National Breakthrough Series Teams Selected
In order to achieve its overall goal of improving the quality, effectiveness, provision, and availability of therapeutic services delivered to all children and adolescents experiencing traumatic events, the NCTSN is sponsoring a National Breakthrough Series Collaborative (BSC) focused on the Adoption and Implementation of Trauma-focused Cognitive Behavioral Therapy (TF-CBT). This BSC will include teams from 12 sites that are committed to providing TF-CBT with sufficient fidelity in order to appropriately serve and improve outcomes for children and families. Participating sites are committed to testing small, rapid changes that are quickly implemented to accomplish this goal. These sites will share their adoption and adaptation successes and lessons learned in real time to further accelerate their achievement of improved outcomes.

Following a rigorous and competitive application and review process, the following Network teams were selected to participate:

• Chadwick Center for Children and Families,
  San Diego, CA
• Aurora Mental Health Center,
  Aurora, CO
• Safe Horizon,
  New York, NY
• Child and Parent Support Services/Center for Child and Family Health,
  Durham, NC
• Kennedy Krieger Family Center,
  Baltimore, MD
• Open Arms, Inc.,
  Albany, GA
• Oklahoma Child Traumatic Stress Treatment Collaborative,
  Tulsa, OK
• Catholic Charities, Inc.,
  Jackson, MS
• The Mental Health Center of Dane County,
  Madison, WI
• Directions for Mental Health, Inc.,
  Largo, FL
• Trauma Intervention Center for Children and Adolescents,
  Nashville, TN
• Children's Institute International,
  Los Angeles, CA

Each selected site has put together a five to ten member team that includes clinicians, supervisors, agency administrators, family members, and community partners. The teams will come together for three, two-day Learning Sessions, the first of which is scheduled for September 8-9 in Washington, DC. Questions about the National BSC can be directed to Cassie Kisiel. Congratulations to the selected teams!

NCTSN Culture Consortium Meeting: Let's Continue the Dialogue!
On June 6-7, 2005 the first meeting of the NCTSN Culture Consortium was held in Boston, Massachusetts. Thanks to the wonderful contributions and participation of approximately 25 Network members and two partners from the National Center for Cultural Competence at Georgetown University, we had an interesting and productive meeting. It is clear that this Network has essential expertise to offer and the commitment to better understanding the fusion of culture and trauma is already an important priority.

The general goals of the meeting were to review work that has already been done to address issues of culture, diversity, and cultural competence, and their intersection with trauma; to identify gaps in knowledge and resources; and to prioritize projects and products. The meeting began with a review of the NCTSN Cultural Needs Assessment, which was conducted in the Winter 2004 with National Center staff and NCTSN working group chairs. The report from the Needs Assessment outlined five recommendations, which served as a starting point for discussion at the meeting. We then reviewed other collaborative projects that are ongoing (e.g., via working groups, and at individual sites), in order to begin dialogue about gaps in knowledge, resources, training, etc. We ended the meeting with some important ideas about priorities for this group, and the Network as a whole, as we seek to infuse cultural competence throughout all of our activities.

The process of the meeting resulted in narrowing down a long list of priority areas for addressing cultural competence to three major ones: Organizational Change/Systems Issues, Assessment and Treatment, and Training. Perhaps even more importantly, we outlined the manner in which these three priorities are cross-cutting. The group's ideas for next steps included:

• Integrate priorities so that any guidelines that are developed are all-inclusive and address each of the three priorities.
• Pay particular attention to the fusion of culture and trauma. This is where our Network has a special niche and can greatly contribute to addressing gaps in the field.
• Focus on developing partnerships, especially with the National Center for Cultural Competence. Build upon resources (e.g., policy briefs) that have already been developed.
• Continue to advocate for the implementation of existing guidelines and principles.
• Emphasize evaluation as a key component that should have a role in all activities that seek to promote cultural competence and the fusion of culture and trauma.
• Do not forget to identify areas of strength; focus on adaptive functioning (of individuals and systems), as opposed to symptoms and pathology only.
• Make sure that family involvement is a part of all priority areas.
• Continue this important dialogue.

In the short-term:

• We will set up a listserve as a mechanism to enable continued dialogue among the members of the Culture Consortium, other Network members and partners, and beyond. We envision that listserve participants will share and contribute information, and also respond as a consultative resource. Over the summer, you will see us highlight the listserve and promote it as a key vehicle for establishing the members as a vibrant community dedicated to the work of infusing issues related to diversity, culture, and cultural competence into trauma treatment and practices.
• We will maintain a link with the activities of the Breakthrough Series Collaborative (BSC) via Cassie Kisiel (NCCTS Training Director), as well as Michael de Arellano, Karen Batia, and Elizabeth Thompson who have been and will continue to be involved with the BSC expert panel.
• We will continue to move forward with the development of the guidelines for culturally competent treatment, led by Michael de Arellano and Carla Danielson. This project will involve forming an expert working group for the project, developing a template that calls for promising adaptations to evidence-based treatments, and modifying criteria from the Office of Victims of Crime to evaluate promising practices on the extent to which they reflect cultural competence in trauma treatment.

