The National Child Traumatic Stress Network (NCTSN)
Baseline Demographic and Clinical Characteristics
1
Ph.D. ,
1
Ph.D. ,
1
Haynes ,
1
Ph.D. ,
Matthew D. Kliethermes
Steven E. Bruce
Stacey
Ally Burr-Harris
and the principal investigators and program directors of the National Child Traumatic Stress Network
1University
Objective: Established in 2001, the National Child Traumatic
Stress Network (NCTSN) is a collaborative of 70 research
and treatment centers throughout the United States funded
by the Substance Abuse and Mental Health Services
Administration. Its purpose is to improve the quality and
availability of therapeutic services for youth exposed to
trauma. A major goal of NCTSN has been to create a
national data set consisting of information about services
provided to youth at NCTSN centers.
Methods: Data were drawn from intakes of 2118 traumatized
youth who received services at a NCTSN treatment center.
Analyses were conducted to provide demographic and
clinical characteristics of these children and adolescents
Results: Participants reported high levels of traumatic
events, including sexual abuse (19.4%), physical abuse
(23.2%), witnessing domestic violence (39.9%) and
traumatic loss (44.4%). Results also indicated that various
emotional and behavioral difficulties (e.g., symptoms of
posttraumatic stress), were prevalent in the sample. For
example, nearly one-third of participants met or exceeded
the suggested cutoff scores on PTSD measures. Half of
the sample also had reported emotional and behavioral
difficulties.
Conclusion: Results indicated that domestic violence and
traumatic loss appear to be among the most common
reasons that participants presented for trauma-focused
services. This study suggests that along with symptoms of
posttraumatic stress, children exposed to trauma
experience a broad range of emotional and behavioral
difficulties, which are suggestive of compromised
developmental status.
School Violence
Community Violence
Extreme Interpersonal Violence
Impared Caregiver
Forced Displacement
Mean
SD
Demographic Characteristics
• Many participants were no longer in the legal or physical custody of
their biological parents (see Figures 2 and 3).
• 19% of participants were in state custody (see Figure 2).
Recent Treatment/Service Usage
• Participants made frequent use of medical services (see Figure 5)
• Linkage to various social and mental health services in the month
prior to assessment was common (see Figure 5).
Types of Traumatic Experiences
• “Reportable” forms of child trauma were common (see Figure 1).
• Domestic violence and traumatic loss/bereavement were the most
common traumatic experience (See Figure 1).
• Caregiver impairment was endorsed by approximately 1/3 of the
sample (see Figure 1).
Clinical Characteristics
• As defined by results of standardized assessment measures (i.e.,
CBCL, TSCC-A, UCLA PTSD RI).
• Large percentages of participants presented with clinically significant
difficulties on multiple CBCL scales (See Table 3)
• Over one fourth of the sample was experiencing clinically significant
symptoms of PTSD (see Table 1).
• Large portions of the sample met or exceeded a T-score of 60 on the
Posttraumatic Stress (31.2%) and Dissociation (24.3%) subscales of
the TSCC-A, as well as other non-directly trauma-related scales (see
Table 2).
