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National Child Traumatic Stress Network e-Bulletin December 2014

New on the NCTSN Website 

Complex Trauma Fact Sheet Series & Complex Trauma Resource Webpage

Visit our new Complex Trauma Resource Webpage to find fact sheets, speaker series information, webinar notices, and other resources on complex trauma. 
Public Awareness 
As the holiday season approaches, many of us look forward to spending time with family and friends and to sharing in the joys of the season. However, for people who have been exposed to a traumatic event, the holi-day season may bring up negative feelings. Especially at this time of year, thinking about loved ones who have died can be painful—particularly for those who have recently lost someone. 
Even for people who have not been exposed to trauma, the holidays can be a stressful time. Besides the stress of buying gifts, travel expenses and hassles, and family interactions, the short days and lack of sunlight in winter can trigger bouts of depression and seasonal affective disorder (SAD). A 2008 poll on holiday stress conducted by the American Psychological Association revealed that eight in ten Americans anticipated stress during the holiday season. The APA's 2012 Stress in America survey found that 69 percent of Americans attribute their stress to money-related concerns.
To help people cope with grief, stress, and depression during the holiday season, the National Child Traumatic Stress Network (NCTSN) has gathered resources for educators, families, and mental health professionals on such topics as Holiday Stress on the Body, Seasonal Affective Disorder, Tips on Managing Holiday Stress, Celebrating the Holidays without Family Members, Striking Out Stress: A Gallery Walk Activity, and much more.

Noteworthy Resources

Trauma-Informed Perspectives and Resources
Our FITT Center colleagues, Kay Connors, Laurel Kiser, and Fred Strieder, and other NCTSN partners are featured in a new educational tool developed by JBS International’s Disability Services Center and Georgetown University’s National Technical Assistance Center for Children’s Mental Health. Trauma Informed Care: Perspectives and Resources is a comprehensive web-based, video-enhanced resource too that aims to help build state-by-state and provider capacity to serve children and youth who have experienced trauma. 
NCTSN member Kay Connors, Program Director at the FITT Center, has participated as a panel member in a webisode, Trauma-Informed Approaches for Caring for Every Child’s Mental Health, for KSOC-TV, SAMHSA’s Knowledge Network for System of Care (KSOC-TV). The webisode explores youth and families can overcome traumatic experiences with appropriate supports and how service systems may help resolve or exacerbate trauma-related issues. Watch the episodes, find links to NCTSN resources and the FITT Toolkit, and find previous webisodes at:
Recent Publications by Network Members, Affiliates, and Colleagues:
NCTSN members Judith Cohen, Jennifer Cole, Ginny Sprang, and Robert Lee have co-authored The Trauma of Commercial Sexual Exploitation of Youth: A Comparison of CSE Victims to Sexual Abuse Victims in a Clinical Sample in the Journal of Interpersonal Violence. Their study examined the demographic features, trauma profiles, clinical severity indicators, problem behaviors, and service utilization characteristics of youth victims of commercial sexual exploitation (CSE) compared with a matched sample of sexually abused/assaulted youth who were not exploited in commercial sex. Statistically significant differences were noted between the groups on standardized (e.g., UCLA Posttraumatic Stress Disorder Reaction Index [PTSD-RI], Child Behavior Checklist [CBCL]) and other measures of emotional and behavioral problems (e.g., avoidance and hyperarousal symptoms, dissociation, truancy, running away, conduct disorder, sexual¬ized behaviors, and substance abuse). More research is needed to determine if and what modifications to trauma therapies may be required to address the more severe symptomatology and behavior problems asso¬ciated with youth exploited in commercial sex. 

