Faculty Bibliography

INTRODUCTION: The purpose of this study was to examine predictors of risk for and the transition between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in a longitudinal sample of youth with severe injuries admitted to the hospital. These data would assist with treatment and discharge planning. METHODS: Youth were assessed for ASD during the initial hospital stay and were followed-up over an 18-month period for PTSD (n = 151). Youth were classified into four groups, including Resilient (ASD-, PTSD-), ASD Only (ASD+, PTSD-), PTSD Only (ASD-, PTSD+), and Chronic (ASD+, PTSD+). Demographic, psychiatric, social context, and injury-related factors were examined as predictors of diagnostic transition. RESULTS: The results of multivariate analysis of variance and pairwise comparisons found that peritraumatic dissociation, gender, and socioeconomic status were significant predictors after controlling for multiple testing. DISCUSSION: Results suggest that both within-child and contextual factors contribute to the longitudinal response to trauma in children. Clinicians should consider early screening and discharge planning, particularly for children most at risk.

Objectives: This presentation details the intervention model that was implemented in the Bridging the Way Home program. Trauma systems therapy (TST) is a standardized model of clinical care that includes a defined organizational process so that it can be adapted to the needs of providers and their organizations. This organizational approach, used within the Bridging the Way Home program, defines the organizational processes that must be implemented for the clinical model to be successfully implemented, sustained, and scaled across the organization. Methods: The clinical model of TST includes a defined sequence of assessment, treatment planning, treatment engagement, and treatment implementation. The information gathered within TST assessment defines a traumatized child's problems within two dimensions: 1) a child who is not able to regulate emotional and behavioral states in specific contexts; and 2) a social environment/services system that is not able to help the child regulate these emotional and behavioral states. Specific interventions are chosen based on the magnitude of the child's problems within these two dimensions. These interventions aim to build the child's regulation capacities and the capacity of those around the child to support regulation. Depending on the child's needs, a specific intervention approach is selected that may involve combinations of psychotherapy, psychopharmacology, home-based care, and legal advocacy. The TST organizational model facilitates an organization's integration of services to implement clear and specific treatment plans. Results: TST was implemented successfully within the Bridging the Way Home Program. Providers and foster parents were able to deliver TST with fidelity, and greater fidelity contributed to a greater benefit for foster children. Conclusions: TST defines a clinical and organizational model for children that can serve to improve care across a service-oriented system. This outcome was achieved for foster children within the Bridging the Way Home Program

Objectives: The goal of this study is to present the results of one of the largest evaluations of an intervention model for children in foster care aimed to improve care within the services system. This Bridging the Way Home program created processes by which a defined trauma-informed intervention model [trauma systems therapy (TST)] could inform the work of all those involved in the care of a foster child (i.e., clinical and nonclinical providers, foster parents). An overarching aim of this project was to determine whether such concerted care could drive improvements in outcomes. Methods: In this Clinical Perspectives session, we will detail all elements of the Bridging the Way Home program. We will begin with a presentation of the clinical model used in this program, TST, and how it was adapted for foster children. We then will detail how the Bridging the Way Home program was implemented in Kansas, including the process of training all providers and foster parents to provide this care, launching the care teams, and monitoring the quality of care. This implementation trained approximately 430 providers and 516 foster parents. We then will present the evaluation approach that aimed to insert sufficient scientific rigor without sacrificing external validity so that the results would be as generalizable as possible. Results: The evaluation revealed that implementing a trauma-informed approach within a large, complex service system can be achieved successfully, and findings indicate that doing so results in improved mental health and placement stability for the children served. Conclusions: Results indicate that improvements inmentalhealthoutcomesand placement stability were not the result of the delivery of TST by any one individual but, rather, by the concerted provision of care by all those around the child

