Trauma Focused Cognitive Behavioral Therapy with Children of Incarcerated Parents

This paper explores children’s trauma symptoms related to parental incarceration and lays the groundwork for the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) within a clinical community-based setting treating children and adolescents affected by parental incarceration. Children and adolescents who experience parental incarceration are more likely to develop symptoms of post-traumatic stress disorder (PTSD): depression, anger, aggression, and isolating and self-harming behaviors. Although parental incarceration is a known source of trauma, there are no documented studies examining effective clinical treatments to reduce the effects of the trauma experienced by these children and adolescents. Except for children and adolescents affected by parental incarceration, TF-CBT, a promising model for treating and reducing the symptoms of PTSD, has been successfully applied to various populations affected by trauma. Children of incarcerated parents resemble populations treated with TF-CBT in earlier applications. In this paper, we present a case illustration that examines the application of TF-CBT with one child who experienced trauma symptoms related to parental incarceration, while discussing the results of that application and the potential for broader applicability of TF-CBT within community-based organizations that treat the population of children and families affected by parental incarceration.     

Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child–Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implemented with a racially diverse sample of youth ages 3–18 at six agencies. Culturally sensitive adaptations were made to treatment approaches to improve client retention and outcomes. Data analyses revealed no racial differences in retention in the program and no differences in outcomes between minority youth exposed to the intervention and other participants. All three evidence-based treatments were effective in reducing symptoms and improving functioning among minority youth. Implementation issues, including challenges and culturally competent accommodations, are discussed.     

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N = 114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.     

War-related mental health problems of today's veterans: new clinical awareness

1. Veterans of the military conflicts in Iraq and Afghanistan may have been exposed to significant psychological stressors, resulting in mental and emotional disorders. 2. Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and symptoms of increased autonomic arousal. 3. Treatment of PTSD often requires both psychological and pharmacological interventions. 4. In addition to PTSD, other mental disorders may be precipitated or worsened by exposure to combat, including depression, anxiety, psychosis, and substance abuse.     

Evaluating a multiple-family group access intervention for refugees with PTSD

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.     

Statewide dissemination of an evidence-based practice using Breakthrough Series Collaboratives

The emerging field of implementation science has begun to inform the increasing efforts to disseminate evidence-based practices. The Breakthrough Series Collaborative (BSC) model was used to disseminate trauma-focused cognitive behavioral therapy (TF-CBT) across Connecticut over three years. Participants were 179 outpatient clinical staff across 16 community-based agencies that implemented TF-CBT. A total of 588 children and families received TF-CBT. Children completing treatment showed significant reductions in PTSD and depression symptoms. Quantitative and qualitative data about the BSC model are presented. The BSC is a promising approach for dissemination of evidence-based practices, and recommendations for additional research on BSCs and sustainment of evidence-based practices are made.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

The Indochinese Refugees

Cambodian, Laotian and Vietnamese refugees who have come to North American host countries via the South Asian camps have been exposed to many potentially traumatic events and have been submitted to an alienating migration process. A comprehensive analysis of their experience both in refugee camps and North American host countries is facilitated by the use of various stress theories. The stressors of change, acculturation, bereavement and trauma are identified with regard to the migration process of the Indochinese refugees as well as to the pre- and post-migration period. Some implications for practice in social, physical and mental health settings are underlined: in particular a sensitivity to the meaning of physical illness within this population, to the cultural reticence towards mental health consultation, to the possibility of longterm vulnerability to post-traumatic stress disorders and to increasing value conflicts within the family. Intervention experiences both in the South Asian refugee camps and in North American host countries suggests the importance of traditional healers and natural support networks.     

School Counselors Supporting African Immigrant Students' Career Development: A Case Study

School counselors play a critical role in preparing adolescent immigrant students to be college and career ready by attending to the complex variables that promote and inhibit career development. This article provides an illustrative case study of a Somali immigrant student's educational journey to highlight the academic and familial challenges that she encountered while attending U.S. schools. Through this case study, the authors discuss the issues immigrant high school students experience and present culturally responsive practices that school counselors can use to address career development. These culturally responsive practices include developing a strong knowledge of students’ backgrounds and cultures, designing small group interventions that are timely and sensitive to immigrant students’ needs, and strengthening school–family partnerships.     

Posttraumatic Psychological Distress and Resettlement: The Need for a Different Practice in Assisting Refugee Families

Social work practitioners are increasingly confronted with couples and families who have come from war-torn countries. Refugees may have experienced genocide, organized violence, ethnic wars, displacement, and losses of various kinds. Such experiences will often be carried through the post-migratory period and obscure legitimate individual and family processes that are often evaluated through a psychopathology lens. In this context, there is a pressing need to be attentive to refugee situations around the world and to issues related to forced migration and its impact on families. In an attempt to fill the gap in the literature on intervention with refugee families, this article presents two of the most compelling aspects of the refugee experience that can have a lasting impact on families and couples: premigration traumatic events and their potential impact on the refugee resettlement experience, and postmigration social and psychological experiences. The concept of “trauma” is presented within the context of resettlement of asylum seekers and refugees. Key stressors documented as having an impact on the long-term well-being of individuals, families, and communities who have been touched by war and conflict are outlined. Multiple-family group intervention is discussed as one of the promising approaches for helping families cope with pre- and postmigration trauma.     

Culturally Responsive Teaching: What do selected United States elementary school teachers think?

