Cassandra Kisiel

UNDERSTANDING THE MENTAL HEALTH NEEDS OF CHILDREN AND ADOLESCENTS IN RESIDENTIAL TREATMENT

with the penetration of managed care approaches in child welfare, residential treatment services have come under increased scrutiny. In these circumstances it is critical to understand the clinically indicated use of these expensive interventions. As part of a community-reinvestment strategy of reform within a state child welfare agency, a needs-based assessment of children and adolescents was undertaken. A review of cases revealed that although the level of mental health need for many was significant, a substantial proportion of children in residential placement were not at high levels of risk. On the basis of these data, a process of placement review was designed and implemented for more effective use of residential treatment.

Assessment of Complex Trauma Exposure, Responses, and Service Needs Among Children and Adolescents in Child Welfare

Exposure to multiple, chronic interpersonal traumas, often referred to as complex trauma exposure, can impact several areas of mental health need and functioning. A comprehensive assessment of needs and strengths is essential to making appropriate service recommendations. This study assessed 4,272 youth within the Illinois child welfare system using the Child and Adolescent Needs and Strengths (CANS). A significant proportion of this sample had multiple/chronic caregiver-related trauma. Children with this complex trauma exposure exhibited more traumatic stress and mental health symptoms, risk behaviors, and day-to-day functioning difficulties, and fewer strengths compared to other children. Implications for these findings are discussed in terms of appropriate treatment/service planning and improved diagnostic classification to better capture the complex trauma needs among youth in child welfare.

Changes in self-destructiveness of borderline patients in psychotherapy : a prospective follow-up

Thirty-seven female inpatients with borderline personality disorder were followed prospectively for up to 5 years to assess changes in two forms of self-destructiveness: suicidal behavior/ideation, and self-harm behavior/ideation. It was found that suicidal behavior declined significantly at 1-, 2-, 3-, 4-, and 5-year follow-up; self-harm behavior showed trends but no significant decline over 5 years. Ideation (both suicidal ideation and self-harm) did not decline notably. Three alternate courses of self-harm behavior are identified: “fluctuating,” “consistently low,” and “steadily declining.” The majority of patients fell in the fluctuating category. The fluctuating group showed higher baseline dysphoria than did the consistently low group, while the latter reported higher baseline drug use. Intercorrelations showed that self-harm behavior and suicidal behavior were not associated, nor were suicidal behavior and suicidal ideation. Clinical and research implications 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.

Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings.

Empirically supported treatments for posttraumatic stress reactions in children are not widely available. This observational study evaluates the feasibility and utility of adapting the Institute for Healthcare’s Breakthrough Series Collaborative (BSC) to support the broad implementation and sustained use of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in community practice settings. Study findings indicated that agency staff in diverse roles viewed the BSC methodology as a valuable and practicable approach for facilitating skillful delivery of TF-CBT with fidelity. Use of TF-CBT increased over the course of the collaborative and findings from a survey conducted one year later indicated that participating agencies were able to sustain and spread the practice.

Crisis Assessment and Psychiatric Hospitalization of Children and Adolescents in State Custody

We investigated the clinical characteristics and placement decisions among a group of children who were wards of the state and had been evaluated for a crisis assessment. The sample consisted of 383 children and adolescents (ages 2-20 years) who were wards of the Illinois Department of Children and Family Services (DCFS). This study retrospectively reviewed the symptoms, risk factors, functioning and co-morbid variables, and placement or system characteristics of these children using a structured assessment tool, the Childhood Severity of Psychiatric Illness (CSPI). Results indicated that risk behaviors as rated on the CSPI, including suicidality, dangerousness, and runaway tendency, were significant predictors of psychiatric hospitalization. The importance of more widespread usage of standardized assessment tools in evaluating childrens mental health needs is discussed.

Evaluation of a Theater-Based Youth Violence Prevention Program for Elementary School Children

Abstract The present study evaluated the impact of Urban Improv (UI), a theater-based youth violence prevention (YVP) program developed for inner-city youth, on three behavioral and psychological outcome domains: aggressive behaviors, prosocial behaviors, and scholastic attention and engagement. This study compared outcomes for 77 elementary school students in classrooms designated to receive UI with those of 63 students from matched control classrooms. Findings revealed that students who received UI were superior to matched controls on all outcome domains. Findings support UI as a promising practice for YVP with urban elementary school students and suggest that greater attention should be focused on application of theater-based programs in YVP.

Assessing the Effects of Trauma in Children and Adolescents in Practice Settings

Assessment is a critical part of understanding and addressing the needs of children and adolescents exposed to trauma. A comprehensive approach to assessment that measures a range of traumatic exposures and domains of impact and uses multiple informants and techniques over time is needed to best capture the complexity of needs and presentations of traumatized youth. This approach provides a pathway to effective treatment planning. The purpose of this article is to offer a comprehensive overview of the assessment of childhood trauma, with a focus on specific tools and techniques, and the use of assessment information in practice settings.

Childhood Trauma Experience and the Expression of Problematic Sexual Behavior in Children and Adolescents in State Custody

The present study is designed to identify which types of trauma experiences interact with later development of normal and abnormal sexual behavior in children and adolescents. More specifically, our goal is to determine which types of trauma exposure are related to issues of sexuality, sexually reactive behavior, sexually aggressive behavior, and the combination of both sexually reactive and sexually aggressive behavior. A sample of 5,976 children ages 5 to 18 who were wards of the State of Illinois were studied. All children were assessed with the Child and Adolescent Needs and Strengths (CANS) at entry into care. These data were used to understand the relationship between prior trauma experiences and the expression of problematic sexual behavior. Child sexual abuse was the most common form of maltreatment found in children and adolescents with problematic sexual behaviors. However, other types of trauma experiences, especially exposure to violence, were also related. Sexual abuse and multiple trauma experiences both appear to have an important possible etiological roles in the development of sexually problematic behaviors.

Understanding Bad Girls: The Role of Trauma in Antisocial Behavior Among Female Youth

There is a substantial body of research on delinquent behavior and symptoms of conduct disorder among young males; however, less attention has been dedicated to understanding the female population. The aim of this study is to examine young girls’ severity of needs related to conduct disorder and delinquent behavior in relation to various past traumatic experiences. We hypothesized that for girls the presence of these needs will be correlated with physical and sexual abuse. Furthermore, we propose the relationship of trauma to conduct-related needs will be higher among females as compared to males. Data were collected on 1,479 girls ages 12–18 who entered into state child welfare custody. Each participant has been assessed using the Child and Adolescent Needs and Strengths (CANS), which helps identify mental health needs and strengths of every youth. Results show partial support for the hypothesis that sexual abuse has a significant correlation with conduct disorder symptoms; however, physical abuse showed no significant correlation with severe conduct disorder symptoms. Surprisingly, school and community violence had the highest correlation with conduct disorder symptoms. The results clearly establish a relationship between lifetime trauma experiences and the presentation of symptoms of conduct disorder among adolescent females. These results were not replicated among comparison sample of adolescent males.