This document discusses Trust-Based Relational Intervention (TBRI) as a treatment for foster youth with behavioral and emotional disorders. TBRI focuses on improving life habits through family training and therapy rather than medication. It has three main principles: Empowering, Connecting, and Correcting. The hypothesis is that foster youth who receive only TBRI will be more likely to overcome their disorders than those receiving only medication. While older studies support medication, more recent research finds foster youth are often overmedicated and TBRI provides an alternative treatment approach without medication side effects.
Power point upload for class TECA 1311 about early childhood pioneer Bruce Perry, MD, Ph.D. Made by Jack DisPennett. Plagiarism is wrong and is just plain rude, so please do not copy without giving proper credit. Enjoy!
This document summarizes and critically analyzes research on prescribing psychotropic medications to children and adolescents. It finds five major flaws that undermine the scientific validity of key antidepressant and stimulant drug trials. These flaws include: 1) compromised blinding due to the use of inactive placebos, 2) reliance on clinician ratings over patient self-ratings, 3) short trial timeframes that do not reflect real-world use, 4) conflicts of interest from pharmaceutical industry funding and ties to researchers, and 5) minimization of risks and side effects in the presentation of results. The analysis aims to help clinicians evaluate scientific claims and inform children, families, and their own practices regarding the risks and benefits of medicating youth.
When ADHD presents in traumatized children: A differential diagnoses.sophiaerez
This document discusses the importance of considering trauma and post-traumatic stress disorder (PTSD) as potential differential diagnoses when a child presents with symptoms of attention deficit hyperactivity disorder (ADHD). It notes that trauma, especially prolonged or interpersonal trauma at a young age, can produce effects that overlap with ADHD symptoms. Assessing for a history of trauma is crucial to properly diagnose and treat the child's symptoms. Misdiagnosing trauma as ADHD could result in ongoing trauma if the root cause is not addressed, as well as unnecessary medication without treating the underlying trauma.
Implementing Trauma Focused Cognitive Behavioral Therapy in MNShaylyn Bernhardt
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for children impacted by trauma. The document discusses implementing TF-CBT in Minnesota through learning collaboratives that train providers. It provides an overview of TF-CBT, defines trauma, and reviews the impact of trauma on children and parenting. Data is also presented on the number of Minnesota providers trained in TF-CBT and children screened for trauma.
Childhood Sexual Abuse: Assessment and Treatment Using Trauma-Focused Cogniti...Dr. Bernadette Marson
This document discusses childhood sexual abuse (CSA), including statistics on prevalence and treatment options. It provides statistics showing that CSA affects millions of children worldwide each year, with prevalence rates ranging from 7.9% for males to 28.2% for females in rural New Zealand. The effects of CSA can last a lifetime. Trauma-focused cognitive behavioral therapy (TF-CBT) is presented as the most effective treatment, consisting of components delivered to both the child and parent, including psychoeducation, relaxation techniques, affect expression/regulation, cognitive coping, trauma narrative/processing, in vivo exposure, and conjoint parent-child sessions to improve communication and safety skills.
Effects of trauma on implicit emotion regulation within a family system a res...Michael Changaris
This paper explores emotion regulation, family functioning, PTSD, impact of moral development and points to family therapy techniques to re-establish health in the family.
Major depressive disorder is a common psychological disorder characterized by a depressed mood lasting more than two weeks along with symptoms like loss of interest, sleep, and pleasure. It can be caused by genetic, biological, cognitive, social, and environmental factors. Treatment approaches include biomedical treatments using antidepressant drugs, individual cognitive therapies to change negative thoughts, and group therapies where people with similar issues provide support. The effectiveness of different treatment approaches is evaluated based on how long symptoms are relieved and whether observable behavior changes.
Power point upload for class TECA 1311 about early childhood pioneer Bruce Perry, MD, Ph.D. Made by Jack DisPennett. Plagiarism is wrong and is just plain rude, so please do not copy without giving proper credit. Enjoy!
This document summarizes and critically analyzes research on prescribing psychotropic medications to children and adolescents. It finds five major flaws that undermine the scientific validity of key antidepressant and stimulant drug trials. These flaws include: 1) compromised blinding due to the use of inactive placebos, 2) reliance on clinician ratings over patient self-ratings, 3) short trial timeframes that do not reflect real-world use, 4) conflicts of interest from pharmaceutical industry funding and ties to researchers, and 5) minimization of risks and side effects in the presentation of results. The analysis aims to help clinicians evaluate scientific claims and inform children, families, and their own practices regarding the risks and benefits of medicating youth.
When ADHD presents in traumatized children: A differential diagnoses.sophiaerez
This document discusses the importance of considering trauma and post-traumatic stress disorder (PTSD) as potential differential diagnoses when a child presents with symptoms of attention deficit hyperactivity disorder (ADHD). It notes that trauma, especially prolonged or interpersonal trauma at a young age, can produce effects that overlap with ADHD symptoms. Assessing for a history of trauma is crucial to properly diagnose and treat the child's symptoms. Misdiagnosing trauma as ADHD could result in ongoing trauma if the root cause is not addressed, as well as unnecessary medication without treating the underlying trauma.
