analysis, we will address families’ dilemmas related to coping patterns, evolving family bonds, and parenting roles during times of adversity. In addition, we will address the issue of how the parenting pendulum swings between care and control; dependence and independence; and taking care of one's self versus taking care of others. We will also discuss the issue of personal, familial, and community responsibility, particularly as it impacts the decision to remain in, or move away from, a war zone. Keeping in mind trauma theory, the "multigenerational family," and the implications of living in a peripheral community, the findings will be discussed. Recommendations regarding micro and macro interventions for trauma-impacted communities will be provided.

Reciprocal Influences between Distress Symptoms of Parents of Combat Soldiers and of their Soldier Son as a Result of the Military Service

Tuval-Mashiach, Rivka, PhD
Bar-Ilan University, Ramat Gan, Israel, Israel

Military service is a turbulent period for soldiers, and includes challenges and dangers that can trigger stress. Alongside the soldier’s experience, military service can evoke stress in his parents. Despite evidence that parental stress in non-military populations is significantly related to their child's stress, the experience of parents in the military context, has been mostly ignored. The current study prospectively examined the emotional responses and distress of combat soldiers’ parents before and during the enlistment to service of their child. Method: 80 family units (father, mother, son) were evaluated twice: several weeks before enlistment, and after six months following enlistment. Half the sons were combat soldiers, and the others were controls (non-combat). Parents’ and child’s anxiety, depression, perceived stress, and well-being were assessed.

Results: Mothers' stress was significantly higher than fathers'. Distress levels of all family members in the pre-enlistment stage were correlated, and each family member's distress level predicted his distress level following enlistment. In addition, the son's pre-enlistment distress predicted the father's distress after enlistment. We will discuss the findings suggesting a model for reciprocal influences between family members.

Concurrent Session Seven: Panel Presentation

Friday, November 9 | 3:00 PM to 04:15 PM

Two Empirically-Based Treatment Models for Complex Trauma in High Risk Adolescents

Lanktree, Cheryl, PhD1; Habib, Mandy, PsyD2; Briere, John, PhD3; Labruna, Victor, PhD2

1University of Southern California, Torrance, California, USA
2Adelphi University, Garden City, New York, USA
3University of Southern California, Los Angeles, California, USA

This panel will describe two empirically-based treatments (EBTs), Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), developed to treat the immediate and long-term impacts of complex trauma, focusing especially on high risk behavior in vulnerable youth. Both treatment models have been widely adopted throughout the U.S. with the support of the National Child Traumatic Stress Network, in a range of settings (e.g., outpatient, juvenile justice, residential treatment, shelters, schools) using multiple modalities. Complex trauma involves repeated exposure to multiple forms of childhood abuse, neighborhood violence, and peer assaults, frequently in the context of parental neglect and racial/cultural discrimination. Interventions presented will address trauma-related impacts, especially high risk behavior such as substance abuse, self-injury, dysfunctional sexual behavior, suicidality, dissociation, and impulsive aggression, to facilitate safety, affect regulation and distress reduction skills, trauma processing, and relational/attachment processing within the therapeutic relationship. Cultural adaptations and interventions addressing discrimination, poverty, and familial issues that further compound trauma in socio-culturally marginalized youth will also be presented. 


Concurrent Session Eight: Symposium

Friday, November 9 | 4:30 PM to 05:45 PM


Joining Forces: Large-Scale International Studies of Emerging PTSD in Children and Adults

Chair: Lowe, Sarah, PhD

Longitudinal research on survivors of traumatic events has provided great insights into the patterns and predictors of long-term symptoms and functioning. However, many such studies have been conducted on relatively small samples or in particular geographic contexts, limiting the statistical power of analyses and generalizability of results, respectively. Pooling data from several individual studies has the potential to overcome these limitations, yet poses several logistic and analytic challenges to researchers. The proposed symposium will provide two examples of large-scale international efforts to pool data from child and adult trauma survivors: The Prospective studies of Acute Child Trauma and Recovery (PACT/R) data archive, and the International Consortium to Predict PTSD (ICPP). The symposium will begin with two presentations detailing the myriad challenges to pooling data and how such challenges were addressed in creating data archives. Subsequently, investigators will present specific analyses with attention to how the pooled nature of the data was handled analytically. Time will be allotted for a discussion of how the challenges encountered in the two projects could inform future efforts to promote the pooling of data longitudinal sources in order to better understand the course of PTSD symptoms after a range of trauma.


