Complex Trauma Working Group
NCTSN 3rd Annual Meeting
Minutes 12/12/03
Working Group Members In Attendance: Margaret Blaustein (TC-MMHI), Ruth DeRosa (North
Shore), Rebecca Gaba (Children’ Institute Intl.), Rebecca Hubbard (Clearwater), Richard Kagan
(Parsons), Joyce Kennedy (Aurora), Joan Liautaud, (FACES), Karen Mallah (MHCD), David
Pelcovitz (North Shore), Frank Putnam (Cincinnati), Joseph Spinazzola (Co-Chair; TC-MMHI),
Bessel van der Kolk (Chair; TC-MMHI)
New Members In Attendance: Connie Black-Pond (Michigan), Arlene Fisher (Texas), Amy
Hoch-Espada (New Jersey), Cheryl Lanktree (Long Beach), Ineke Way (Michigan)
Also Present: Malcolm Gordon (SAMHSA), Lisa Amaya-Jackson (NCCTS; LRCP), Jenifer
Wood (NCCTS)
Contents:
A. Overview & 2003 Accomplishments
B. 2004 Working Group Goals
C. Network Complex Trauma Survey Results
D. DSM-V
E. Thoughts for Next Meeting
A. Overview
Brief history of the Complex Trauma Working Group (formed at inaugural meeting of NCTSN)
was provided, with update on major projects to date.
Two major goals for Working Group set at 2nd Annual NCTSN Meeting:
1. Conduct network survey on scope of complex trauma exposure, symptoms, and
effective interventions: Completed. Data presented at ISTSS and this NCTSN ANM
2003 and summarized in Complex Trauma White Paper.
2. Draft a position paper (“white paper”) on Complex Trauma: Completed and
disseminated at this NCTSN ANM 2003. To be posted on NCTSN website.
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B. Working Group goals discussed and proposed for 2004 at 3rd Annual Meeting
1. Dissemination of White Paper and revision of format into peer-review journal
publication version as well as policy brief.
a. Alexandra Cook to take lead role on peer-review journal version with editorial
team consisting of Cheryl Lanktree, Julian Ford, Margaret Blaustein, Joseph
Spinazzola & Bessel van der Kolk. Raul Silva to advocate for publication of
the paper in JAACAP. Lisa Amaya-Jackson will discuss suitability and
effectiveness of a letter from Bob Pynoos and John Fairbank endorsing
publication of this paper.
b. Rebecca Hubbard and Jenifer Wood to take lead role on development of
policy brief with support from the Policy Core to develop and the National
Resource Center to disseminate.
c. White Paper currently lacks a diagnostic formulation (phenomenology based).
Utility of a developmentally framed diagnosis proposed (Bob Pynoos).
d. It was noted that John Fairbank, Frank Putnam and Bill Harris are currently
writing a policy paper for the J & J foundation. Will their be overlap between
these two initiatives?
2. Elaboration of a plan to organize the Working Group to provide training and technical
assistance on complex trauma across the network.
a. Importance of working with the NCCTS Training Core on this project.
Training Committee is developing list of core competencies, this group can
offer perspective on core competencies for addressing complex trauma
b. Margaret Blaustein to take lead on this project. She has coordinate accepted
invitation to join NCTSN Training Committee to represent incorporation of
core competencies around complex trauma in network training initiative.
Margaret to coordinate Workgroup staff interested in participating in this
project.
c. Complex Trauma training curriculum should be developed and as this is the
majority population clinicians in the network are serving.
d. Use of a systematic, algorithm based, pathways approach (Chadwick) to
training in assessment and treatment of complex trauma suggested by
Malcolm Gordon
3. Design and submission of multi-site prevalence and characterization study of
complex trauma exposures and outcomes in children in effort to propose a new
diagnosis for DSM-V addressing impact of developmental trauma on children.
a. Lisa Amaya-Jackson will be involved in consideration of this project.
b. Logistical, methodological and fiscal challenges of pursuing this kind of
project were discussed.
