Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth

Abstract Background A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice. Methods Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression. Results One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria. Conclusion Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program

Concert recording 2017-11-06

[Track 1]. Sebben crudele / Antonio Caldara -- [Track 2]. Orpheus with his lute / William Schuman -- [Track 3]. Heaven help my heart -- [Track 4]. Little elegy / John Duke -- [Track 5]. Bel piacere / G.F. Handel -- [Track 6]. I dreamed a dream from Les Miserables / Claude-Michel Schönberg -- [Track 7]. In questa tomba oscura / Ludwig van Beethoven -- [Track 8]. Lasst mich nur auf meinem Sattel gelten! from Freisinn / Robert Shumann -- [Track 9]. Für Musik / Robert Franz -- [Track 10]. Edelweiss from The sound of music / Rodgers & Hammerstein -- [Track 11]. Tu lo sai / Giuseppe Torelli -- [Track 12]. Glück / Max Reger -- [Track 13] Le colibri / Ernest Chausson -- [Track 14] Der Der Schäfer / Hugo Wolf -- [Track 15]. A route to the sky / Jake Heggie -- [Track 16]. Ich liebe dich / Edvard Grieg -- [Track 17]. When it all fall down from Chaplin / Christopher Curtis -- [Track 18]. Voyage a Paris / Francis Poulenc -- [Track 19]. Crucifixion / arr. Hall Johnson -- [Track 20]. Bright is the ring of words / Ralph Vaughan Williams -- [Track 21]. Non t\u27amo piu / Francesco Paolo Tosti -- [Track 22]. Se tu m\u27ami / Alessandro Parisotti -- [Track 23]. I love the way from Something\u27s rotten / Kirkpatrick & Kirkpatrick -- [Track 24]. A madrigal / Herbert Howells -- [Track 25]. El majo discrete / Enrique Granados -- [Track 26]. The roadside fire / Ralph Vaughan Williams -- [Track 27]. Che fiero costume / Giovanni Legrenzi -- [Track 28]. An die Musik / Franz Shubert -- [Track 29]. I will sing new songs of gladness / Anton Dvorak -- [Track 30]. Full fathom five from The tempest / Henry Purcell -- [Track 31]. Nimmerstate Libe / Hugo Wolf -- [Track 32]. Deposuit potentes from Magnificat / Johann Sebastian Bach -- [Track 33]. Vaghissima sembiante / Stefano Donaudy -- [Track 34]. Tormani a vaghegghiar from Alcina / G.F. Handel -- [Track 35]. Nobody knows this little rose / John Duke -- [Track 36]. Let beauty awake / Ralph Vaughan Williams -- [Track 37]. Steal away / arr. Hall Johnson -- [Track 38]. Come paride vezzoso from L\u27elisir d\u27amore / Kirkpatrick & Kirkpatrick -- [Track 39]. Dich, teure Halle from Tannhaüser / Richard Wagner -- [Track 40]. Non t\u27accotare all\u27urna / Giuseppe Verdi -- [Track 41]. Zur Rosenzeit / Edvard Grieg

Behavioral Markers of Coping and Psychiatric Symptoms among Sexually Abused Children.

The current study examined coping and psychiatric symptoms in a longitudinal sample of sexually abused children. Coping was behaviorally coded from children\u27s forensic interviews in the aftermath of sexual abuse. Using principal components analysis, coping behaviors were found to cluster into 3 categories: avoidant, expressive, and positive affective coping. Avoidant coping had predictive utility for a range of psychiatric symptoms, including depressive, posttraumatic stress, anxiety, and dissociative symptoms as well as aggression and attention problems measured 8-36 months following the forensic interview. Specific behaviors, namely fidgetiness and distractibility, were also found to be associated with future symptoms. These findings suggest the predictive utility of avoidant behaviors in general, and fidgetiness and distractibility in particular, among sexually abused children

Dissociation Predicts Later Attention Problems in Sexually Abused Children.

OBJECTIVE: The goals of this research are to develop and test a prospective model of attention problems in sexually abused children that includes fixed variables (e.g., gender), trauma, and disclosure-related pathways. METHODS: At Time 1, fixed variables, trauma variables, and stress reactions upon disclosure were assessed in 156 children aged 8-13 years. At the Time 2 follow-up (8-36 months following the initial interview), 56 of the children were assessed for attention problems. RESULTS: A path analysis involving a series of hierarchically nested, ordinary least squares multiple regression analyses indicated two direct paths to attention problems including the child\u27s relationship to the perpetrator (beta=.23) and dissociation measured immediately after disclosure (beta=.53), while controlling for concurrent externalizing behavior (beta=.43). Post-traumatic stress symptoms were only indirectly associated with attention problems via dissociation. Taken together, these pathways accounted for approximately 52% of the variance in attention problems and provided an excellent fit to the data. CONCLUSIONS: Children who report dissociative symptoms upon disclosure of CSA and/or were sexually abused by someone within their family are at an increased risk of developing attention problems. PRACTICE IMPLICATIONS: Findings from this study indicate that children who experienced sexual abuse at an earlier age, by someone within their family, and/or report symptoms of dissociation during disclosure are especially likely to benefit from intervention. Effective interventions should involve (1) providing emotion regulation and coping skills; and (2) helping children to process traumatic aspects of the abuse to reduce the cyclic nature of traumatic reminders leading to unmanageable stress and dissociation