Posttraumatic Stress Symptom Trajectories among Survivors of Civilian-related Injuries 

Lowe, Sarah, PhD1; Lai, Betty, PhD2; Ratanatharathorn, Andrew, MS (PhD Student)3; Van Der Mei, Willem, MPH4; Koenen, Karestan, PhD5; Shalev, Arieh, MD6

1Montclair State University, Montclair, New Jersey, USA
2Georgia State University, Atlanta, Georgia, USA
3Columbia University School of Public Health, New York, New York, USA
4New York University School of Medicine, New York, New York, USA
5Harvard School of Public Health, Boston, Massachusetts, USA
6New York University Langone Medical Center, New York, New York, USA

Research exploring posttraumatic stress symptom (PTSS) trajectories have consistently documented low-persistent and high-persistent patterns, but have otherwise produced inconsistent results. This could be due to variability across studies in the type of traumatic event, sample size, timing of assessment, and assessment instrument. The current study pooled data from five ICPP studies of PTSS as measured by Clinician-Administered PTSD Scale within the first year of exposure to civilization trauma-related injuries (N = 2,388). Among the challenges in pooled latent class growth analysis were deriving time clusters with adequate coverage, limited common predictors, and varying inclusion criteria across studies. Three trajectories were documented: Low-Persistent (n=1,879, 78.7%), Moderate-Persistent (n=369, 15.5%), and High-Persistent (n=140, 5.9%). Female gender, having an injury due to assaultive violence, and lower education were associated with membership in the more distressed trajectories. The results suggest that at least 20% of traumatic injury survivors will experience chronically elevated PTSS in the first year after exposure, and provide insight into which survivors might be in need of services. Efforts to streamline posttrauma assessments in future research will provide greater insight into a broader range of factors that predict longitudinal patterns of PTSS.


Conducting Individual Participant Data (IPD) Meta-analysis: Challenges and Solutions in Longitudinal Studies of PTSD

Ratanatharathorn, Andrew, MS (PhD Student)1; Laska, Eugene, PhD2; Qi, Wei, MD2; Bryant, Richard, PhD3; Delahanty, Douglas, PhD4; Matsuoka, Yutaka, MD PhD5; Olff, Miranda, PhD6; Schnyder, Ulrich, MD7; Shalev, Arieh, MD2; Koenen, Karestan, PhD8; The, International Consortium to Predict PTSD9

1Columbia University School of Public Health, New York, New York, USA
2New York University Langone Medical Center, New York, New York, USA
3University of New South Wales, Sydney, New South Wales, Australia
4Kent State University, Kent, Ohio, USA
5National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
6Academic Medical Center at the University of Amsterdam and Arq Psychotrauma Expert Group, Amsterdam, Noord-Holland, the Netherlands, Netherlands
7Zurich University, Zurich, Switzerland, Switzerland
8Harvard School of Public Health, Boston, Massachusetts, USA
9Multiple Universities, Boston, Massachusetts, USA

Models for predicting Posttraumatic Stress Disorder (PTSD) have been developed that perform better than chance; however clinically useful prediction tools have not been developed. The difficulty in predicting PTSD stems from the multiplicity, complexity, and distributional variation of PTSD risk factors, which no individual study has been able to capture. Individual Participant Data Meta-Analysis (IPD-MA), which combines individual-level data from multiple studies, can improve upon current prediction models by assessing a greater number of trauma types, predictors, and time points following trauma. Furthermore, contributing studies’ heterogeneities can be explored to understand the generalizability of a prediction tool and improved sample sizes allow examination of subgroup variation. Challenges of IPD-MA include the development of quality control pipelines for disparate sources of data, harmonizing instruments across studies, and the availability of key predictors in all studies. Methods for addressing each challenge will be presented as well as examples using data from the International Consortium to Predict PTSD.

