Intergenerational Associations Between Trauma and Dissociation

The purpose of this study was to investigate intergenerational relationships between trauma and dissociation. Short and long term consequences of betrayal trauma (i.e., trauma perpetrated by someone with whom the victim is very close) on dissociation were examined in a sample of 67 mother–child dyads using group comparison and regression strategies. Experiences of high betrayal trauma were found to be related to higher levels of dissociation in both children and mothers. Furthermore, mothers who experienced high betrayal trauma in childhood and were subsequently interpersonally revictimized in adulthood were shown to have higher levels of dissociation than non-revictimized mothers. Maternal revictimization status was associated with child interpersonal trauma history. These results suggest that dissociation from a history of childhood betrayal trauma may involve a persistent unawareness of future threats to both self and children.     

Clinically Significant Trauma Symptoms and Behavioral Problems in a Community-based Sample of Children Exposed to Domestic Violence

This study assessed the associations of characteristics of domestic violence incidents with clinically significant levels of traumatic symptoms and behavioral problems in a socio-economically and ethnically mixed sample of 687 children participating in a community-service program for children witnessing violence. Study predictors included child/family demographic characteristics, type and chronicity of exposure, and child’s perceptions of control over the event and threat to personal safety. Outcomes consisted of traumatic symptoms and behavior problems. Results showed that perceived threat and control were associated with greater odds of clinically significant levels of several trauma symptoms (and behavior problems in the case of perceived threat) after adjusting for effects of demographic factors and violence characteristics. Child co-victimization increased odds of reaching clinically significant levels of traumatic symptoms compared to children who witnessed the event but were not victimized. Female sex and White ethnicity increased odds of specific trauma symptoms and behavior problems. Increasing age reduced odds of some trauma symptoms. Associations between predictors and one outcome measure did not generalize across the other outcome measure. Implications of study findings, and directions for future research are discussed.     

Best Practices for Serving Traumatized Children and Families

This paper highlights the traumatic impact of child abuse and neglect upon children and adolescents who are commonly seen in court systems. In addition to describing prevalence rates of trauma exposure and psychological reactions among traumatized children, it addresses the need for judges and court personnel to work with children and families in a manner that is sensitive to their traumatic experiences and emphasizes the need for these children to receive the very best evidence‐based care available in order to help them more effectively cope and recover from trauma exposure. Cultural issues and model adaptations are covered in relation to the use of evidence‐based practices with children from various cultural and ethnic backgrounds. Specific recommendations are given to help judges and court personnel become better informed about the use of evidence‐based practices for treating child trauma, enabling them to respond more sensitively and appropriately in these cases.     

Traumatized Youth in Residential Treatment Settings: Prevalence, Clinical Presentation, Treatment, and Policy Implications

Children and adolescents with histories of traumatic exposure comprise a substantial portion of youth in residential treatment programs. However, until recently, little has been known about this specific population. Given the well-documented unique treatment considerations for traumatized youth, it is important to understand how the distinct needs of this population factor into the particular residential treatment setting approach. This paper presents a comprehensive overview of the current understanding of this vulnerable youth population, the impact trauma exposure can have on their clinical presentation and response to treatment, and the available empirical research regarding effective intervention strategies. In addition, policy implications specific to traumatized youth receiving treatment in residential settings are discussed.     

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.     

Helping Children in the Child Welfare Systems Heal from Trauma: A Systems Integration Approach

Numerous organizations touch the lives of children and their families following incidents of maltreatment, including family/dependency courts, child welfare agencies, foster parent associations, foster care agencies or substitute care facilities, mental health agencies, and others. The way these organizations work together is critically important. They have the potential to promote child safety and reduce the harmful impact of maltreatment on children, but also, unfortunately, at times their actions may worsen the traumatic experience for children and their families. The National Child Traumatic Stress Network conducted a survey of 53 child‐serving organizations in 10 states, to assess the ways the organizations gather and share trauma‐related information and the basic training about child trauma their staffs receive. The goal was to determine how the various service systems, including the courts, communicate with each other about trauma and the extent to which, alone or in combination, they promote children's healing following traumatic events. The survey results point to a need to improve collaboration on issues associated with child maltreatment and trauma. Judges can be important leaders in bringing about necessary changes. Recommendations for judges and courts are included.     