Implementing Trauma Focused Cognitive Behavioral Therapy in MNShaylyn Bernhardt
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for children impacted by trauma. The document discusses implementing TF-CBT in Minnesota through learning collaboratives that train providers. It provides an overview of TF-CBT, defines trauma, and reviews the impact of trauma on children and parenting. Data is also presented on the number of Minnesota providers trained in TF-CBT and children screened for trauma.
Childhood Sexual Abuse: Assessment and Treatment Using Trauma-Focused Cogniti...Dr. Bernadette Marson
This document discusses childhood sexual abuse (CSA), including statistics on prevalence and treatment options. It provides statistics showing that CSA affects millions of children worldwide each year, with prevalence rates ranging from 7.9% for males to 28.2% for females in rural New Zealand. The effects of CSA can last a lifetime. Trauma-focused cognitive behavioral therapy (TF-CBT) is presented as the most effective treatment, consisting of components delivered to both the child and parent, including psychoeducation, relaxation techniques, affect expression/regulation, cognitive coping, trauma narrative/processing, in vivo exposure, and conjoint parent-child sessions to improve communication and safety skills.
Effects of trauma on implicit emotion regulation within a family system a res...Michael Changaris
This paper explores emotion regulation, family functioning, PTSD, impact of moral development and points to family therapy techniques to re-establish health in the family.
Major depressive disorder is a common psychological disorder characterized by a depressed mood lasting more than two weeks along with symptoms like loss of interest, sleep, and pleasure. It can be caused by genetic, biological, cognitive, social, and environmental factors. Treatment approaches include biomedical treatments using antidepressant drugs, individual cognitive therapies to change negative thoughts, and group therapies where people with similar issues provide support. The effectiveness of different treatment approaches is evaluated based on how long symptoms are relieved and whether observable behavior changes.
This document discusses the rationale for developing trauma-informed service systems. It begins by defining psychological trauma and reviewing research showing high rates of trauma in vulnerable populations. Trauma affects brain development and can cause lasting negative impacts. The document advocates for a universal precautions approach and trauma-informed care across organizations, rather than just trauma-specific treatment. It outlines 12 criteria for building trauma-informed mental health systems, such as having trauma-focused policies, training staff, and involving trauma survivors. The goal is to minimize re-traumatization and promote healing.
This document summarizes a presentation on breaking the intergenerational cycle of violence. It discusses how childhood exposure to violence can increase the risk of adult perpetration, and the impact of violence on brain development and mental health. Interventions like trauma-informed care and cognitive behavioral therapy aim to treat trauma and break the cycle. Data is presented on programs in Ohio that serve at-risk youth using evidence-based models like multi-systemic therapy and wraparound services.
Depression is a growing problem among teenagers. It can be caused by biological factors, traumatic events like abuse, stress from body changes and independence struggles, and pessimistic thinking patterns. Screening tools like the PHQ-2 are used but have limitations like low sensitivity. Untreated depression can be damaging, so parents should support teenagers through open communication, prioritizing physical health with exercise, and considering talk therapy for mild to moderate cases before medication.
The document discusses a study that examined emotion regulation (ER) patterns in 196 Chinese school-age children using reports from mothers, teachers, and children themselves. A cluster analysis identified 3 ER groups: a poor family ER group, poor school ER group, and overall good ER group. The study found significant differences among the groups in teacher-reported psychopathological symptoms like depression and attention problems, but no differences in mother-reported symptoms. Children in the overall good ER group had fewer symptoms, showing the value of a multi-informant approach to understanding children's emotional profiles and functioning.
Psychological assessment of burns by Suhasini Oliveira, National Burns Centre...NationalBurnsCentre2000
This document provides information about psychological assessment of burn patients from the National Burns Centre in India. It describes the purpose of psychological assessment as helping to identify psychological problems in burn patients who often experience anxiety, depression, and other issues. It outlines several assessment methods and standardized tests that are used, including the Zung Self-Rating Depression and Anxiety Scales. Treatment options discussed include counseling, relaxation techniques, cognitive behavioral therapy, and other approaches.
This document discusses childhood trauma and its lasting impacts. It defines trauma and notes that childhood trauma is common, with over 25% of children experiencing some form of violence. Chronic childhood trauma is particularly damaging because it disrupts neurodevelopment and attachment during critical periods. The lasting impacts of childhood trauma include difficulties with emotion regulation, relationships, self-perception, and physical and mental health issues like depression, anxiety, substance abuse, and medical disorders. Treatment focuses on stabilization, processing traumatic memories, and reintegration. Resources are provided to help trauma survivors.
There are an estimated 8 million children in the United States in need of mental health services. Two subfields, pediatric psychology and clinical child psychology, are uniquely qualified to address these needs. These fields have evolved and grown over time, with pediatric psychology emerging to address mental health issues that arise in medical settings. Both fields take a developmental perspective in understanding and treating children's psychological problems.
1) Adolescents with dual diagnoses face barriers to treatment including reluctance to seek help, parents refusing treatment, and limited access to community services.