Data Harmonization in an International Data Archive of Child Trauma Studies


Kassam-Adams, Nancy, PhD1; Palmieri, Patrick, PhD2; Kenardy, Justin, PhD3; Delahanty, Douglas, PhD4; Kohser, Kristen, MSW1; Marsac, Meghan, PhD5; Meiser-Stedman, Richard, PhD6; Nixon, Reginald, PhD7; Landolt, Markus, PhD8

1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
2Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, Ohio, USA
3The University of Queensland, Herston, QLD, Australia
4Kent State University, Kent, Ohio, USA
5University of Kentucky, Lexington, Kentucky, USA
6University of East Anglia, Norwich, Norwich, United Kingdom
7Flinders University, School of Psychology, Adelaide, South Australia, Australia
8University of Zurich, Zurich, Switzerland, Switzerland

A growing number of prospective studies track PTS and related symptoms in children exposed to acute trauma, many with small Ns limiting power and generalizability. The goal of the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive ( is to preserve and harmonize child trauma datasets, enabling cross-study analyses of participant-level data. We will describe harmonization processes and initial analyses of study- and participant-level variables. The first 20 PACT/R datasets (N=3232 child participants) include 2 to 5 assessment points per study. Pooling data across studies, 70% of participants had a follow-up assessment. Expert consensus guided development of item- and scale-level harmonization rules for heterogeneous PTS measures. The prevalence of significant PTS symptoms ≥ 3 months post-event was 16% in pooled and harmonized data (2% to 35% in individual studies). PTS prevalence was higher in children who were younger, female, ethnic minority, had parents with less than secondary education, or who reported acute PTS symptoms in the first month. Harmonization is underway for measures of depression, anxiety, and health-related quality of life. As a research resource for the field, PACT/R will continue to add new datasets, share meta-data and harmonization algorithms, and make data available to qualified researchers.

Determining the Risk of PTSD: Results from the International Consortium to Predict PTSD (ICPP)

Shalev, Arieh, MD1; Ratanatharathorn, Andrew, MA PhD Student2; Laska, Eugene, PhD1; Gevonden, Martin, PhD1; Qi, Wei, MD1; Van Der Mei, Willem, MPH3; Kessler, Ronald, Other4; Koenen, Karestan, PhD5

1New York University Langone Medical Center, New York, New York, USA
2Columbia University, Mailman School of Public Health, New York, New York, USA
3New York University School of Medicine, New York, New York, USA
4Harvard Medical School, Boston, Massachusetts, USA
5Harvard School of Public Health, Boston, Massachusetts, USA

Reliable determination of PTSD risk is a pre-requisite for efficient prevention and service delivery planning. Numerous risk indicators have been identified, but a reliable risk assessment tool remains elusive. In this presentation we will describe successful efforts to develop a PTSD prediction tool for clinicians from data pooled together in the ICPP study. Ten studies have longitudinally evaluated 2,473 adults using the Clinician Administered PTSD Scale at baseline (0-60 days post-trauma) and follow-up (4-15 months post-trauma). The prevalence of PTSD at follow-up was 12%. Baseline CAPS scores of participants who developed PTSD were distributed across the full range of the instrument’s severity scores, thereby defying efficient use of classification models. However, a logistic model predicting PTSD likelihood from early PTSD symptom severity produced remarkably accurate risk estimates, amenable to clinical implementation. Additional risk predictors including female sex, having less than a high school education, and prior interpersonal trauma, were significant, but did not improve prediction from initial PTSD symptoms. The model provides a reliable risk estimate tool to predict PTSD likelihood among civilians admitted to acute care services. Risk estimates may successfully replace case prediction in efforts to discern survivors at risk.


Concurrent Session Nine: Symposium

Saturday, November 10 | 9:45 AM to 11:00 AM

Parents' Early Experiences, Children's Risk: Examining Biological and Behavioral Pathways for the Intergenerational Transmission of Trauma

Chair: Gray, Sarah, PhD

While the intergenerational transmission of trauma has been long observed in clinical and descriptive studies, only recently has research examined mechanistic pathways that underlie transmission of risk across generations.  Looking across physiological, biological, and behavioral systems, in cohorts from three countries, these papers together present an emerging picture of possible pathways by which mothers’ experiences of trauma result in heightened risk for her offspring.  Paper 1 links mothers’ exposure to Adverse Childhood Experiences (ACEs) to infants’ developmental outcomes at 12 months via antepartum risk in pregnancy and infant health at birth.  In paper 2, mothers’ ACEs exerted impacts on preschoolers’ parasympathetic activity and reactivity during dyadic interaction, independent of children’s traumatic experiences, in patterns consistent with heightened mental health risk.  Paper 3 will review links from mothers’ ACEs to children’s outcomes across two populations, including evidence of epigenetic programming. Finally, in the longitudinal study reported on in Paper 4, mothers’ experiences of IPV were linked to mothers’ EEG activity and emotion appraisal, as well as child outcomes. Together, these papers point to pathways – health risk, autonomic activity, epigenetic programming, affect appraisal and EEG activity – that connect mothers’ experiences of adversity to children’s outcomes. They also point to specific features of the parent-child relationship that might be targeted to prevent intergenerational transmission of risk. Clinical implications for the conceptualization and treatment of trauma-exposed dyads will be discussed, as will next steps for this body of research.

