Validation of the Attitudes Related to Trauma-Informed Care Scale (ARTIC).

OBJECTIVE: The purpose of the current study is to validate the Attitudes Related to Trauma-Informed Care Scale (ARTIC; Baker et al., 2016), a measure of trauma-informed care (TIC) attitudes for human service/health providers and educators. METHOD: The current study with 1,395 human services/health providers and educators from 17 settings examined the factor structure, reliability, and construct validity of the ARTIC. RESULTS: The 7-factor structure of the ARTIC-45 and the 5-factor structure of the ARTIC-35 were replicated with regard to the absolute fit indices though they failed to meet the cutoff for the incremental fit indices, likely due to the complexity of the measure. Internal consistencies ranged from acceptable to excellent across the instrument's forms, subscales, and versions. Providing support for construct validity, ARTIC scores were predictably related to familiarity with and knowledge about TIC, compassion satisfaction, burnout, and secondary traumatic stress, with effect sizes typically in the medium range. However, predicted relationships between ARTIC scores and training in TIC and trauma-sensitive school elements were not evident. CONCLUSIONS: The ARTIC is a direct, efficient, and cost-effective measure of attitudes related to TIC. This study further demonstrates the reliability of the ARTIC and provides some support for its validity. Evaluating the favorability of staff attitudes about TIC plays a key role in ensuring readiness for, effectiveness of, and sustainability of TIC in systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating foundational professional development training for trauma-informed approaches in schools.

Trauma-informed schools reflect a national movement toward implementing organizational practices and systems-change strategies that support trauma-exposed individuals. Although frameworks for trauma-informed schools delineate key features for navigating implementation processes, methods of installing these features in schools require additional study. Although foundational professional development (FPD) training is often utilized to prepare schools for implementing trauma-informed approaches, few researchers have examined whether such training influences factors known to promote implementation success: staff knowledge of and perceptions of acceptability for these approaches. The current study utilized a pre-post design to evaluate a 2-day FPD training as a tool for enhancing teacher knowledge of trauma-informed approaches prior to implementation. The study also examined whether gains in knowledge following the training were associated with teacher perceptions of acceptability of trauma-informed approaches and whether perceived alignment of trauma-informed approaches with existing school norms and practices, or system fit, moderated that relationship. Participants included 183 teachers from six schools who completed the training. Knowledge was assessed at pre- and posttraining, and perceptions of acceptability and system fit were assessed at posttraining. Results indicated significant knowledge growth following the training. Among teachers who perceived better system fit, knowledge growth was associated with increased acceptability for trauma-informed approaches. However, among teachers perceiving less system fit, knowledge growth was associated with decreased acceptability. Implications for the installation and implementation of trauma-informed approaches in schools are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration.

This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.

Impact of exposure to community violence, Hurricane Katrina, and Hurricane Gustav on posttraumatic stress and depressive symptoms among school age children.

This study examined the relationship between exposure to Hurricane Gustav and distress among 122 children (ages 7-12) to determine whether that relationship was moderated by prior experiences with Hurricane Katrina and exposure to community violence (ECV). Measures of hurricane experiences, ECV, posttraumatic stress (PTS) symptoms, and depression were administered. Assessments occurred after the third anniversary of Katrina, which coincided with the landfall of Gustav. Results indicated that the relation between exposure to Gustav and PTS was moderated by prior experiences. There was a positive association between Gustav exposure and PTS for children who experienced high Katrina exposure and low ECV, with a similar trend for children with high ECV and low Katrina exposure. There was no relationship between Gustav exposure and PTS for children with low Katrina and low ECV or for children with high Katrina and high ECV. The relationship between exposure to Gustav and depression was not moderated by children's prior experience. However, there was a relationship between Katrina exposure and depression for children with high ECV. Results suggest that prior trauma may amplify the relationship between hurricane exposure and distress, but children with high cumulative trauma may remain highly symptomatic regardless of disaster exposure.

A school-based assessment of secondary stressors and adolescent mental health 18 months post-Katrina.

The goals of the current study were to examine the prevalence of secondary stressors related to Hurricane Katrina and to determine their impact on posttraumatic stress disorder (PTSD) symptoms among a sample of high school students. In addition, the moderating role of problem substance use was examined to determine whether it increased the risk of PTSD symptoms in the face of secondary stressors. A total of 271 ethnically and socioeconomically diverse adolescents completed an anonymous survey. Results indicated that problem substance use potentiated the positive relation between secondary stressors and PTSD symptoms, specifically symptoms of re-experiencing. The findings highlight the need for school-based assessment of and interventions for the long-term psychological effects of disasters.

Effects of early rearing conditions on cognitive performance in prepubescent male and female rats.

The interactions between a mother and her offspring during early postnatal life impact cognitive development in altricial species. The current study examined the influence of postnatal rearing conditions on subsequent cognitive functioning in male and female Long-Evans rats prior to puberty. Maternal conditions were manipulated by repeated separations of rat pups from their dams on postnatal days 2 though 14. In the early handling condition, pups were removed from mothers briefly for 15min daily, while in the maternal separation condition pups were separated from their mothers for 180min daily. Offspring from handled or separated litters were evaluated prior to puberty between days 25-36 of life on a battery of cognitive tasks that assessed several types of memory. Male rats separated from mothers for 180min were impaired in their non-spatial and spatial memory compared to early-handled males as indicated by their performance on an object recognition task, a Y-maze task, and reference and working memory versions of the water maze task. In contrast, maternally-separated females were not impaired, and in some cases performed better on memory tasks, compared to early-handled females. Results indicate that the biological sex of offspring moderated the effects of maternal conditions on diverse cognitive tasks. Because sex differences were evident prior to puberty, gonadal hormones likely had a limited influence on cognition. Although the bases for sex differences in the cognitive response to rearing conditions are unknown, disparities in maternal attentiveness directed toward male and female offspring may play a role.

