Victimization and posttraumatic stress disorder among runaway and homeless adolescents

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims.     

Quality of life in workplace trauma victims seeking treatment for posttraumatic stress disorder

Traumatic events at work can have debilitating effects on employees. This pilot study aims to describe the trauma exposure, posttraumatic stress disorder (PTSD) severity, functioning level, and general and work-related quality of life of employees who experienced a workplace trauma and consequently developed PTSD. Forty-four participants with current PTSD were recruited and assessed using semistructured interviews and questionnaires. ANOVAs were performed to assess differences in outcomes between employees from different work settings. Specific types of traumatic events appear to occur in particular types of occupations. Participants manifested severe PTSD, low levels of current functioning, and poor general and work-related quality of life. Overall, these results did not significantly differ between employees in different occupations. Unemployed participants showed poorer outcomes than those who were still working despite their current difficulties. PTSD severity and the presence of comorbid major depression significantly predicted several quality-of-life outcomes. In conclusion, PTSD stemming from workplace trauma appears to have major consequences for employees. Clinical implications are discussed.     

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.     

A follow-up study of posttraumatic stress disorder, anxiety, and depression in Australian victims of domestic violence

Although posttraumatic stress disorder (PTSD), anxiety, and depression are acknowledged consequences of domestic violence, little information is available on the course of recovery over time and factors that may mediate positive outcome. Fifty-nine women were assessed for the presence of PTSD and levels of anxiety and depression at time of shelter residence and again one year later. Results at follow-up indicated a significant reduction in the incidence of PTSD, although a substantial number of women continued to report a range of posttrauma symptoms. There were also significant reductions in the levels of anxiety and depression over the 12-month period. Findings indicated the particular importance of safety and the presence of social support as prerequisites for recovery.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Adverse childhood experiences,post-traumatic stress disorder symptoms,and self-reported stress among traditional and nontraditional college students

Abstract

Objective: To investigate the relationships between adverse childhood experiences (ACEs), post-traumatic stress disorder symptoms (PTSD-S), and self-reported stress among college students. Participants: A total of 236 undergraduate students enrolled in nursing courses participated. Method: Using a correlational design, participants completed questionnaires online. To examine PTSD moderation between ACE and self-reported stress, multiple regression was employed. Stress outcomes were examined using a 4-group variable. Mean differences in stress response between these four groups were examined. Differences in ACE, PTSD-S, and stress response between traditional and nontraditional students were also examined. Results: PTSD-S moderated the relationship between ACEs, and self-reported stress. This indicates that students who report PTSD-S following childhood adversity perceive higher levels of stress. Nontraditional and traditional students differed in their responses to the ICLRE scale. Conclusion: Individuals who report PTSD-S following childhood adversity perceive higher levels of stress later in life. Stress reduction programs may be beneficial for students.     

Folk-healing among Mexican-American families as a consideration in the delivery of child welfare and child health care services

If practitioners in cross-cultural services do not understand traditional health beliefs and practices and find ways to incorporate a compatible approach to them in their work, their clients and patients will go their own ways, sometimes with dire results. Practices among Mexican-American families are described.     

Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder

The current study provides a portrait of emotional-behavioral functioning within a small sample of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD), their partners, and older adolescent and adult children. Veterans, their partners and children reported moderate-low to moderate-high levels of violent behavior. In addition, partner and veteran hostility scores were elevated relative to gender and age matched norms. Partners also reported heightened levels of psychological maltreatment by veterans. Veterans' combat exposure was positively correlated with hostility and violent behavior among children but unrelated to partner variables. Veterans' reports of PTSD symptoms were positively associated with reports of hostility and violence among children, and hostility and general psychological distress among partners. Veterans' violent behavior was also positively correlated with children's violent behavior, but did not yield significant correlations with other child or partner variables. Findings are discussed in relation to prior work and directions for future research are addressed.     