2) Common treatments for dual diagnoses include CBT and DBT, but MDT which incorporates mindfulness has shown success in reducing substance abuse and improving mental health issues.
3) Barriers to treatment include youth and family factors like denial of problems, parental substance abuse or lack of resources, and a fragmented mental health system with funding gaps.
?A landmark study and the many since that have supported the initial results have led to a growing consensus on the need for policies and practices to prevent, intervene, and promote healing" #AdverseChildhoodExperiences
This document summarizes a thesis that examines the effects of maternal posttraumatic stress disorder (PTSD) on parenting and adolescent outcomes. The thesis analyzed data from 194 low-income mother-adolescent dyads, controlling for maternal depressive symptoms. There were few differences found between mothers with and without PTSD, except adolescents of mothers with PTSD reported greater sexual risk-taking. The document provides context on PTSD and reviews limited prior research showing PTSD may have distinct effects on children beyond other disorders like depression.
Critical Review of Research Evidence Part 3 FDRobert Cope
This document discusses trauma experienced by children in foster care and the potential for EMDR (eye movement desensitization and reprocessing) therapy to help address it. Children in foster care often experience trauma from being removed from their biological homes as well as potential abuse or neglect. They also face issues from multiple placements and aging out of the system unprepared. EMDR is presented as a promising 8-step therapy that could help youth resolve memories from traumatic experiences. The document examines the scope of problems faced by the foster care population and why addressing trauma is important to help youth as they transition into adulthood.
Pia is a 16-year-old who is overweight, pale, avoids eye contact, and gives brief indifferent answers. She drinks excessively, is sexually active with older men, and is pregnant for the second time but does not want her parents notified. Adolescence is traditionally considered a period of turmoil, but recent studies suggest this turmoil has been exaggerated. Pia needs counseling, to join support groups, and appointments for sexual education, nutrition advice, and to discuss her abortion options.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
This document discusses research on the association between being physically abused and becoming a bully. It reviews literature finding children who bully were often bullied themselves and experience depression. The research aims to determine if physically abused children are more likely to bully others due to developing psychological disorders. More research is needed to better understand bullies and how childhood experiences influence bullying behavior.
1) The document discusses treatment options for children diagnosed with ADHD, specifically whether medication should be the first option.
2) While medication can help mask ADHD symptoms, it risks long-term side effects as the brain is still developing.
3) There are alternative treatments that combine therapy, lifestyle changes, and non-stimulant options that may be more effective without side effects.
This research focuses on parents’ perceptions of pediatric antidepressant use—relative to psychotherapy—and is one of the first to measure parents’ perceptions of the risk and benefits of pediatric antidepressant use.
This document discusses childhood trauma treatment services provided by The Children's Home in Cincinnati, Ohio. It notes that childhood trauma is highly prevalent in the US, with many children experiencing physical abuse, neglect, sexual victimization or witnessing violence. Left untreated, childhood trauma can lead to serious long-term health problems. The Children's Home provides evidence-based trauma therapy using models like TF-CBT and works with a network of experts to train its therapists. It aims to help vulnerable children overcome trauma and avoid poor health outcomes through its experienced staff and proven therapy methods.
This study examines the relationship between experiences of repeated bullying victimization before age 12 and levels of depression in late adolescence and adulthood, while controlling for prior mental health and stressful life events. Using data from the National Longitudinal Survey of Youth 1997, the study finds that repeated bullying victimization before age 12 is associated with higher levels of depression from late adolescence into adulthood. Subgroup analyses show these relationships are specific to females, with whites primarily affected in late adolescence and non-whites in adulthood. The study concludes that experiences of bullying during childhood can serve as a marker for subsequent mental health problems later in life.
CHAPTER NINEMedicating ChildrenThis chapter is divided into se.docxDinahShipman862
CHAPTER NINE
Medicating Children
This chapter is divided into seven sections. Section One is an overview that discusses current trends in medicating children, problems the trends cause, and directions for the future. It also discusses developmental issues. Section Two focuses on stimulant medication and the diagnosis of attention deficit hyperactivity disorder (ADHD). Section Three focuses on research on combined interventions and particularly the Multimodal Treatment Study (MTA study) of Children with ADHD. Section Four focuses on children taking mood stabilizers. Section Five focuses on antipsychotics and children. Sections Six and Seven focus on anxiolytics and antidepressants in children, respectively.
SECTION ONE: PERSPECTIVES, DILEMMAS, AND FUTURE PARADIGMS
Learning Objectives
• Understand the problematic increase in psychotropic medications for children despite a dearth of evidence of the effectiveness of these drugs.
• Have a general understanding of the impact of the FDA Modernization Act and the Best Pharmaceuticals Act for Children.
• Be able to state the “developmental unknowns” associated with giving kids psychotropic medications.
Thus far, we have explored the medical model and psychological, cultural, and social perspectives as they relate to psychopharmacology. In this chapter, we demonstrate that using psychotropic medications with children and adolescents raises particular problems and concerns from several perspectives. As discussed in Chapter Three, we frequently see explanations and justifications from the medical model perspective used to reduce childhood disorders to chemical and genetic problems, excluding crucial consideration of environmental traumas, developmental foreclosures, or life stressors.
