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Core Data Set – the First of Its Kind – Ready for Launch This Month
The collection of core data across participating NCTSN centers using InForm, a web-based data entry system, will begin this month. The significance of this launch is that this will be the first time child trauma data will be collected in a formalized way across a diverse range of treatment centers. The core data set is pivotal in helping the NCTSN meet its mission to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States.
The InForm system will allow NCTSN centers to remotely enter client data into the core data database and get back immediate scoring results for all assessments completed. All center data entered into the database will be sent back to the centers on a scheduled basis for their own research purposes.
Also, aggregate NCTSN data can be sent to each center as requested. The InForm system will also allow for a limited set of core data variables to be immediately downloaded to an Excel spreadsheet for use at each NCTSN center. Clinical reports generated from the system will also be sent to each participating center on a periodic basis. “We have no illusions; we know this is going to be a lot of work for centers and want them to get useful clinical information in return for their efforts,” said Betsy Farmer, the National Center's director of the Data Core.
A data collection effort of this magnitude has multiple challenges, not the least of which is limited resource pools and available staff time. Also, some centers already have sophisticated data collection means of their own. The Data Core plans to work with each center individually toward an acceptable means of sending data. The Data Core and some NCTSN centers have already worked in concert to come up with processes acceptable to both. “We know this is a huge challenge for some centers. Our role is to provide viable process options and to be as flexible as possible toward meeting our mutual objectives,” said Patrick Loebs, project leader at the Duke Clinical Research Institute (DCRI).
In order for NCTSN centers to be ready to implement InForm, all regulatory assurances need to be in place before the Data Core can accept a center's data. Once the assurances are in place the Data Core will contact each NCTSN center and train its staff to use the web-based system. After this training session, the Data Core will grant passwords so that each center can begin to enter data. Staff within the Data Core will be on call during normal business hours to address any technical problems the centers may encounter.
“This is a very exciting time for the NCTSN as this is the first step toward meeting the Data Core's primary goals and objectives established when the NCTSN was first formed," said Farmer. "Many, many people across the NCTSN have worked very hard to get us where we are today and I'm proud to be a part of this one-of-a-kind endeavor.”
For additional information about this month's core data set launch e-mail Patrick Loebs or Betsy Farmer.
Trauma Information for School Personnel Now on NCTSN Website
The National Center has created new resources specifically to help school personnel address safety, disaster planning and response, trauma and optimal learning in school settings.
Prepared by a team of experts at the National Center's School Crisis and Intervention Unit, the resources are available at the NCTSN Website. The web pages contain a general introduction to school safety; information on the effects of trauma on schools and learning; the "3 R's" of school crises and disasters (Readiness, Response and Recovery); information on service intervention programs; and other valuable resources for schools.
“School personnel are intimately aware of the social, psychological and academic toll that traumatic experiences can take on our children and adolescents,” said Marleen Wong, the National Center's director of the School Crisis and Intervention Unit and also director of Crisis Counseling and Intervention Services for the Los Angeles Unified School District. Wong and colleagues have responded to riots, fires, earthquakes, shootings and other traumatic events at schools in Los Angeles and around the country.
Researchers have documented disrupted academic performance, negative classroom behavior, and lower school attendance among students with traumatic stress reactions.
“Children may not do well in preschool because domestic violence has interfered with their brain development, capacity to learn, and behavior. In elementary school, exposure to trauma and violence can lead to poor sleep and poor learning, compromising acquisition of basic skills. A middle school child may be exposed to bullying or violence in the community and go on to develop symptoms of posttraumatic stress that disturb academic performance, classroom behavior, and school attendance A student in high school may suffer a traumatic loss because of the death of a close friend through a traffic accident, school violence, or suicide, and become seriously depressed and unable to learn,” Wong explained.
The U.S. Department of Justice has reported that 1 percent of students ranging in age from 12-to-18 years, or 225,000 children, have been victims of serious violent crimes either at school or as they traveled to and from it. Nationally, one in four youth experience a significant traumatic event by age 16. Many children experience multiple traumas. Any child exposed to a traumatic event is at risk of developing posttraumatic stress. Common sources of child trauma include abuse and neglect, serious accidental injury, disasters, violence, and life-threatening and chronic illnesses.
Learning from Research and Clinical Practice Core Identifies Key Objectives and Approaches for 2004-2005
During last month's first annual Learning from Research and Clinical Practice
(LRCP) Core meeting, participants discussed their accomplishments, their upcoming challenges and how they will approach these challenges over the next year.