PTSD Criterion B Raw
Score (Reexperiencing)
730
8.17
5.47
N/A
PTSD Criterion C Raw
Score (Avoidance)
730
10.26
6.55
N/A
PTSD Criterion D Raw
Score (Arousal)
730
9.82
4.69
N/A
PTSD Overall Raw
Score
730
28.25
14.70
28.10%
Traumatic Loss or Bereavement
Table 2: TSCC-A Scales
Kidnapping
N
Natural Disaster
Mean
SD
% Above
Cutoff
(PTSD Overall ≥ 60)
Validity:
One
Trauma,
42.9
Multiple
Trauma
s, 57.1
Injury / Accident
Underresponse
564
53.08
11.69
Hyperresponse
564
56.28
17.84
Anger
564
50.09
11.03
19.5%
Anxiety
564
52.93
12.91
26.2%
Depression
564
52.04
12.28
23.6%
Posttraumatic Stress
564
53.46
11.74
31.2%
Dissociation:
564
52.65
11.88
24.3%
Fantasy
564
51.70
11.73
Overt Dissociation
564
52.84
11.562
Medical Trauma
Clinical:
Political Violence Outside US
Political Violence Inside US
Domestic Violence
Neglect
Psychological Maltreatment
Physical Assault
Table 3: CBCL Measures
Physical Maltreatment
Sexual Assault / Rape
N
Mean
SD
% Above
Cutoff
(PTSD Overall ≥ 65)
Sexual Maltreatment
20%
Figure 2: Current Legal Guardian
Other Adult
Relative, 4.1%
Unspecified,
0.7%
Unknown,
7.4%
40%
60%
Table 4: Gender
Gender
Male
Female
Emancipated
Minor (Self),
0.3%
%
48.2
51.6
Parent, 57.1%
State, 19.0%
N = 2118
Other Adult
Relative,
11.4%
Figure 3: Adult Type in the
Home
Unknown,
Other
Adult
(NonRelative),
3%
Other
Adult
(NonRelative),
3%
Other
Adult, 9%
Grandparent,
10%
406
62.04
10.22
45.60%
Withdrawn*
406
61.25
9.71
30.30%
Aggressive Behavior**
1335
64.30
12.00
44.60%
Anxious / Depressed**
1335
61.02
10.01
36.40%
Attention Problems**
1335
62.22
10.41
38.65%
Externalizing Behaviors**
1335
62.37
11.80
45.80%
Internalizing Behaviors**
1335
61.00
11.23
43.40%
Somatic Complaints**
1335
58.93
9.02
26.40%
Sleep Problems**
406
61.18
12.22
28.30%
Total Score**
1335
62.78
11.03
49.40%
Rule-Breaking
Behavior***
929
62.10
8.75
39.50%
Social Problems***
929
61.81
9.50
37.90%
Thought Problems***
929
61.46
9.25
37.50%
Withdrawn / Depressed***
929
62.30
9.81
38.60%
Figure 4: Primary Residence
21%
Mother,
37%
Emotionally Reactive*
Unknown,
21%
Mother,
37%
Other
Adult, 9%
Grandparent,
10%
Partner,
5%
Father,
15%
Partner,
5%
Father,
15%
Table 5: Ethnicity
Ethnicity
%
Hispanic / Latino
12.7
Indian
2.1
Asian
1.7
African-American
40.4
Hawaiian
0.1
Caucasian
45.0
Unknown
13.9
Conclusions
Children Aged 1½ to 5
0%
Suspected
Participants
 2118 children (age 3-19 M = 9.19 years old) participating
in the NCTSN Core Data Set (CDS) and presenting for
trauma-focused services were included in this study
 The data utilized in this project was submitted from the 29
NCTSN treatment centers to the CDS during the time period
of May 2004 through February 2006.
Inclusion Criteria: Presence of lifetime exposure to at least
one traumatic event.
The CDS includes information related to demographics,
domestic environment, service utilization, trauma exposure
history, and severity of emotional and behavioral difficulties.
Measures
f
Intake data collection was standardized across all NCTSN
treatment centers and consisted of a baseline information
form designed by NCTSN and standardized assessment
measures (i.e., CBCL, TSCC, UCLA PTSD RI).
Only baseline intake data was analyzed for the purpose of
this project.
N
% Above
Cutoff
(PTSD Overall ≥ 38)
Present
Method
Results
Table 1: UCLA PTSD Reaction Index
Other Trauma
Children Aged 6 to 18
Abstract
Figure 1: Prevalence of Trauma Types in Youths
of Missouri-St. Louis
• The primary support systems appear to have been
compromised
for many of the participants, which likely contributed to their
need
or trauma-focused treatment services.
• The results appear to confirm that children who present for
traumafocused treatment tend to experience deficits across multiple
areas of
functioning (e.g., social, academic, behavioral, etc.).
• The results highlight the need for assessment and treatments
services aimed at addressing “non-traditional forms of child
trauma (i.e., traumatic loss, domestic violence, impaired
caregiver).
• Symptoms of posttraumatic stress were clearly evident;
however,
many participants also experience a broad range of emotional
and
behavioral difficulties that may not be initially identified as
traumarelated (e.g., somatic complaints, interpersonal difficulties,
noncompliance). Trauma exposure in children appears to
represent a
“developmental insult” and hinders the capacity to develop
competencies in a variety of areas.
Future Directions
• This study represents an initial description of participants in the
CDS.
It is anticipated that future research using the CDS will take a
This
is supported by SAMHSA grant XXXX
varietystudy
of
directions including the following:
 Longitudinal treatment outcome data