Vicarious Trauma in Judges: The Personal Challenge of Dispensing Justice

Symptoms of vicarious trauma, coping strategies, and prevention suggestions were investigated with 105 judges. Participants completed a self‐report measure developed for this study. The majority of judges (63%) reported one or more symptoms that they identified as work‐related vicarious trauma experiences. Female judges reported more symptoms, as did judges with seven or more years of experience. In addition, female judges were more likely to report internalizing difficulties, while judges with more experience reported higher levels of externalizing/hostility symptoms. Coping and prevention strategies were multi‐domain (i.e., personal, professional, and societal) and underscored the need for greater awareness and support for judges.     

Trauma,Psychiatric, Substance Use,and Thought Disorders Among Youth in the Juvenile Justice System and How to Deal with Them

The personal stories that youth in juvenile facilities report to their counselors are heartbreaking because they are filled with accounts of excessive trauma resulting from neglect, physical, sexual, and emotional violence perpetrated on these children. Perry found that trauma develops from severe neglect, abuse, and living in terrorizing environments. Trauma changes the neural processing ability within the child's developing brain which can lead to hypervigilance and dysfunctional behavior. ¹ Widom found that children who had been abused or neglected as children have 30% higher arrests as a juvenile and as an adult for a violent offense. ²      

Adolescent Girls’ Use of Avoidant and Approach Coping as Moderators Between Trauma Exposure and Trauma Symptoms

High rates of child maltreatment demand attention, as exposure to child maltreatment substantially increases the risk of developing PTSD. Some evidence exists that the presence of coping skills may reduce the likelihood that victims of childhood maltreatment will develop PTSD (Agaibi & Wilson, Trauma Violence Abuse 6:195–216, 2005). This study examined whether avoidant and/or approach coping skills moderated the relationship between childhood trauma exposure and trauma symptoms among adolescent females with a history of complex trauma. Results suggest that the use of avoidant coping moderates the relationship between trauma exposure and trauma symptoms. More specifically, girls with higher levels of trauma exposure demonstrated lower levels of trauma symptoms if they reported using higher levels of avoidant coping. Clinical implications for these results are discussed.     

Symptom Patterns among Youth Exposed to Intimate Partner Violence

Children and adolescents exposed to intimate partner violence display a broad range of symptoms. We sought to differentiate symptom patterns and predictors of these patterns using a person-oriented approach. Previous cluster analysis research of exposed youth was extended to include youth PTSD symptoms and trauma history. Participants were 74 mothers who had received a police call for domestic violence, and who had a child between 2 and 17 years old. Cluster analysis was used to identify four symptom patterns among exposed youth: Typical, Asymptomatic, General Distress, and Acute PTSD. These patterns were replicated in separate cluster analyses with younger and older participants. Symptom patterns were differentiated by maternal distress, maternal aggression, and youth trauma history, but not by male partner aggression. Implications for assessment and treatment of youth exposed to intimate partner violence, and suggestions for further research, are discussed.     

A Call for Help: Women Offenders' Reflections on Trauma Care

Female prisoners have extensive trauma histories and complex treatment needs that contribute to their criminality, yet trauma screening and treatment is not widespread in prisons. This article examines qualitative data gathered from face-to-face interviews with 31 female offenders in Canadian prisons. Using a grounded theory approach we demonstrate an unmet need for trauma-specific services for female offenders. These services go beyond trauma-informed practice and treat the psychological and behavioral sequelae of trauma exposure (e.g., mental illness and addictions) to facilitate recovery. The findings suggest that women in prison want and need specific treatment for trauma exposure. Integrating trauma-specific services involves a cultural shift within the prison environment that might be achieved by positioning trauma within the risk–need–responsivity model as an additional risk factor for criminality. Although counter to the public health perspective that trauma is a health concern, it is a way to ensure that trauma becomes part of the battery of care in corrections so that the needs of traumatized women are addressed while they are in custody. This was a unique opportunity to learn about what women would like to help deal with their experiences of trauma.     

