Alan Steinberg

Behavioral Health Innovations

Objective: Experiencing traumatic events places children and adolescents at risk for developing posttraumatic stress disorder (PTSD), often leading to adverse mental health consequences. Although well-validated measures of PTSD are available, very brief screening tools are needed to assess PTSD when resources are limited. This study was conducted t...

This book provides a comprehensive overview of the extensive post-disaster mental health recovery program implemented after the 1988 Spitak earthquake in Armenia. It covers the program’s evolution, from the initial acute phase of clinical fieldwork to its expansion as a three-year teaching and training program for local therapists to the building o...

At 1.5 years post-Spitak-earthquake, elderly survivors had significantly less intrusive and more hyperarousal symptoms (e.g., startle, hypervigilance, irritability, insomnia) than younger adults, indicating that treatment for the elderly requires more focus on hyperarousal symptoms (e.g., use of anxiety management techniques). At 1.5- and 4.5-years...

This chapter summarizes the organizational and clinical lessons learned in implementing and conducting a post-disaster recovery program. It underscores the importance of a hierarchical approach with a centralized chain of command. This approach can facilitate recovery by mitigating adversities and removing roadblocks to community recovery. Supporti...

This fascinating book provides a comprehensive overview of the extensive post-disaster mental health recovery program implemented after the 1988 Armenian earthquake. Covering the program's evolution, from the initial acute phase of clinical fieldwork, to its expansion as a three-year teaching and training program for local therapists, to the buildi...

This fascinating book provides a comprehensive overview of the extensive post-disaster mental health recovery program implemented after the 1988 Armenian earthquake. Covering the program's evolution, from the initial acute phase of clinical fieldwork, to its expansion as a three-year teaching and training program for local therapists, to the buildi...

At 1.5- and five-year follow-ups after the Spitak earthquake, there was a significant dose–response relation between earthquake exposure and severity of PTSD and depression. The more severely exposed Spitak group had higher PTSD and depression scores than the less severely exposed group from Gumri. However, at twenty-five years, this relation had d...

This fascinating book provides a comprehensive overview of the extensive post-disaster mental health recovery program implemented after the 1988 Armenian earthquake. Covering the program's evolution, from the initial acute phase of clinical fieldwork, to its expansion as a three-year teaching and training program for local therapists, to the buildi...

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is un...

Objective: This study examined bereavement-related risk markers (number of deaths, cause of death, and relationship to deceased) of mental and behavioral health problems (suicidal thoughts or behaviors, self-injury, depression, posttraumatic stress, and substance use) in a national sample of clinic-referred bereaved adolescents. Method: Particip...

Skills for Psychological Recovery (SPR), is an intervention designed to follow Psychological First Aid (PFA) in the weeks and months following disasters and mass violence events. SPR aims to help survivors gain skills to manage distress and cope with post-disaster stress and adversity. The SPR Field Operations Guide was developed jointly by the Nat...

25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression—ERRATUM - Armen K. Goenjian, Alan M. Steinberg, David Walling, Sheryl Bishop, Ida Karayan, Robert Pynoos

Background There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors. Methods At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate–severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subj...

Aims: The Louisiana Spirit Hurricane Recovery Program was a statewide disaster mental health initiative implemented in response to the 2005 Hurricanes Katrina and Rita. Major components of the program included community-based culturally appropriate outreach strategies, risk screening and triage, and provision of Specialized Crisis Counseling Servic...

Objective: Children and adolescents who experience potentially traumatic events are at risk for developing posttraumatic stress disorder (PTSD). Although psychometrically sound measures are now available to assess these youth, brief tools are currently needed for screening purposes. Two studies were conducted to develop and validate the UCLA PTSD R...

Objective: To describe the test construction procedure and evaluate the internal consistency, criterion-referenced validity, and diagnostic accuracy of the Child/Adolescent Self-Report Version of the UCLA PTSD Reaction Index for DSM-5 (RI-5) across 2 independent samples. Method: Study 1 examined the clarity, developmental appropriateness, accept...

Objective: To evaluate potential differences in therapeutic outcomes between youths who completed a full course of treatment as planned compared to youths who terminated treatment prematurely. Method: Using longitudinal data from the National Child Traumatic Stress Network (NCTSN) Core Data Set, the present study examined demographic characteristic...

Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 cl...

This population-based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM-5 criteria...

