The National Child Traumatic
Stress Network
The National Child Traumatic Stress Network is supported
through funding from the Donald J. Cohen National Child
Traumatic Stress Initiative, administered by the Center for
Mental Health Services (CMHS), Substance Abuse and
Mental Health Services Administration.
National Child Traumatic Stress Network
Mission Statement
The mission of the National Child Traumatic
Stress Network (NCTSN) is to raise the
standard of care and improve access to services
for traumatized children, their families and
communities throughout the United States.
Type of Personal Physical Exposure to the WTC Attack
Among NYC Public School Students, Grades 6-12:
Ground Zero Compared to the Remainder of the City
(New York City Board of Education, 2002)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
91%
99%
90%
80%
73%
70%
41%
36%
27%
9%
2% 1%
In smoke/dust
Fled for
safety
Problem
Smelled
Had to move Any Direct
getting home smoke post
house
9/11
Ground Zero
NYC Remainder
Type of Exposure to Family Member due to the WTC Attack
among NYC Public School Students, Grades 6-12:
Ground Zero Compared to the Remainder of the City
(New York City Board of Education, 2002)
11%
12%
9%
10%
8%
8%
7%
6%
4%
2%
2%
1%
1% 1%
0%
Family Member Family Member Family Member Any Family
escaped unhurt
hurt
killed
(escaped, hurt or
killed)
Ground Zero
NYC Remainder
Type of Previous Traumatic Exposure
Among NYC Public School Students, Grades 6-12:
Ground Zero Compared to the Remainder of the City
(New York City Board of Education, 2002)
70%
64%
60%
51%
50%
39%
40%
30%
20%
29%
28%
27%
23%
19%
11%
15%
10%
0%
3%
Self badly
Seen Close friend Family
hurt
killing/injury killed
member
killed
Ground Zero
5%
Lived in
country at
war
3%
4%
In major
disaster
NYC Remainder
Any
previous
trauma
Range of Traumatic Events
• Trauma embedded in the fabric of daily life
–
–
–
–
–
–
Child abuse and maltreatment
Domestic violence
Community violence and criminal victimization
Medical trauma
Traumatic loss
Accidents/fires
Range of Traumatic Events
• Humanitarian crises
– Natural and man-made disasters
•
•
•
•
•
•
•
•
Earthquakes
Floods, mudslides
Hurricanes
Tornadoes
Volcanic eruptions
Major transportation accidents
Industrial accidents
Technological disasters
– Catastrophes of human origin
• Armed conflicts/wars
• Genocide
• Terrorist attacks
Prevalence of exposure to the range of traumatic
events in the general population of children
• Nationally representative survey of 12-17 year old youth
reported lifetime prevalence of sexual assault (8%),
physical assault (17%) and witnessing violence (39%)
(Kilpatrick, Saunders & Resick, 1998).
• Longitudinal general population study of children and
adolescents (9-16 years) in Western North Carolina found
that one-quarter (25.1%) experienced at least one
potentially traumatic event by age 16, 6% within the past
three months (Costello, Erkanli, Fairbank & Angold, in
press)
Rates of Exposure to the Range of Traumatic
Events in School Surveys
Elementary and middle school children in inner city (n=500): 30%
witnessed a stabbing, 26% witnessed a shooting (Bell & Jenkins, 1993).
Middle and Junior High school students (n=2,248) in urban school
system: 41% reported witnessing a stabbing or shooting in the past year
(Schwab-Stone et al., 1995).
High School students (n=3,735) in six schools in two states. Relatively
high rates of exposure in the past year that varied by location and size
of the high school. Males: 3%-33% reported being shot or shot at, 6% 16% attacked with knife. Females: Lower reported rates of
victimization, higher rates for sexual abuse or assault (Singer et. al.,
1995).
Student Exposure-Santana H.S.
