Pilot Studies for Traumatized Children with Alexithymia Starting
An NCTSN site is conducting a pilot study for further development of a new instrument and has been seeking pilot sites that use the Network's core dataset in an assessment protocol. The Children's Alexithymia Measure (CAM) is a project of the Southwest Michigan Children's Trauma Assessment Center (CTAC) in Kalamazoo.

Alexithymia literally means a lack of language for one's own feelings. It has three components: difficulty identifying feelings, difficulty expressing feelings, and externally oriented thinking. Alexithymia is defined as “a cognitive and affective disturbance that affects the ways individual internally process and become aware of their own feelings. It is primarily manifested in a person's communication style where external verbal and nonverbal expressions of emotions are limited or absent. Alexithymia is often seen in individuals who have experienced psychologically traumatic events.”

The purpose of the CAM project is to develop and test an adult observer–rated instrument that measures alexithymia in children. The instrument has been developed over the past 16 months and is now ready to be piloted with children who have experienced trauma. The anticipated total sample size is 320 children, ages 6 to 14 with diversified ethnicity. Some sites have been identified, and others may be needed. It is estimated that any one site might collect data for 35 to 100 children.

Responsibilities for pilot sites include:

• Obtain HSIRB approval using the prototype approved for Kalamazoo site (in conjunction with CAM researchers)
• Administer informed-consent process
• Administer additional instruments: CAM , demographic data sheet, Alexithymia Scale for Children
• Administer CBCL, (caregiver report) according to current protocol
• Administer TSCC-A, PTSDRI (child self-report) according to current protocol
• Collect raw pilot study data
• FedEx data to CAM researchers

Contact Dr. Ineke Way or phone (269) 387-3195 for additional information about the instrument and to see if additional pilot sites are still needed.

Two New Sexual Abuse Measures Being Used in NCTSN
Kevin J. Gully of the Child Trauma Treatment Network - Intermountain West has developed two tests to measure interpersonal constructs and the social context of child abuse for children ages 4 to 17. Both have been published in peer reviewed journals. He is interested in having people use them - a limited number of sample copies have been available. The Social Behavior Inventory and Expectations Test is published by PEAK Ascent, and more information can be found at PEAK's website. Center representatives can e-mail Gully to let him know if they are interested.

Legislative Update
The bipartisan “Child Healthcare Crisis Relief Act” was introduced in the U.S. House (H.R. 1106) and Senate (S. 537) to address the dearth of mental health professionals for children. The legislation includes incentives that would help professionals to enter and stay in the child mental health care field. The President's New Freedom Commission on Mental Health noted a severe shortage of trained mental health professionals, especially those who serve children.  It went on to underscore the severity of this shortage: "If the system does not appropriately screen and treat children early, these childhood disorders may persist and lead to a downward spiral of school failure, poor employment opportunities, and poverty in adulthood. No other illnesses damage so many children so seriously." The legislation takes a multipronged approach toward providing incentives to help recruit and retain child mental health professionals providing direct clinical care, including loan repayments and scholarships, grants to graduate schools, grants for inservice training for paraprofessionals, and more. For further information, go to http://thomas.loc.gov .

New Freedom Commission on Mental Health, Subcommittee on Evidence - Based Practices, Releases “Background Report”
This background paper of the commission's Subcommittee on Evidence-Based Practices begins with a definition and discussion of the importance of evidence-based practices as reflected in the report on mental health from the Surgeon General (HHS, 1999). After reviewing the opportunities created by the evidence-based practice approach, as well as some of its limitations, this paper describes a series of current initiatives in implementing evidence-based practices. It also covers the importance of having an infrastructure for supporting that implementation activity. Because infrastructure is so critical, it becomes the focus of much of the final section, which consists of the proposed policy options from the subcommittee. All of the commission's reports may be found at:
www.mentalhealthcommission.gov/reports

Senate Resolution: Shaken Baby Awareness Week
A resolution designating the third week of April in 2005 as “National Shaken Baby Syndrome Awareness Week” passed the U.S. Senate on April 15 by unanimous consent. The commemorative bill, S. Res. 112, introduced by Senators Christopher Dodd (D-CT) and Lamar Alexander (R-TN), recognizes abusive head trauma, including Shaken Baby Syndrome, as “the leading cause of death of physically abused children” and “a totally preventable form of child abuse” which can “result in loss of vision, brain damage, paralysis, seizures or death.”

