Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.     

Does community violence exposure predict trauma symptoms in a sample of maltreated youth in foster care?

Previous studies find that childhood exposure to family and community violence is associated with trauma symptoms. Few studies, however, have explored whether community violence exposure (CVE) predicts trauma symptoms after controlling for the effects associated with family violence exposure (FVE). In the current study, CVE and FVE were examined in a sample of 179 youth with a recent history of maltreatment. CVE was associated with trauma symptoms after controlling for FVE, but FVE was not associated with trauma symptoms after controlling for CVE. In addition, negative coping strategies (e.g., self-harm, interpersonal aggression) partially mediated the association between CVE and trauma symptoms. These findings are discussed in terms of their implications for interventions aimed at addressing the needs of children exposed to violence.     

Perceived Need for Psychosocial Services in the Context of Political Violence: Psychological Distress Among Israeli Mothers with Young Children

The current study investigated the association between mothers’ perceived need for psychosocial services due to exposure to political violence, and theirs and their children’s psychological distress. A representative sample of 904 Israeli mothers of young children aged 2–6 were asked to fill out a questionnaire about exposure to war and other types of trauma, psychological distress, social support, and perceived need for help. The results showed that mothers who reported a need for psychosocial services due to exposure to political violence had higher levels of exposure to political violence, depressive symptoms and more emotional problems in their young children than mothers who reported no need for help. Those who reported a need for psychosocial services also had less social support even when all other variables are controlled. Furthermore, Arab mothers and mothers with low family income perceived a greater need for psychosocial services. The implications of this study are relevant for policies of outreach to vulnerable groups in situations of ongoing political violence.     

Children and Violence: Findings and Implications from a Rural Community

The present study addresses gaps in the youth violence literature by exploring the types and levels of children's violence exposure in a rural setting and examining psychological trauma associated with violence exposure. The study is a secondary data analysis using a rural sample (N = 549) from a larger study. The larger study employed a 45-minute questionnaire given to students in grades 3 through 8. The questionnaire was designed to assess children's present and past violence exposure as a victim and witness across the home, school, and neighborhood. In addition, this questionnaire assessed children's psychological trauma symptoms.Our study found that children in the rural sample were exposed to high amounts of violence as both victims and witnesses within, and prior to, the past year. Violence exposure variables explained a significant amount of variance in total trauma symptoms after controlling for demographic variables. This finding is consistent with the literature examining the association of trauma and violence exposure.     

A Comparison Study of Low Trauma Disclosure Participants and Their Partners in Army Couples

Intimate partner relationships provide unique conditions for examining how the interpersonal and/or systemic impact of trauma exposure and post-trauma responses can impact both the primary and secondary trauma survivors and the interpersonal dynamics of the couple. The current study explored qualitative and quantitative data from low trauma disclosure individuals (n?=?15) and their partners to understand the experiences of low trauma disclosure to spouses in a sample of Army couples. Contrary to the original hypothesis, the results indicated mixed trauma disclosure partners seemed to be functioning at lower individual and relationship functioning levels than the low or high trauma disclosure partners. Implications for practice and future research also are described.     

Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.     

Domestic Violence and Parental Divorce as Predictors of Best Friendship Qualities Among College Students

Data regarding the effects of domestic violence and parental divorce have been inconsistent. Assessments of the effects of childhood trauma on psychosocial adjustment might be enhanced by an examination of the way developmental stressors interact. A total of 370 college students with histories of combinations of parental divorce and domestic violence participated in this correlational study of best friendships in early adulthood. College students exposed to domestic violence during childhood described their best friendships as relatively less reinforcing, helpful, and sustainable than those without the abuse history. Participants from intact families, as compared to those with parental divorce histories, described their best friendship as relatively more reinforcing and favorable. The combination of parental divorce and exposure to domestic violence was linked to magnified effects regarding these best friendship qualities. Average effect sizes for domestic violence (d?=?.31), parental divorce (d?=?.18), and the interaction between domestic abuse and divorce (d?=?.85) pointed to mild to modest links between these stressors and best friendship qualities. These results emphasized the benefits of interaction analysis in attempts to predict the adverse effects of developmental stressors on late psychological functioning.     