More information about all of these activities will be forthcoming via the listserve. Although logistics required us to limit participation in the Culture Consortium meeting to a small number, we are looking forward to expanding involvement in the Culture Consortium with many more interested members. If you feel that you have contributions to make to the listserve and are willing to occasionally respond to consultative requests, please contact Iliane Morrissey at imorrissey@mednet.ucla.edu about joining the listserve. For other questions or comments about the NCTSN Culture Consortium, please contact Susan Ko, Service Systems Director, or Michael de Arellano, Culture Consortium Chair.

Data Core:
Closing In On One Thousand!!!
A message from the Data Core : There are over 900 cases entered into the InForm (web-based) System with almost 80 percent of participating centers entering or on the verge of entering data!!! Follow-up data is beginning to be entered as well with over 200 cases having at least some follow-up data entered. We are also currently piloting a data transfer process with Depelchin Children's Center of Texas , Kennedy Krieger of Maryland and the Intercultural Child Traumatic Stress Center of Oregon. This piloting process has taken a great deal of time and effort from center staff and we want them to know how much we at the Data Core appreciate their hard work and patience.

Please accept our gratitude for such great work and the efforts made by each and every staff member at all of those centers who have participated in data collection (24 centers total!!) and to our “high-enrollers” (The Center for Medical and Refugee Trauma in Boston, The Cullen Center for Children, Adolescents and Families of Ohio, The Kansas City Metropolitan Child Traumatic Stress Center of Missouri, The Maine General Medical Center, The Mental Health Corporation of Denver, The Child Trauma Treatment Network/Intermountain West of Utah, Louisiana State University Health Science Center and Western Michigan University).

Other Good News

All the rest of the centers are actively working on getting all of the necessary regulatory documents in place. More than 80 percent of participating centers (equaling about 170 staff across the Network) have been trained to use the InForm System. We have also been contacted by centers outside of the Network who want to participate in data collection, and, to date, have one such center that is entering data. Thank you all for making this possible.

Also, remember to contact your IRB if you received approval for this initiative a year ago. All IRBs require annual updates on progress made over the last 12 months. Also inform them of any significant changes you have made, if any, since your original submission. Check with your IRB for a reporting format that would be best.

Summer Expert Panel on Adolescent Trauma and Substance Abuse
The Adolescent Traumatic Stress and Substance Abuse Treatment Center at Boston University , in conjunction with NCTSN and SAMHSA, hosted the “Summer Expert Panel Meeting on Adolescent Trauma and Substance Abuse.” This convening, held in Boston on June 20 and 21, 2005, brought together approximately 60 participants representing the fields of adolescent trauma, substance abuse, and community health. Panels of experts in the fields of substance abuse and trauma presented current treatment practices as well as their research, and community-practitioners discussed the treatment needs and challenges presented by adolescents at their treatment and service sites.

The purpose of this meeting was to begin to bridge the fields of adolescent substance abuse and trauma with an overarching goal of fostering future collaboration among attendees. Four breakout groups convened on the second day of the meeting to discuss essential treatment components for youth with traumatic stress and substance abuse problems, strategies for adolescent engagement, raising community awareness, and dissemination and training of clinicians. Plans were discussed to share meeting findings and resultant products with the broader NCTSN community and to continue to develop the themes addressed during the break-out groups. This convening constituted a first step in trying to raise the standard of care for youth experiencing traumatic stress and substance abuse problems. Ongoing collaborations resulting from this meeting will lead to increased knowledge about ways to address gaps in access to services and treatment of youth with traumatic stress and substance abuse problems as well as to establishing a consensus on promising practices to serve the unique needs of this challenging population.

Judicial Education Group Working with Juvenile Court Judges
The Judicial Education Working Group, under the leadership of Joy Osofsky and Erna Olafson, is pursuing a number of activities to educate judges about child trauma. The National Council on Juvenile Court Judges (NCJFCJ) and the National Child Traumatic Stress Network (NCTSN) held two focus groups at the Annual Conference of the NCJFCJ in July to explore ways these organizations can benefit and learn from each other. The focus groups followed two presentations by Network members at the conference in Pittsburgh.

The two groups were facilitated by Julian Ford, PhD, of the University of Connecticut and Erna Olafson, PhD, PsyD, of the Trauma Treatment Replication Center at the Cincinnati Children's Hospital Medical Center. Judges Cindy Lederman and James Ray, both of whom are on the NCJFCJ Board, helped to promote the groups to fellow judges and sat in on the sessions. Also assisting with the groups were Kris Buffington, MSW, from the Cullen Center of Toledo Hospital, and Deborah Ling, MBA, from the National Center for Child Traumatic Stress at UCLA.