The resolution refers to a 2003 report in the Journal of the American Medical Association that estimates that in the United States an average of 300 children will die each year, and 600 to 1,200 more will be injured as a result of Shaken Baby Syndrome, of whom two-thirds will be babies or infants under one year in age. In making a case for preventive steps, the measure says “prevention programs have demonstrated that educating new parents about the danger of shaking young children and how they can help protect their child from injury can bring about a significant reduction in the number of cases of Shaken Baby Syndrome.”

The text of the resolution names the National Child Abuse Coalition and other coalition members as supportive of the resolution, including Children's Defense Fund, American Academy of Pediatrics, Child Welfare League of America, Prevent Child Abuse America, National Exchange Club Foundation, American Humane Association, American Professional Society on the Abuse of Children, Association of University Centers on Disabilities, Children's Healthcare is a Legal Duty, National Alliance of Children's Trust and Prevention Funds, and National Association of Children's Hospitals and Related Institutions.

(Source: The National Child Abuse Coalition “ Washington Memorandum”)

Medicaid Largest US Payer for Mental Health Services, Study Finds
Access this story and related links online
Medicaid programs pay for more mental health services than private insurance, Medicare, or other state and local programs, according to a study published Tuesday in Health Affairs, CQ HealthBeat Reports (CQ HealthBeat, 3/29). The study, funded by the Substance Abuse and Mental Health Services Administration, found that total spending between 1991 and 2001 on mental health services increased 73% to $104 billion (Rapaport, Sacramento Bee, 3/29). The report also included the following findings:

• Public funding paid for 63% of mental health services in 2001 up from 57% in 1991.
• Public sources paid for 76% of substance abuse treatment in 2001, compared with 62% in 1991.
• Public spending for mental health services and substance abuse treatment in 2001 totaled $67.4 billion, compared with $36.3 billion in private spending.
• Prescription drug spending for mental health patients increased 17.1% annually between 1991 and 200, while spending for all prescription drugs increased 12% during that time period.
• The share of mental health spending going to inpatient services declined 12 percentage points to 28% during the study period.

According to the report, the decrease in mental health inpatient services spending might be attributable to new psychotropic drugs, the increasing frequency of treatment, closure of
psychiatric hospitals and cost pressures of managed care. SAMHSA Administrator Charles Curie said, "Mental health and substance abuse treatment services spending accounts for a sizeable portion of the health care economy.... Overall, we have seen a decline in inpatient spending and a shift to public financed
care. As we continue to work to improve the community-based services available to people in need, it is clear the public sector is now the major financial driver" (CQ HealthBeat, 3/29).

Surgeon General's Workshop: Summary Notes
The Surgeon General's Workshop, "Making Prevention of Child Maltreatment A National Priority – Implementing Innovations of a Public Health Approach," held at the National Institutes of Health on March 30 and 31, 2005, brought together some 100 invited participants representing diverse fields of medicine, public health, child development, social services, child welfare, academia, education, law enforcement, faith community, juvenile justice, philanthropic foundations, communications, mental health, as well as federal government representatives - about half of the attendees - from the Departments of Health and Human Services, Education, State, Justice, Defense, and Agriculture.

US Surgeon General Richard H. Carmona in his welcoming remarks called on the workshop participants to formulate a new public health priority: preventing child maltreatment and promoting child well-treatment. He set the aim of the initiative to “integrate prevention services into all systems of care and incorporate child development literacy into the national consciousness.” Carmona proposed adopting a public health approach to prevent child maltreatment, identifying ways to promote the prevention of child abuse and neglect, and focusing attention on the gap in public health and what can be done to make a difference.