A longitudinal analysis of some risk and protective factors in marijuana use by adolescents receiving child welfare services

The present study sought to identify risk and protective factors in marijuana use by adolescents involved in child welfare services. Longitudinal records of 1797 adolescents were extracted from the National Survey of Child and Adolescent Well-Being data set. The obtained multivariate results from generalized estimating equations showed that an adolescent's likelihood of being a current marijuana user rose with prior lifetime use of the drug and was also associated with out-of-home child welfare services, perceived parental monitoring, perceived closeness to parent, engagement with school environment, and age. Implications for child welfare services are discussed.     

The influence of posttraumatic stress disorder, depression, and sensory processing patterns on occupational engagement: a case study

The purpose of this article is to provide a brief overview of how Posttraumatic Stress Disorder (PTSD), Depression, and Sensory Processing patterns influence occupational engagement, including work performance. Interventions and outcomes of the Sensory Modulation Program and approaches from Cognitive Behavior Therapy (CBT) are reviewed through single case exploration with a 42 year-old woman in outpatient services. The marked increase in occupational engagement and improved work performance in this single case review demonstrates the need for more research on the use of the Sensory Modulation Program and approaches from CBT with populations with PTSD, Depression, and Sensory Processing disorder.     

Peer mentoring services,opportunities, and outcomes for child welfare families with substance use disorders

Peer recovery support services (PRSS) in child welfare are being provided by peer mentors in sustained recovery from substance use disorders (SUD) to parents with acute SUD. Previous retrospective interviews demonstrate that peer mentors engage parents in family-centered systems of care through relationships and empowerment. However, the specific profile of services provided is unknown. Personnel challenges and opportunities for persons in recovery serving as peer mentors are described in the literature without understanding the frequency of both. As enthusiasm for hiring peer mentors grows, it is important to understand the specific services provided, the risks and opportunities associated with hiring individuals in recovery, and the impact of mentor services on outcomes. This knowledge can assist in developing training, implementation guides, policies, job expectations, and program evaluation strategies. This is a prospective study of 28 family mentors providing PRSS services to 783 families with child maltreatment and parental SUD over 8 years in a family-centered integrated program with SUD treatment providers. We describe mentor services overall, during the early engagement period, in rural and urban settings, and test the association between services and child/parent unification status at case closure; we identify the proportion of peer mentors that experienced employment challenges and career advancement opportunities. Results demonstrate the complexity of service provision overall and in differing contexts. Face to face visits with children were associated with greater likelihood of parent/child unification at case closure and 64.3% of peer mentors experienced career advancement opportunities. The implications of these findings are discussed.     

Childhood abuse history,secondary traumatic stress,and child welfare workers

Social workers are exposed to trauma vicariously through the trauma of their clients. This phenomenon, called secondary traumatic stress, vicarious traumatization, or compassion fatigue, presents a risk of negative personal psychological consequences. Based on a sample of 166 child welfare workers and using standardized measures, the study findings document the link between a personal history of primary trauma, childhood abuse or neglect, and the heightened risk for secondary traumatic stress in child welfare workers.     

Women who use violence in intimate relationships: the role of anger, victimization, and symptoms of posttraumatic stress and depression

The present study examines the role of anger and victimization in women's use of aggression in heterosexual intimate relationships. The sample was composed of 108 women, primarily African American, urban, and poor, who had used violence against a partner in the previous 6 months. Path modeling was used to examine the interrelationships among anger, women's aggressive behavior, victimization, childhood abuse experiences, and symptoms of posttraumatic stress and depression. Results revealed that almost all of the women experienced violence from their partners. Greater frequency of victimization from partners and experiences of childhood abuse increased the likelihood that women would use aggression against their partners. Victimization from partners and childhood abuse also increased the likelihood that women would experience symptoms of posttraumatic stress and depression. Women with more symptoms of posttraumatic stress were also more likely to express anger outwardly towards others. Expressing anger outwardly toward others, in turn, predicted an increased likelihood of using aggression against partners.     

