Laurel J. Kiser

Helping traumatized families

Part I: Understanding the Impact of Trauma on Families. The Family as a Living System. Individual Responses to Trauma. Spreading Beyond the Individual: Family Adaption to Stress and Trauma. Part II: Empowering Families. Foundations of the Empowerment Treatment Approach. Phase I: Joining the Family. Phase II: Understanding and Framing the Familys Trauma Response. Phase III: Building Healing Skills. Phase IV: Sharing and Healing. Phase V: Moving Forward. Part III: Empowering Family Trauma Therapists. The Family Trauma Therapist. Epilogue: Looking Back and Looking Forward. References.

Physical and sexual abuse in childhood: Relationship with post-traumatic stress disorder

This study describes the reactions of children and adolescents to physical and/or sexual abuse, suggesting two distinct symptom pictures. Findings indicate that a majority (55%) of this clinical population develop symptoms characteristic of post-traumatic stress disorder, whereas abused children and adolescents who do not develop associated post-traumatic stress disorder symptoms exhibit more anxiety, depression, externalizing behaviors, and more problems overall. Significant differences were also found between children and adolescents reacting to single event abuse who display more behavior disorders and victims of ongoing abuse who appear significantly more disturbed, with symptoms ranging from depression to psychosis.

Post-Traumatic Stress Disorder in Young Children: A Reaction to Purported Sexual Abuse

Abstract This paper reviews systematically gathered data on a group of 10 young children, aged 2 to 6 years, who were evaluated and treated for post-traumatic stress disorder (PTSD) after reported sexual abuse in a daycare setting. These children developed symptoms consistent with a DSM-III-R classification of PTSD as well as Terrs descriptions of type II (repeated abuse) disorders. Discussion of Terrs classification is presented and, in addition, some significant sex differences are explored.

The Current Practice of Child and Adolescent Partial Hospitalization: Results of a National Survey

OBJECTIVE In 1992, the American Association for Partial Hospitalization initiated a national survey of partial hospitalization providers to investigate their present status (programming, staffing, and pricing), to track market trends, and to improve advocacy for appropriate utilization and reimbursement. METHOD Instrument development and field testing preceded widespread distribution of the survey. From survey data, a description of child and adolescent partial hospital services based on statistical averages is reported as are analyses of program differences by length of stay and for-profit/not-for-profit status. RESULTS Of the 580 programs responding, 95 indicated that at least 50% of their patient population consisted of children and adolescents. Descriptive statistics on this subsample suggest continued variability in child and adolescent partial hospital programming. Program differences in referral and discharge patterns, population and programming, and utilization and funding patterns based on length of stay and profit status are presented. CONCLUSIONS The pattern of significant program differences between acute-care and long-term child and adolescent partial hospital programs and for-profit/not-for-profit programs (along with the absence of for-profit programs treating children and adolescents in long-term programs) points to an evolving system of care.

Results of treatment one year later : child and adolescent partial hospitalization

OBJECTIVE One criticism of academicians is that they evaluate and disseminate outcome studies based more on the value and merit of the research design than on the utility of the findings for improving clinical practice. Increasing pressure on programs to evaluate the effectiveness of behavioral health care is transitioning outcome measurement from the exclusive domain of the researcher toward the clinical/organizational domain. To explore the multiple applications of such clinical outcome data, this article presents the results from a study of 114 patients completing treatment in two child and adolescent partial hospital programs. METHOD Four areas define the scope of clinical outcome measurement pertinent to partial hospitalization: changes in the patients clinical status, changes in the patients level of daily functioning, impact on the utilization of behavioral health services after discharge, and patient/family satisfaction with treatment. Using these four domains, this study compares data assessed at admission and at 1 year postdischarge. RESULTS Analyses used paired t tests primarily to measure change between admission and 1 year after discharge. Overall, the data show improvement in general functioning that remains evident up to 1 year postdischarge. CONCLUSIONS Finding positive results in specific areas emphasized therapeutically--such as family functioning and use of community-based mental health resources after discharge, and the parents attribution of improvement to experiences in treatment--provides justification for relating improvement to the treatment episode.

Family Mealtime Q-Sort: A Measure of Mealtime Practices

Studies outlining the protective functions of shared family meals suggest that helping families experience successful meals is an important goal. Measuring the effectiveness of family mealtime interventions necessitates the ability to quantify both the frequency and context of shared mealtimes. This article introduces a new instrument, the Family Mealtime Q-Sort, describes its development, and presents preliminary data about its psychometric properties. Data from initial evaluation of the Family Mealtime Q-Sort using family mealtime videos (N = 51) demonstrate acceptable interrater reliability, promising validity, and the ability to compare family mealtimes to an independently derived, culturally appropriate standard. The results suggest that the Q-sort adequately measures important dimensions of a successful mealtime including a positive atmosphere, making use of the shared time to engage in meaningful conversation, and proceeding with a clear plan and minimal distractions. Further research on the tool is warranted.

Effects of the child–perpetrator relationship on mental health outcomes of child abuse: It's (not) all relative

The present study was conducted to better understand the influence of the child-perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrators status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

The Role of Family Processes in Childhood Traumatic Stress Reactions for Youths Living in Urban Poverty

This article reports findings from a cross-sectional study exploring relationships between trauma exposure, childhood traumatic stress, and family functioning. Data were collected from a sample of 100 mostly African American, 6- to 9-year-old children and their caregivers who were living in low-income, urban neighborhoods and analyzed using hierarchical multiple regressions. The children experienced high levels of exposure and traumatic stress symptoms. Trauma exposure was correlated with reexperiencing, avoidance, and arousal and also with externalizing behavior problems. Reexperiencing and avoidance symptoms were related to lower ratings of the value of family routines reported by caregivers. Higher ratings of family structure, including both organization and support, were related to fewer internalizing and externalizing behavior problems.

Strengthening Family Coping Resources: The Feasibility of a Multifamily Group Intervention for Families Exposed to Trauma

Families exposed to urban poverty face a disproportionate risk of exposure to repeated trauma. Repeated exposures can lead to severe and chronic reactions in multiple family members with effects that ripple throughout the family system. Interventions for distressed families residing in traumatic contexts, such as low-income, urban settings are desperately needed. This report presents preliminary data in support of Strengthening Family Coping Resources, a trauma-focused, multifamily, skill-building intervention. Strengthening Family Coping Resources is designed for families living in traumatic contexts with the goal of reducing symptoms of posttraumatic stress disorder and other trauma-related disorders in children and caregivers. Results from open trials suggest Strengthening Family Coping Resources is a feasible intervention with positive effects on childrens symptoms of trauma-related distress.

Understanding the Impact of Trauma on Family Life From the Viewpoint of Female Caregivers Living in Urban Poverty.

Children and their families living in poor, inner-city neighborhoods are at high risk for experiencing multiple traumas. This article describes findings from a qualitative study designed to explore the impact of chronic traumas on family life through the voices of primarily African American caregivers coping with urban poverty. Structured interviews are conducted with 16 caregivers of children ages 6 to 9 years who had been exposed to multiple traumas and had symptoms of posttraumatic stress disorder. Caregivers explain changing daily routines to accommodate child distress and promoting positive family processes such as increased protectiveness. They also describe various roles that religion/spirituality play in their coping with trauma, including finding comfort in the faith that God controls what happens in their lives. These themes are discussed with regard to theory and practical applications for assisting traumatized families.