We explore child and adolescent psychopharmacology primarily from the medical model perspective but complement this approach with information from the other perspectives (psychological, cultural, and social). We set the stage by exploring the current status of the treatment of children and adolescents with mental and emotional disorders. This chapter is structured differently from the others in this book. We begin by discussing the context from the social and cultural perspectives and the problems with prescribing psychotropic medications to children. Then we cover an introduction to stimulants used to treat symptoms of ADHD. Finally, we give the status of their current use since the last edition of the book if that is possible.
THE COMPLEX STATE OF THERAPY
Dr. Frank O'Dell, Professor Emeritus of Counseling in the College of Education and Human Services at Cleveland State University, has argued in all his lectures on counseling children and adolescents that the United States is an “anti-kid” society (Personal Communication, 2001). By that he means fewer and fewer therapists and psychiatrists choose to treat or continue to work with children in counseling. To support his argument, O'Dell points out that resources for childre.
- About half to three quarters of children in foster care in the US exhibit mental health symptoms warranting treatment. Psychotropic medications are often prescribed when psychosocial interventions like counseling are unavailable.
- The use of psychotropic medications for foster youth has risen over the past two decades, with rates 13-37% compared to 4% for non-foster youth. Off-label use is common due to a lack of clinical trials testing these drugs on children.
- Efforts are being made to improve oversight of psychotropic medication use for foster youth, including developing state policies and programs coordinating mental health services.
This document discusses the rationale for developing trauma-informed service systems. It begins by defining psychological trauma and reviewing research showing high rates of trauma in vulnerable populations. Trauma affects brain development and can cause lasting negative impacts. The document advocates for a universal precautions approach and trauma-informed care across organizations, rather than just trauma-specific treatment. It outlines 12 criteria for building trauma-informed mental health systems, such as having trauma-focused policies, training staff, and involving trauma survivors. The goal is to minimize re-traumatization and promote healing.
This document summarizes a presentation on breaking the intergenerational cycle of violence. It discusses how childhood exposure to violence can increase the risk of adult perpetration, and the impact of violence on brain development and mental health. Interventions like trauma-informed care and cognitive behavioral therapy aim to treat trauma and break the cycle. Data is presented on programs in Ohio that serve at-risk youth using evidence-based models like multi-systemic therapy and wraparound services.
Depression is a growing problem among teenagers. It can be caused by biological factors, traumatic events like abuse, stress from body changes and independence struggles, and pessimistic thinking patterns. Screening tools like the PHQ-2 are used but have limitations like low sensitivity. Untreated depression can be damaging, so parents should support teenagers through open communication, prioritizing physical health with exercise, and considering talk therapy for mild to moderate cases before medication.
The document discusses a study that examined emotion regulation (ER) patterns in 196 Chinese school-age children using reports from mothers, teachers, and children themselves. A cluster analysis identified 3 ER groups: a poor family ER group, poor school ER group, and overall good ER group. The study found significant differences among the groups in teacher-reported psychopathological symptoms like depression and attention problems, but no differences in mother-reported symptoms. Children in the overall good ER group had fewer symptoms, showing the value of a multi-informant approach to understanding children's emotional profiles and functioning.
Psychological assessment of burns by Suhasini Oliveira, National Burns Centre...NationalBurnsCentre2000
This document provides information about psychological assessment of burn patients from the National Burns Centre in India. It describes the purpose of psychological assessment as helping to identify psychological problems in burn patients who often experience anxiety, depression, and other issues. It outlines several assessment methods and standardized tests that are used, including the Zung Self-Rating Depression and Anxiety Scales. Treatment options discussed include counseling, relaxation techniques, cognitive behavioral therapy, and other approaches.
This document discusses childhood trauma and its lasting impacts. It defines trauma and notes that childhood trauma is common, with over 25% of children experiencing some form of violence. Chronic childhood trauma is particularly damaging because it disrupts neurodevelopment and attachment during critical periods. The lasting impacts of childhood trauma include difficulties with emotion regulation, relationships, self-perception, and physical and mental health issues like depression, anxiety, substance abuse, and medical disorders. Treatment focuses on stabilization, processing traumatic memories, and reintegration. Resources are provided to help trauma survivors.
There are an estimated 8 million children in the United States in need of mental health services. Two subfields, pediatric psychology and clinical child psychology, are uniquely qualified to address these needs. These fields have evolved and grown over time, with pediatric psychology emerging to address mental health issues that arise in medical settings. Both fields take a developmental perspective in understanding and treating children's psychological problems.
1) Adolescents with dual diagnoses face barriers to treatment including reluctance to seek help, parents refusing treatment, and limited access to community services.
2) Common treatments for dual diagnoses include CBT and DBT, but MDT which incorporates mindfulness has shown success in reducing substance abuse and improving mental health issues.
3) Barriers to treatment include youth and family factors like denial of problems, parental substance abuse or lack of resources, and a fragmented mental health system with funding gaps.
