Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma.

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer's trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child's trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.

Neural vulnerability and hurricane-related media are associated with post-traumatic stress in youth.

The human toll of disasters extends beyond death, injury and loss. Post-traumatic stress (PTS) can be common among directly exposed individuals, and children are particularly vulnerable. Even children far removed from harm's way report PTS, and media-based exposure may partially account for this phenomenon. In this study, we examine this issue using data from nearly 400 9- to 11-year-old children collected before and after Hurricane Irma, evaluating whether pre-existing neural patterns moderate associations between hurricane experiences and later PTS. The 'dose' of both self-reported objective exposure and media exposure predicted PTS, the latter even among children far from the hurricane. Furthermore, neural responses in brain regions associated with anxiety and stress conferred particular vulnerability. For example, heightened amygdala reactivity to fearful stimuli moderated the association between self-reported media exposure and PTS. Collectively, these findings show that for some youth with measurable vulnerability, consuming extensive disaster-related media may offer an alternative pathway to disaster exposure that transcends geography and objective risk.

Integrated CARE: Adaptation of Child-Adult Relationship Enhancement (CARE) Model for Use in Integrated Behavioral Pediatric Care.

The authors adapted the established Child-Adult Relationship Enhancement (CARE) interaction model for use in integrated behavioral health clinics. CARE was modified for delivery in the examination room, during routine primary care visits. Adopting a real-world implementation approach, clinical social workers were trained in the new model-IntegratedCARE-and provided the brief, 3-session treatment to 30 different parent-child dyads. Measurements included the Parental Stress Index-4 Short Form (PSI 4-SF), the Eyberg Childhood Behavior Inventory (ECBI), and the Therapy Attitude Inventory (TAI). There was a statistically significant mean score decrease on the both subscales of the ECBI at pre- and posttreatment. Scores on the TAI indicated that participants were satisfied with the treatment. Attrition rates were somewhat lower than similar studies. Findings indicate the IntegratedCARE model is feasible for sustainable delivery by trained behavioral health professionals in primary care.

Leveraging parent-child interaction therapy and telehealth capacities to address the unique needs of young children during the COVID-19 public health crisis.

COVID-19 and related efforts to mitigate its spread have dramatically transformed the structure and predictability of modern childhood, resulting in growing concerns children may be particularly vulnerable to serious mental health consequences. Worldwide stay-at-home directives and emergency changes in healthcare policy and reimbursement have smoothed the trail for broad implementation of technology-based remote mental health services for children. Parent-Child Interaction Therapy (PCIT) is particularly well-positioned to address some of the most pressing child and parental needs that arise during stressful times, and telehealth formats of PCIT, such as Internet-delivered PCIT (iPCIT), have already been supported in controlled trials. This commentary explores PCIT implementation during the COVID-19 public health crisis and the challenges encountered in the move toward Internet-delivered services. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Child-Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges.

Child maltreatment impacts approximately two million children each year, with physical abuse and neglect the most common form of maltreatment. These children are at risk for mental and physical health concerns and the ability to form positive social relationships is also adversely affected. Child Adult Relationship Enhancement (CARE) is a set of skills designed to improve interactions of any adult and child or adolescent. Based on parent training programs, including the strong evidence-based treatment, Parent-Child Interaction Therapy (PCIT), CARE was initially developed to fill an important gap in mental health services for children of any age who are considered at-risk for maltreatment or other problems. CARE subsequently has been extended for use by adults who interact with children and youth outside of existing mental health therapeutic services as well as to compliment other services the child or adolescent may be receiving. Developed through discussions with Parent-Child Interaction Therapy (PCIT) therapists and requests for a training similar to PCIT for the non-mental health professional, CARE is not therapy, but is comprised of a set of skills that can support other services provided to families. Since 2006, over 2000 caregivers, mental health, child welfare, educators, and other professionals have received CARE training with a focus on children who are exposed to trauma and maltreatment. This article presents implementation successes and challenges of a trauma-informed training designed to help adults connect and enhance their relationships with children considered at-risk.

Trauma, grief and depression in Nairobi children after the 1998 bombing of the American Embassy.

