The National Child Traumatic Stress Network

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The National Child Traumatic Stress Network

• The National Child Traumatic Stress Network is
  supported through funding from the Donald J.
  Cohen National Child Traumatic Stress Initiative,
  administered by the Center for Mental Health
  Services (CMHS), Substance Abuse and Mental
  Health Services Administration.

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National Child Traumatic Stress Network Mission
Statement

• The mission of the National Child Traumatic
  Stress Network (NCTSN) is to raise the standard
  of care and improve access to services for
  traumatized children, their families and
  communities throughout the United States.

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Type of Personal Physical Exposure to the WTC
Attack Among NYC Public School Students, Grades
6-12 Ground Zero Compared to the Remainder of
the City(New York City Board of Education, 2002)
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Type of Exposure to Family Member due to the WTC
Attackamong NYC Public School Students, Grades
6-12Ground Zero Compared to the Remainder of
the City (New York City Board of Education, 2002)
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Type of Previous Traumatic Exposure Among NYC
Public School Students, Grades 6-12Ground Zero
Compared to the Remainder of the City (New York
City Board of Education, 2002)
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Range of Traumatic Events

• Trauma embedded in the fabric of daily life
• Child abuse and maltreatment
• Domestic violence
• Community violence and criminal victimization
• Medical trauma
• Traumatic loss
• Accidents/fires

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Range of Traumatic Events

• Humanitarian crises
• Natural and man-made disasters
• Earthquakes
• Floods, mudslides
• Hurricanes
• Tornadoes
• Volcanic eruptions
• Major transportation accidents
• Industrial accidents
• Technological disasters
• Catastrophes of human origin
• Armed conflicts/wars
• Genocide
• Terrorist attacks

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Prevalence of exposure to the range of traumatic
events in the general population of children

• Nationally representative survey of 12-17 year
  old youth reported lifetime prevalence of sexual
  assault (8), physical assault (17) and
  witnessing violence (39) (Kilpatrick, Saunders
  Resick, 1998).
• Longitudinal general population study of children
  and adolescents (9-16 years) in Western North
  Carolina found that one-quarter (25.1)
  experienced at least one potentially traumatic
  event by age 16, 6 within the past three months
  (Costello, Erkanli, Fairbank Angold, in press)

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Rates of Exposure to the Range of Traumatic
Events in School Surveys
Elementary and middle school children in inner
city (n500) 30 witnessed a stabbing, 26
witnessed a shooting (Bell Jenkins,
1993). Middle and Junior High school students
(n2,248) in urban school system 41 reported
witnessing a stabbing or shooting in the past
year (Schwab-Stone et al., 1995).  High School
students (n3,735) in six schools in two states.
Relatively high rates of exposure in the past
year that varied by location and size of the high
school. Males 3-33 reported being shot or
shot at, 6 -16 attacked with knife. Females
Lower reported rates of victimization, higher
rates for sexual abuse or assault (Singer et.
al., 1995).
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Student Exposure-Santana H.S.
(n)
Physically Injured .8 (9)
Shooter Spoke Directly at Me .5 (6)
Directly Witnessed Someone Get Shot 19 (219)
Shooter shot directly at me 4 (43)
Saw Someone Wounded or Killed 39 (452)
Gave First Aid or Support to Injured 2 (22)
Heard Gun Shots but Didnt See Anything 35 (410)
Witnessed First Aid to Injured 9 (100)
Only Saw People Running 18 (205)

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Biological Studies of Child and Adolescent
Traumatic Stress

• Structural brain development
• Neurophysiology
• Neurohormones

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Link between Violence Exposure and Chronic PTSD
with

• Substance Abuse
• Reckless Behavior
• High-risk Sexual Behavior
• Gang Participation
• Disturbances in Academic Functioning

(Kilpatrick, Saunders Resick, 1998)
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Violence and Trauma affects school performance

• Children with life threatening violence exposure
• Lower GPA
• More negative comments in permanent record
• More absences
• Children with Depression and Posttraumatic Stress
  Disorder
• Even Lower GPA
• More absences

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History of either physical or sexual abuse
associated with Higher incidence of early
illness Faster cycling frequencies
Lifetime Axis I and II disorders, including
lifetime history of alcohol and substance
abuse Higher prevalence of medical illness
Pattern of increasing severity of mania in those
who reported history of physical abuse (Early
physical and sexual abuse associated with adverse
course of bipolar illness. Leverich et al., Biol.
Psych., 2000)
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Mental HeaIth Intervention Improves Grades
Improvement in grades significant plt0.05
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General Barriers to Care

• System
• Lack of insurance
• Poor continuity in insurance coverage
• Poor Medicaid reimbursement rates
• Provider shortage
• Lack of provider training in evidence-based
  treatments
• Community
• Residential instability (i.e., homeless, foster
  care children)
• Geographic distance from programs (i.e., rural
  areas)
• Parent / Family
• attitudes, knowledge, and beliefs about signs of
  common mental health problems and mental health
  services for children
• Poverty
• Education
• Poor social support
• Poor family functioning / high stress

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Specific Issues Pertaining to Child and
Adolescent Trauma
Better Education and Training for Parents,
Students, School Personnel, Community Agencies,
Health and Mental Health Practitioners, Law
Enforcement, Child Protective, Child Welfare, and
Victim Witness Staff, and Others Responsible for
the Care and Supervision of Children
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Specific Issues Pertaining to Child and
Adolescent Trauma
-         Better Surveillance and
Screening Inclusion in Medicaid Early Periodic
Screening, Diagnosis, and Treatment Systematic
Screening in Child Service Settings
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Specific Issues Pertaining to Child and
Adolescent Trauma
Expand Resources and Build Capacity for Child,
Adolescent, and Family Trauma Services
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Specific Issues Pertaining to Child and
Adolescent Trauma
- Integration of Child and Adult Trauma Services
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Specific Issues Pertaining to Child and
Adolescent Trauma
-         Improve Funding of Case Managers
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Specific Issues Pertaining to Child and
Adolescent Trauma
Integration of Child and Adolescent Trauma
Evaluation and Treatment Services into Efforts to
Develop Integrated Service Systems
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Specific Issues Pertaining to Child and
Adolescent Trauma
Advantages of Providing School-based Trauma
Related Services
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Specific Issues Pertaining to Child and
Adolescent Trauma
Better Integration of Mental Health Services in
School Crisis and Disaster Preparedness, Response
and Recovery Programs
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Insurance Parity for Childhood Trauma Mental
Health Services Within the Wider Scope of Child
and Adolescent Mental Health Disorders
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The Vision of the NCTSN
The NCTSN will raise public awareness of the
scope and serious impact of child traumatic
stress on the safety and healthy development of
our nations children and families. We will
improve the standard of care by integrating
developmental and cultural knowledge to advance a
broad range of effective services and
interventions that will preserve and restore the
future of our nations traumatized children. We
will work with established systems of care,
including the health, mental health, education,
law enforcement, child welfare and juvenile
justice systems, to ensure that there is a
comprehensive continuum of care available and
accessible to all traumatized children and their
families. We will address the needs of children
across the developmental spectrum, from infancy
through the school-aged years into the beginning
years of young adulthood. We will be a community
dedicated to collaboration within and beyond the
Network to ensure that widely shared knowledge
and skills create a national resource to address
the problem of child traumatic stress.
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Five Foci of Trauma-Grief Focused Intervention

• Traumatic Experience(s)
• Trauma and Loss Reminders
• Traumatic Bereavement
• Adversities and Current Stresses
• Developmental Progression

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National Child Traumatic Stress Initiative
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