Moderating effects of race on internalizing and externalizing behaviors among children of criminal justice and child welfare involved mothers

This study examined whether the influences of multiple maternal criminal justice involvement (MCJI), community adversity, and violence exposure on children's internalizing and externalizing behaviors were moderated by race. The study included 409 children of criminal justice and child welfare involved mothers, ages 5–15 who participated in the National Survey on Child and Adolescent Well-Being (NSCAW). Results indicated that race, defined as Black vs. non-Black, moderated the associations between multiple MCJI and internalizing and externalizing behaviors. Decomposition of the regression effects indicated that non-Black children exposed to multiple MCJI, as compared to non-Black children who were not exposed to multiple MCJI, exhibited significant increases in both internalizing and externalizing behaviors, while Black children who experience multiple MCJI, on average, showed no increases. Similarly, race moderated the association between exposure to community adversity and externalizing behaviors. The decomposition of regression effects indicated that non-Black children who experienced higher levels of community adversity exhibited increases in externalizing behaviors, while Black children showed no increases. Criminal justice and child welfare practice and policy implications are discussed.     

Integrating child welfare, juvenile justice, and other agencies in a continuum of services

This article presents a comprehensive strategy framework for integrating mental health, child welfare, education, substance abuse, and juvenile justice system services. It proposes an infrastructure of information exchange, cross-agency client referrals, a networking protocol, interagency councils, and service integration models. This infrastructure facilitates integrated service delivery.     

Broadening the etiological discourse on Alzheimer's disease to include trauma and posttraumatic stress disorder as psychosocial risk factors

Biomedical perspectives have long dominated research on the etiology and progression of Alzheimer's disease (AD); yet these approaches do not solely explain observed variations in individual AD trajectories. More robust biopsychosocial models regard the course of AD as a dialectical interplay of neuropathological and psychosocial influences. Drawing on this broader conceptualization, we conducted an extensive review of empirical and theoretical literature on the associations of trauma, posttraumatic stress disorder (PTSD) and AD to develop a working model that conceptualizes the role of psychosocial stressors and physiological mechanisms in the onset and course of AD. The proposed model suggests two pathways. In the first, previous life trauma acts as a risk factor for later-life onset of AD, either directly or mediated by PTSD or PTSD correlates. In the second, de novo AD experiential trauma is associated with accelerated cognitive decline, either directly or mediated through PTSD or PTSD correlates. Evidence synthesized in this paper indicates that previous life trauma and PTSD are strong candidates as psychosocial risk factors for AD and warrant further empirical scrutiny. Psychosocial and neurological-based intervention implications are discussed. A biopsychosocial approach has the capacity to enhance understanding of individual AD trajectories, moving the field toward ‘person-centered’ models of care.     

Formal and informal helping in child welfare services: implications for management and practice

The author raises questions about whether and how informal and professional helping networks may work hand-in-hand to help children at risk of harm and families at risk of dissolution.     

Immigrant families and public child welfare: barriers to services and approaches for change

This article describes the results of two focus groups of immigrant parents who recently experienced child protective investigations in New York City. The purpose of this study was: 1) to hear immigrant parents describe their experiences with child welfare services, 2) to identify barriers to services these parents encountered, and 3) advocate for changes in policy, program, and practice so that public child welfare services can effectively address the special needs of immigrant families, children, and youth. Barriers to child welfare services identified by immigrant parents in this study were caseworker's lack of knowledge about immigration status, cultural misunderstanding, and language access issues. Recommendations for addressing these barriers are offered.     

The elusive continuum of child welfare services: implications for minority children and youths

The foster care population is increasingly one of minority children and youths, the product largely of the worsening well-being of our nation's minority families. The obstacles child welfare agencies face in developing a continuum of quality services thus are obstacles to appropriate care for minority children. The author sets forth and defines the problems, and proposes the actions that each requires.