Upcoming NCTSN Webinars
Our Podcast Center is growing fast! Listen to the poem “I Love You More” created by Colonel David Rabb and his daughter Alyse while he was deployed in Afghanistan. Hear tips on implementing the Resource Par¬ent Curriculum by RPC workshop leaders. Going forward, each month you will find a new audio selection of fewer than twenty minutes by an expert in the field of child trauma. And, stay tuned: soon you will be able to download these informative tips and snippets on iTunes.
Newest Podcasts
HEAR Kate Murray and Chaney Stokes on: 
Preparation and Process: Recruiting, Preparing and Collaborating with Co-Facilitators Who Have Lived Ex-pertise 
When using the RPC curriculum, Caring for Children Who Have Experienced Trauma: A Workshop for Re-source Parents, organizations ask how they can recruit and prepare facilitators with 'lived experience." They are concerned potentially exposing a co-facilitator to trauma reminders, having a co-facilitator "overshare," and the time involved in training someone with a trauma history. In this podcast, two trainers discuss investing time in preparation and debriefing, acknowledging "hot buttons," and using tools to keep in sync with and support one another in order to successfully blend clinical, professional, and personal experience for the ben-efit of all. 
HEAR Liz Sharda on: 
The Importance of Modeling Trauma Informed Concepts in the Resource Parent Curriculum (RPC) Environ-ment
It is not enough to talk about trauma informed care principles when delivering the RPC; facilitators must also model these concepts within the training environment if they hope to be successful in helping families develop a trauma informed parenting approach. In this podcast, an NCTSN member—who trains facilitators in this curriculum—talks about modeling the principles of Safety, Choice and Control, Connections and Managing Emotions, and Self Reflection as a critical piece of effectively delivering RPC. Referenced in this podcast: Walking the Walk: Modeling Trauma Informed Practice in the Training Environment from 
HEAR Chris Foreman on:    
How Spending Hours Saved Time!  
A former foster care consultant shares how investing time in delivering the RCP curriculum resulted in fewer crisis and in increasing the ability to effectively manage a higher caseload.
New Special Section Features NCTSN Members and Core Data Set
In November 2014, the APA journal Psychological Trauma: Theory, Research, Practice, and Policy published an invited special section featuring the NCTSN Core Data Set. Co-guest-edited by NCCTS program directors Christopher Layne and Ernestine Briggs (with Christine Courtois, the Journal's associate editor), the special section is entitled Unpacking Risk Factor Caravans across Development: Findings from the NCTSN Core Data Set and contains six papers authored by NCCTS members including Christopher Layne, Robert Pynoos, and Alan Steinberg, as well as two NCTSN mini-grant teams led by Cassie Kisiel and Joseph Spinazzola.
In the Introduction to the Special Section: Unpacking Risk Factor Caravans Across Development: Findings from the NCTSN Core Data Set, Chris Layne, Ernestine Briggs, and Christine Courtois discuss the concept of risk factor caravan as a vehicle for depicting how various risk factors tend to co-occur, accumulate in number, accrue and cascade forward in their harmful effects, and “travel” with their host across development. They propose the concept of risk factor caravan passageway to describe the disadvantaged, resource-poor, and often dangerous ecologies that maintain risk factor caravans across the life course. They discuss ways in which the Trauma History Profile (Pynoos et al., 2014), combined with the concepts of risk factor caravans and passageways, add conceptual richness, balance, developmental perspective, and methodological rigor to the study of such complex phenomena as the ACE Pyramid (Felitti et al.,1998), complex trauma exposure, and complex traumatic stress disorder (Ford & Courtois, 2013). Layne, Briggs, and Courtois conclude by dis-cussing ways in which the five papers making up the special section illustrate key concepts and applications of these conceptual and assessment tools. In Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S1-S8.
In their article Modeling Constellations of Trauma Exposure in the National Child Traumatic Stress Network Core Data Set, Robert Pynoos, Alan Steinberg, Chris Layne, Li-Jung Lang, Rebecca Vivrette, Ernestine Briggs, Cassandra Kisiel, Mandy Habib, Thomas Belin, and John Fairbank describe the features and utility of the Trauma History Profile (THP), a comprehensive tool to assist in identifying twenty types of trauma experi-enced by children and adolescents. Authors present illustrative findings from the NCTSN CDS (N = 14,088), including frequencies and mean duration of exposure to specific trauma types; distributions of age of onset by trauma type; frequencies of specific trauma exposure details relating to domestic violence; and a principal component analysis of clusters of co-occurring trauma types during childhood and adolescence. The article concludes with a discussion of implications of the THP for research and practice. In Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S9-S17. 
