[Show abstract][Hide abstract] ABSTRACT: This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.
[Show abstract][Hide abstract] ABSTRACT: Recognition of the nationwide high prevalence of psychological trauma in children and adolescents, combined with increasing awareness of the far-reaching adverse consequences of childhood trauma, have led to calls to develop a trauma-informed mental health workforce. We describe the initial pilot test of the Core Concepts portion of the Core Curriculum on Childhood Trauma, as conducted in a large graduate school of social work. The Core Curriculum uses detailed case vignettes of trauma-exposed youth and families, combined with problem-based learning methods, to promote two primary learning aims: (a) to enhance the development of foundational trauma-related conceptual knowledge, and (b) to accelerate the acquisition of trauma-informed clinical reasoning and clinical judgment. Vignettes are presented in segments to simulate gathering, organizing, drawing meaning from, and making decisions based on information in professional practice. After each segment, the facilitator helps learners to summarize relevant facts, develop hunches and hypotheses, identify learning issues, and plan next steps. The Curriculum was very favorably received by students and was associated with marked increases in self-efficacy in applying the Core Concepts to work with trauma-exposed youth and families. We discuss ways in which the Curriculum can be used, especially as a foundation for training in specific evidence-based treatment protocols, to help prepare a national mental health workforce capable of implementing trauma-informed evidence-based practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychological Trauma Theory Research Practice and Policy 08/2011; 3(3):243-252. DOI:10.1037/a0025039 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).
Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs).
For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.
The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.
Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.
[Show abstract][Hide abstract] ABSTRACT: A prenatal intervention designed to prevent the onset of major depressive episodes (MDEs) during pregnancy and postpartum was pilot tested at a public sector women’s clinic. The Mamás y Bebés/Mothers and Babies Course is an intervention developed in Spanish and English that uses a cognitive-behavioral mood management framework, and incorporates social learning concepts, attachment theory, and socio-cultural issues. The four goals of this project were to develop the intervention, assess its acceptability, test the feasibility of conducting a randomized trial with public sector patients, and obtain estimates of its effect size. Forty-one pregnant women at high risk for developing MDEs were randomized to the Mothers and Babies Course (n = 21) or a comparison condition (n = 20). Assessments occurred during pregnancy and at 1, 3, 6, and 12 months postpartum. Differences in terms of depression symptom levels or incidence of MDEs between the two groups did not reach statistical significance in this pilot trial. However, the MDE incidence rates of 14% for the intervention condition versus 25% for the comparison condition represent a small effect size (h = 0.28) that will be further examined in a larger scale study. The intervention was well received by the participants and implementation of a randomized trial appeared quite feasible as indicated by our follow-up rate of 91% at 12 months. Implications for the continuing development of preventive interventions for perinatal depression are discussed.
Cognitive and Behavioral Practice 02/2007; 14(1-14):70-83. DOI:10.1016/j.cbpra.2006.04.021 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the durability of improvement in child and maternal symptoms 6 months after termination of child-parent psychotherapy (CPP).
Seventy-five multiethnic preschool-age child-mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. Children were 3 to 5 years old. Follow-up assessments were conducted 6 months after the end of a 1-year treatment period. Mothers completed the Child Behavior Checklist and the Symptom Checklist Revised to assess child's and mother's symptoms.
For treatment completers, general linear model (GLM) repeated-measures analyses support the durability of CPP with significant group x time interactions for children's total behavior problems and mothers' general distress. Intent-to-treat analyses revealed similar findings for children's behavior problems but were not significant for maternal symptoms.
The findings provide additional evidence of the efficacy and durability of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers.
Journal of the American Academy of Child & Adolescent Psychiatry 09/2006; 45(8):913-8. DOI:10.1097/01.chi.0000222784.03735.92 · 7.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Treatment outcome for preschool-age children exposed to marital violence was assessed, comparing the efficacy of Child-Parent Psychotherapy (CPP) with case management plus treatment as usual in the community.
Seventy-five multiethnic preschool mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. CPP consisted of weekly parent-child sessions for 1 year monitored for integrity with the use of a treatment manual and intensive training and supervision. Parents completed the Child Behavior Checklist and participated in the Structured Clinical Interview for DC:0-3 to assess children's emotional and behavioral problems and posttraumatic stress disorder (PTSD) symptoms. Mothers completed the Symptom Checklist-90 and the Clinician Administered PTSD Scale interview to assess their general psychiatric and PTSD symptoms.
Repeated-measures analysis of variance demonstrated the efficacy of CPP with significant group x time interactions on children's total behavior problems, traumatic stress symptoms, and diagnostic status, and mothers' avoidance symptoms and trends toward significant group x time interactions on mothers' PTSD symptoms and general distress.
The findings provide evidence of the efficacy of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers.
Journal of the American Academy of Child & Adolescent Psychiatry 01/2006; 44(12):1241-8. DOI:10.1097/01.chi.0000181047.59702.58 · 7.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to identify subgroups of pregnant women at imminent (1 year) risk for major depressive episodes. Participants were 84 low-income, predominantly Mexican women using public sector obstetrics services who participated in monthly interviews during pregnancy and up to 6 months postpartum. Participants were designated a priori as “more vulnerable” or “less vulnerable” to future perinatal depression based on evidence of mood regulation problems defined as (a) a self-reported history of major depressive episodes, (MDE) and/or (b) high current depressive symptom scores on a continuous depression scale. Two definitions of a major depressive episode based on meeting 2 or 3 DSM-IV MDE criteria, were used to measure the incidence of a new major depressive episode. Results suggest that more vulnerable groups (i.e., with the greatest mood regulation problems) had a higher incidence of major depressive episodes than less vulnerable groups. Implications for screening and developing preventive interventions for postpartum depression are discussed.
[Show abstract][Hide abstract] ABSTRACT: This paper argues that research on preventing major depression in women should be a national priority. We highlight the following points: (a) the prevalence of major depression is double the rate in women than in men; (b) the incidence of major depression in women increases drastically during adolescence; (c) women who develop major depression during pregnancy and postpartum period are more likely to have recurrent episodes during the next 5 years and beyond, and their babies are more likely to develop cognitive, social, and mood problems; and (d) clinical depression is related to many other major public health problems, including smoking. We list the steps necessary to make progress in depression prevention research and illustrate how this research might proceed by focusing on three populations of women for whom such work ought to be a priority: adolescents, women about to become mothers, and women at risk for smoking. We conclude with specific recommendations for the type of research that will have the most impact and can guide preventive efforts in the next decade. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[Show abstract][Hide abstract] ABSTRACT: This article is a response to Coyne, Thompson, Palmer, Kagee, and Maunsell's (2000) article, “Should We Screen for Depression? Caveats and Potential Pitfalls.” We address four points that we view as central to their argument: (1) current screening measures are inadequate; (2) correct identification of depressed patients does not result in improved clinical outcomes; (3) screening is too expensive; and (4) screening may have harmful negative effects. We discuss the following important issues: (1) screening and prevention are still in the research and development phase; (2) the kindling phenomenon is an important reason to screen; (3) there is a need to focus screening and prevention efforts on ethnic minorities; and (4) high depressive symptoms have a substantial public health impact. Finally, we present reasons why screening is advisable, both for prevention and treatment purposes, and provide our recommendations. Our stance is that, in order for screening and prevention to become practical, they need to be implemented in both research and practice contexts. Therefore, we should make screening for major depression a priority.