Going Upstream: The Moderating Role of Social Support on the Intergenerational Transmission of Maternal Adverse Childhood Experiences to Child Outcomes


Madigan, Sheri, PhD1; Racine, Nicole, PhD1; Plamondon, Andre, PhD2; Eirich, Rachel, BA (Hons)1; McDonald, Sheila, PhD1; Tough, Suzanne, PhD1

1University of Calgary, Calgary, Alberta, Canada
2Universite Laval, Quebec, Quebec, Canada

Introduction: Exposure to Adverse Childhood Experiences (ACEs) in mothers is associated with maladaptive maternal health, as well as infant health and development. The current study examines whether social support, in both the pre- and postpartum periods, moderates the association between maternal adverse childhood experiences and maternal health, infant health, and infant development. Material and Methods: Participants were 1,994 mothers and their infant who were recruited in pregnancy as part of a prospective longitudinal cohort. Women completed self-report questionnaires in pregnancy and 4-months postpartum related to mental health and social support. A health care professional assessed the mother’s health risk in pregnancy and infant health risk at birth. Mothers completed child development questionnaires at 12-months postpartum. Results: Maternal ACEs was associated with infant developmental outcomes via compromised prenatal health, and postnatal functioning. Regression analysis revealed a significant interaction between maternal ACEs and social support in pregnancy, whereby women exposed to high ACEs but high levels of social were buffered from the impact of maternal ACEs. Conclusions: Social support in pregnancy may be a key target for intervention to mitigate transmission of maternal ACEs.  

Mothers’ Adverse Childhood Experiences Predict Dysregulated Autonomic Activity in their Preschoolers


Gray, Sarah, PhD; Glackin, Erin, MA PhD Student
Tulane University, New Orleans, Louisiana, USA

Alterations to stress response systems are hypothesized to be pathways by which Adverse Childhood Experiences (ACEs) are linked to mental health, including across generations, as mothers’ experiences shape offsprings’ emergent physiology. Respiratory sinus arrhythmia (RSA) is a parasympathetic biomarker of self-regulation associated with psychopathology. Our prior work has demonstrated intergenerational impacts of mothers’ ACEs on infant RSA. This study extends this examination to the preschool period. Mothers (n=102) of preschoolers (aged 3-5 years) retrospectively reported their ACEs and their children’s trauma exposure. RSA was assessed during a 2-minute resting baseline and a 5-minute parent-child puzzle challenge. Even accounting for children’s own trauma exposure, high maternal ACEs (n=48) was associated with lower preschooler baseline RSA and, in repeated measures models, exaggerated RSA suppression during the dyadic interaction (F=4.166, p=.045). Intergenerational impacts of mothers’ ACEs on children’s self-regulation, persist into the preschool period, with patterns consistent with higher mental health risk. Findings emphasize considering children’s emergent regulatory capacities in relational context and underscore that stress-reducing interventions for pregnant women and mothers with histories of early adversity may lead to improved mental health across generations.

Parental Interpersonal Trauma and Offspring Development in Diverse Populations: Potential Mechanisms and Implications for Pediatricians and Parenting Programs


Folger, Alonzo, PhD
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Adverse childhood experiences (ACEs) and adult interpersonal trauma are associated with a myriad or negative physical and mental health outcomes over the life course. Recently, epidemiologic evidence has emerged that also links these adverse exposures to poor developmental and behavioral outcomes for the next generation. Studies have demonstrated intergenerational effects in multiple populations and have begun to characterize the mechanisms that underlie risk. Parent functioning, depressive symptoms, and interpersonal supports are pathways that can mediate the transmission of trauma effects and represent potential targets for intervention. We will discuss novel findings from two distinct populations including families in pediatric primary care and mother-child dyads in early childhood home visiting. Growing evidence also supports infant/child epigenetic responses to early adversity as having a role in ‘programming’ risk for negative development. We will describe preliminary epigenetic findings and implications for prevention programs. In the context of recent findings, we will discuss implications for pediatricians and parenting programs. Strategies include parental and childhood screening for trauma exposure and symptoms in pediatric primary care, actively engaging community practices, leveraging novel data to promote interest, and expanding two-generational approaches.