The assessment of early trauma exposure on social-emotional health of young children

Children exposed to traumatic events (e.g., violence in the home, school, community) report more adverse physical and mental health outcomes than children who have not been exposed to trauma. Caregiver reports provide an opportunity for early identification of intervention needs to aid healthy development of children exposed to trauma. The goal of this study was to determine unique social-emotional profiles and examine how traumatic events vary across these developmental profiles among a sample of caregivers who live in socioeconomically disadvantaged neighborhoods. Caregivers (N = 223) provided responses regarding their young children's (aged 3 years through 5 years) social-emotional health. Latent Profile Analysis was used to develop three distinct social-emotional profiles: Typical Social-emotional Health (low-risk), Some Social-emotional Challenges (moderate-risk), and Social-emotional Problems (high-risk). Results revealed that children exposed to increased non-family-based traumatic events had a greater likelihood of being a member of the moderate-risk group, whereas children exposed to increased family-based traumatic events had a greater likelihood of being a member of the high-risk group than of the low-risk group. The high-risk group was more likely to consist of older children and girls as compared to the low-risk group. There were no significant differences across profiles relative to ethnicity, caregiver education, and income. This research may aid in early identification and the distribution of services to youth at risk for trauma exposure and highlight pathways of resiliency.     

Domestic violence counselors and secondary traumatic stress (STS): A brief qualitative report and strategies for support

ABSTRACT

Mental health counselors who provide trauma counseling to domestic violence survivors are exposed to catastrophic stories of danger, physical and emotional vulnerability. As counselors try to assess and treatment plan for and with survivors, they are often deeply affected. For some practitioners, bearing witness to these frightening narratives results in a sympathetic form of trauma known as secondary traumatic stress. This article reports on the findings from a convenience sampling of domestic violence shelter counselors (N = 11). Patterns of emotional reactions emerge as a result of two focus groups. Four themes emerged: 1) hypervigilance, 2) impact on personal life, 3) a shift in worldview and 4) methods of coping.     

The effectiveness of intervention for adolescents exposed to domestic violence

The purpose of this study is to evaluate the effectiveness of a 10-week group intervention for adolescents who were exposed to domestic violence in their home, and compare behavioral and emotional symptoms between adolescents with direct or indirect exposure to domestic violence. Participants of the group intervention (N = 32) reported an increase in knowledge of domestic violence based on quiz scores of pre- and post-tests. Compared to those without direct exposure to domestic violence, the participants that were directly exposed to domestic violence presented greater symptoms in the subscales of the Child Behavioral Checklist and the Revised Children's Anxiety and Depression Scale. Such findings are discussed along with previous literature. The study also discusses limitations related to internal and external validity threats and suggestions for future replication of the group intervention toward adolescents who were exposed to domestic violence and the related program evaluation.     

“I’d rather injure somebody else than get injured”: An introduction to the study of exposure to physical violence among young people experiencing homelessness

ABSTRACT

Homeless young people are at risk for a range of negative health and behavioral outcomes, and they commonly report exposure to physical violence, as both perpetrators and victims. Semi-structured interviews focusing on exposure to physical violence were conducted with 18 homeless young people in Victoria, Australia. Results showed perpetration of physical violence occurred as a form of self-protection. Painful experiences of physical victimization were also described. Injuries were sustained as a result of both physical violence perpetration and victimization. Results suggest an important duality exists between homeless young people’s acceptance of exposure to physical violence as normal and requiring emotional detachment at the time of its occurrence, and later reflection about exposure to physical violence with emotional engagement and problematizing the necessity of normalization and detachment. Shame, stigma, and unequal power relationships were described in relation to interactions with health professionals. Future research exploring violence as a response to vulnerability and subsequent feelings of shame and stigma in homeless young people is especially warranted.     