?A landmark study and the many since that have supported the initial results have led to a growing consensus on the need for policies and practices to prevent, intervene, and promote healing" #AdverseChildhoodExperiences
This document summarizes a thesis that examines the effects of maternal posttraumatic stress disorder (PTSD) on parenting and adolescent outcomes. The thesis analyzed data from 194 low-income mother-adolescent dyads, controlling for maternal depressive symptoms. There were few differences found between mothers with and without PTSD, except adolescents of mothers with PTSD reported greater sexual risk-taking. The document provides context on PTSD and reviews limited prior research showing PTSD may have distinct effects on children beyond other disorders like depression.
Critical Review of Research Evidence Part 3 FDRobert Cope
This document discusses trauma experienced by children in foster care and the potential for EMDR (eye movement desensitization and reprocessing) therapy to help address it. Children in foster care often experience trauma from being removed from their biological homes as well as potential abuse or neglect. They also face issues from multiple placements and aging out of the system unprepared. EMDR is presented as a promising 8-step therapy that could help youth resolve memories from traumatic experiences. The document examines the scope of problems faced by the foster care population and why addressing trauma is important to help youth as they transition into adulthood.
Pia is a 16-year-old who is overweight, pale, avoids eye contact, and gives brief indifferent answers. She drinks excessively, is sexually active with older men, and is pregnant for the second time but does not want her parents notified. Adolescence is traditionally considered a period of turmoil, but recent studies suggest this turmoil has been exaggerated. Pia needs counseling, to join support groups, and appointments for sexual education, nutrition advice, and to discuss her abortion options.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
This document discusses research on the association between being physically abused and becoming a bully. It reviews literature finding children who bully were often bullied themselves and experience depression. The research aims to determine if physically abused children are more likely to bully others due to developing psychological disorders. More research is needed to better understand bullies and how childhood experiences influence bullying behavior.
1) The document discusses treatment options for children diagnosed with ADHD, specifically whether medication should be the first option.
2) While medication can help mask ADHD symptoms, it risks long-term side effects as the brain is still developing.
3) There are alternative treatments that combine therapy, lifestyle changes, and non-stimulant options that may be more effective without side effects.
This research focuses on parents’ perceptions of pediatric antidepressant use—relative to psychotherapy—and is one of the first to measure parents’ perceptions of the risk and benefits of pediatric antidepressant use.
This document discusses childhood trauma treatment services provided by The Children's Home in Cincinnati, Ohio. It notes that childhood trauma is highly prevalent in the US, with many children experiencing physical abuse, neglect, sexual victimization or witnessing violence. Left untreated, childhood trauma can lead to serious long-term health problems. The Children's Home provides evidence-based trauma therapy using models like TF-CBT and works with a network of experts to train its therapists. It aims to help vulnerable children overcome trauma and avoid poor health outcomes through its experienced staff and proven therapy methods.
This study examines the relationship between experiences of repeated bullying victimization before age 12 and levels of depression in late adolescence and adulthood, while controlling for prior mental health and stressful life events. Using data from the National Longitudinal Survey of Youth 1997, the study finds that repeated bullying victimization before age 12 is associated with higher levels of depression from late adolescence into adulthood. Subgroup analyses show these relationships are specific to females, with whites primarily affected in late adolescence and non-whites in adulthood. The study concludes that experiences of bullying during childhood can serve as a marker for subsequent mental health problems later in life.
CHAPTER NINEMedicating ChildrenThis chapter is divided into se.docxDinahShipman862
CHAPTER NINE
Medicating Children
This chapter is divided into seven sections. Section One is an overview that discusses current trends in medicating children, problems the trends cause, and directions for the future. It also discusses developmental issues. Section Two focuses on stimulant medication and the diagnosis of attention deficit hyperactivity disorder (ADHD). Section Three focuses on research on combined interventions and particularly the Multimodal Treatment Study (MTA study) of Children with ADHD. Section Four focuses on children taking mood stabilizers. Section Five focuses on antipsychotics and children. Sections Six and Seven focus on anxiolytics and antidepressants in children, respectively.
SECTION ONE: PERSPECTIVES, DILEMMAS, AND FUTURE PARADIGMS
Learning Objectives
• Understand the problematic increase in psychotropic medications for children despite a dearth of evidence of the effectiveness of these drugs.
• Have a general understanding of the impact of the FDA Modernization Act and the Best Pharmaceuticals Act for Children.
• Be able to state the “developmental unknowns” associated with giving kids psychotropic medications.
Thus far, we have explored the medical model and psychological, cultural, and social perspectives as they relate to psychopharmacology. In this chapter, we demonstrate that using psychotropic medications with children and adolescents raises particular problems and concerns from several perspectives. As discussed in Chapter Three, we frequently see explanations and justifications from the medical model perspective used to reduce childhood disorders to chemical and genetic problems, excluding crucial consideration of environmental traumas, developmental foreclosures, or life stressors.
We explore child and adolescent psychopharmacology primarily from the medical model perspective but complement this approach with information from the other perspectives (psychological, cultural, and social). We set the stage by exploring the current status of the treatment of children and adolescents with mental and emotional disorders. This chapter is structured differently from the others in this book. We begin by discussing the context from the social and cultural perspectives and the problems with prescribing psychotropic medications to children. Then we cover an introduction to stimulants used to treat symptoms of ADHD. Finally, we give the status of their current use since the last edition of the book if that is possible.