Given that an analysis of disposition ascription cannot be made in terms of a simple subjunctive conditional, we present a multiply qualified conditional analysis that places disposition ascription within an implicit fundamental causal conceptual typography within which a disposition ascription is embedded, framed, and understood. By placing the mu...

The severity of posttraumatic stress disorder (PTSD) symptoms is linked to race and ethnicity, albeit with contradictory findings (reviewed in Alcántara, Casement, & Lewis-Fernández, 2013; Pole, Gone, & Kulkarni, 2008). We systematically examined Caucasian (n = 3,767) versus non-Caucasian race (n = 2,824) and Hispanic (n = 2,395) versus non-Hispani...

The present study focused on identifying risk factors for early readmission of patients discharged from an urban community hospital. Retrospective chart reviews were conducted on 207 consecutive inpatient psychiatric admissions that included patients who were readmitted within 15 days, within 3 to 6 months, and not admitted for at least 12 months p...

Dopaminergic and serotonergic systems have been implicated in PTSD. The present study evaluated the association of four catechol-O-methyltransferase (COMT) gene loci, and the joint effect of COMT and tryptophan hydroxylase 2 (TPH2) genes on PTSD symptoms. Subjects included 200 Caucasian Armenian adults exposed to the 1988 Spitak earthquake from 12...

Recent calls to action for competency-based training, evaluation, and credentialing of mental health professionals focus heavily on instilling the knowledge and skills needed for performing evidence-based assessment and treatment. We propose the content of a companion training curriculum in clinical decision-making that reflects the pervasive and i...

This article describes the features and utility of the Trauma History Profile (THP) component of the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS). The THP, which is derived from the Trauma History section of the University of California PTSD Reaction Index for DSM–IV, is a comprehensive tool to assist providers in identifying...

The National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS) is the first national, web-based, data repository designed to answer key questions relevant to the field of child traumatic stress and policymakers. The CDS currently contains comprehensive information on trauma history and standardized assessments on 14,088 children seen betwe...

A substantial body of evidence documents that the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms are linked to such demographic variables as female sex (e.g., Kaplow et al., 2005) and age (e.g., Meiser-Stedman et al., 2008). Considerably less is known about relations between biological sex and age with PTSD's latent factor...

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 w...

We examined the underlying factor structure of the UCLA PTSD Reaction Index (PTSD-RI) using data from 6,591 children/adolescents exposed to trauma, presenting for treatment at any of 54 National Child Traumatic Stress Network (NCTSN) centers. Using confirmatory factor analysis, we tested the 3-factor DSM-IV PTSD model, 2 separate 4-factor models (D...

There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-a...

This chapter provides a review of basic concepts essential to understanding the nature and role of factors that may mediate or moderate the relationship between traumatic stress and a broad range of outcomes. Such intervening factors, including risk, vulnerability, protective, and resilience factors, can be conveniently accommodated within the cate...

The Roots of the Blues in Trauma, Loss, and AdversityTransforming Trauma, Loss, and AdversityThe Blues as Living Oral HistoryTransformation through MusicEmotional Regulation in the BluesThe Creative Reverberation of Traumatic LossThe Blues as a Living, Evolving LegacyNotes

To examine the potential contribution of the serotonin hydroxylase (TPH1 and TPH2) genes, and the serotonin transporter promoter polymorphism (5HTTLPR) to the unique and pleiotropic risk of PTSD symptoms and depressive symptoms. Participants included 200 adults exposed to the 1988 Spitak earthquake from 12 multigenerational families (3 to 5 generat...

The National Child Traumatic Stress Network (NCTSN) is a federally funded child mental health service initiative designed to raise the standard of care and increase access to evidence-based services for traumatized children and their families across the United States. As part of the quality improvement goal, a Core Data Set (CDS) was established to...

In defending the scientific legitimacy of ceteris paribus qualified causal generalizations, we situate and specify the reference of the ceteris paribus proviso within a fundamental causal framework consisting of causal agents, pathways of influence, mediators, moderators, and causal consequences. In so doing, we provide an explication of the refe...

This study examined perceptions of training, supervision, consultation, services provided, and role satisfaction among program personnel (N = 93) providing assistance to children, adults, and families affected by Hurricanes Katrina and Rita through the Louisiana Spirit Specialized Crisis Counseling Services (SCCS) Program. Findings indicated that t...