Vicarious traumatization,secondary traumatic stress,and burnout in sexual assault and domestic violence agency staff

This study investigated three occupational hazards of therapy with trauma victims: vicarious trauma and secondary traumatic stress (or "compassion fatigue"), which describe therapists' adverse reactions to clients' traumatic material, and burnout, a stress response experienced in many emotionally demanding "people work" jobs. Among 101 trauma counselors, client exposure workload and being paid as a staff member (vs. volunteer) were related to burnout sub-scales, but not as expected to overall burnout or vicarious trauma, secondary traumatic stress, or general distress. More educated counselors and those seeing more clients reported less vicarious trauma. Younger counselors and those with more trauma counseling experience reported more emotional exhaustion. Findings have implications for training, treatment, and agency support systems.     

Gun violence exposure and trauma among rural youth

This study compared rural youth exposed to gun violence and rural youth not exposed to gun violence on a number of variables: anger, anxiety, dissociation, depression, posttraumatic stress, total trauma, violent behavior, parental monitoring, and levels of violence in the home, school, and community. One-fourth (25%) of the rural youth in this study reported having been exposed to gun violence at least once. Youth exposed to gun violence reported significantly more anger, dissociation, posttraumatic stress, and total trauma. In addition, youth exposed to the violence of guns reported significantly higher levels of violent behaviors and exposure to violence in other settings and also reported lower levels of parental monitoring. The present study contributes to the growing body of literature addressing the stereotype that rural communities are not immune to the violence of firearms. This stereotype acts as a barrier to mental health practice, research, and policy issues in rural communities.     

Exposure to Economically Abusive Tactics Among Adolescent Girls in the Child Welfare System

Economically abusive tactics (EAT), including financial exploitation, economic control, and employment sabotage, have been increasingly identified in intimate relationships. Negative outcomes include increased material hardship, increased depression, and co-occurrence with physical and emotional abuse. However, there is no known research on adolescent exposure to EATs, or its relationship with other well-being indicators. This exploratory study examined the extent of witnessing EAT among adolescent girls involved in child welfare, along with relationships between witnessing EAT and exposure to physical violence, risk of mental health challenges, and current financial self-efficacy. Interviews were conducted with 105 girls ages 12–19. Results indicated that nearly half witnessed moderate to high EATs. Rates of EATs were significantly higher among girls who witnessed physical violence. At the bivariate level, witnessing EATs was correlated with increased rates of physical and emotional abuse, physical neglect, and number of types of trauma, as well as higher levels of depression and PTSD and decreased financial self-efficacy. Implications include the need for measurement refinement, screening, prevention, and intervention for child welfare-involved girls, and continued research regarding EAT exposure.     

Keeping safe: teaching undergraduate social work students about interpersonal violence

While most social work graduates will not practice in organizations specializing in the threat or aftermath of violence, they will encounter clients affected by interpersonal violence and trauma in almost all fields of practice. Therefore, the social work curriculum should provide students with the knowledge and skills necessary to work with these clients. In developing a suitable curriculum it is important to be mindful of the adverse reactions students might experience when exposed to traumatic material, especially those who have experienced prior trauma. This article discusses a third-year social work course that examined social work interventions in response to interpersonal violence, with a focus on sexual assault and domestic violence. It describes four “safety strategies” implemented in 2010; (a) ongoing recognition of, and education about, self-care and vicarious trauma, (b) development of a supportive culture in the classroom, (c) accessible avenues of personalized support and debriefing, and (d), providing transparent and diverse curriculum. Finally, it draws from relevant research and student feedback to discuss the strengths and limitations of each “strategy.”     

Factors associated with emotional distress and suicide ideation among international college students

Abstract

Objective: To identify risk and protective factors associated with greater emotional distress and suicide ideation among international college students. Participants: International students (n?=?435) from two Midwestern and two Southeastern universities in the US. Methods: Online surveys were administered that measured emotional distress, past-year suicide ideation, entrapment, cultural stress, family conflict, perfectionism, ethnic discrimination, interpersonal needs, ethnic identity, and cultural sanctions against suicide. Results: In final linear regression analyses, higher levels of entrapment, unmet interpersonal needs, and ethnic discrimination were significantly associated with increased emotional distress. Only unmet interpersonal needs remained significantly associated with greater past-year suicide ideation in a multivariate regression analysis. Conclusions: Clinicians working with international students and prevention programmers targeting this population should address students’ perceptions of entrapment, ethnic discrimination, and especially unmet interpersonal needs in efforts to decrease or prevent students’ feelings of emotional distress and suicide ideation.     

