Cameo Borntrager

A Case Series: Cognitive-Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children

Two case studies are presented to demonstrate that children who experience trauma-related nightmares may benefit from cognitive-behavioral therapy for this sleep problem. The treatment was adapted from the empirically supported adult treatment for chronic trauma-related nightmares: exposure, relaxation, and rescripting therapy (ERRT). Pretreatment and posttreatment nightmare frequency and severity were measured in addition to subjective nightmare-related distress, behavioral problems, sleep quality and quantity, and symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression. Improvement in nightmare and sleep disturbance frequencies were found as well as reductions in parents’ reports of child behavior problems. This study provides preliminary support for the use of ERRT with children.

Relations Among Gender, Violence Exposure, and Mental Health: The National Survey of Adolescents

Using a nationally representative sample of 4,008 adolescents, this study examines gender differences in violence exposure, major depressive episode (MDE) and posttraumatic stress disorder (PTSD), and characteristics of violence incidents. It was hypothesized that there would be gender differences in the types of violence exposure reported and in the prevalence of MDE and PTSD and that gender would moderate the relationship between violence exposure and mental health outcomes. Results indicated significant gender differences in rates of violence exposure, PTSD, and MDE. Additionally, gender was a moderating variable in the relation between sexual assault and PTSD, but not in the other violence exposure?mental health relations examined. It thus appears that the pathways for developing PTSD may be different for male and female victims of sexual abuse. Implications for interventions and future research are discussed.

Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care.

OBJECTIVE This article reports outcomes from the Child STEPs randomized effectiveness trial conducted over a 2-year period to gauge the longer term impact of protocol design on the effectiveness of evidence-based treatment procedures. METHOD An ethnoracially diverse sample of 174 youths ages 7- 13 (N = 121 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, or disruptive behavior were treated by community therapists randomly assigned to 1 of 3 conditions: (a) standard, which involved the use of 1 or more of 3 manualized evidence-based treatments, (b) modular, which involved a single modular protocol (Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems; MATCH) having clinical procedures similar to the standard condition but flexibly selected and sequenced using a guiding clinical algorithm, and (c) usual care. RESULTS As measured with combined Child Behavior Checklist and Youth Self-Report Total Problems, Internalizing, and Externalizing scales, the rate of improvement for youths in the modular condition was significantly better than for those in usual care. On a measure of functional impairment (Brief Impairment Scale), no significant differences were found among the 3 conditions. Analysis of service utilization also showed no significant differences among conditions, with almost half of youths receiving some additional services in the 1st year after beginning treatment, and roughly one third of youths in the 2nd year. CONCLUSIONS Overall, these results extend prior findings, supporting incremental benefits of MATCH over usual care over a 2-year period.

From distal to proximal: routine educational data monitoring in school-based mental health

Research and practice in school-based mental health (SBMH) typically include educational variables only as distal outcomes, resulting from improvements in mental health symptoms rather than directly from mental health intervention. Although sometimes appropriate, this approach also has the potential to inhibit the integration of mental health and schools. This paper applies an existing model of data-driven decision-making (Daleiden, E., & Chorpita, B.F. (2005). From data to wisdom: Quality improvement strategies supporting large-scale implementation of evidence based services. Child and Adolescent Psychiatric Clinics of North America, 14, 329–349) to detail how SBMH can better integrate routine monitoring of school and academic outcomes into four evidence bases: general services research evidence, case histories, local aggregate and causal mechanisms. The importance of developing new consultation protocols specific to data-driven decision-making in SBMH as well as supportive infrastructure (e.g. measurement feedback systems) to support the collection and use of educational data is also described.

Measuring Trauma: Considerations for Assessing Complex and Non-PTSD Criterion A Childhood Trauma

The current definition of a traumatic event in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5; American Psychiatric Association, 2013) may be too narrow to describe the myriad of difficult childhood experiences. Furthermore, youth may develop a distinct pattern of symptoms in relation to complex or multiple childhood trauma experiences, the proposed developmental trauma disorder (DTD; B. A. van der Kolk, 2005) We developed and utilized a new measure, the Potentially Traumatic Experiences Questionnaire (PTEQ), to assess patterns in childhood trauma exposure. We used 2 item formats (open ended vs. closed ended) in order to explore potential differences in reporting. Furthermore, we assessed for symptoms associated with DTD following exposure to complex childhood trauma in a sample of adolescents. Participants were 186 adolescents ages 18 and 19 years old who were asked to report retrospectively on their difficult childhood experiences. The results showed that participants reported multiple events that would not be considered traumatic according to DSM–5 Posttraumatic Stress Disorder Criterion A, and those who completed the PTEQ with closed-ended items reported more differentiated trauma types than participants who completed the open-ended questionnaire. Also, participants who reported multiple or chronic events were more likely to endorse symptoms associated with DTD. This study has implications for the diagnosis and treatment of complex trauma experiences in youth.

Secondary traumatic stress in school personnel

Although research has examined secondary traumatic stress (STS) among mental health workers, no studies have systematically addressed STS among public school personnel. Given the amount of time children spend in school (7–8 h per day) and high national estimates of youth trauma exposure, this line of inquiry is warranted. Participants included 229 school staff members across six schools in the northwestern USA. Results indicated that school staff reported very high levels of STS, despite also deriving satisfaction from doing their job well at levels that approximate national averages of job satisfaction. Their levels of job burnout are remarkably average. Although individuals working in mental health receive training in recognition of STS in self and colleagues, and are provided with STS referral, mitigation, and treatment opportunities on the job, no opportunities such as these are routinely provided for school personnel. Implications and recommendations for such programs are discussed.

Comparison of Racial Groups on Trauma and Post-Trauma Functioning

Abstract A paucity of literature exists on racial/ethnic differences in post-trauma functioning on samples other than combat veterans. Overall, the results of this literature are unclear in terms of the nature and direction of differences in trauma exposure and post-trauma functioning. In the present study, African American and Caucasian treatment seeking women were assessed on structured clinical interviews and self-report measures. Results indicated no differences in overall degree of trauma exposure. In terms of mental health variables, Caucasians reported greater distress on several measures and were more likely to be diagnosed with post-traumatic stress disorder. African Americans reported more sibling sexual abuse, multiple incidents of abuse, and more acquaintance physical abuse. The finding that Caucasian participants reported greater distress is dissimilar to most other published data. Potential explanations for these findings are discussed.

Technology in Child and Adolescent and School Mental Health: A Look at Today and Tomorrow

Technological applications are increasingly being used in mental health promotion and intervention with children, adolescents and adults. This article describes various forms of technology and their application to school mental health promotion, either as the primary method of counseling or as a supplement to traditional mental health counseling. Technology applications are reviewed for their role in promotion/intervention with autism spectrum disorders, depression, anxiety and other behavioral or emotional disabilities. The article culminates in a discussion of considerations and issues for practitioners involving the use of technology in child and adolescent and school mental health promotion.