The first day's panels, focuses on “Defining the Public Health Approach,” elicited the following observations:

• Integration of the child development and public health systems could be the opportunity to optimize protective factors and minimize risk factors.
• A systems-wide approach, essential to this objective, does not exist in the United States; the First Five initiative in California, bringing together pediatricians, child care services and home visitors, may be approaching the goal of reaching across systems.
• Extended family services over a period of years allow families the necessary time to build relationships with other community services, to overcome addictions and address other challenges.
• Home visitor services for poor mothers with a first baby have been shown to improve pregnancy outcomes, improve child health and development, and improve the parent's economic self-sufficiency.
• Co-occurring with child maltreatment are issues of poverty, domestic violence, substance abuse, mental illness and depression, and race and ethnicity.
• To develop the public will for change at the national level involves creating a social movement, calling upon the involvement of “authentic voices.”

The second day's panels, “Achieving the Public Health Approach,” raised the following observations:

• Effective policy change depends on a variety of strategies, including the placement of messages into media and entertainment. The surgeon general should convene media experts to develop a social marketing strategy.
• Because of the interrelationship of child maltreatment to other issues, assessment of the problem depends upon ability to scan for data across other systems and sources .
• Additional resources are essential to the effort.
• Promoting optimal child health demands the mobilization of community partnerships; no system can do it alone.

The surgeon general closed with remarks laying out thinking for developing a strategic plan beginning with a report that would condense the information presented at the two-day workshop, look at themes that emerged, and identify next steps needed to carry the initiative forward. He called on the workshop participants to “keep my feet to the fire.”

Are You Trying to Keep up with the Research Literature on Child Traumatic Stress?
The National Resource Center is pleased to offer a new service to NCTSN partners and others involved in child traumatic stress. We are providing monthly electronic alerts listing new research articles on child traumatic stress and related topics.

You'll get a monthly email with the full publication details (bibliographic citation and abstract, not the full text of the articles) for new journal articles on the topic. Copies can be obtained from any university library, and sometimes are available online.

The alerts run on the National Library of Medicine's MEDLINE database, using PubMed to provide citations from the world's biomedical literature. We don't promise to catch every article on the topic, but MEDLINE contains bibliographic citations and author abstracts from more than 4,800 journals published in the United States and 70 other countries.

The following Alerts categories are available now:

1. Articles on traumatic stress in children and/or adolescents, limited to English-language publications (includes all forms of traumatic stress)
2. Articles on traumatic stress, all languages and populations (includes animal studies, adults, etc.)

If you are interested in receiving these alerts, send an email to Peggy Schaeffer, MLS, resource coordinator, National Resource Center,
peggy.schaeffer@duke.edu

Florida Association for Infant Mental Health 5th Annual Florida Association for Infant Mental Health Conference: "Building Our Future." June 2 - 3, 2005, Safety Harbor, FL
Register Online at www.jwbpinellas.org
"Building Our Future" is an infant-toddler development and mental health conference. It is based on the premise that early experiences have unique power. The conference features cutting-edge knowledge, systemic thinking, and opportunities for collaborative planning. It will showcase Florida 's strategic plan for a birth-to-five mental health system and facilitate its implementation. CONFERENCE GOALS: To gather experts from different disciplines who can share new knowledge and promising practices related to prevention/mental health promotion, early intervention, and treatment. To provide participants with current information, research, and practices including the building of an infant mental health infrastructure, the assessment of infant mental health, and the delivery of innovative mental health services. To recruit a cadre of committed professionals and advocates who will work together to implement Florida 's Strategic Plan for Infant Mental Health. WHO SHOULD ATTEND: " Building Our Future" will bring together early educators and caregivers, physicians, nurses, mental health professionals, college professors, law enforcement personnel, social workers, therapists from many different disciplines, child advocates, psychologists, program administrators, and policy makers who are in a position to implement a mental health strategic plan in Florida and in other states or countries.

Parent-Child Interaction Therapy (PCIT) Training Workshop. June 13-17, 2005, Tallahassee, FL
The Child Study Lab at the University of Florida will be having a Parent-Child Interaction Therapy (PCIT) Training Workshop ( June 13-17, 2005 ). Parent-Child Interaction Therapy is an empirically supported treatment for young conduct-disordered children and was named by the Kauffman's Best Practice Project as one of three "best practices" for treating child abuse. Registration for this workshop is now available on-line. Please visit www.PCIT.org to learn more about the workshop, register on-line, and learn about future workshops. If you have any questions, please contact us at PCIT@phhp.ufl.edu.

