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.

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.

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) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 9%

In smoke/dust

91% 27%

Fled for safety

80% 36% 90% 41% 2% 1% 99% 70%

Problem getting home Smelled smoke post 9/11 Had to move house Any Direct

Ground Zero NYC Remainder

Type of Exposure to Family Member due 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) 12% 10% 8% 6% 7% 9% 8% 11% 4% 2% 2% 1% 1% 1% 0%

Family Member escaped unhurt Family Member hurt Family Member killed Any Family (escaped, hurt or killed)

Ground Zero NYC Remainder

Type of Previous Traumatic Exposure Among NYC Public School Students, Grades 6-12: Ground Zero Compared to the Remainder of the City ( New York City Board of Education, 2002) 70% 60% 50% 39% 40% 30% 20% 10% 11% 15% 28% 23% 29% 19% 27% 0%

Self badly hurt Seen killing/injury Close friend killed Family member killed

3% 5%

Lived in country at war

3% 4%

In major disaster

51% 64%

Any previous trauma

Ground Zero NYC Remainder

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

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

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)

Rates of Exposure to the Range of Traumatic Events in School Surveys

Elementary and middle school children in inner city (n=500): 30% witnessed a stabbing, 26% witnessed a shooting (Bell & Jenkins, 1993).

Middle and Junior High school students (n=2,248) in urban school system: 41% reported witnessing a stabbing or shooting in the past year (Schwab-Stone et al., 1995).

High School students (n=3,735) 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).

Student Exposure-Santana H.S.

Physically Injured Shooter Spoke Directly at Me Directly Witnessed Someone Get Shot Shooter shot directly at me Saw Someone Wounded or Killed Gave First Aid or Support to Injured Heard Gun Shots but Didn’t See Anything Witnessed First Aid to Injured Only Saw People Running % (n) .8 (9) .5 (6) 19 (219) 4 (43) 39 (452) 2 (22) 35 (410) 9 (100) 18 (205)

National Surv e y of Adole sce nts %PTSD as a Function of Life History (N=1,245) Kilpatrick e t. al., 1995

25 20 15 10 5 0 No Violence Direct Assault Witness Only Assault + Witness

Biological Studies of Child and Adolescent Traumatic Stress • Structural brain development • Neurophysiology • Neurohormones

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)

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

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)

15 10 5 0 40 35 30 25 20

Number of Classes Failed (Pre-Post Intervention) UCLA Trauma Psychiatry OCJP Pasadena Project (N=17)

38 13 Progress Report #1 (Week 5) Progress Report #2 (Week 20)

Mean Grade Point Average (Pre-Post Intervention) UCLA Trauma Psychiatry OCJP Pasadena Project (N=17)

2.5

2 1.5

1 0.5

0 1.35

2.12

Progress Report #1 (Week 5) Progress Report #2 (Week 20)

Mental HeaIth Intervention Improves Grades

Change in GPA

Non-traumatized MHI Community 3 2.9

2.8

2.7

2.6

2.5

2.4

2.3

First quarter Fourth Quarter

Improvement in grades significant p<0.05

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

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

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

Specific Issues Pertaining to Child and Adolescent Trauma Expand Resources and Build Capacity for Child, Adolescent, and Family Trauma Services

Specific Issues Pertaining to Child and Adolescent Trauma Integration of Child and Adult Trauma Services

Specific Issues Pertaining to Child and Adolescent Trauma Improve Funding of Case Managers

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

Specific Issues Pertaining to Child and Adolescent Trauma Advantages of Providing School based Trauma Related Services

Specific Issues Pertaining to Child and Adolescent Trauma Better Integration of Mental Health Services in School Crisis and Disaster Preparedness, Response and Recovery Programs

Insurance Parity for Childhood Trauma Mental Health Services Within the Wider Scope of Child and Adolescent Mental Health Disorders

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 nation’s 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 nation’s 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.

Five Foci of Trauma-Grief Focused Intervention • Traumatic Experience(s) • Trauma and Loss Reminders • Traumatic Bereavement • Adversities and Current Stresses • Developmental Progression

National Child Traumatic Stress Initiative Network Sites WA OR CA UT CO MO IL See Other Map OH PA NY ME CT MA DC VA LOS ANGELES NM AL FL Category I - National Center Category II – 2001 Intervention Development and Evaluation Centers Category III – 2001 Community Treatment and Service Centers Category II – 2002 Intervention Development and Evaluation Centers Category III – 2002 Community Treatment and Service Centers