The objectives identified during this meeting include:
• Use a developmental epidemiological framework for prioritization of treatments for further development.
• Employ new models of intervention, development, and collaboration that partner service delivery sites with intervention developers at the onset of the treatment development process (intervention construction and manualization) and at the same time begin building the dissemination and implementation protocols.
• Simultaneously evaluate two classes of outcomes, implementation effectiveness and intervention effectiveness, so to more fully understand how a treatment fits within a host organization.
• Identify new criteria of effectiveness and fidelity. Effectiveness is related to fidelity and fidelity requires only the implementation of core components as designed and demonstrated in trials.
• Design and utilize new approaches to large-scale dissemination and implementation (including strong interface with the Training Core) that result in sustained increases in the standard of trauma care.
The LRCP plans to address the above challenges through the following:
• The Multisite Implementation Evaluation subcommittee plans to facilitate the design of multisite implementation efforts to disseminate interventions to a diverse array of providers and settings. The selected trauma-focused interventions include TF-CBT for sexual abuse, PCIT and TF-CBT for physical abuse, and Parent-Child Dyadic Therapy. The subcommittee will also support the submission of program evaluation results to SAMHSA's National Registry of Effective Programs (NREP).
• The Promising Practices subcommittee will create consultation teams to assist developers of promising practices to identify critical issues and next steps in development of their practices. The consulting teams can make recommendations for next steps in collecting data about the promising practices that are in their early stages of development (including manualization, core component identification, and outcome measures) and assist in partnering Community Treatment and Services Centers with Intervention, Development, and Evaluation Centers to further refine, standardize (including construction of fidelity, implementation, and outcome measures) and collect multisite data for selected promising practices that are farther along in their stages of development.
• The Capacity Building and Rapid Dissemination subcommittee will facilitate the dissemination and implementation (with fidelity) of selected trauma-focused interventions on a scale that will impact the standard of care. This subcommittee will help centers assess their readiness and capacity for adoption of an intervention, obtain core competency, intervention, and implementation training, and evaluate treatment integrity and quality in ways that provide feedback to centers. Finally, this subcommittee will work closely with the Training Technology subcommittee from the Training Core to utilize best available intervention diffusion practices.
For additional information, e-mail Charlene Allred, the National Center's director of the Learning from Research and Clinical Practice Core.
Infusing Cultural Competency into NCTSN Operations—New Resources Now on NCTSN Website
One of the National Center 's strategic priorities for this year is to enhance its focus on cultural competence. Thus, it has identified three first steps as part of a strategy for infusing cultural competency to NCTSN operations.
First, helpful resources and materials related to cultural competence are now available on the NCTSN Website.
Second, the National Center will conduct a cultural needs assessment in September 2004 with core directors, branch/unit leaders, and working group chairs. This group of individuals was selected first since they represent the “functional units” of the National Center and are involved in the development of materials that must reflect an awareness and understanding of cultural issues. The summary report of the needs assessment will serve as the basis for bringing together a group of NCTSN members who will review the report and collectively prioritize subsequent “action steps.”
Third, the National Center is requesting submissions of anecdotes, stories, and case studies which highlight the successes and challenges involved in being culturally competent. The National Center plans to compile these “real world” examples for the NCTSN Website and possibly other products.
Questions, suggestions, ideas for “real world” submissions, and/or interested readers who would like to be involved in this priority may e-mail Susan Ko, the National Center's director of the Service Systems Core.
Collaboration Reports Completed by all 54 NCTSN Centers
The National Center is currently processing data received during the previous two months regarding the NCTSN Collaborative Groups for each member of the Network. Once this data has been recorded, those individuals at each NCTSN center that have expressed interest in a particular collaborative group can expect to be contacted by the group chairperson or the designated National Center contact.
Additionally, some collaborative groups that have been inactive for some time are in the process of reestablishment based on the interests expressed in the collaboration reports. Once these groups become active again, the group chairperson will be contacting the NCTSN centers accordingly.
It is SAMHSA's future expectation that each NCTSN center will provide a similar report of this kind twice a year as part of the quarterly reports.
Additional questions about the NCTSN collaborative groups may be e-mailed to Debbie Ling, the National Center's internal consultant and project manager.