The judges were divided into two groups, one to include discussions regarding juvenile delinquency and dependency, and the other to focus on issues pertaining to divorce, dependency, custody, visitation, and domestic violence. There were 20 judges total who participated, and both groups felt the exchange was helpful and would lead to future opportunities for partnerships and product development.

The responses indicated that judges feel cases involving traumatized children are among their most difficult. They had questions about how deeply the child has been traumatized, how not to exacerbate the trauma and/or cause further harm, whether their custody decisions are going to place children in safe or harmful environments, how to deal with a general lack of knowledge about child trauma within many service systems, and how to effectively communicate with traumatized children to determine their abilities to cope.

The judges also agreed that child trauma experts (and NCTSN) could provide several basic items that would be helpful to them. These included basic trainings and seminars about child trauma provided repeatedly and regularly, which would include recent findings and current research in child-trauma treatment. The judges also requested a basic checklist and/or interview protocol to assess trauma in simple non-medical language, including the acute and long-term effects of trauma. They wanted tips for how to deal with trauma effects and/or refer out to experts in the short and long term. They also felt a tool to evaluate the quality of trauma experts would be helpful. In fact, they said even a simple listing of all the child trauma specialists affiliated or part of out Network would be helpful to them. They hope the Network can provide information about Network members local to their jurisdiction and what materials and consultation assistance the Network can offer.

The NCJFCJ and NCTSN are also preparing a special edition of the Juvenile and Family Court Journal for this winter. The Journa l has been published for over 50 years by the NCJFCJ and is sent to over 1700 juvenile and family court judges, court administrators, probation workers, attorneys, social workers and others around the country. The goal of this special issue is to provide the judiciary and other professionals working in the court system with practical information and tools to improve responses to children and youth who have experienced trauma.

For more information on the work of the Judicial Education group, contact Joy Osofsky at Louisiana Rural Trauma Services Center or Erna Olafson at Cincinnati Children's Hospital Medical Center.

Federal Mental Health Action Agenda Announced
In July, the federal government announced the Federal Mental Health Action Agenda. The agenda's executive summary noted the following: “The work of the New Freedom Commission on Mental Health is a key component of President George W. Bush's New Freedom Initiative. In its final report to the President, the Commission called for nothing short of fundamental transformation of the mental health care delivery system in the United States-from one dictated by outmoded bureaucratic and financial incentives to one driven by consumer and family needs that focuses on building resilience and facilitating recovery. The following Federal Mental Health Action Agenda articulates specific, actionable objectives for the initiation of a long-term strategy designed to move the Nation's public and private mental health service delivery systems toward the day when all adults with serious mental illnesses and all children with serious emotional disturbances will live, work, learn, and participate fully in their communities.”

The Campaign for Mental Health Reform
Also in July, and in conjunction with the Federal Mental Health Action Agenda, the Campaign for Mental Health Reform released "Emergency Response: A Roadmap for Federal Action on America´s Mental Health Crisis." The coalition of 16 national organizations has proposed 28 action steps as a "roadmap" for Congress and the administration to transform the country´s ailing mental health care system.

The campaign came together after President Bush´s New Freedom Commission on Mental Health released its groundbreaking report in July 2003, "Achieving the Promise: Transforming Mental Health Care in America." In that report, the 22 commissioners found the US mental health system "fragmented and in disarray, lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration." The commission called for a "fundamental transformation of the Nation´s approach to mental health care." Visit mhreform.org for more information.

Call for Abstracts: APSAC's 14th Annual National Colloquium
Research submissions for the American Professional Society on the Abuse of Children's colloquium must be postmarked by January 14, 2006. This year's event will be held June 12 – 25, 2006, in Nashville. For more information, please visit APSAC's website.

Grant Opportunity: Healthy Tomorrows Partnership for Children Program
The purpose of this Health Resources and Services Administration program is to stimulate innovative community-based programs that employ prevention strategies to promote access to health care for children and their families nationwide. Click here for for more information on the HRSA website. Deadline: September 12, 2005.

Grant Opportunity : Developing Centers for Innovation in Services and Intervention Research
The ultimate goal of this program announcement is to establish support for groups of researchers to develop intervention and services research studies that will directly address the missions of NIMH and NIAAA and to prepare these research groups to develop advanced centers. It also supports two of the three central themes of the NIH Roadmap initiative: developing interdisciplinary research teams for the future, including public-private partnerships; and re-engineering the clinical research enterprise. Click here for more information.