In this paper culturally responsive teaching is viewed as one way of implementing the concept of multicultural education in schools. In recent years, scholars have devoted considerable attention to the importance of aligning classroom experiences with students' home culture as a way of enhancing social, academic and cultural enrichment of all children. This study was, therefore, designed to identify perceptions of teachers toward the importance of culturally responsive teaching in elementary schools in the United States. The responses of 33 teachers were analyzed by using both qualitative and quantitative techniques. The findings of this study, along with a summary and implications for future studies, are presented in this paper. The data analysis clearly indicated that over 96% of the respondents considered culturally responsive teaching to be an important part of working with culturally diverse students. It was significant to note that the way teachers reported their perception toward the importance of culturally responsive teaching matched the manner with which they responded to the characteristics of culturally relevant teaching.     

Refugee Children in Wales: Coping and Adaptation in the Face of Adversity

This article aims to makes a contribution to redressing a methodological and theoretical imbalance in existing research on refugee and asylum‐seeking children. It draws on two qualitative studies from Wales with children and young people. The samples include unaccompanied minors and children living with families as well as both children who are supported in the asylum system and those who have been granted refugee status. The focus on ecological post‐migratory stressors and coping processes that young people identify as being integral to their well‐being and, once granted status, to how they adapt to settlement includes a selective study of some of the sources of resilience referred to in the children's talk. Recognising the interplay between individual and environment leads to a discussion of both personal attributes and collective cultural identities.     

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.     

The Diversity Imperative: Building a culturally responsive school ethos

In the wake of increasing globalization and the growing migration of refugees and asylum seekers from conflict, post-conflict and third world societies, dramatic changes are taking place in the cultural demography of many western European nations. Correspondingly, schools in these countries are experiencing increasing ethnic diversity in their student enrolments and, as such, are facing an imperative that challenges their traditional western, monocultural foundations. In trying to manage this diversity, these schools commonly are ill-equipped to address the different needs of ethnically diverse learners. This paper presents a framework of practical considerations and strategies for pursuing a whole-school approach toward building a culturally responsive ethos in which all students are valued and assured equal opportunities for success.     

A grassroots prototype for trauma-informed child welfare system change

The development of trauma-informed child welfare systems (TICWSs) that advance individual agency practice to target transformation of the system as a whole has been conceptualized but not documented. A grassroots effort to build a TICWS with key participants (e.g., Department of Human Services, Community Mental Health, Family Court, schools) in nine Michigan communities provides a field tested model for implementation. This article described what emerged as the core elements for a TICWS, which includes (1) development and support of a project champion, (2) trauma identification, (3) comprehensive assessment of traumatic impact, (4) evidence based trauma treatment, (5) establishing a common trauma language, and (6) trauma-informed decision-making. Several new instruments for assessing aTICWS are identified. Lessons learned are highlighted for consideration of communities seeking to develop TICWSs.     

Using psychodynamic interventions to engage in trauma-informed practice

In recent years, trauma-informed practice has received increased attention in the social work literature. Although the adoption of trauma-informed practice is necessary for preparing social workers to practice effectively with clients, these frameworks do not necessarily provide social workers with the specific skills for doing so. Therefore, we argue that using interventions grounded in contemporary psychodynamic theory can help transform them into trauma-informed practitioners. Psychodynamic psychotherapy interventions, especially from object relations and self psychology, align with many of the principles of trauma-informed practice (e.g. establishing an atmosphere of safety and acceptance, relying upon relational collaboration). We begin by discussing trauma-informed practice and then discuss how the use of psychodynamic psychotherapy interventions (holding environment, containment, and selfobject transferences) can facilitate the application of trauma-informed principles. We conclude with a case illustration of how to incorporate psychodynamic interventions into trauma-informed practice.     

Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents

This study investigated the prevalence of emotional and behavioral symptoms in unaccompanied refugee adolescents living in Italy; an area which remains under-researched despite the relatively high number of asylum seekers registered in Italy compared to other industrialized countries. The Child Behavior Checklist (CBCL) for 6–18 year-olds was completed by a social worker or parent for each of the 120 participating adolescents; sixty male unaccompanied refugee adolescents and sixty male native Italian adolescents. The paper presents findings that illustrate high levels of emotional and behavioral problems in unaccompanied refugee youth living in Italy. On all components of the CBCL, unaccompanied refugee adolescents were found to present with significantly more problems, as reported by social workers, compared to the Italian group of adolescents. In the light of these results, the importance of interventions and culturally sensitive therapeutic programs for refugee youth is discussed.     

Race and risk behaviors: The mediating role of school bonding

This study tests the hypotheses that school bonding mediates the relationship between adolescents' racial background and key risk behaviors (substance use, failing grades, and fighting). Data sources include an epidemiological survey administered at 50 urban schools to 16,169 students, linked to information about school context (socioeconomic composition, attendance rate, and grade-level). Results indicate that school bonding partially mediates the relationship between race and risk behavior. Findings suggest that culturally responsive efforts to strengthen educational attachment, connection, commitment, and involvement among youth of color may reduce gaps in outcomes that are perceived to be distal from schooling. Further development and testing of multi-level interventions that increase school bonding among youth from non-dominant racial groups are needed.     

War Traumas and Community Violence

SUMMARY

This cross-sectional survey study examined the relationship between exposure to war traumas and community violence and academic, behavioral, and psychological well-being among Khmer refugee adolescents. The 144 adolescents studied were exposed to high rates of violence. One third had symptoms indicative of PTSD and two thirds had symptoms indicative of clinical depression. The number of violent events they were exposed to significantly predicted their level of PTSD, personal risk behaviors, and GPA, but not their level of depression or behavior problems reported at school. Perceived social support made a difference in the lives of these youth and predicted better outcomes. The implications for research and practice are discussed.