THE COMPLEX STATE OF THERAPY
Dr. Frank O'Dell, Professor Emeritus of Counseling in the College of Education and Human Services at Cleveland State University, has argued in all his lectures on counseling children and adolescents that the United States is an “anti-kid” society (Personal Communication, 2001). By that he means fewer and fewer therapists and psychiatrists choose to treat or continue to work with children in counseling. To support his argument, O'Dell points out that resources for childre.
- About half to three quarters of children in foster care in the US exhibit mental health symptoms warranting treatment. Psychotropic medications are often prescribed when psychosocial interventions like counseling are unavailable.
- The use of psychotropic medications for foster youth has risen over the past two decades, with rates 13-37% compared to 4% for non-foster youth. Off-label use is common due to a lack of clinical trials testing these drugs on children.
- Efforts are being made to improve oversight of psychotropic medication use for foster youth, including developing state policies and programs coordinating mental health services.
Running head CHILDREN OF THE SUBSTANCE ABUSE WARS 6.docxsusanschei
Running head: CHILDREN OF THE SUBSTANCE ABUSE WARS 6
Children of the Substance Abuse Wars
Tiffany Seace, Veronica Webb, Julia Krueger, Rachel Losey, Emelda Isaac, Angel Reid
BSHS/435
October 3, 2016
Dr. Vanessa Byrd
Children of the Substance Abuse Wars
Approximately 12% of children in the United States have one or both parents with substance abuse issues. According to David Sack (2013), more than 28 million American children have one parent who is addicted to alcohol but this addiction is not being discussed at home (Sack, 2013) and of those 11 million are under the age of 18 (Rodriquez, 2004). These children are at a higher risk of developing complex behavioral, academic, and emotional difficulties than other children. Children of addicts are four times more likely to marry an addict and are at risk of becoming a victim of abuse, neglect, or violence. Children of addicted parents are fiercely loyal to the parent. Adolescents are hesitant to open up and are vulnerable. They are reluctant to reveal parental confidences, even if they urgently need the help (Sack, 2013).
Statistics of Children from Parental Substance Abuse Backgrounds
It is important to analyze the severity of the problem before analyzing the effectiveness of counseling as a corrective measure. It is estimated that nearly 8.3 million children under the age of 18 live with at least one substance abusing/ dependent parent. Also, approximately more than half of child maltreatment cases in the United States were because of parental substance abuse in one way or another.
Kirisci et al. (2002) stated that recent research has found that children of substance-addicted parents are more likely to suffer neglect or abuse than those children who do not have an addicted parent. Additionally, comparable to inattentive mothers and fathers, numerous substance-addicted parents were also mistreated and/or neglected as children (Dunn et al., 2001; Connors et al., 2004; Cash & Wilke, 2003), and describe other disturbing incidents as adults and children (Cohen et al., 2008).
Wulczyn, Ernst & Fisher (2011) hypothesize that nearly 61% of infants and 41% of older children in the welfare system stem from families with active parental alcohol abuse issues. Children who enter the system as infants are more likely to spend a longer duration in care. Infants, especially those aged three months or younger, are more apt to be adopted and spend less or no time in group home placement. All children who enter out-of-home care are vulnerable to delays in social, emotional and cognitive development, which increases the risk of school failure, drug and alcohol abuse and criminality. The toxic stress levels that some infants endure links with developmental delays and poor outcomes for children who are the victims of abuse and neglect. Up to 80% of parents who are involved in the child welfare system are substance abusers, and many have had prior involvement with the system, either as chi ...
Running head CHILDREN OF THE SUBSTANCE ABUSE WARS 9.docxsusanschei
Running head: CHILDREN OF THE SUBSTANCE ABUSE WARS 9
Children of the Substance Abuse Wars
Tiffany Seace, Veronica Webb, Julia Krueger, Rachel Losey, Emelda Isaac, Angel Reid
BSHS/435
October 3, 2016
Dr. Vanessa Byrd
Children of the Substance Abuse Wars
Approximately 12% of children in the United States have one or both parents with substance abuse issues. According to David Sack (2013), more than 28 million American children have one parent who is addicted to alcohol but this addiction is not being discussed at home (Sack, 2013) and of those 11 million are under the age of 18 (Rodriquez, 2004). These children are at a higher risk of developing complex behavioral, academic, and emotional difficulties than other children. Children of addicts are four times more likely to marry an addict and are at risk of becoming a victim of abuse, neglect, or violence. Children of addicted parents are fiercely loyal to the parent. Adolescents are hesitant to open up and are vulnerable. They are reluctant to reveal parental confidences, even if they urgently need the help (Sack, 2013).
Statistics of Children from Parental Substance Abuse Backgrounds
It is important to analyze the severity of the problem before analyzing the effectiveness of counseling as a corrective measure. It is estimated that nearly 8.3 million children under the age of 18 live with at least one substance abusing/ dependent parent. Also, approximately more than half of child maltreatment cases in the United States were because of parental substance abuse in one way or another.