Children of Mothers with Interpersonal Violence-related PTSD: A Longitudinal Look from Toddlerhood to School-age

Schechter, Daniel, MD
NYU School of Medicine/Bellevue Hospital, New York, New York, USA

Mothers exposed to interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) compared to non-PTSD controls demonstrate psychobiological dysregulation that compromises mothers’ ability to participate in mutual emotion regulation with their young children. The present study follows up at school-age (5-9 years) children who were originally seen as toddlers (ages 1-3.5 years) seeking to examine endophenotypes established by school-age. Data will be presented from traumatic experiences, maternal CAPS, and child K-SADS, examining predictors of greater disruptive behavior vs anxiety, including maternal-child performance on an emotional face-matching task and corresponding high-density EEG involving localized neural activity. Results demonstrated continuity of separation anxiety and hypervigilance; group by emotion interactive differences in global field strength in the N170 component linked to facial recognition; and decreased activity in prefontal cortical areas associated with emotion regulation. While maternal IPV-PTSD severity was linked to maternal errors in appraisal of anger, a specific maternal emotion appraisal error was associated with disruptive behavior. Preliminary evidence suggests that maternal IPV-PTSD together with child IPV exposure are associated with group differences and within-group endophenotypic differences that can be targeted in intervention.

Concurrent Session Ten: Workshop Presentation

Saturday, November 10 | 11:15 AM to 12:30 PM


Trauma Informed Policing: Equipping Officers to Respond Effectively and Initiate Recovery for Children and Families following Violence and Overwhelming Events

Marans, Steven, PhD1; Hahn, Hilary, MPH, MA2; Pierce, Catherine, BA3; Campbell, Anthony, MA4

1Yale University School of Medicine Child Study Center, New Haven, Connecticut, USA
2Yale School of Medicine, New Haven, Connecticut, USA
3United States Department of Justice, Washington, District of Columbia, USA
4New Haven Department of Police Service, New Haven, Connecticut, USA

Police officers and policing strategies have been at the center of national controversy in recent years. As first responders, police are uniquely positioned to play a major role in the lives of vulnerable children and can be a key protective factor in changing the trajectory towards negative outcomes often associated with exposure to trauma and violence. When equipped with skills to effectively to respond in ways that initiate recovery, police can offer a critical addition to the continuum of care; however, some citizens do not experience the police as agents of protection and service. Partners from the Department of Justice, Yale School of Medicine and the field of law enforcement will describe recent initiatives to train police officers on biological, neurological, and psychological responses to trauma, as well as in operational protocols that facilitate the transformation of everyday encounters with children and adults from impersonal interactions into opportunities for identification and intervention. Presenters will engage the audience in a discussion of the potential for societal change that becomes possible when police officers are supported to embrace their critical role in the healing process, and are able not only to advance the recovery of individual children and families, but to strengthen relationships between police and the communities they are sworn to serve.

Concurrent Session Eleven: Symposium

Saturday, November 10 | 2:00 PM to 03:15 PM

Statewide Collaboration to Establish Policy and Improve Early Intervention Services for Young Children and Families Impacted by the Opioid Crisis

Chair: Dean, Kristin, PhD

The opioid epidemic is rampant in rural communities in east Tennessee, with approximately 1,034 newborns in 2017 diagnosed with Neonatal Abstinence Syndrome (NAS: Tennessee Department of Health, 2018). Four clinical administrators who consult with the state child welfare system will present data from four projects aimed at improving mental health services for young children and families. Project one developed a state-wide infant mental health association; project two conducted a breakthrough series collaborative to initiate trauma screening in child welfare for children under age 5; project three developed infant court teams in concert with state legislators; and project four was the training and implementation of two evidence-based treatment models, Parent-Child Interaction Therapy and Child-Parent Psychotherapy, with community mental health centers. Each phase included specific successful strategies and challenges, along with common themes to improve inter-agency and systems collaboration for vulnerable populations.