Designated Media Contacts and Area of Expertise Still Needed from Majority of NCTSN Centers
The National Resource Center (NRC) requests that each NCTSN center identify and provide the name of its designated media relations contact. Please include the contact name(s), daytime phone, e-mail, pager, and cell phone information and the center's area(s) of expertise in the field of child traumatic stress. This information, along with any questions, may be e-mailed to the NRC or faxed to 919-667-9578.
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NCTSN's Adolescent Trauma Treatment Program, Madison, Wisconsin
Madison, Wisconsin is now home to the Adolescent Trauma Treatment Program (ATTP), a new NCTSN level III center that is focusing on adolescents and trauma. ATTP is part of the Mental Health Center of Dane County, Inc., a private, not-for-profit community mental health center that serves low-resource, high-need individuals and families from a recovery-oriented, consumer-involvement perspective. ATTP benefits from being nested within this comprehensive mental health center, which includes 24-hour crisis response, outpatient clinics, psychiatric services, and a diverse staff committed to delivering culturally competent services.
ATTP will focus on 11-to-17 year olds who live in Dane County, which includes Madison and many surrounding communities. The program works closely with several NCTSN level II centers regarding best practices. ATTP is implementing the CBITS curriculum (Wong et al., Los Angeles, California) and the Enhancing Resiliency curriculum (DeRosa et al., Manhasset, New York) during its first year.
Additionally, ATTP hopes to develop a better coordinated first responder network in Dane County by providing training to first responders and serving as a referral source for them. ATTP clinicians provide short-term crisis intervention and longer-term trauma-focused CBT group, individual, family, and parent-child therapy, paying particular attention to the co-occurrence of trauma and substance abuse.
ATTP also collects data through its collaboration with Dr. Seth Pollak at the University of Wisconsin Department of Psychology. Program staff are working closely with other providers in the community by offering trauma-focused trainings and by teaming with other agencies to co-facilitate trauma-focused groups in the schools, in other mental health agencies, and in some of the Dane County adolescent group homes.
ATTP values its close associations with many community partners, such as Safe Harbor (Dane County Child Advocacy Center), Oasis (sexual abuse treatment center), the Adolescent Alcohol and Drug Assessment and Intervention Program (University of Wisconsin ), and the Madison Metropolitan School District. "Stakeholders throughout Dane County have whole-heartedly endorsed ATTP's efforts and are coming forward to show their support and interest," said James Van Den Brandt, project director. "We are looking ahead to four very exciting years with the NCTSN, and hope to make significant contributions in the area of best and promising practices for traumatized adolescents." |
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Multiple NCTSN Centers to Participate in National Center's TF-CBT and AF-CBT Trainings This Month
In order to address some of the immediate needs and requests from multiple NCTSN centers, a team from the National Center's Training Core, in conjunction with the Learning from Research and Clinical Practice Core and Liaison Team, are planning to pilot their first centralized training, May 24-25, in Pittsburgh, Pennsylvania, in association with Allegheny Hospital. Nineteen NCTSN centers plan to participate in the May training.
This particular training will be focused on specific models for treating child sexual and physical abuse. Training will be provided over the course of two days; each day will focus on a particular treatment model: Trauma-focused Cognitive Behavioral Therapy (TF-CBT), offered by Judy Cohen and Tony Mannarino, and Abuse-Focused Cognitive Behavioral Therapy (AF-CBT), offered by David Kolko.
For additional information about this training opportunity, along with future training opportunities, e-mail Cassandra Kisiel, the National Center's director of the Training Core.
Multiple NCTSN Programs Presented at SAMHSA's "Strengthening Our Future" Grantee Meeting in Kansas City
In addition to the NCTSN, the Substance Abuse and Mental Health Services Administration (SAMHSA) funds a number of other major child mental health programs in the areas of mental health promotion and violence prevention.
Three major grant programs in these areas held a joint national meeting in Kansas City the week of April 26, and a number of NCTSN programs presented workshops. Over 1,000 people attended the Kansas City meeting from three major SAMHSA grant programs—Safe Schools/Healthy Students, Youth Violence Prevention Program, and Targeted Capacity Expansion: Mental Health Prevention and Promotion.
Many of the grantees were either schools or programs that provide services in schools. They work in communities with high levels of social distress, minority populations, and youth problems with attendant high rates of trauma exposures. The issue of trauma is not usually addressed in these grant programs, so SAMHSA and NCTSN members saw this as an opportunity to raise awareness of trauma in a large audience of school systems and community service agencies that work with children and children's mental health.