Kirisci et al. (2002) stated that recent research has found that children of substance-addicted parents are more likely to suffer neglect or abuse than those children who do not have an addicted parent. Additionally, comparable to inattentive mothers and fathers, numerous substance-addicted parents were also mistreated and/or neglected as children (Dunn et al., 2001; Connors et al., 2004; Cash & Wilke, 2003), and describe other disturbing incidents as adults and children (Cohen et al., 2008).
Wulczyn, Ernst & Fisher (2011) hypothesize that nearly 61% of infants and 41% of older children in the welfare system stem from families with active parental alcohol abuse issues. Children who enter the system as infants are more likely to spend a longer duration in care. Infants, especially those aged three months or younger, are more apt to be adopted and spend less or no time in group home placement. All children who enter out-of-home care are vulnerable to delays in social, emotional and cognitive development, which increases the risk of school failure, drug and alcohol abuse and criminality. The toxic stress levels that some infants endure links with developmental delays and poor outcomes for children who are the victims of abuse and neglect. Up to 80% of parents who are involved in the child welfare system are substance abusers, and many have had prior involvement with the system, either as chil ...
The document summarizes several research articles on the topic of psychopharmacology in children. It discusses issues like misdiagnosis of conditions like ADHD, the importance of relationships between therapists, parents and teachers, increases in medication use over time, and the role medications can play in treating certain disorders. The conclusion is that while medications may help when diagnoses are accurate, alternative treatments should also be considered and pediatricians need more training on properly diagnosing childhood disorders.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
This is the summary text of a presentation at the Vatican addressing: "The Question of the Use of Pharmaceuticals in Pediatrics." This presentation covers the clinical trial evidence and offers prescription guidelines
This chapter is from Drugging Our Children (Olfman & Robbins, 2012), a great book about the epidemic prescription of antipsychotics to children, especially poor children and children of color.
This document discusses substance abuse in special populations such as adolescents, women, and the geriatric population. It provides details on:
1. Substance abuse in adolescents, including risk factors like family history, peer influences, and common substances abused. Treatment approaches for adolescents include motivational interviewing, cognitive behavioral therapy, and contingency management.
2. Substance abuse is less prevalent in women but they progress faster from use to substance use disorder. Pregnant women who abuse substances can negatively impact fetal development.
3. The geriatric population is also at risk for substance abuse due to medical conditions, medications, and social isolation. Proper screening and treatment tailored for their needs is important.
1Proposal Effectiveness of non-pharmacological in Compari.docxdurantheseldine
1
Proposal: Effectiveness of non-pharmacological in Comparison to
Methylphenidate Stimulant Therapy
Barbara Maclure
9/18/2022
2
Effectiveness of non-pharmacological in Comparison to
Methylphenidate Stimulant Therapy
Introduction
Attentive–deficit hyperactivity is a psychological disorder that is well known, affecting
both children and adults. Some of the associated symptoms that are associated with ADHD include
inattention, hyperactivity, impulsivity, and difficulty in focusing. It is reported that in the United
States, about 8.5% of children are affected by ADHD. In the treatment process, several ways have
been put into place. Despite the treatment, many studies reported that some treatment methods
have side effects. Therefore, knowing the method that least has the side effects is crucial. This
research proposal will play an essential role as it will identify whether non-pharmacological
intervention, behavioral therapy, and stimulant therapy have the same results in children aged 4 to
8.
Background of the study
Dr. George first identified ADHD when he was a pediatrician. He noted that his patients
had uncontrollable impulsive behavior. There was an introduction of the drug Benzedrine, which
was approved as it showed to improve ADHD symptoms in children. In 1950 there was the
introduction of Ritalin drugs which were used in ADHD treatment in both children and
adolescents. (Holland & Higuera (2017). The drug that is used in the treatment of ADHD to date is
Ritalin. Despite the doctors treating patients with ADHD symptoms from the 1930s, there was no
actual definition of ADHD. Still, it was given much attention in 1987 when the American
Psychiatric Association (APA) redefinition of the disorder.
3
By 2020, approximately 7.1 million young children aging between 2-17 years with ADHD
had been diagnosed. (Garbe (2018). Despite the prevalence of the disorder among children and
adolescents, ADHD is also present in adulthood. In most cases, this disorder is noted when the
child gets into the class and starts issues of failing to focus on the classroom. There are different
forms of ADHD which entails hyperactive/impulsive type, inattentive type, or a combination of the
two. There is a criterion that is customarily utilized in the treatment of ADHD. The parents and the
teacher are required to document the children's symptoms for a period of six months. Research
shows that ADHD is more common in males than women. One of the interventions utilized is
stimulant therapy, considered standard treatment for children after reaching an appropriate age.
The stimulus, for example, the medication, is said to have side effects which can be either mild or
severe. Some noticeable side effects include upset stomach, appetite change, heart abnormalities,
tics, and weight loss. Although the treated symbols are 70-80% treated, there can be the utilization
of.
