Factors Affecting End of Treatment Symptom Severity for Children Receiving Trauma-Informed Evidence-Based Treatment

The purpose of this project is to examine how the factors of gender, placement status, type of treatment, the number of different types of trauma experienced, and a child’s age at the start of treatment may influence end of treatment symptom severity scores for children ages 2-12 years who received trauma-informed evidence-based treatment for trauma. Method: Caregivers and children receiving outpatient services (N=134) completed the Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternate Version at baseline and end of treatment. Hypotheses were tested with a series of ANCOVA analyses, Independent t-Tests, and a Paired Samples t-Test. Results: While statistically significant improvements were found between baseline and termination outcome scores regardless of treatment type, TF-CBT was found to more successfully reduce externalizing and total problem scores at termination compared to PCIT. Despite the relatively young age of this sample, significant differences in externalizing and total problem scores on the CBCL were found for older children at the end of treatment. No significant differences were found between pre-and post-test internalizing and externalizing scale scores for either TF-CBT or PCIT. Additionally, examination of caregiver and child daily functioning scale scores indicated improved ratings of daily functioning from baseline to the end of treatment. Implications: Behavior problems stemming from traumatic exposure may resolve differently from behaviors that result from environmental factors apart from trauma. Trauma recovery is dependent upon successful matching of client characteristics and need to treatment type. Practitioners are encouraged to be mindful of the specialized needs of older children who are seeking treatment. Research that focuses on clarifying the factors that differentiate symptom resolution can inform treatment selection decisions. Social work educators are encouraged to design curriculum that is trauma-informed with an emphasis on helping students learn how to think critically about a child’s needs and to integrate this knowledge into treatment decisions. The development of policies that incentivize agencies to provide evidence-based care can increase the availability of research-supported care for trauma exposed youth

Adverse childhood experiences, support, and the perception of ability to work in adults with disability

Objective To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability. Participants Adults (ages 18–64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009). Design and Main Outcome Measures The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model. Results ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5–2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42–0.63]) and structural support (adjusted OR 0.48 [0.41–0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health. Conclusions ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability

Support, Recent Health and Education and Relationship to ACEs and Work Inability.

<p>Support, Recent Health and Education and Relationship to ACEs and Work Inability.</p

Sample Demographics: Relationship to ACEs¹ and Perceived Work Inability.

<p>Sample Demographics: Relationship to ACEs<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157726#t002fn001" target="_blank">¹</a> and Perceived Work Inability.</p

Evaluation of the Differential Effect of Support at Different Levels of Health¹.

<p>Evaluation of the Differential Effect of Support at Different Levels of Health<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157726#t006fn001" target="_blank">¹</a>.</p

Adverse Childhood Experience (ACE)¹ Prevalence Estimates by Category, Type and ACE Score (Sample n = 13,009).

<p>Adverse Childhood Experience (ACE)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157726#t001fn001" target="_blank">¹</a> Prevalence Estimates by Category, Type and ACE Score (Sample n = 13,009).</p

Relationship between Adverse Childhood Experience (ACE) Categories, Type and Score with Perceived Inability to Work and Support.

<p>Relationship between Adverse Childhood Experience (ACE) Categories, Type and Score with Perceived Inability to Work and Support.</p

Multivariate Logistic Regression¹ Analyses of Odds of Inability to Work.

<p>Multivariate Logistic Regression<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0157726#t005fn001" target="_blank">¹</a> Analyses of Odds of Inability to Work.</p