On April 16, 2007, in the worst campus shooting incident in U.S. history, 49 students and faculty at Virginia Polytechnic Institute and State University (Virginia Tech) were shot, of whom 32 were killed. A cross-sectional survey of 4,639 Virginia Tech students was carried out the following summer/fall to assess PTSD symptoms using the Trauma Screen...

To investigate the course of PTSD, depression, and current quality of life among adolescents 32-months after the 1999 Parnitha earthquake in Greece. The follow-up was conducted among 511 adolescents originally evaluated at 3-months post-earthquake using the UCLA PTSD Reaction Index (PTSD-RI), Depression Self-Rating Scale (DSRS), and Quality of Life...

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 s...

As a consequence of a terrorist attack, children may experience trauma-related internal and external reminders that are directly linked to their physical and psychological health. We assessed PTSD and trauma reminders in 58 school-age children three years after the terrorist attack in Beslan, Russia in 2004, as well as their association with degree...

Psychological First Aid (PFA), developed by the National Child Traumatic Stress Network and the Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, has been widely disseminated both nationally and internationally, and adopted and used by a number of disaster response organizations and agencies after major catastrophic...

A substantial number of children and families experience emotional difficulties in the aftermath of disasters and terrorist events. Only recently has training in disaster preparedness and response been systematically incorporated into the curricula of mental health disciplines. The goal of the Child & Family Disaster Research Training & Education P...

Disaster mental health is a burgeoning field with numerous opportunities for professional involvement in preparedness, response, and recovery efforts. Research is essential to advance professional understanding of risk and protective factors associated with disaster outcomes; to develop an evidence base for acute, intermediate, and long-term mental...

Please note: I cannot publish this manual directly, nor can I send copies privately to any person or organization. There is an established procedure that must be followed. If you are interested in learning more about how to obtain a copy, please contact Dr. Melissa Brymer at MBrymer@mednet.ucla.edu. Thank you for your interest--Christopher Layne Ph...

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) should ensure systematic attention to age-specific manifestations and selective modifications of the diagnostic criteria for posttraumatic stress disorder (PTSD) among children and adolescents. The authors propose developmental refinements to the conceptual framework f...

Conducting research in the aftermath of disasters is complicated by chaotic conditions, competing priorities, and resource constraints, and raises a variety of ethical concerns. Ultimately, research should extend our understanding of the impact of disasters on children, families, and communities and translate findings into improved services and pub...

To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity. A total of 127 war-exposed a...

We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20,000 adult tsunami survivors by analyzing survey data from coastal Aceh and North Sumatra, Indonesia. A population-representative sample of individuals interviewed before the tsunami was traced in 2005 to 2006. We constructed 2 scales measuring PTSR by us...

Mental health practitioners are often called upon to provide services to children, adolescents, and families in the aftermath of traumatic experiences such as child neglect, sexual or physical abuse, family/domestic violence, sexual assault, interpersonal violence, school and community violence, serious accidental injury, catastrophic medical illne...

Professional psychologists are called upon to deal with a broad array of crises and traumatic events. However, training and expertise in crisis response varies widely among practitioners, and there has been considerable controversy about the value of widely disseminated mental health crisis intervention protocols that include "debriefing" as an ess...

This article describes the exposure of refugees, and particularly refugee children, to trauma, loss, and severe hardship in their countries of origin, while fleeing to their host countries, and after arrival in the host country. It then discusses acute psychosocial interventions for traumatized children and families, in particular the "Psychologica...

To compare depression and PTSD symptoms of parentally bereaved adolescents and a comparison group after a catastrophic natural disaster. Six and a half years after the Spitak earthquake, 48 parentally bereaved adolescents and a comparison group of 44 subjects with no parental loss were evaluated using the Depression Self - Rating Scale (DSRS) and C...

In this study, the complexity of subjective responses during or immediately after traumatic experiences was explored. Immediate emotional reactions, intense physiological activity, cognitive reaction, and alterations in consciousness were evaluated in relation to current PTSD. The sample consisted of 51 multi-ethnic youth in a middle school. Youth...

Originally published in 2007, this was the first textbook to focus specifically on disaster psychiatry. It brings together the views of international experts to provide a comprehensive review of the psychological, biological, and social responses to disaster, describing evidence-based clinical and service-led interventions to meet mental health nee...