The interactive effects of elevated mid-afternoon cortisol and trauma history on PTSD symptoms in children: a preliminary study.

Given the alarming frequency and severity of trauma exposure among children, identifying contextual and biologic factors that increase risk for symptomatic responses to trauma is an essential step toward preventing psychopathology. Basal functioning of the hypothalamic pituitary adrenal axis was evaluated to determine its role in relations between trauma exposure and PTSD symptoms among 66 children (M age=10.7 years). Exposure to recent trauma (within the past year), previously experienced trauma (more than 1 year ago), and basal mid-afternoon cortisol levels were each positively related to PTSD symptoms. Further, these factors interacted in an additive manner to account for a significant proportion of the variance in PTSD symptoms. Implications for the early identification of children at risk for symptomatic responses to trauma are discussed.

Effects of exposure to community violence on school functioning: the mediating role of posttraumatic stress symptoms.

This study investigated the association between exposure to community violence (ECV) and school functioning, as well as posttraumatic stress (PTS) symptoms as a potential mediator of the relationship. PTS symptoms are commonly associated with ECV, and are characterized by difficulty regulating emotions and behaviors. Thus, PTS symptomatology may be one mechanism through which community violence impacts school functioning. The community-based sample included 47 low-income African American children (aged 10-13). Results revealed that ECV was inversely related to academic performance and attendance. Symptoms of posttraumatic stress emerged as a mediator of the relation between ECV and academic performance. Results have implications for urban students who face violence in their communities, and emphasize the need for school-based mental health services.

Child and adolescent mental health research in the context of Hurricane Katrina: an ecological needs-based perspective and introduction to the special section.

This article introduces the special section on child and adolescent mental health research in the context of Hurricane Katrina. We outline the purpose and intent of the special section and present an integrative perspective based on broad contextual theories of human development with which to think about the impact of disasters like Katrina. The perspective emphasizes multiple levels of influence on mental health and normal development through the impairment of multiple human needs. The perspective helps show the interconnections among the diverse theoretical and methodological paradigms that are utilized to understand the impact of disasters on youth and may help to guide future research.

Evaluation of individual and group grief and trauma interventions for children post disaster.

This study evaluated a community-based grief and trauma intervention for children conducted postdisaster. Fifty six children (7 to 12 years old) who reported moderate to severe levels of symptoms of posttraumatic stress were randomly assigned to group or individual treatment. Treatment consisted of a manualized 10-session grief- and trauma-focused intervention and a parent meeting. Measures of disaster-related exposure, posttraumatic stress symptoms, depression, traumatic grief, and distress were administered at preintervention, postintervention, and 3 weeks postintervention. There was a significant decrease in all outcome measures over time, and there were no differences in outcomes between children who participated in group intervention and those who participated in individual intervention. Results suggest that this intervention using either treatment modality may be effective for addressing childhood grief and trauma postdisaster.

Relations between recurrent trauma exposure and recent life stress and salivary cortisol among children.

The present study evaluated the independent and cumulative effects of recent life stress, previous trauma, and recent trauma exposure on salivary cortisol levels among school-aged children. Sixty-eight children (mean age=10.7 years) reported their exposure to life stressors and traumatic events in the 12 months preceding the study. Children and their caregivers reported frequency of exposure to trauma earlier in life. Exposure to life stress within the past 12 months was related to higher afternoon cortisol levels. Exposure to high levels of recent trauma in combination with frequent exposure to trauma earlier in life was related to both lower morning cortisol levels and higher afternoon cortisol levels. Results suggest that frequency, duration, and severity of exposure to stress and trauma played key roles in the prediction of basal cortisol levels in a community sample of urban youth.

Advances and future directions in the study of children's neurobiological responses to trauma and violence exposure.

One of the most exciting developments to emerge from the field in the past 20 years is the increasing attention to neurobiological responses to violence and trauma exposure. Although researchers have yet to identify a consensual pattern of neurobiological response to violence and trauma exposure, it does appear that some type of alteration in the hypothalamic pituitary adrenal (HPA) axis is likely. This article briefly reviews the multiple moderating factors that help account for the divergent patterns in HPA function as well as methodological advances that will continue to improve the assessment of HPA function in youth exposed to violence and trauma.

Brief report: self-care behaviors of children with type 1 diabetes living in Puerto Rico.

OBJECTIVE: To examine self-care behaviors among children and adolescents with type 1 diabetes living in Puerto Rico, to determine the relationship between self-care and demographic variables, and to investigate the utility of the 24-hour recall interview within a Hispanic population. METHOD: Forty-one children (M age = 12.6 years) with type 1 diabetes, and their mothers, were administered the 24-hour recall interview on three separate occasions to assess diabetes-related self-care behaviors. RESULTS: Children reported self-care behaviors that included daily administration of an average of two insulin injections and two blood glucose tests, and consumption of 5.5 meals a day comprised of 52% carbohydrates and 29% fat. Younger age, female gender, longer illness duration, and better metabolic control were associated with higher rates of several self-care behaviors. CONCLUSIONS: Data provide a first look at self-care behaviors of children with type 1 diabetes living in Puerto Rico and suggest the utility of the 24-hour recall interview within this population.