William R. Saltzman

Trauma- and Grief-Focused Intervention for Adolescents Exposed to Community Violence: Results of a School-Based Screening and Group Treatment Protocol

Recent studies document high levels of community violence exposure among adolescents and link violence exposure to psychological distress and impaired academic achievement. This study assessed the prevalence of trauma exposure among middle school students and evaluated the effectiveness of a school-based, trauma/grief-focused group psychotherapy protocol in treating a sub-group of students with severe exposure, posttraumatic stress disorder (PTSD) and functional impairment. Using a stratified screening procedure, 812 students completed a screening survey, 58 students (7.1% of those surveyed) met criteria for group treatment, and 26 students participated in the group. Group participation was associated with improvements in posttraumatic stress and complicated grief symptoms, and in academic performance. Results suggest that students who are exposed to severe levels of community violence may not be typically identified or treated. The findings also suggest that severe PTSD in adolescence may be associated with impaired school functioning, and that a reduction in PTSD symptoms may be related to academic remediation.

Unpacking Trauma Exposure Risk Factors and Differential Pathways of Influence: Predicting Postwar Mental Distress in Bosnian Adolescents

Methods are needed for quantifying the potency and differential effects of risk factors to identify at-risk groups for theory building and intervention. Traditional methods for constructing war exposure measures are poorly suited to unpack differential relations between specific types of exposure and specific outcomes. This study of 881 Bosnian adolescents compared both common factor-effect indicator (using exploratory factor analysis) versus composite causal-indicator methods for unpacking dimensions of war exposure and their respective paths to postwar adjustment outcomes. The composite method better supported theory building and most intervention applications, showing how multitiered interventions can enhance treatment effectiveness and efficiency in war settings. Used together, the methods may unpack the elements and differential effects of caravans of risk and promotive factors that co-occur across development.

Multi-informant assessment of maltreated children: Convergent and discriminant validity of the TSCC and TSCYC

OBJECTIVEnThis study examined the convergent and discriminant validity of two trauma symptom measures, the Trauma Symptom Checklist for Children (TSCC) [Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources] and the Trauma Symptom Checklist for Young Children (TSCYC) [Briere, J. (2005). Trauma Symptom Checklist for Young Children (TSCYC). Odessa, FL: Psychological Assessment Resources].nnnMETHODSnChildrens scores on the TSCC and their caretakers ratings on the TSCYC were analyzed in a study of 310 children presenting to one of two child abuse treatment centers.nnnRESULTSnTSCC and TSCYC scales generally converged in their assessment of symptomatology in maltreated children. Equivalent scales measuring anxiety, depression, anger, dissociation, and sexual concerns were generally most correlated with one another. Similarly, the Posttraumatic Stress-Intrusion (PTS-I) scale of the TSCYC correlated highest with the Posttraumatic Stress (PTS) and Anxiety (ANX) scales of the TSCC, the TSCYC Posttraumatic Stress-Arousal (PTS-AR) scale was correlated with the TSCC ANX scale, and the TSCC PTS scale was most correlated with the TSCYC ANX, PTS-I, and Sexual Concerns (SC) scales. The TSCYC Posttraumatic Stress-Avoidance scale was unrelated to any TSCC scale. Discriminant function analysis revealed that the TSCC PTS scale was the best single predictor of sexual abuse-related PTSD status as identified by the TSCYC.nnnCONCLUSIONSnThe TSCC and TSCYC display moderate convergent and discriminant validity with respect to one another, despite different information sources. Nevertheless, the relatively small association between relevant TSCC and TSCYC scales indicates that different symptom informants may have different perspectives on the childs symptomatology; an outcome that may be beneficial when both measures are administered simultaneously.nnnPRACTICE IMPLICATIONSnThese results reinforce the notion that both child- and parent/caretaker report measures should be used in the evaluation of traumatized children, so that multiple sources of information can be considered simultaneously. In the current context, administration of the TSCC to the child and the TSCYC to the caretaker, when appropriate (i.e., in children 8-12 years of age) may yield more clinical information on the childs symptomatology than either measure would alone-perhaps especially in cases when one of the two respondents under- or over-reports the childs distress.