Sixth National Conference on Child Sexual Abuse Prevention. August 10-12, 2005 , Huntsville, AL
The National Children's Advocacy Center and the Association for Sexual Abuse Prevention invites you to attend a tuition-free conference on child sexual abuse prevention. This conference is specifically designed for prevention educators, administrators, and researchers. It is an opportunity to hear about state-of-the-art prevention practices from those working in schools with children and teens, those in the community educating adults, those doing outreach to offenders and potential offenders, researchers on all aspects of prevention, and those doing public awareness campaigns.

Space is limited, so register early at www.nationlacac.org . If you have any questions, please contact Sharen Barrett at sbarrett@nationalcac.org. This conference is supported by a training grant from the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice, Washington, DC.

13th Annual Oklahoma Conference on Child Abuse and Neglect and Healthy Families 2005. September 28- 30, 2005, Norman, OK
The educational goal of the 13th Annual Oklahoma Conference on Child Abuse and Neglect and Healthy Families 2005 is to foster professional excellence in the field of child maltreatment by providing advanced interdisciplinary professional education. The conference's intensive skill-building seminars combine the best of research and practice, providing immediately useful skills firmly grounded in the latest empirical research. This conference has been designed specifically for professionals in child protective services, juvenile services, nursing, community-based family resource and support services, child guidance, mental health, law, medicine, substance abuse services, law enforcement, prevention services, and education. All aspects of child maltreatment will be addressed including, prevention, assessment, intervention and treatment with victims, perpetrators and families affected by physical, sexual, and psychological abuse and neglect. Cultural considerations will also be addressed.

Conference website:
http://okcdrb.ouhsc.edu/conference

Contact Information:
Jessica Shatley
Center on Child Abuse and Neglect
940 NE 13th Street ; CHO 3B-3406
Oklahoma City , Oklahoma 73104
(405) 271-8858 phone
(405) 271-2752 fax
E-mail Jessica-shatley@ouhsc.edu

Alexandra Roussos, Armen K. Goenjian, Alan M. Steinberg, Christina Sotiropoulou, Marina Kakaki, Christos Kabakos, Stavroula Karagianni, and Vagelis Manouras, “Posttraumatic Stress and Depressive Reactions Among Children and Adolescents After the 1999 Earthquake in Ano Liosia, Greece,” American Journal of Psychiatry, no. 162 (2005): 530-7.

M.A. De Arellano, A.E. Waldrop, E. Deblinger, J.A. Cohen, C.K. Danielson, and A.R. Mannarino, "Community Outreach Program for Child Victims of Traumatic Events: A Community-Based Project for Underserved Populations," Behavior Modification 29, no. 1 (2005 ): 130-55.
Behavioral and cognitive behavioral treatment interventions have been shown to be effective for the treatment of trauma-related problems in children. However, many children and families in need of treatment do not have adequate access to services and do not have access to effective, evidence-based treatment services. The present article describes a community-based program that provides in-home and in-school treatment services, based on behavioral and cognitive behavioral approaches to addressing trauma-related emotional and behavioral problems in children.

J.A. Cohen, A.P. Mannarino, "Treatment of Childhood Traumatic Grief," Journal of Clinical Child and Adolescent Psychology 33, no. 4 (2004): 819-31.
Childhood traumatic grief (CTG) is a condition in which trauma symptoms impinge on children's ability to negotiate the normal grieving process. Clinical characteristics of CTG and their implications for treatment are discussed, and data from a small number of open-treatment studies of traumatically bereaved children are reviewed. An empirically derived treatment model for CTG is described; this model addresses both trauma and grief symptoms and includes a parental treatment component. Future research directions are also addressed.