Implementation of Evidence-based Models to Treat Young Children with Dysregulated Behavior and Opioid Addicted Caregivers with Trauma

Dean, Kristin, PhD
University of Tennessee, Knoxville, Tennessee, USA

Through our efforts to make statewide changes in policy and awareness about infant and young child mental health, we recognized the dearth of evidence-based practices targeted at these families. Many of our community providers did not treat children younger than five because they were not trained. We collaborated with a local master trainer in Parent-Child Interaction Therapy (PCIT) to implement five Learning Collaborative training models in Tennessee. We will present data on the training and sustainability model, which included training local agency trainers who can train within their agency to maintain fidelity and sustainment. Child outcome data will be presented demonstrating significant decreases in disruptive behaviors. While pleased with the success of PCIT, we also recognized that caregivers recovering from substance use need help working through their own traumas and bonding with their infants and children under age 2. In partnership with the East Tennessee Children’s Hospital (ETCH), who have been nationally recognized for their work with Neonatal Abstinence Syndrome (NAS), we implemented the Child Parent Psychotherapy (CPP) Learning Collaborative with community health agencies. We will present specific strategies for dissemination, including forming strategic partnerships, helping agencies shift to working with younger children, and addressing logistical challenges.

Trauma Screening and Assessment of Infants and Young Children: The Child Welfare Breakthrough Series Collaborative

Hoffmann, Melissa, PhD1; Billings, Giovanni, PsyD2

1University of Tennessee, Memphis, Tennessee, USA
2Vanderbilt University, Nashville, Tennessee, USA

Trauma-informed and evidence-based screening, assessment, and treatment for infants and young children have been a gap in the children’s system of care. In the state of Tennessee, approximately one in three youth entering state custody is 5 years old or younger (KidsCount, 2012), in part because the number of infants born with Neonatal Abstinence Syndrome (NAS) has increased ten-fold over the last 10 years. The sudden influx of very young children created a need for the Department of Children's Services (DCS) to screen children under age 5 for traumatic experiences and related symptoms to improve treatment planning and target at-risk families for early intervention services. In this presentation, a Breakthrough Series Collaborative (BSC) focused on trauma-informed screening and assessment of infants and young children will be described. Consistent with BSC methodology (Kilo, 1998), teams consisting of DCS personnel, mental health providers, resource/foster parents, and biological parents worked together to learn about, implement, and spread new practices related to screening and assessment of young children. The subsequent state-wide dissemination of a new screening process for young children in state custody involving a module of the CANS (Child and Adolescent Needs and Strengths) for children aged 4 and under will be discussed as well.

Collaboration to Change the Trajectory for Child Welfare Involved Infants, Young Children, and their Families: Implementation of Research Informed Infant Courts

Moser, Michele, PhD1; Billings, Giovanni, PsyD2

1ETSU Center of Excellence, Johnson City, Tennessee, USA
2Vanderbilt University, Nashville, Tennessee, USA

Infant Court is a multisystem, trauma-focused approach designed to address the complex needs of infants, toddlers, and their parents involved in the child welfare system and to improve outcomes.  Infant mental health values and principles as well as knowledge areas such as the impact of trauma on early brain development, attachment theory, and trauma -informed care are integrated into the practice of infant courts. The core components of evidenced informed infant and early childhood courts will be reviewed. Presenters will describe two pilot infant court projects and the expansion of infant courts statewide through legislation.

Developing a Statewide Infant Mental Health Association: From Grassroots Collaborations to Non-profit Organization Status

Todd, Janet, PhD1; Moser, Michele, PhD2

1University of Tennessee, Memphis, Tennessee, USA
2ETSU Center of Excellence, Johnson City, Tennessee, USA

For six years, under the informal leadership of a few professionals committed to fostering the healthy social and emotional development of infants and young children in Tennessee, a group of passionate individuals and agencies came together on a bimonthlly and subsequently quarterly basis for the purpose of building relationships, identifying existing resources and opportunities, and beginning to identify what is needed to address the mental health needs of the birth through age 5 population. From the initial meeting of 25 or so individuals, the attendance and agency representation steadily grew and the group’s identity as a valuable initiative was established. In this presentation, the expansion of this informal grassroots initiative into a formal non-profit corporation receiving funding from the Tennessee Department of Health to support developing the capacity and quality of the early childhood workforce will be described. The presenter also will describe the current work of the Association of Infant Mental Health in Tennessee (AIMHiTN), including the implementation of the Infant Mental Health (IMH) Endorsement® for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health (IMH-E®), an internationally recognized credential.