Obstacles to victims' cooperation with the criminal prosecution of their abusers: the role of social support

Over the last 20 years, diminishing tolerance for domestic violence has triggered significant criminal justice reforms designed to facilitate the prosecution of abusers. Prosecutors, for example, have adopted policies requiring that cases go forward even if the victim later has second thoughts. Although increasingly common, these "no drop" policies reflect a profound irony about domestic cases that is well known but little understood: the most formidable problem in prosecuting such cases is often the victim's own unwillingness to bring the abuser to justice. This prospective study explored a range of factors potentially predictive of domestic violence victims' cooperation with the prosecution of their abusers. Although the study focused on interpersonal and institutional social support, it also investigated the influence of violence severity, victim demographic factors, and victim mental health characteristics, including the presence of depressive symptoms, emotional dependence on the abuser, and substance abuse. Findings showed that tangible support, severity of violence in the relationship, and the presence of children in common with the abuser all significantly predicted victims' cooperation with the prosecution of their abusers. Substance abuse significantly predicted victims' noncooperation with prosecution. The research and policy implications of these findings are discussed.     

Development of a framework for classifying threat and neglect in childhood: A qualitative study

Quantification of childhood adversity has typically involved a cumulative risk approach in which total number of discrete adversities serves as an index of overall risk. However, this approach fails to account for the growing evidence of differential outcomes following exposure to childhood adversities. An alternative approach adopts a dimensional perspective, with growing evidence for distinct developmental impacts associated with exposure to threat (violence/abuse) and deprivation (neglect). This study developed a framework for the classification of these dimensions through a thematic analysis of health practitioners' views and accounts of different forms of childhood adversity. Ten health practitioners experienced in working with children with challenging behaviours and neurodevelopmental disorders participated in semi-structured interviews regarding definitions and examples of six categories of adversity: physical/emotional/sexual abuse, physical/emotional neglect, and domestic and family violence. The qualitative analysis identified 23 themes across the six categories of adversity, along with two overarching themes regarding ambiguity of classifying exposures and non-specific outcomes of exposures. Themes were integrated to provide a framework and checklist for classifying indicators of exposure to threat and deprivation. The findings offer a framework and checklist for the assessment of threat and deprivation that will allow for further testing of the dimensional risk model.     

Out‐of‐Home Placement of Children Exposed to Violence

There is growing concern about the increasing number of children in the USA who are exposed to community violence and the need to remove some of them from their families. This study examines risk factors for out‐of‐home placement among a large pool of children and adolescents who were referred for general clinical assessment following exposure to violence and/or psychological trauma in their communities or homes. Children with greater familial and environmental support and children exposed to incidents involving a non‐parental personal threat were associated with a significantly lower risk of out‐of‐home placement. A greater likelihood of being placed out of home was associated with older age (adolescents), history of mental health service use, involvement with law enforcement agencies, higher clinical ratings of depression or impaired thought processes, lower clinical functioning and greater exposure to traumatic events. Evidence of maltreatment and a threat to life was associated with 13.6 times greater likelihood of being placed out of the home. This study raises an important issue in respect to the children's past use of mental health service and current symptoms. It is not just the risk of violence but also evidence of psychiatric problem that trigger out‐of‐home placement. Further studies are needed to assess the quality and effectiveness of mental health services provided to children exposed to violence. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau.     

The developmental priority of the evaluative dimension in perceptions of nonverbal cues

Researchers who have attempted to map the basic structure of broad psychological domains (such as interpersonal behavior) have invariably pointed to the importance of the evaluative dimension. It was predicted that sensitivity to such a salient dimension would develop prior to sensitivity to other important but apparently weaker dimensions, such as dominance-submissiveness. The predicted developmental trend was supported in a study of nonverbal decoding. When judging pairs of emotional cues communicated by the face or body and by the tone of voice, younger subjects, compared to older ones, were more likely to notice discrepancies in the degree of expressed positivity than in the degree of expressed dominance.