Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents

It is consistently recognized that children and adolescents who have repeatedly experienced or witnessed violence are at significant risk for a multitude of lasting difficulties across many domains of functioning. Adolescents in residential settings often have extensive trauma histories and experience profound behavioral, emotional, and interpersonal difficulties. Unfortunately, there are few structured trauma-informed treatments that have been implemented in residential settings, and even fewer that have been evaluated. This article describes the core components of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a manually-guided trauma-informed group treatment, and provides clinical examples within residential facilities for adolescents with emotional and behavioral difficulties and extensive victimization histories. Preliminary data on self-reported emotional, behavioral, and posttraumatic stress symptoms are presented.     

Clinical Considerations for the Treatment of Latency Age Children in Residential Care

Children in the United States are exposed to alarmingly high rates of violence and trauma. Notable are the rates of maltreatment among children and the heightened risk for both out of home placement and an array of developmental, behavioral, and psychosocial sequelae. Despite these risks, little information is available on effective interventions and services designed to address the complex needs of youth in residential treatment settings. To effectively respond to their unique developmental, behavioral, and emotional needs, trauma-informed interventions and services must be provided to support optimal outcomes. To this end, this paper delineates the prevalence of children in residential care secondary to chronic maltreatment and other trauma exposures, identifies behavioral and emotional issues through the theoretical framework of complex trauma, highlights the importance of organizational capacity to deliver trauma-informed services, and describes effective clinical interventions that are often used in residential treatment. Clinical considerations and recommendations are also provided.     

Trauma Severity,Poly-victimization,and Treatment Response: Adults in an Inpatient Trauma Program

The goal of the current study was to evaluate the extent to which abuse history predicted change in treatment in an inpatient setting. Poly-victimization and trauma severity were examined as predictors of treatment response measured by the Trauma Symptom Checklist-40 and the Symptom Checklist-90-R at admission, discharge, and 6-months follow-up. Data from 161 clients of an inpatient trauma treatment program were analyzed using structural equation modeling. Results indicate that level of poly-victimization predicted treatment response from admission to discharge on two of four outcome variables; however, this relationship was not found at follow-up. Further analyses suggest that the difference in treatment response at discharge among clients with higher rates of poly-victimization was an artifact of scores at admission. Trauma severity analyses reveal that differing types of abusive experiences generally did not predict treatment response. Overall, results demonstrate that this inpatient treatment program is similarly effective for a broad array of patients, including those with a greater number, and higher severity, of victimizations.     

Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Although abundant evidence exists indicating the prevalence of trauma exposure among youth in residential care, few models exist for creating trauma-informed milieu treatment. This article outlines the problem and describes the implementation of Trauma Systems Therapy (TST) in three residential centers. TST is unique in emphasizing youth emotions and behaviors as well as the role a distressed or threatening social environment may play in keeping a traumatized youth in a dysregulated state. This dual emphasis makes TST specifically appropriate to implementation in congregate care, focusing assessment and intervention strategies on both clinical treatment and the functioning of the therapeutic milieu itself. Data are reported on incidents of the use of physical restraint; numbers of disrupted foster care placements following discharge from residential treatment; and scores on psychometric measures of children’s functioning and emotion regulation capacity. Knowledge gained through TST implementation in these three residential centers has important implications for developing a model of trauma-informed congregate care.     

分类公示:不动产物权变动的理想模式--兼评《物权法(草案)》

我国在建立物权公示制度这一重大问题上,既要学习和借鉴国外成熟立法,也要对以往体制下形成的各种规范进行整理与总结,还必须考虑本土社会的历史与民众的现实生活。本文提出,我国应尊重包括习惯权利在内的各种现存社会规范,建立不动产物权的分类公示制度,使物权法这部与民众利益密切相关的法律获得民众的广泛认同与遵从。     

Assessing the Latent Factor Association Between the Dysphoria Model of PTSD and Positive and Negative Affect in Trauma Victims from India

