Screening for PTSD and functional impairment in trauma-exposed young children: evaluation of alternative CBCL-PTSD subscales

The Child Behavior Checklist (CBCL 1.5–5 years) posttraumatic stress disorder (PTSD) subscale by Dehon & Scheeringa (2006) as a screener for PTSD in trauma-exposed young children has yielded inconsistent results so far. Therefore, the aim of this study was to create and examine the validity of alternative CBCL-PTSD subscales and compare them to the existing CBCL-PTSD subscale based on the DSM-5 PTSD diagnostic criteria for children 6 years and younger. Further, the CBCL-PTSD subscales were examined regarding their usefulness in screening for posttraumatic stress-related functional impairment. The sample comprised 116 trauma-exposed young children (M$_{age}$ = 3.42 years, SD$_{age}$ = 1.21 years, female = 49.1%). The psychometric properties of the existing CBCL-PTSD subscale as well as the alternative subscales based on expert rating (CBCL-PTSD-17) and based on variable importance (CBCL-PTSD-6) were evaluated by means of receiver operating characteristic curves, sensitivity, specificity, positive predictive values, and negative predictive values. Area under the curves for all three investigated CBCL-PTSD subscales were good to excellent for PTSD and functional impairment. Further, all three CBCL-PTSD subscales showed high sensitivity for PTSD and functional impairment. Considering the length and the performance of the three investigated subscales, the CBCL-PTSD-6 appears to be a promising and clinically useful CBCL-PTSD subscale as a screener for PTSD and functional impairment due to the easiest and most practicable application. For purposes of discriminant validation of the CBCL-PTSD-6, young children without a history of trauma should be compared to young children with trauma history

Project Reach: Implementation of Evidence-Based Psychotherapy Within Integrated Healthcare for Hurricane Harvey Affected Individuals

Project Reach was established to deliver evidence-based mental healthcare services to children and adults affected by Hurricane Harvey and its aftermath. Through Project Reach, an innovative multi-component assessment and treatment service is utilized to identify and treat in integrated healthcare settings both children and adults exhibiting significant behavioral health concerns in Houston. The aim is to provide sustainable, integrated mental health services through primary care and school-based settings to post-Harvey affected individuals whose emotional needs remain unmet. This paper describes the design and implementation of Project Reach as well as special considerations for implementation. The overall goal of Project Reach is to form a platform for expanding integrated services for those affected by Harvey that will maximize behavioral health outcomes while reducing cost and improving access

Concerted Regulation of cGMP and cAMP Phosphodiesterases in Early Cardiac Hypertrophy Induced by Angiotensin II

Left ventricular hypertrophy leads to heart failure and represents a high risk leading to premature death. Cyclic nucleotides (cAMP and cGMP) play a major role in heart contractility and cyclic nucleotide phosphodiesterases (PDEs) are involved in different stages of advanced cardiac diseases. We have investigated their contributions in the very initial stages of left ventricular hypertrophy development. Wistar male rats were treated over two weeks by chronic infusion of angiotensin II using osmotic mini-pumps. Left cardiac ventricles were used as total homogenates for analysis. PDE1 to PDE5 specific activities and protein and mRNA expressions were explored

Child welfare workers' perspectives on contributing factors to retention and turnover : recommendations for improvement

Rates of turnover are high in child welfare settings, impacting the organization, remaining workers and the children and families under their care. A number of demographic, psychological, social and organizational features have been associated with increased staff turnover, although we have limited understanding about how and why these factors are important; differences in influence at varying levels of seniority and career duration; and workers’ perspectives on how to address workplace issues. This qualitative study assessed how factors impact employee retention and turnover in focus groups with 25 employees at different stages of employment: resigned case managers, case managers employed for less than one year and more than three years, and supervisors. Results suggested few differences in themes identified by groups. Two broad themes emerged for retention: supportive environment (including themes relating to children/parents, co-workers, and the organization) and opportunities within the agency (including new positions, experience and knowledge and job security). Two broad themes emerged for turnover: organizational issues (including themes about low compensation, challenging work demands, and system issues) and stress. Workers’ perspectives and recommendations on how to address workplace problems were reported. Results are consistent with the existing literature, although a number of unique issues were identified, including workers’ desire for clear communication flow through hierarchies, increased collaboration, and revisions to the way data is used/integrated. Workers expressed a strong desire to be heard by management, and this study reflects an important effort to provide feedback. These findings are relevant for informing organizational policy in child welfare agencies.11 page(s

Posttraumatic Symptoms in 3–7 Year Old Trauma‑Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress

Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3–7 year old children reported on their child’s symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment

The Role of self-care on compassion satisfaction, burnout and secondary trauma among child welfare workers

Child welfare workers are routinely exposed to multiple traumatic events when working with children and families, and are at an increased risk of experiencing burnout and secondary trauma. Self-care is often recommended as a restorative or protective activity against the negative effects of working with traumatized individuals, although few studies have examined the benefit of self-care empirically. Trauma-informed self-care (TISC) includes being aware of one's own emotional experience in response to exposure to traumatized clients and planning/engaging in positive coping strategies, such as seeking supervision, attending trainings on secondary trauma, working within a team, balancing caseloads, and work-life balance. Compared with generic personal care activities, TISC is likely to be especially relevant for child welfare workers. This study examined the role of TISC on compassion satisfaction, burnout and secondary trauma which was assessed by administering surveys to a sample of 104 child welfare case managers and supervisors. Almost one third of the sample reported high levels of burnout (29.8%) and secondary trauma (28.8%), and low levels of compassion satisfaction (31.7%). Results suggested that workers who engaged in higher levels of TISC experienced higher levels of compassion satisfaction and lower levels of burnout, although there was no relationship with secondary trauma. Findings provide preliminary evidence that TISC may be a beneficial practice to reduce risk of burnout and preserve workers' positive experience of their job, however workers experiencing secondary trauma are likely to need additional specialized intervention to assist them with their recovery.8 page(s

Parents’ Descriptions of Young Children’s Dissociative Reactions after Trauma

There is limited research on the phenomenology of how young children who have been exposed to trauma express the intrusive symptom of dissociative reactions. The current qualitative study utilized interviews from a semi-structured diagnostic clinical interview with 74 caregivers of young children (ages 3 to 7) who were exposed to trauma to identify parents’ descriptions of their children’s dissociative reactions during a clinical interview. Based on results from the interview, 45.9% of the children had dissociative reactions (8.5% had flashbacks and 41.9% had dissociative episodes). Interviews were transcribed to identify themes of dissociative reactions in young children. Common themes to flashbacks and dissociative episodes included being triggered, being psychologically in their own world (e.g., spaced out and shut down), and displaying visible signs (e.g., crying and screaming). For flashbacks, caregivers reported that it seemed as if the child was re-experiencing the trauma (e.g., yelling specific words and having body responses). For dissociative episodes, caregivers noted that the child not only seemed psychologically somewhere else (e.g., distant and not there) but also would be physically positioned somewhere else (e.g., sitting and not responding). Caregivers also expressed their own reactions to the child’s dissociative episode due to not understanding what was occurring, and trying to interrupt the occurrences (e.g., calling out to the child). Themes, descriptions, and phrases to describe dissociative reactions in young children after trauma can be used to help parents and professionals more accurately identify occurrences of dissociative reactions

Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale

Objective: The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Methods: Participants were 73 children 7-13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status. Results: Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings. Conclusions: With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice.10 page(s