Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma.

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

Twenty-year follow-up of adults traumatized during childhood in Armenia.

BACKGROUND: Most children who experience trauma recover and display resilience; however, there are few long-term follow-up studies of traumatized children and fewer still have examined factors that may lead to resilience. This study is a 20-year follow-up of adults who experienced an earthquake as children. METHODS: Nineteen of 25 adults who experienced the earthquake in Armenia in 1988 and participated in the initial study approximately two years later (Time 1) were reinterviewed in 2008 (Time 2). Forty-four Armenian adults aged 22-37 who had not experienced the earthquake comprised the comparison group. All participants at Time 2 were administered the Symptom Checklist-90 Revised (SCL-90-R) and the UCLA PTSD Reaction Index (RI) and also received a clinical interview. RESULTS: The earthquake group had clinically elevated SCL-90-R GSI, PSDI, PST and subscale scores for all but one subscale and had significantly more subscale clinical elevations than the comparison group. All earthquake survivors at Time 2 scored from 1 to 46 on the RI with 4 having probable PTSD. No comparison subjects had experienced an A1 trauma. LIMITATIONS: The small number of subjects in this follow-up, our inability to follow the comparison group in the original study and the measures used at the two time points limits the applicability of the results. CONCLUSIONS: Most of the earthquake survivors experienced anxiety disorders at follow-up but not high levels of PTSD or depression. Clinical interviews identified resilient factors that may have helped these subjects maintain functional and adaptive capacities despite clinical elevations on the SCL-90.

The role of adolescent physical abuse in adult intimate partner violence.

This study's primary aims were to examine whether a sample of young adults, aged 23 to 31, who had been documented as physically abused by their parent(s) during adolescence would be more likely to aggress, both physically and verbally, against their intimate partners compared with nonabused young adults and whether abuse history was (along with other risk factors) a significant predictor of intimate partner physical and emotional violence perpetration or victimization. In this longitudinal study, 67 abused and 78 nonabused adults (of an original sample of 198 adolescents) completed the Modified Conflict Tactics Scale and the Jealousy and Emotional Control Scales. Nonabused comparison adolescents were matched for age, gender, and community income. As adults, participants with abuse histories had significantly higher rates of intimate partner physical violence and verbal aggression than did comparison participants. Multivariate logistic regressions indicated that adults with histories of physical abuse were more than twice as likely to be physically violent and almost six times more likely to be verbally aggressive to their intimate partners than were comparison participants. Having had an alcohol use disorder, being married to or living with a partner, and perceiving one's partner as controlling were also significantly associated with physical violence. Jealousy and feeling controlled by one's partner were also significant predictors of verbal aggression. These findings underscore the importance of preventing adolescent abuse as a means of decreasing the incidence of intimate partner physical violence in adulthood.

Enhancing pain management in the PICU by teaching guided mental imagery: a quality-improvement project.

OBJECTIVE: This quality-improvement study, following the PDCA methodology, compared the effectiveness of teaching mental imagery (MI) for pain management versus conducting a detailed inquiry (DI) about pain-related experiences with acutely injured PICU patients. METHODS: Participants included 44 hospitalized children and adolescents assigned to one of two intervention groups, MI (N = 24) or DI (N = 20). Pain was assessed pre- and post-intervention using the Wong-Baker Faces Pain Rating Scale and a 0-10 Likert pain rating scale, and the Pediatric Trauma Score was utilized to assess the severity of each child's injuries. RESULTS: Boys in the MI condition exhibited a significant decrease in average pain ratings [t(38) = 3.41, p = .0015]. Girls in the MI condition exhibited a non-significant decrease in average pain ratings. CONCLUSIONS: Teaching children the use of MI for pain management in an intensive-care setting was supported; the use of DI with boys was not supported.

Physical abuse during adolescence: Gender differences in the adolescents' perceptions of family functioning and parenting.

OBJECTIVE: To examine the relationship between physical abuse of adolescents and parenting by mothers and fathers and whether the association differs by gender. METHODS: Subjects were adolescents, 51 girls and 45 boys, documented by Child Protective Services (CPS) as physically abused during adolescence. Comparison subjects were non-abused adolescents, 47 girls and 48 boys, from the same suburban communities. Subjects completed the following: Family Adaptability and Cohesion Evaluation Scale, Parental Bonding Instrument, modified Conflict Tactics Scale (assessing physical abuse/punishment by each parent). RESULTS: Although CPS generally cited fathers as the abuse perpetrators, abused boys and girls often reported experiencing physical maltreatment from both parents. Not surprisingly, comparison subjects rated parents more positively than abused subjects. For both groups, mothers were perceived as more caring and less controlling, were reported to have closer relationships with their adolescents, and were less likely to use abuse/harsh punishment than were fathers. Differences between the adolescents' perceptions of mothers and fathers were more pronounced for abused than for comparison subjects. Boys' and girls' perceptions of parenting were generally similar except that girls, especially the abused girls, reported feeling less close to fathers. Abused girls also viewed mothers as less caring than the other groups viewed mothers. Abused girls were also less likely than abused boys to perceive that either parent, but particularly fathers, had provided them with an optimum style of parenting. CONCLUSIONS: Adolescents who experienced relatively mild physical abuse reported dysfunctional family relationships, which may place them at risk of poor adult outcomes. Adolescents' reports suggest that CPS reports may underestimate physical maltreatment by mothers.