The NCTSN-sponsored workshops offered to meeting attendees included:
• “Addressing the Needs of Refugee and Immigrant Children Who Have Experienced Violence and Trauma” presented by Dennis Hunt from the Center for Multicultural Human Services
• “Collaborative Responses to Children's Exposure to Violence: Law Enforcement and Mental Health Partnerships” presented by Steven Marans from the National Center for Children Exposed to Violence at Yale Child Study Center
• “Childhood Traumatic Grief” presented by Chris Layne from BYU, Elissa Brown from NYU, and Stephanie Handel from the Wendt Center
• “Readiness, Response and Recovery: Enhancing the Mental Health Component to School Emergency Plans” presented by Melissa Brymer from the National Center
• “Training School Personnel to Identify and Assist Child Victims: The School Child Abuse Liaison Program” presented by Elizabeth Ralston and Rochelle Hanson from the National Crime Victims Research and Treatment Center
• “Assessment of Children and Adolescents Who Have Experienced Trauma” presented by Robert Murphy from the Yale Child Study Center
• “Building and Maintaining Strong Community Collaborations: Promises and Pitfalls” presented by Sharon Portwood at the KC Metro Child Traumatic Stress Program
NCTSN School Expert Presents to U.S. Senate: Traumatic Stress Common in Schools
“School personnel are intimately aware of the social, psychological, and academic toll that mental health disorders, traumatic experiences, and mental illness can take on our children and adolescents,” Marleen Wong told members of the U.S. Senate HELP subcommittee on Mental Health and Substance Abuse Services on April 28.
Wong, director of crisis counseling and intervention services for the Los Angeles Unified School District (LAUSD) and director of the School Crisis and Intervention Unit of the National Center, has responded to riots, fires, earthquakes, shootings, and other traumatic events at schools in Los Angeles and around the country.
“Some disorders, such as psychological trauma and depression, are very amenable to identification and treatment within a school setting. These are also the disorders that are being identified as leading causes of disability among the general population of children in the United States,” Wong said. “Schools routinely screen for vision and for hearing, two conditions which we would all agree are crucial to learning. Just as crucial may be school screening for trauma and depression, where fear, disturbing thoughts, feelings and images become barriers to school attendance and classroom participation.”
In Los Angeles, Wong and colleagues screened thousands of children in LAUSD and found that 90 percent of students in some neighborhoods had been exposed to multiple incidents of violence as witnesses and victims and that 27 percent of them had clinical levels of posttraumatic stress disorder (PTSD) and 16 percent of them had clinical levels of depression.
Wong reported that nationally one in four youth experience a significant traumatic event by age 16. Many children experience multiple traumas and repeated traumas. Any child exposed to a traumatic event is at risk of developing posttraumatic stress. Common sources of child trauma include abuse and neglect, serious accidental injury, disasters, violence in neighborhoods, schools and homes, and life-threatening and chronic illnesses.
NCTSN Centers In the News
The Idaho State Journal on April 2 profiled a researcher who was
instrumental in bringing the NCTSN to Idaho, at the Center for Rural,
Frontier and Tribal Child Traumatic Stress Interventions.
WLBT-TV in Mississippi on March 23 did a news story on TRY: Trauma Recovery for
Youth, the NCTSN center in Jackson. At a coalition meeting that celebrated
the launch of the program, the center convened community leaders to discuss
the problem of child traumatic stress, community needs, and solutions.
If other NCTSN centers have been in the news, e-mail this information to Patrick Cody, the National Center's media consultant.
NCTSN's Kennedy Krieger Collaborates with Ed Block Courage Award Foundation
In March 2004, The Kennedy Krieger Family Center Trauma Intervention Program had the opportunity to collaborate with the Ed Block Courage Award Foundation in conjunction with the foundation's annual awards ceremony held in Baltimore.
The foundation established the Courage House National Support Network For Kids, whose main objective is to heighten awareness of the plight of abused and neglected children and families in crisis. To date, there is a Courage House in 16 NFL cities, with a goal of establishing one in every NFL city.
Each year the foundation honors a player from each team in the National Football League who has conducted himself as positive role model in his community and served as an inspiration to teammates.