Trauma and Posttraumatic Stress Disorder Among Substance-Using Women Entering Cook County Jail

In the United States, the number of incarcerated women continues to rise each year, with African American women having the highest incarceration rates. Many women enter prisons and jails with an extensive trauma history, though little is known about the percentage of these individuals suffering from posttraumatic stress disorder (PTSD) and specific trauma exposures they have had based on factors such as homelessness, degree of substance problems, and race. The present study examines a largely African American substance-using population of incarcerated women to determine the impact of various factors on specific traumas reported. We found that individuals reporting symptoms meeting criteria for PTSD had experienced the highest average number of traumas, and those who had ever been homeless also experienced many and varied trauma exposures compared with those who had never been homeless. Higher substance problems were also associated with more trauma exposure. Fewer than 10 percent of the sample met full criteria for PTSD, though those reporting having ever been homeless and those with higher substance problems were significantly more likely to meet all criteria. Results indicate a need to assess previous homelessness as a method for identifying additional trauma exposures and guiding treatment to women's specific needs and trauma profiles.     

Do Not Make their Trauma Your Trauma: Coping with Burnout as a Family Law Attorney

In the field of family law, attorneys frequently expose themselves to highly emotional and traumatized clients. Litigation is by nature a high‐stress occupation, demanding a high level of intellectual and emotional engagement from the contesting lawyers. Adding the burden of inherently distressing content to litigation can impair a lawyer's functioning. The effects are often referred to as “secondary trauma.” This Note proposes that state bar associations should take a more active role in providing mental health support to prevent burnout in family law attorneys by (1) offering voluntary classes to educate attorneys about the dangers of, and ways to cope with, the burnout that comes with working with traumatized clients in family law and (2) organizing support groups among local family law communities.

Key Points for the Family Court Community:
• Claims against family law practitioners account for the third highest percentage of all malpractice claims against lawyers.
• Burnout is a serious problem for family law attorneys.
• Programs sponsored by state bar associations are available and need to be expanded.
• The American Bar Association's Model Rules require that a lawyer shall not represent a client or, where representation has commenced, shall withdraw from the representation of a client if the lawyer's physical or mental condition materially impairs the lawyer's ability to represent the client.
• The unique nature of family law, centered on relationships and emotions, puts family law attorneys at a higher risk for experiencing the effects of secondary trauma than other areas of law.
• Lawyers at risk for secondary trauma can avoid its effects by educating themselves about such effects.

     

PTSD Symptom Trajectories among Mothers Reporting Interpersonal Trauma: Protective Factors and Parenting Outcomes

The childbearing years are further complicated when experiences of interpersonal trauma from childhood and/or adulthood lead to symptoms of posttraumatic stress disorder (PTSD). Maternal symptoms of PTSD over time were examined in relation to supportive adult relationships and parenting experiences. Ninety-five primarily economically disadvantaged mothers reporting exposure to childhood maltreatment and/or intimate partner violence were assessed from pregnancy through 2-years postpartum. Latent class growth analysis of PTSD symptoms indicated a 2-group model: stable low (82%) and moderate dysfunction (18%). The stable low group reported higher levels of support from romantic partners and family members, but not friends, and lower levels of parenting distress compared to the moderate dysfunction group. Results highlight individual variability in adaptation after violence exposure; current support from romantic partners and family members may have helped maintain lower PTSD symptoms for some trauma-exposed mothers. Psychological interventions aimed at reducing the impact of trauma exposure on parenting should consider promoting ongoing social support.     

Maternal Childhood Sexual Trauma and Child Conduct Problems

This study examines multiple pathways by which maternal childhood sexual trauma may be related to the behavioral development of children. Propensity score matching procedures were used to create matched groups (total n?=?204) of mothers who retroactively did and did not self-report childhood sexual trauma in a longitudinal sample of families living in poor, rural communities. Using structural equation modeling, maternal characteristics and behaviors were examined as potential mediators of the relationship between maternal histories of childhood sexual trauma and children’s conduct problems. After controlling for numerous socio-demographic factors, analyses indicate that maternal depressive symptoms, intimate partner violence, and maternal parenting were significant mediators and highlight the lasting impact of childhood sexual trauma on victims and their children.     

Emotion Regulation Mediates the Relationship between a History of Child Abuse and Current PTSD/Depression Severity in Adolescent Females

Although experiencing child abuse (i.e., physical abuse, sexual abuse, exposure to violence) is associated with a variety of mental health difficulties, simple exposure to abuse does not produce symptoms in every individual. The current study explored emotion regulation as a mediator in the relationship between a history of child abuse and symptoms of posttraumatic stress and depression. Adolescent females (ages 11–17 years) were asked to retrospectively report on their exposure to child abuse, current symptoms of PTSD/depression, and emotion regulation abilities. Caregiver report of adolescent emotional difficulties was also obtained. Analyses revealed that child abuse-exposed females, when compared to females without a trauma history, had worse emotion regulation abilities and increased mental health difficulties. Moreover, emotion regulation significantly mediated the relationship between child abuse and all assessed mental health symptoms. These findings extend previous work from adult samples, underscoring the importance of assessing emotion regulation abilities in abuse-exposed youth.     