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

Allred CA, Burns BJ, and Phillips SD, "The Assertive Community Treatment Team as a Complex Dynamic System of Care," Administration and Policy in Mental Health 32, no. 3 (2005):211-20. This paper presents a dynamic systems view of Assertive Community Treatment (ACT), a recognized evidence-based treatment for adults with severe and persistent mental illness. It is argued that because an ACT team operates as a complex adaptive system, it engages in the organizational processes of "sense making" and self-organization, which help to bring order to the actions of team members and sustainability of the intervention itself. Consequently, successful implementation of ACT requires that management technologies such as meaning-creation and -design are used in conjunction with traditional "command and control" technologies of policies, procedures, processes, and structures.

Berlin LJ, Ziv Y, Amaya-Jackson, and Greenberg MT, Enhancing Early Attachments (New York: Guilford Press, 2005). Synthesizing the latest theory, research, and practices related to supporting early attachments, this volume by the Center for Child and Family Policy provides a unique window into the major treatment and prevention approaches available today. Chapters address the theoretical and empirical bases of attachment interventions; explore the effects of attachment-related trauma and how they can be ameliorated; and describe a range of exemplary programs operating at the individual, family, and community levels. Throughout, expert authors consider cross-cutting issues such as the core components of effective services and appropriate outcome measures for attachment interventions. Also discussed are policy implications, including how programs to enhance early child–caregiver relationships fit into broader health, social service, and early education systems.

Brown EJ and Goodman RF, "Childhood Traumatic Grief: An Exploration of the Construct in Children Bereaved on September 11,"Journal of Clinical Child & Adolescent Psychology 34, no. 2 (2005): 248-59. This study is an exploration of the measurement and correlates of childhood traumatic grief (CTG). Eighty-three children of uniformed service personnel who died during the World Trade Center attack on September 11, 2001, were assessed using measures of demographic characteristics, trauma exposure (physical proximity, emotional proximity, and secondary adversities), use of coping strategies, psychiatric symptoms (posttraumatic stress disorder [PTSD], general anxiety, depression), self-esteem, and traumatic grief. An exploratory factor analysis of the Extended Grief Inventory (EGI; Layne, Savjak, Saltzman, & Pynoos, 2001) indicated distinct constructs of normal versus traumatic grief. CTG factor scores were correlated with secondary adversities from the traumatic event, symptoms of PTSD, anxiety, depression, and coping responses, underscoring the theoretical and clinical utility of the content of the measure. Study limitations and future research recommendations are discussed. Click here to find this article on the publisher's website.

DeArellano MA, Waldrop AE, Deblinger E, Cohen J, Danielson CK, and Mannarino AR, "Community Outreach Program for Child Victims of Traumatic Events: A Community-Based Project for Underserved Populations," Behavior Modifacation 29, no. 1 (2005): 130-55.

Kaplow JB, Dodge KA, Amaya-Jackson L, and Saxe GN, “Pathways to PTSD, Part II: Sexually Abused Children,” American Journal of Psychiatry 162 no. 7 (July 2005).

Raghavan R , Bogart LB, Vestal KD, Elliott M, and Schuster MA, "Sexual Victimization among a Nationally Representative Sample of Adolescent Girls," Perspectives on Sexual and Reproductive Health 36 (2004): 225-32.

Raghavan R, Zima BT, Andersen RM, Leibowitz AA, Schuster MA, and Landsverk J, "Psychotropic Medication Use in a National Probability Sample of Children in the Child Welfare System," Journal of Child and Adolescent Psychopharmacology 15, no. 1 (2005):97-106. The aim of this study was to estimate the point prevalence of psychotropic medication use, and to describe relationships between child-level characteristics, provider type, and medication use among children in the child welfare system. METHODS: The National Survey of Child and Adolescent Well-Being is the first nationally representative study of children coming into contact with the child welfare system. We used data from its baseline and 12-month follow-up waves, and conducted weighted bivariate analyses on a sample of 3114 children and adolescents, 87 percent of whom were residing in-home. RESULTS: Overall, 13.5 percent of children in child welfare were taking psychotropic medications in 2001-2002. Older age, male gender, Caucasian race/ethnicity, history of physical abuse, public insurance, and borderline scores on the internalizing and externalizing subscales of the Child Behavior Checklist were associated with higher proportions of medication use. African-American and Latino ethnicities, and a history of neglect, were associated with lower proportions of medication use. CONCLUSIONS: These national estimates suggest that children in child welfare settings are receiving psychotropic medications at a rate between two and three times that of children treated in the community. This suggests a need to further understand the prescribing of psychotropic medications for child welfare children.

Saxe GN, Stoddard F, Hall E, Chawla N, Lopez C, Sheridan R, King D, King L, and Yehuda R, “Pathways to PTSD, Part I: Children with Burns,” American Journal of Psychiatry 162 no. 7 (2005).