In response to a request from Joe Ehrmann, the president of the foundation, Kennedy Krieger developed a brochure that was designed to heighten player awareness to child abuse and neglect issues. The brochure was distributed at the player's only luncheon on the day before the awards ceremony. “As the NFL players arrived in Baltimore for the 26th Annual Ed Block Courage Awards, it was important for us to clearly articulate to them how significant their roles were in shaping the lives of young people,” stated Joe Ehrmann, foundation president. “Professional football is a game built around aggression and contact. However, as we introduced players to our mission to raise awareness of child abuse and help those who suffer from such mistreatment, the materials provided by Kennedy Krieger enabled us to better reach the compassionate side of those gentlemen and motivate them to help end the cycle of abuse.”
For additional information about this collaboration, e-mail Elizabeth Thompson,
director of the Kennedy Krieger Family Center Trauma Intervention Program.
NCTSN's Project Tamaa Celebrates Grand Opening
The Children's Crisis Treatment Center's (CCTC's) Project Tamaa celebrated the grand opening of its new offices on April 1 in Philadelphia, Pennsylvania.
Project Tamaa, one of CCTC's newest programs, is a community and school-based program designed to meet the complex mental health and social service needs of the large and growing number of West African refugee children and their caregivers who have relocated to Southwest Philadelphia.
“I am excited and proud that we have been able to add this new program to the array of mental and behavioral health services that CCTC provides to Philadelphia's children and families, as the West African children and families have tremendous needs which have gone unrecognized and unmet for too long,” said Antonio Valdes, CCTC's executive director.
CCTC joined with the African Cultural Alliance of North America (ACANA), a grassroots organization dedicated to enriching the lives of the African refugees and immigrants through social and cultural programs, to renovate a building in the Southwest Philadelphia community to house both Project TAMAA and ACANA offices.
Anne Holland, CCTC director of Trauma Services and director of Project Tamaa, emphasized, “Despite their considerable needs, very few West African refugee children and their families have prior contact with Philadelphia's mental health and social service agencies, because the services were not designed to be culturally acceptable or accessible. One of the factors that has made Project Tamaa a success thus far is that we have brought the services to the neighborhood and schools where the West African refugee children and families live.”
The grand opening celebration included West African music, dance, and food. Highlights were a musical performance by Liberian recording artist Big Steve Worjloh and a dance performance by the Liberian Cultural Dance Troupe, which includes a number of children who participate in Project Tamaa's school-based therapy groups.
The leadership of CCTC and ACANA welcomed leaders from the city of Pittsburgh and the state of Pennsylvania's mental health and social service agencies and organizations; school district officials; CCTC's board of directors; and major contributors and representatives from several other NCTSN centers. Featured speakers included John Fairbank, co-director of the National Center for Child Traumatic Stress and State Representative James R. Roebuck.
NRC Continues to Call for NCTSN Assistance in Building the National Library
The NRC is continuing the important process of collecting materials for the NCTSN’s National Library. To achieve this goal, the NRC requests that any relevant resources from NCTSN centers relating to the topic of child traumatic stress be sent to the NRC librarian as soon as possible since the physical library will be up and running this month. Materials to be submitted include, but are not limited to, journal articles, book chapters, guides, manuals, training curricula, white papers, videos, DVDs, etc. Please send materials to:
Smyth Lai, Assistant Librarian
National Resource Center
NCCTS—Duke University School of Medicine
905 West Main Street, Suite 23-D
Durham, NC 27701
Phone: 919-682-1552 ext. 240
Fax: 919-667-9578
Camp Forget-Me-Not
July 30–August 1, 2004 – Washington, D.C.
The NCTSN's Wendt Center for Loss and Healing will host its annual three-day sleep-away bereavement camp for children from the metro Washington, D.C. area. Camp Forget-Me-Not offers 50 children (ages 6-15) who have experienced a loss due to death the opportunity to enter a safe space—away from their everyday lives—to gently explore the normal process of grief. Camp Forget-Me-Not provides an environment in which each child's self-expression is heard, valued, and honored. Each camper is paired with an adult “buddy” for the weekend. The weekend blends traditional camp programming (swimming, confidence course, camp fires, and sports) with grief-focused activities including support groups, therapeutic art, playback theater, and a memorial boat launch. To learn more about volunteering as a "buddy" or to refer a potential camper, e-mail Stephanie Handel or call 202-624-0010 extension 106.
Steinberg, Alan M., Brymer, Melissa, J., Decker, Kelly B., and Pynoos, Robert S. (2004). The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Current Psychiatry Reports. 6:96-100.
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