G. Fairbrother, J. Stuber, S. Galea, A.R. Fleischman, B. Pfefferbaum, "Posttraumatic Stress Reactions in New York City Children after the September 11, 2001, Terrorist Attacks." Ambulatory Pediatrics 3, no. 6 (2003):304-11.
OBJECTIVE: To assess the prevalence of posttraumatic stress reactions (PTSR) in New York City (NYC) children following the September 11, 2001 , attacks and determine the key predictors of PTSR. METHODS: Cross-sectional random digit-dial survey in NYC of parents of children 4-17 years old 4 months after the attacks. PTSR in children was measured using the 20-item Posttraumatic Stress Disorder Reaction Index-Child Revision, with parents as respondents. RESULTS: Overall, 18% of NYC children had "severe" or "very severe" PTSR, and 66% had "moderate" PTSR. In a multivariate model, parental posttraumatic stress disorder (PTSD; odds ratio [OR] = 4.50; P <.01), the parent crying in front of the child (OR = 3.19; P <.001), seeing 3 or more graphic images of the disaster on television (OR = 3.18; P <.01), and living in Manhattan were associated with severe or very severe PTSR in children. CONCLUSIONS: A substantial proportion of NYC children had severe or very severe PTSR after September 11, and most children exhibited at least moderate PTSR. These findings suggest an enhanced role for primary care physicians, particularly pediatricians, for screening, treatment, and referral (coupled with appropriate training and reimbursement), especially in light of continued terrorist threats. These findings also have implications for advice that pediatricians can give to parents about limiting disaster-related television exposure and children's need for emotional support.

E. Hall, G. Saxe, F. Stoddard, J. Kaplow, K. Koenen, N. Chawla, C. Lopez, L. King, and D. King, "Posttraumatic Stress Symptoms in Parents of Childen with Acute Burns," Journal Pediatric Psychology (March 23, 2005 Epub ahead of print)
OBJECTIVE To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. METHODS: Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. RESULTS: Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. CONCLUSIONS: This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.

N. Kassam-Adams, J.F. Garcia-Espana, J.A. Fein, F.K. Winston, "Heart Rate and Posttraumatic Stress in Injured Children," Archives of General Psychiatry 62, no. 3 ( 2005):335-40.
BACKGROUND: Elevated, acute heart rate has been related to later posttraumatic stress disorder (PTSD) development in injured adults, but this has not been examined in children and adolescents. Better understanding of the relationship between acute physiological arousal and later child PTSD could help elucidate the etiology of posttrauma responses in children and might identify useful markers for PTSD risk. OBJECTIVE: To evaluate the relationship between heart rate assessed in the emergency department (ED) during normal clinical care and later PTSD outcome in traumatically injured children. DESIGN: Prospective cohort study assessed heart rate at ED triage and PTSD an average of 6 months' postinjury. SETTING: Large, urban pediatric academic medical center in the northeastern United States . PARTICIPANTS: One hundred ninety children and adolescents (aged 8-17 years) hospitalized for traffic-related injury.Main Outcome Measure Clinician-Administered PTSD Scale for Children and Adolescents. RESULTS: The group of children who developed partial or full PTSD had a higher mean +/- SD heart rate at ED triage than those who did not go on to have PTSD (109.6 +/- 22.3 vs 99.7 +/- 18.0 beats per minute). Children with an elevated heart rate (defined as >/=2 SDs higher than the normal resting heart rate for their age and sex) at ED triage were more likely to meet criteria for partial or full PTSD at follow-up, even after adjusting for age, sex, and injury (adjusted odds ratio, 2.4 [95% confidence interval, 1.1-5.4]). CONCLUSION: These results suggest an association between early physiological arousal and the development or persistence of PTSD symptoms in injured children and point to the importance of better understanding the interplay between physiological and psychological functioning after a traumatic stressor.

R.L. Pfefferbaum, G. Fairbrother, E.N. Brandt Jr, M.J. Robertson, R.H. Gurwitch, J. Stuber, and B. Pfefferbaum, "Teachers in the Aftermath of Terrorism: A Case Study of One New York City School," Family and Community Health, 27, no. 3 (2004):250-9.
Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional but felt ill-equipped to intervene with students and expressed substantial need for assistance.

Christine Siegfried and Susan Ko, " Addressing Child Trauma in Juvenile Justice and Residential Settings," Child Welfare League of America Link 4, no. 1 (2005), available at
www.cwla.org/programs/juvenilejustice/thelink2005spring.pdf.