Conventional research methodologies and data analytic approaches in psychiatric research are unable to reliably infer causal relations without experimental designs, or to make inferences about the functional properties of the complex systems in which psychiatric disorders are embedded. This article describes a series of studies to validate a novel hybrid computational approach-the Complex Systems-Causal Network (CS-CN) method-designed to integrate causal discovery within a complex systems framework for psychiatric research. The CS-CN method was first applied to an existing dataset on psychopathology in 163 children hospitalized with injuries (validation study). Next, it was applied to a much larger dataset of traumatized children (replication study). Finally, the CS-CN method was applied in a controlled experiment using a 'gold standard' dataset for causal discovery and compared with other methods for accurately detecting causal variables (resimulation controlled experiment). The CS-CN method successfully detected a causal network of 111 variables and 167 bivariate relations in the initial validation study. This causal network had well-defined adaptive properties and a set of variables was found that disproportionally contributed to these properties. Modeling the removal of these variables resulted in significant loss of adaptive properties. The CS-CN method was successfully applied in the replication study and performed better than traditional statistical methods, and similarly to state-of-the-art causal discovery algorithms in the causal detection experiment. The CS-CN method was validated, replicated, and yielded both novel and previously validated findings related to risk factors and potential treatments of psychiatric disorders. The novel approach yields both fine-grain (micro) and high-level (macro) insights and thus represents a promising approach for complex systems-oriented research in psychiatry.

Introduction: The objective of this study was to use two interventions to decrease PTSD and PTSD symptomatology in young burned children as measured by the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Report, or PTSDSSI (Sheeringa et al., 1994; 2003). The PTSDSSI was an appropriate instrument for evaluating PTSD in young children because its use elsewhere informed the DSM 5 diagnostic subtype, "PTSD in Children 6 Years and Younger" (APA, 2013). The PTSDSSI also requires parent observation of symptoms appropriate for young children-such as children's posttraumatic play, distressing dreams, withdrawal and irritibility; with a maximal score of 38. The Intervention group in this study received either the DEF (Distress, Emotional Support, and Family Functioning protocol) or the DEF+COPE (Creating Opportunities for Parent Empowerment program). Outcomes of child stress were compared with a Non-Intervention, control group. Methods: Children aged 0-5 years old admitted for an acute burn or for reconstructive surgery and their families, who speak English or Spanish, were eligible. The DEF consists of an initial meeting with caregivers to identify distress or support from an interview and offer clinical referrals for the family, and can be found online on nctsnet.org. The COPE (Melnyk, 2004) provides a workbook to increase parents' knowledge of typical behaviors and emotions children display in hospital and advice on how to participate more directly in child's care. Parents completed the PTSDSSI after their child's admission and at 6 month follow-up, to measure child stress. The 6-month change scores of the PTSDSSI were analyzed for three symptom clusters: re-experiencing(B), numbing/avoidance(C), and hyperarousal(D). Results: Although results did not reach statistical significance in this small sample, there was a clear trend of larger decreases in PTSD symptoms for children in the intervention group as compared to children in the control group. Conclusions: Both forms of intervention appear to have aided in the reduction child stress as measured by the PTSDSSI. Future studies with larger samples should explore both types of intervention. Applicability of Research to Practice: The psychosocial interventions outlined have clear benefits that should be taken into consideration when providing care to children with burns. (Figure presented)

This article examines key setting events and personal factors that are associated with support for either non-violent activism or violent activism among Somali refugee young adults in the United States. Specifically, this article examines the associations of trauma, stress, symptoms of posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), strength of social bonds, and attitudes towards legal and non-violent vs. illegal and violent activism. Structured interviews were conducted with a sample of Somali refugee males ages 18-25 living in the northeastern United States (N=79). Data were analyzed using multiple linear regressions and path analysis. Greater exposure to personal trauma was associated with greater openness to illegal and violent activism. PTSD symptoms mediated this association. Strong social bonds to both community and society moderated this association, with trauma being more strongly associated with openness to illegal and violent activism among those who reported weaker social bonds. Greater exposure to trauma, PTG, and stronger social bonds were all associated with greater openness to legal non-violent activism.