This article promotes integrating assessment and evidence-based practice in the treatment of traumatized children through a review of two newly developed trauma assessment tools: (1) the Child Welfare Trauma Referral Tool (CWT), and (2) Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model (TAP). These tools use pat...

We consider and reject a variety of attempts to provide a ground for identifying and differentiating disembodied minds. Until such a ground is provided, we must withhold inclusion of disembodied minds from our picture of the world.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is un...

This report describes symptoms of posttraumatic stress disorder (PTSD) among a group of Beslan's children (N=22) and their primary caregivers (N=20) 3 months after the children had been taken hostage in their school by a group of terrorists. Attention and memory were also measured. Children and their caretakers showed high levels of ongoing PTSD sy...

Catastrophic disasters are nothing new to the human condition, deeply affecting populations across large regions, often dramatically altering the course of history, from earliest recorded time. After massive trauma, a large segment of the child and adolescent population may experience posttraumatic stress reactions and traumatic grief. As evidenced...

This study evaluated 1) the natural course of posttraumatic stress and depressive reactions among untreated adolescents from two cities in an earthquake zone (Gumri and Spitak) and one at the periphery (Yerevan) who were differentially exposed to the 1988 Spitak earthquake in Armenia and 2) the effectiveness of brief trauma/grief-focused psychother...

This study evaluated the severity of posttraumatic stress and depressive reactions among children and adolescents 3 months after the 1999 earthquake in Ano Liosia, Greece, and additionally assessed the relationship of these reactions to objective and subjective features of earthquake exposure, sex, school level, postearthquake difficulties, death o...

Over the past decade, the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index has been one of the most widely used instruments for the assessment of traumatized children and adolescents. This paper reviews its development and modifications that have been made as the diagnostic criteria for post-traumatic stress dis...

This report describes the cascade of stressful events and secondary life changes experienced by parents in a case of alleged sexual abuse at a day care program. The study evaluated parents' Posttraumatic Stress Disorder (PTSD) symptoms and general psychological responses to the stressful events 4 years after the alleged abuse, and explored predicti...

This study evaluated basal levels and responsiveness to exercise of plasma adrenocorticotropic hormone (ACTH), and serum thyroid stimulating hormone (TSH), growth hormone (GH) and cortisol among adolescents from two differentially exposed groups 6 1/2 years after the 1988 earthquake in Armenia. Severity of total PTSD and Category C and D symptoms w...

This article describes the public mental health approach used to develop and implement a school-based postwar trauma/grief intervention program for adolescents in Bosnia-Herzegovina. This approach includes development of multilateral partnerships with local and ministerial stakeholders, systematic assessment that yields a detailed understanding of...

The present article reviews progress in the field of childhood traumatic stress and presents a developmental model of trauma in children and adolescents that can inform research, evaluation and treatment. Selected research findings from the UCLA Trauma Psychiatry Program are presented regarding the biology of posttraumatic stress disorder (PTSD) am...

This study assessed the prevalence of trauma exposure among middle school students and evaluated the effectiveness of a school-based, trauma- and grief-focused group psychotherapy protocol in treating a subset of students with severe exposure, posttraumatic stress disorder (PTSD), and functional impairment. Using a stratified screening procedure, 8...

This study assessed the prevalence of trauma exposure among middle school students and evaluated the effectiveness of a school-based, trauma- and grief-focused group psychotherapy protocol in treating a subset of students with severe exposure, posttraumatic stress disorder (PTSD), and functional impairment. Using a stratified screening procedure, 8...

This study determined the severity of posttraumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoughts of revenge. Six months after the hurricane, 158 adolescen...

Over the past decade, the UCLA Trauma Psychiatry Program has developed a school-based intervention program for children and adolescents who have been exposed to trauma and/or traumatic loss, and who suffer from chronic distress and related impairments in academic, peer and family functioning. The program includes a systematic method for screening a...

The authors sought to assess the severity and longitudinal course of posttraumatic stress, anxiety, and depressive reactions among two groups of adults differentially exposed to severe and mild earthquake trauma and a third group exposed to severe violence. They also examined interrelationships among these reactions and predictors of outcome and co...

Empirical findings regarding childhood traumatic stress are placed within a developmental life-trajectory model that incorporates a tripartite etiology of posttrauma distress. This approach recognizes an intricate matrix of child-intrinsic factors, developmental maturation and experience, life events, and evolving family and social ecologies. Of ce...