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c. Greater interest was expressed across the Working Group in treatment
development and dissemination than in conduct piloting and grant writing for
a multi-site epidemiological/classification study.
d. Agreed that establishing reliability/validity of a new/modified instrument
would be less feasible than use of existing instruments designed for this
purpose (e.g., CANS-TEAM) or secondary data analysis of available
measures (e.g., examine system clusters of instruments developed by
Friedrich, Berliner etc. for child trauma assessment).
e. Use of archival data for secondary data analysis discussed. Potential data sets
include Cornell data archive (Jenny Knowle & Frank Putnam trauma subscale
factor analysis of CBCL); UMDNJ data archive (Deblinger); Chadwick
Center; John Landsverk’s dataset, etc.
f. Karen Mallah (Denver) proposed conducting chart review of de-identified
MHCD data to further development and validation of the CANS-TEA (Child
and Adolescent Needs and Strengths-Trauma Exposure and Adaptation
version) as a complex trauma assessment tool (clinician rating scale) for this
population. Amy Hoch-Espada and Ineke Way also offered to participate in
this project
g. Question was also raised whether results of core dataset could be sufficiently
robust to assess complex trauma exposures and outcomes, and whether an
optional add-on module on complex trauma could be added at the site-level.
C. Network Survey Results (see survey attached)
1. Most trauma exposure in children served across the network is early onset
a. Children served by the network are rarely victims of single-incident trauma, with
multiple onset and/or chronic exposure predominant.
b. These findings raised the question of the appropriateness of the PTSD diagnosis
for such children.
c. In summary, survey suggests that multiple, early onset trauma exposure and
complex adaptation to these experiences is the norm for the children and
adolescents currently being served by the network.
2. Most common forms of trauma exposure in network children involved intrafamilial
trauma (Top three most prevalent forms of trauma exposure are psychological
maltreatment/abuse; traumatic loss; and impaired caregiver).
a. Discussion (Putnam) that these findings constitute a near inversion of
maltreatment cases reported by the child welfare system (i.e., physical and sexual
maltreatment reported more frequently than psychological maltreatment). Is this
because it’s harder to document emotional abuse? Alternately, prevalence of
emotional abuse (psychological maltreatment) in survey might suggest a gap or
imbalance in the CPS system. Finally, as reflected in research by Pelcovitz,
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childhood emotional abuse is emerging as an important issue and a powerful
predictor of negative mental health outcomes.
b. Mediating and contextual factors unable to be addressed given the design of this
survey (aggregate data) need to be teased out in future work.
3. Raised question about how to best use the survey data given it’s limitations. Publication
as a brief report in JTS was suggested.
4. No consistent picture in types of interventions perceived by survey clinicians as
most/least effective.
a. In open-ended follow-up queries many clinicians noted that effective
interventions involve parents and address systems of care.
b. No clear consensus or gold standard emerged from a clinical practice perspective
on how to best treatment complex trauma in children.
D. DSM-V
DSM-IV represents a window of opportunity to address diagnostic classification of complex
trauma outcomes in children and adolescents.
Who will do it if we don’t?
Discussed option of convening a pre-meeting institute on complex trauma in children and
adolescents at the 2004 meeting of ISTSS.
Bessel van der Kolk to identify pivotal figures in process/progress for DSM-V.
Of all the things we do, this is so important.
Discussed dimensional models of characterization of psychopathology associated with exposure
to complex trauma.
E. Thoughts for next meeting/agenda
Attachment – implication for caregivers
What can we learn from what isn’t working
And how does that stem from inaccurate diagnosis?
Training Initiatives
Complex Trauma treatment development and dissemination
June 10-12, 2004, Boston Trauma Conference
Evening of Wednesday, June 9, 2004, proposed for annual Complex Trauma Working Group
meeting.
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