Despite the increasingly dangerous world where trauma and loss are common, relatively few studies have explored traumatic grief in children. The 1998 American Embassy bombing in Nairobi, Kenya, provided an unfortunate opportunity to examine this topic. This report describes findings in 156 children who knew someone killed in the incident, assessed 8 to 14 months after the explosion. Bomb-related posttraumatic stress was associated with physical exposure, acute response, posttraumatic stress related to other negative life events, type of bomb-related loss, and subsequent loss. Grief was associated with bomb-related posttraumatic stress, posttraumatic stress related to other negative life events, and type of bomb-related loss. The study supports the developing literature on traumatic grief and the need for studies exploring the potentially unique aspects of this construct.

Teachers in the aftermath of terrorism: a case study of one New York City school.

Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional, but felt ill-equipped to intervene with students and expressed substantial need for assistance.

When disaster strikes: responding to the needs of children.

When a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.

Teachers' psychological reactions 7 weeks after the 1995 Oklahoma City bombing.

This study assessed teachers' reactions to the Oklahoma City bombing. Peritraumatic reactions, the interaction of media exposure with stress from media coverage, feelings toward the perpetrators, and worry about safety predicted posttraumatic stress. Twenty percent reported difficulty handling demands; 5% sought counseling. Outreach efforts should assess and assist teachers.

Posttraumatic stress and functional impairment in Kenyan children following the 1998 American Embassy bombing.

This study examined a convenience sample of 562 Nairobi school children exposed to the 1998 bombing of the American Embassy in Nairobi, Kenya. Posttraumatic stress reactions to the bombing were related to posttraumatic stress reactions to other trauma and to peritraumatic reaction. Self-reported functional impairment was minimal.

Case finding and mental health services for children in the aftermath of the Oklahoma City bombing.

The 1995 Oklahoma City bombing killed 168 people, including 19 children, and injured hundreds more. Children were a major focus of concern in the mental health response. Most services for them were delivered in the Oklahoma City Public Schools where approximately 40,000 students were enrolled at the time of the explosion. Middle and high school students in the Oklahoma City Public Schools completed a clinical assessment 7 weeks after the explosion. The responses of 2720 students were analyzed to explore predictors of posttraumatic stress symptomatology, functioning, and treatment contact. Posttraumatic stress symptomatology was associated with initial reaction to the incident and to bomb-related television exposure. Functional difficulty was associated with initial reaction and posttraumatic stress symptomatology. Only 5% of the students surveyed had received counseling. There was no relationship between posttraumatic stress symptomatology and counseling contact for students with the highest levels of posttraumatic stress. Implications for school-based services are discussed.

Children's response to terrorism: a critical review of the literature.

The advent of major terrorist assaults has ushered in a sense of insecurity and vulnerability heretofore unknown in the US. There is information about the impact of disasters and trauma on children, but relatively little data on the effects of terrorism. The events of September 11, 2001 have underscored the need to examine this issue. This report summarizes recent studies that address the impact of terrorist incidents on children, and examines issues related to mental health services for children in the post-attack environment. Work related to the 1993 bombing of the World Trade Center, the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, the 1998 bombing of the American Embassy in Nairobi, Kenya, and the September 11 attacks are reviewed. This article indicates significant challenges in the identification, evaluation, and treatment of children potentially in need of attention.

Exposure and peritraumatic response as predictors of posttraumatic stress in children following the 1995 Oklahoma City bombing.

Studies have demonstrated a positive relationship between exposure and posttraumatic stress, but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of posttraumatic stress than more objective measures of exposure. We examined the role of peritraumatic response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Oklahoma City, Oklahoma, bombing. While many children reported hearing and feeling the blast and knowing direct victims, most were in school at the time of the explosion and therefore were not in direct physical proximity to the incident. Physical, interpersonal, and television exposure accounted for 12% of the total variance in our measure of posttraumatic stress when peritraumatic response was ignored. Peritraumatic response and television exposure accounted for 25% of the total variance, and physical and interpersonal exposure were not significant in this context. These findings suggest the importance of peritraumatic response in children's reactions to terrorism. These early responses can be used to help determine which children may experience difficulty over time.