Developing a culturally and ecologically sound intervention program for youth exposed to war and terrorism

This article describes the public mental health approach used to develop and implement a school-based postwar trauma/grief intervention program for adolescents in Bosnia-Herzegovina. This approach includes development of multilateral partnerships with local and ministerial stakeholders, systematic assessment that yields a detailed understanding of the specific range and severity of trauma and loss experiences, current adversities and trauma reminders among the affected population, and a training program aimed at developing the capacities of local service providers and an indigenous support infrastructure so that the intervention program may be directed and sustained by people within the communities served. Concluding comments detail an expanded conceptual framework for public mental health interventions that may be appropriate for terrorist and mass-casualty events.

Maternal Depression and Adolescent Behavior Problems An Examination of Mediation Among Immigrant Latino Mothers and Their Adolescent Children Exposed to Community Violence

This study examines the psychological and behavioral effects of exposure to community violence of 47 Latino mothers and their young adolescent children. Using data gathered from multiple sources, this study tests the associations between lifetime exposure to community violence, maternal depression, and child behavior problems. More than 80% of the youngsters ranging from age 11 to 14 years and 68% of the mothers reported being exposed to at least one act of community violence either as a victim or as a witness. Analyses reveal that maternal depression is a mediator of child behavior problems, reducing the direct effect of community violence exposure by more than 50%. Findings suggest that maternal depression is a factor more important than childs community violence exposure in contributing to young adolescents behavioral problems.

Using Multidimensional Grief Theory to Explore the Effects of Deployment, Reintegration, and Death on Military Youth and Families

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death—especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

A Developmental Approach to School-Based Treatment of Adolescents Exposed to Trauma and Traumatic Loss

Over the past decade, the UCLA Trauma Psychiatry Program has developed a school-based intervention program for children and adolescents who have been exposed to trauma and/or traumatic loss, and who suffer from chronic distress and related impairments in academic, peer and family functioning. The program includes a systematic method for screening a student body, a manualized 16–20 week trauma/grief focused group psychotherapy protocol, adjunctive individual and family therapy and specialized measures to assess symptom reduction and adaptive functioning. This article provides a description of the Program, focusing on the group therapy component and the conceptual model that has guided the design of the assessment tools and treatment strategies.

The FOCUS Family Resilience Program: An Innovative Family Intervention for Trauma and Loss

This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience. Through a narrative sharing process, each family member tells his or her story and constructs a timeline that graphically captures the experience and provides a platform for family discussions on points of convergence and divergence. This narrative sharing process is first done with the parents and then the children and then the family as a whole. The aim is to build perspective-taking skills and mutual understanding, to reduce distortions and misattributions, and to bridge estrangement between family members. Previous studies have confirmed that families participating in this brief program report reductions in distress and symptomatic behaviors for both parents and children and increases in child pro-social behaviors and family resilient processes.

Emotional Reactions, Peritraumatic Dissociation, and Posttraumatic Stress Reactions in Adolescents

In this study, the complexity of subjective responses during or immediately after traumatic experiences was explored. Immediate emotional reactions, intense physiological activity, cognitive reaction, and alterations in consciousness were evaluated in relation to current PTSD. The sample consisted of 51 multi-ethnic youth in a middle school. Youth completed a brief standardized self-report screening measure of exposure to traumatic events, and a follow-up interview that further assessed peritraumatic reactions and PTSD. Current PTSD reactions were significantly associated to four factors describing peritraumatic reactions: intense emotional reactions, physiological arousal, dissociation, and intervention thoughts, and these variables accounted for 48% of the variance in current PTSD reactions. The findings underscore the importance of including immediate subjective responses in evaluations of traumatized adolescents.

Current Practice of Family-Based Interventions for Child Traumatic Stress: Results from a National Survey

Clinical practice and research indicate an important role for family-based interventions for child traumatic stress. However, the field lags behind family-based intervention science for other childhood mental health problems and individual treatment for child traumatic stress. This study describes the current practice of family-based interventions for child traumatic stress across a national network of programs serving traumatized children. Although most programs delivered at least one family-based intervention, less than a third of interventions identified had a treatment manual, and few had data to support intervention efficacy. More detailed information is needed on matching the family-based interventions to clinical contexts, establishing effective family engagement strategies, identifying culturally specific adaptations, as well as developmentally matched protocols for child traumatic stress.