Domestic Violence and Maternal Reports of Young Children’s Functioning

Maternal reports of 60 preschool-aged children were used to investigate trauma responses to living in households where domestic violence was present. Post-trauma symptoms were measured using developmentally modified criteria based on the Child Behavior Checklist (CBCL). Mothers’ level of anxiety, depression, somatization, and self-reported parenting stress were also assessed. Results suggested that, in addition to clinical levels of Internalizing, Externalizing and Total Problem scores on the CBCL, young children displayed a range of post-trauma symptoms. Mothers reported a high level of violence, and a significant relationship was found between self-reported levels of distress and parenting stress. Parenting stress was found to be the strongest predictor of children’s scores on the CBCL. Although domestic violence alone was not significantly correlated to child outcomes, results indicated that maternal distress adversely impacted on the parent-child relationship. The importance of the child’s relationship with the primary caregiver was discussed. Implications regarding further research, developmentally appropriate diagnostic criteria, and early interventions with the primary caregiver are highlighted.     

Parent–Child Discordance and Child Trauma Symptomatology Throughout Therapy: Correlates and Treatment Response

Children and their caregivers often disagree when reporting on child behavioural and emotional difficulties. But how does parent–child discordance relate to outcomes, particularly among children undergoing trauma therapy? This study examined parent–child discordance in relation to children’s trauma symptoms and therapy outcomes. Participants included 96 trauma-exposed children and their caregivers, who received Trauma-Focused Cognitive Behavioural Therapy. Discordance was calculated using absolute difference scores between child- and parent- reported psychological symptoms. Parent–child discordance, calculated at pre-therapy, post-therapy, and at a six-month follow-up, predicted the severity of children’s posttraumatic stress, dissociation, and internalizing and externalizing difficulties at each respective time-point. Pre-therapy discordance predicted improvements in externalizing behaviours after therapy and at follow-up. Improvements in discordance predicted improvements in trauma-specific symptoms over the course of treatment and at follow-up. The findings underscore how changes in parent–child discordance are related to child trauma symptoms and treatment response. Clinical implications and future directions are discussed.     

The counselor's trauma as counseling motivation: vulnerability or stress inoculation?

Should counselors with interpersonal trauma histories work with similarly traumatized clients? How does the work affect them? Current research is inconsistent. This study examines 101 sexual assault and domestic violence counselors' recalled motivations for trauma work, their reported subjective personal changes, and their secondary and vicarious trauma symptoms and burnout. Counselors motivated by interpersonal trauma report both more symptoms and positive changes (including dealing with their own trauma). Those seeking personal meaning report becoming more hypervigilant and self-isolating. Those saying they learned from clients rate symptoms lower, suggesting stress inoculation. Supervisors of trauma counselors should facilitate learning from clients separately from processing the counselor's trauma.     

Factor structure and reliability of the childhood trauma questionnaire and prevalence estimates of trauma for male and female street youth

This study examines the psychometric properties of the Childhood Trauma Questionnaire short form (CTQ-SF) with street youth who have run away or been expelled from their homes (N = 397). Internal reliability coefficients for the five clinical scales ranged from .65 to .95. Confirmatory Factor Analysis (CFA) was used to test the five-factor structure of the scales yielding acceptable fit for the total sample. Additional multigroup analyses were performed to consider items by gender. Results provided only evidence of weak factorial invariance. Constrained models showed invariance in configuration, factor loadings, and factor covariances but failed for equality of intercepts. Mean trauma scores for street youth tended to fall in the moderate to severe range on all abuse/neglect clinical scales. Females reported higher levels of abuse and neglect. Prevalence of child maltreatment of individual forms was very high with 98% of street youth reporting one or more forms; 27.4% of males and 48.9% of females reported all five forms. Results of this study support the viability of the CTQ-SF for screening maltreatment in a highly vulnerable street population. Caution is recommended when comparing prevalence estimates for male and female street youth given the failure of the strong factorial multigroup model.