The recent release of the DSM-5 comes with the division of posttraumatic stress disorder (PTSD) symptoms across four symptom clusters (American Psychiatric Association, 2013). This division is based on the support garnered by two four-factor models; Emotional Numbing (King et al., 1998) and Dysphoria (Simms et al., 2002) and a five-factor model; Dysphoric Arousal (Elhai et al., 2011). Much debate centered on the validity of the Dysphoria factor as a non-specific factor of PTSD within the Dysphoria model. In line with this, we assessed relations between the four factors of the Dysphoria model (Simms et al., 2002) and positive (PA) and negative affect (NA) in natural disaster victims (N?=?200) from Leh, India, using the PTSD checklist (PCL-S) and Positive and Negative Affect Schedule (PANAS short form). Confirmatory factor analysis was implemented to assess the best-fitting model for both the PCL (PTSD) and the PANAS (affect). Two optimal models (the Dysphoria model and a two-factor model for affect) were subsequently used to assess latent variable associations across constructs. It was hypothesized that differential associations between latent factors would be evident with the Dysphoria factor being highly correlated with negative affect compared to alternative PTSD factors. Significant correlations were found between factors of the Dysphoria model and NA (0.52–0.65, p?<?0.001). Comparing the association of pairs of PTSD factors with NA and PA, Wald’s tests revealed that no single PTSD factor was more related to NA than the other. Avoidance and Hyperarousal factors were correlated with PA. Results are discussed in line with literature questioning Dysphoria factor’s unique association with general distress.     

Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework

This project describes application of an evidenced-based, trauma-informed treatment framework, Attachment, Regulation and Competency (ARC), with complexly traumatized youth in residential treatment. The processes of implementing the ARC model into clinical and milieu programming at two residential treatment programs are described. Particular attention is paid to system-level processes and strategies for embedding ARC in a sustainable manner. Pilot data demonstrated a significant relation between use of ARC and reductions in PTSD symptoms, externalizing and internalizing behaviors, and the frequency of restraints used across programs. Preliminary findings contribute to an emerging empirical basis for the ARC model and are supportive of its clinical utility as a practice in the residential context. Next steps include: a) expanding the study findings by conducting controlled efficacy research, b) examining system level variables as mediators of change, and c) describing the full operation stage of implementation of the ARC framework.     

Enhancing Treatment Outcomes for Male Adolescents with Sexual Behavior Problems: Interactions and Interventions

This exploratory study identifies patterns of multidisciplinary interactions and interventions that aim to improve outcomes for juvenile sex offenders (JSOs). With a response rate of 63.45% at two major statewide conferences in Texas, data from 336 JSO service providers suggest that interactions among service providers should occur before the delivery of interventions. Factor analyses indicated that Protocol (26%), Collaboration (17%), and Role Clarity (15%) explain 58% of the variance in “Multidisciplinary Interactions,” while Counseling (13%), Treatment Placement (11%), and Self-Discipline (10%) explain 34% of the variance in “Interventions.” Treatment staff preferred the implementation of cognitive and person-centered treatment approaches. Additional research is needed to establish objectivity and increase awareness about the importance of service diversity with a common goal within this multidisciplinary community.     

Adolescents with Psychopathic Characteristics in a Substance Abusing Cohort: Treatment Process and Outcomes

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B. B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL:YV; A. E. Forth, S. D. Kosson, & R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.     

Negative Life Events and Maladaptive Behaviors Among Filipino Adolescents: an Empirical Test of the General Strain Theory

Agnew’s general strain theory has been widely tested in other countries and has received general support from most studies. To date, however, there has been limited empirical test of the theory in the Philippines. Thus, this study aims to test the core theoretical propositions of the theory that link negative life events (strains) to negative emotions that in turn encourage maladaptive behaviors or criminal coping. The study uses the Global School-based Student Health Survey (2011) data on a nationally representative sample of 5920 secondary Filipino students. In general, the results support the general strain theory: negative life events (e.g., violent experiences, discrimination, sexual harassment victimization) encourage maladaptive behaviors (i.e., suicidality, substance use, and truancy), and this link is somewhat mediated or attenuated by depression. Further, conditioning factors such as parental care and supervision, social support, and engagement in physical activities moderate the effects of negative life events and depression on maladaptive behaviors. Contrary to the theory, however, some conditioning factors intensify the effects of strain on truancy. Overall, the current findings support the theory but call for further research and theory building—delinquent acts are diverse behaviors, and thus, each may require a crime-specific model of the general strain theory.     

The Importance of Establishing Reliability and Validity of Assessment Instruments for Mental Health Problems: an Example from Somali Children and Adolescents Living in Three Refugee Camps in Ethiopia

Assessing mental health problems cross-culturally for children exposed to war and violence presents a number of unique challenges. One of the most important issues is the lack of validated symptom measures to assess these problems. The present study sought to evaluate the psychometric properties of two measures to assess mental health problems: the Achenbach Youth Self-Report and the Child Posttraumatic Stress Disorder Symptom Scale. We conducted a validity study in three refugee camps in Eastern Ethiopia in the outskirts of Jijiga, the capital of the Somali region. A total of 147 child and caregiver pairs were assessed, and scores obtained were submitted to rigorous psychometric evaluation. Excellent internal consistency reliability was obtained for symptom measures for children and their caregivers. Validation of study instruments based on local case definitions was obtained for the caregivers but not consistently for the children. Sensitivity and specificity of study measures were generally low, indicating that these scales would not perform adequately as screening instruments. Combined test–retest and inter-rater reliability was low for all scales. This study illustrates the need for validation and testing of existing measures cross-culturally. Methodological implications for future cross-cultural research studies in low- and middle-income countries are discussed.     

Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Implications for a Developmental Trauma Framework

Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child welfare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth exposed to both interpersonal violence and attachment-based (“non-violent”) traumas within the caregiving system had significantly higher levels of affective/physiological, attentional/behavioral, and self/relational dysregulation in addition to posttraumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of functional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children.     

Bushwhacking the Ethical High Road: Conflict of Interest in the Practice of Law and Real Life

A long‐standing scholarly tradition regards professions, in general, and ethics rules, in particular, as “projects” of market control. It is no surprise, critics charge, that in the latest assault on the monopoly of the American legal profession–waged by multidisciplinary professional service firms–lawyers are hiding behind their ethics rules to protect their turf. In this article, I report on an extensive empirical study of conflict of interest in private legal practice and look comparatively at other fiduciaries, among them, accountants, psychotherapists, physicians, journalists, and academics. I investigate the role of ethics rules that seek to insure fiduciary loyalty in structuring the delivery of services. How does social and institutional change, roiling the fiduciary world, threaten disinterestedness and loyalty and how, if at all, do fiduciaries respond? How is the regulation of conflict of interest accomplished? Where are the conflicts rules most likely to be honored or ignored? What incentive structures encourage compliance? What are the costs and unexpected consequences of compliance? What is foregone? And is it all worth it? In what might come as a surprise to many, I find that the legal profession takes conflict of interest more seriously than many of the rest of us. As the title implies, legal practitioners largely travel alone, bushwhacking through the underbrush snarling the ethical high road. As critical scholarship predicted, lawyers do enjoy a monopoly at the end of the road. But this monopoly is achieved, not by restraint of trade or some other artifice or stratagem of market control, but by lack of competition. It seems that no one else is trudging alongside the lawyers. Lawyers are not necessarily more ethical than the others; they just behave more ethically–at least with respect to conflict of interest. The question is why. And what difference does it make?     

Play to the Whistle: A Pilot Investigation of a Sports-Based Intervention for Traumatized Girls in Residential Treatment

Adolescents in residential treatment settings have symptoms that prevent them from participation in normal youth activities, which in turn prevent development of social skills and competencies. A sports-based intervention called “Do the Good” (DtG) was designed for this population using trauma-informed treatment principles. This paper describes the intervention model and presents outcome data. A total of 88 female residential students aged 12 to 21 participated, including 62 students voluntarily enrolled in the sports league and 26 treatment-as-usual (TAU) comparisons. Positive behaviors (e.g., helping peers, perseverance) during games were observed and coded for sports league participants and their coaches. Mental health charts of DtG and TAU participants were reviewed for behavior and symptoms prior to program participation, and again post-program. Girls in the sports league exhibited reductions in restraints and time-outs, as well as internalizing and externalizing symptoms. These data provide evidence that sports-based interventions present a promising adjunctive approach for traumatized youth.     

Exposure to Intimate Partner Violence,Psychopathology, and Functional Impairment in Children and Adolescents: Moderator Effect of Sex and Age

This work examines the moderator effect of sex and age on the relationship between different types of exposure to intimate partner violence (IPV) and child psychopathology and functional impairment. One hundred and sixty-six Spanish children aged 4 –17 years exposed to intimate partner violence were assessed using a diagnostic interview and other instruments for the measurement of psychopathology and functional impairment. Participants were classified in three groups according to the degree of exposure: witness (N = 77), involved (N = 63) and victim (N = 26). According to mothers’ self-reports and mother-child combined information, boy victims of IPV showed more mood disorders than involved or witness boys. There were no other moderator effects of either sex or age. The effect of exposure to intimate partner violence among children was not dependent, in general, on the child’s sex or age, and this has important implications for the assessment, treatment, and prevention of children’s exposure to IPV.     

Residential Stability and Trust in the Police: an Understudied Area of Police Attitudinal Research

American Journal of Criminal Justice - Residential in/stability has been observed to influence several behavioral outcomes such as mental health, child abuse, adolescent substance uses and...     

MMPI-2 profiles in civilian PTSD: an examination of differential responses between victims of crime and industrial accidents

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with chronic pain (N = 40). Significant differences were seen in profiles between the PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.