% (n)
Physically Injured
.8 (9)
Shooter Spoke Directly at Me
.5 (6)
Directly Witnessed Someone Get Shot
19 (219)
Shooter shot directly at me
4 (43)
Saw Someone Wounded or Killed
39 (452)
Gave First Aid or Support to Injured
2 (22)
Heard Gun Shots but Didn’t See Anything
35 (410)
Witnessed First Aid to Injured
9 (100)
Only Saw People Running
18 (205)
National Surv e y of Adole sce nts
%PTSD as a Function of Life History
(N=1,245) Kilpatrick et. al., 1995
25
20
15
10
5
0
No
Violence
Direct
Assault
Witness
Only
Assault +
Witness
Biological Studies of Child and
Adolescent Traumatic Stress
• Structural brain development
• Neurophysiology
• Neurohormones
Link between Violence Exposure and
Chronic PTSD with:
•
•
•
•
•
Substance Abuse
Reckless Behavior
High-risk Sexual Behavior
Gang Participation
Disturbances in Academic Functioning
(Kilpatrick, Saunders & Resick, 1998)
Violence and Trauma affects school performance
– Children with life threatening violence exposure
• Lower GPA
• More negative comments in permanent record
• More absences
– Children with Depression and Posttraumatic Stress
Disorder
• Even Lower GPA
• More absences
History of either physical or sexual abuse associated with:
* Higher incidence of early illness
* Faster cycling frequencies
* Lifetime Axis I and II disorders, including lifetime
history of alcohol and substance abuse
* Higher prevalence of medical illness
* Pattern of increasing severity of mania in those
who reported history of physical abuse
(Early physical and sexual abuse associated with adverse course of bipolar
illness. Leverich et al., Biol. Psych., 2000)
Number of Classes Failed (Pre-Post Intervention)
UCLA Trauma PsychiatryOCJP Pasadena Project (N=17)
40
Number of Classes Failed
35
38
30
25
20
15
10
13
5
0
Progress Report #1 (Week 5)
Progress Report #2 (Week 20)
Mean Grade Point Average
(Pre-Post Intervention)
UCLA Trauma PsychiatryOCJP Pasadena Project (N=17)
Mean Grade Point Average
2.5
2
2.12
1.5
1
1.35
0.5
0
Progress Report #1 (Week 5)
Progress Report #2 (Week 20)
Mental HeaIth Intervention Improves
Grades
Change in GPA
GPA
Non-traumatized
MHI
Community
3
2.9
2.8
2.7
2.6
2.5
2.4
2.3
First quarter
Improvement in grades significant p<0.05
Fourth Quarter
General Barriers to Care
System
•Lack of insurance
•Poor continuity in insurance coverage
•Poor Medicaid reimbursement rates
•Provider shortage
•Lack of provider training in evidence-based treatments
Community
•Residential instability (i.e., homeless, foster care children)
•Geographic distance from programs (i.e., rural areas)
Parent / Family
•attitudes, knowledge, and beliefs about signs of common mental
health problems and mental health services for children
•Poverty
•Education
•Poor social support
•Poor family functioning / high stress
Specific Issues Pertaining to Child and Adolescent
Trauma
Better Education and Training for Parents,
Students, School Personnel, Community
Agencies, Health and Mental Health
Practitioners, Law Enforcement, Child
Protective, Child Welfare, and Victim
Witness Staff, and Others Responsible for
the Care and Supervision of Children
Specific Issues Pertaining to Child and Adolescent
Trauma
-
Better Surveillance and Screening
Inclusion in Medicaid Early Periodic
Screening, Diagnosis, and Treatment
Systematic Screening in Child Service
Settings
Specific Issues Pertaining to Child and Adolescent
Trauma
Expand Resources and Build
Capacity for Child, Adolescent, and
Family Trauma Services
Specific Issues Pertaining to Child and Adolescent
Trauma
- Integration of Child and Adult Trauma
Services
Specific Issues Pertaining to Child and Adolescent
Trauma
-
Improve Funding of Case Managers
Specific Issues Pertaining to Child and Adolescent
Trauma
Integration of Child and
Adolescent Trauma Evaluation and
Treatment Services into Efforts to Develop
Integrated Service Systems
Specific Issues Pertaining to Child and Adolescent
Trauma
Advantages of Providing Schoolbased
Trauma Related Services
Specific Issues Pertaining to Child and Adolescent
Trauma
Better Integration of Mental Health
Services in School Crisis and Disaster
Preparedness, Response and Recovery
Programs
Insurance Parity for Childhood Trauma
Mental Health Services Within the
Wider Scope of Child and Adolescent
Mental Health Disorders
The Vision of the NCTSN
The NCTSN will raise public awareness of the scope and serious impact of child
traumatic stress on the safety and healthy development of our nation’s children
and families.
We will improve the standard of care by integrating developmental and cultural
knowledge to advance a broad range of effective services and interventions that
will preserve and restore the future of our nation’s traumatized children.
We will work with established systems of care, including the health, mental
health, education, law enforcement, child welfare and juvenile justice systems,
to ensure that there is a comprehensive continuum of care available and
accessible to all traumatized children and their families.
We will address the needs of children across the developmental spectrum, from
infancy through the school-aged years into the beginning years of young
adulthood.
We will be a community dedicated to collaboration within and beyond the
Network to ensure that widely shared knowledge and skills create a national
resource to address the problem of child traumatic stress.
Five Foci of Trauma-Grief Focused
Intervention
•
•
•
•
•
Traumatic Experience(s)
Trauma and Loss Reminders
Traumatic Bereavement
Adversities and Current Stresses
Developmental Progression
National Child Traumatic Stress Initiative
See Other Map
Network Sites
WA
ME
OR
MA
NY
CT
PA
CA
OH
IL
UT
DC
MO
CO
VA
LOS ANGELES
NM
AL
FL
Category I - National Center
Category II – 2001 Intervention Development
and Evaluation Centers
Category III – 2001 Community Treatment and
Service Centers
Category II – 2002 Intervention Development and
Evaluation Centers
Category III – 2002 Community Treatment and
Service Centers