Joe Spinazzola, Hilary Hodgdon, Li-Jung Liang, Julian Ford, Chris Layne, Robert Pynoos, Ernestine Briggs, Bradley Stolbach, and Cassandra Kisiel in their article Unseen wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes evaluated the independent and ad-ditive predictive effects of psychological maltreatment on an array of behavioral problems, symptoms, and disorders in a large national sample of clinic-referred children and adolescents drawn from the NCTSN Core Data Set (CDS). Analysis of a subsample of 5,616 youth with lifetime histories of 1 or more of 3 forms of mal-treatment (psychological maltreatment [emotional abuse or neglect], physical abuse, and sexual abuse) indi-cated on most indicators that psychologically maltreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms, and disorders compared with physically or sexually abused youth. Au¬thors found that the clinical profiles of psychologically maltreated youth overlapped with, yet were distinct from, those of physically and/or sexually abused youth. Despite its high prevalence in the CDS, psychological maltreatment was rarely the focus of intervention for youth in this large national sample. Authors discuss im-plications for child mental health policy; educational outreach to providers, youth, and families; and the devel-opment or adaptation of evidence-based interventions that target the effects of this widespread, harmful, yet often overlooked form of maltreatment. In Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S18-S28. 
In Examining Child Sexual Abuse in relation to Complex Patterns of Trauma Exposure: Findings from the Na-tional Child Traumatic Stress Network, authors Cassandra Kisiel, Tracy Fehrenbach, Li-Jung Liang, Brad Stolbach, Gary McClelland, Gene Griffin, Nicole Maj, Ernestine Briggs, Rebecca Vivrette, Chris Layne, and Joe Spinazzola utilized data from the NCTSN Core Data Set (CDS) to examine the role of child sexual abuse in combination with other types of caregiver-related trauma (physical abuse, domestic violence, emotional abuse, neglect, and impaired caregiving). Groups assessed included multiply-traumatized youth with a docu-mented history of (a) 3 or more caregiver-related traumas with co-occurring sexual abuse (N = 501); (b) 3 or more caregiver-related traumas without co-occurring sexual abuse (N = 1,108); and (c) 3 or more non-caregiver-related traumas (e.g., medical trauma, natural disaster, physical/sexual assault; N = 142). Youth with caregiver-related traumas had significantly earlier onset and longer duration of traumas compared to other traumatized youth. Child sexual abuse had an additive and potent predictive effect on clinical profiles, even in combination with other caregiver-related traumas. Although youth with caregiver-related traumas exhibited significant attachment problems, youth with sexual abuse in particular had higher levels of PTSD and received higher ratings for symptoms of depression, suicidality, and sexualized behaviors in comparison with the other two groups. Findings suggest that careful mapping of trauma history—including age of onset, duration, and co-occurrence of trauma exposure in childhood—can provide a foundation for a more refined developmental approach to the scientific investigation, clinical assessment, and treatment of children with complex histories of trauma in childhood. In Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S29-S39. 
Chris Layne, Johanna Greeson, Soeun Kim, Sarah Ostrowski, Stephanie Reading, Rebecca Vivrette, Ernes-tine Briggs, John Fairbank, and Robert Pynoos, in their article Cumulative trauma Exposure and High Risk Behavior in Adolescents: Findings from the National Child Traumatic Stress Network Core Data Set, tested the hypothesis that cumulative exposure to up to 20 types of trauma and bereavement/loss incrementally predicts high-risk adolescent behavior beyond demographic variables. Logistic regression analyses tested associations among both demographic variables and number of types of trauma and loss exposure as predictors and 9 types of high-risk adolescent behavior and functional impairment (attachment difficulties, skipping school, running away from home, substance abuse, suicidality, criminality, self-injury, alcohol use, and victim of sexual exploitation) as criterion variables. As hypothesized, hierarchical logistic regression analyses revealed that each additional type of trauma exposure significantly increased the odds ratios for each problem behavior (range = 1.06–1.22) after accounting for demographic variables. Study findings extend previously identified links between childhood trauma and problems later in life to include high-risk behavior and functional impairment during adolescence. The findings underscore the need for a trauma-informed public health ap-proach to systematic screening, prevention, and early intervention for traumatized and bereaved youth in child service systems. In Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S40-S49.
The National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS) is the first national, web-based, data repository designed to answer key questions relevant to the field of child traumatic stress and policy-makers. The CDS currently contains comprehensive information on trauma history and standardized assess-ments on 14,088 children seen between 2004 and 2010 in 56 NCTSN academic, hospital, and community-service sites across the United States. Although the CDS does not include a representative national sample, it provides a window into the profiles of a large and diverse group of traumatized children for in-depth investi-gations of trauma histories; clinical and developmental sequelae associated with trauma exposure; the psy-chometrics and clinical utility of widely used assessment instruments; patterns of service utilization; treatment engagement, completion, and outcome; and issues specific to diverse service sectors, race/ethnicity, cultural groups, and special populations. Authors Alan Steinberg, Robert Pynoos, Ellen Gerrity, Chris, Layne, Ernes-tine Briggs, Rebecca Vivrette, and John Fairbank, in their article The NCTSN Core Data Set: Emerging Find-ings, Future Directions, and Implications for Theory, Research, Practice, and Policy have provided an over-view of initial published findings from the CDS in this article, described plans for future analyses, and dis-cussed implications for building theory, refining research questions and methods, improving practice, and in-forming policy. Psychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), 2014, S50-S57.
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