1Running Head FINAL PROPOSAL CHILD ABUSE AND ADULT MENTAL HEAL.docxdrennanmicah
1
Running Head: FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
2
FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
Diamond Newton
Southern New Hampshire University
March 3, 2019
Problem Statement
Several adults struggle from a variety of mental health issues (suicidal thoughts and tendencies, alcoholism, depression, and drug abusers.) A lot of those issues may stem from what took place during an adult’s childhood that stem from a variety of reasons. Some adults seek help and some refuse to seek help. The adults who do seek help come to realize that their current issues stem from when they were a child and still developing as a human. Child abuse can come in many forms, physical, mental, and sexual. Adults who have been exposed or experienced this are likely to suffer from some form of mental health issue. It is important to figure out the root of mental health issues in adults so the root can be addressed. Children need to be in a healthy environment with nothing short of love and care. Exposing children to a harsh reality is only breeding them into an adult who suffers from mental health issues.
Literature Review
The study of psychology helps researchers to understand better what is going on with a person. Researchers studied what happened in a person's life that causes them to make the decisions they do and behave in a certain way. Adults have this stigmatism that they can do whatever they want because they are "grown." Many adults suffer from something that can cause to lead towards suicidal thoughts and tendencies, alcoholism, depression, and drug abusers. A lot of those issues may stem from what took place during an adult’s childhood. There could be some reasons adults tend to display certain mental health traits that have been studied in many different forms by researchers. What we will be reviewed is the abuse, physical or mental, that an adult endured as a child and how it affects them in their adulthood.
Blanco, C., Grant, B. F., Hasin, D. S., Lin, K. H., Olfson, M. Sugaya, L. (2012) recognized that child physical abuse had been associated with an increased risk of suicide attempts. The study conducted included Blacks, Hispanics and young adults between the ages of 18-24 in 2001-2002 and 2004-2005. In person, interviews were conducted in Wave 1. In Wave 2 used similar methods as Wave 1 but it excluded the individuals who were not eligible. Wave 2 also interviews went into depth about the questions asked for the participants first 17 years of life. There are many other variables that have been added to the data that relate to childhood physical abuse and mental health distress in adult years. Those other adversatives included the history of child sexual abuse and neglect, parental psychopathology, and perceived parental support, described as emotional neglect.
The advantages to this design would be the inclusion of other childhood adversities that could contribute to adult psychiatri.
Iacapap workshop on PRESCRIBING FOR CHILDREN AND ADOLESCENTS: PERSPECTIVE FR...Devashish Konar
This document summarizes a workshop on prescribing psychotropic medications for children and adolescents in low resource countries. The workshop covered key differences in pediatric pharmacokinetics and pharmacodynamics compared to adults. It emphasized starting with low doses and slow titration given the active liver and rapid metabolism in children. General principles of monitoring, education, and avoiding polypharmacy were discussed. Challenges in low resource settings where few specialists are available were highlighted, along with the need for collaborative care models involving training of other professionals.
Brianna is a 12 year old, African-American child. Client was sexually and physically abused by her father beginning at age 8 until 11. She has been locked in the closet multiple times and sometimes without food and water. This client has also witnessed her father physically abuse her mother and her younger brother on numerous occasions. Brianna has been diagnosed with Post Traumatic Stress Disorder and Depression. Client often has negative feelings about herself, isolates herself from others, does not trust many people, has flashbacks of her attacks, refuses to leave her room, barely and eats.
More than baby blues_Senefeld, Reider, Schooley_10.13.11CORE Group
Maternal depression has significant negative effects on mothers, infants, and children. It can compromise parenting, impair the mother-infant relationship, and negatively impact child growth and development. Screening and treatment programs are effective but underutilized, especially in developing countries. The HEAL program implements a group intervention model with Latina women that uses screening tools and educates participants on depression, stress management, and empowerment to help mitigate the impacts of maternal mental health issues.
Educational & Child Psychology; Vol. 36 No. 3 33
Evaluating the impact of an autogenic
training relaxation intervention on levels
of anxiety amongst adolescents in school
Tracey Atkins & Ben Hayes
Aim: This study aimed to investigate the impact of a group-based autogenic training (AT) relaxation
intervention on levels of anxiety in adolescents in mainstream school settings.
Method: A mixed-methods design was used to measure differences in levels of anxiety and explore a range
of perceived changes between groups over time. Sixty-six young people aged between 14 and 15 years old
from four mainstream schools in the UK were randomly assigned within each school to an intervention
or wait-list control group. Quantitative data were analysed using a mixed between-within subjects ANOVA.
Qualitative information from 12 volunteer participants was analysed using thematic analysis.
Findings: Results showed a main effect of time for both the intervention group and the wait-list group
however, no significant main interaction was found. Qualitative results showed perceived improvements
in social relationships and connectivity; reflectiveness; self-awareness; physiological symptoms; and a sense
of control.
Limitations: Measures were reliant on self-reported data. Schools were recruited through self-referral and
expression of interest, excluding participants who may not have the opportunity to take part. There were
no opportunities to collect follow-up data.
Conclusions: Results suggest that a structured AT relaxation intervention delivered in a familiar
school environment may significantly reduce levels of anxiety amongst adolescents. However, significant
improvements for the wait-list group also raises questions around the potential of other supportive
variables, such as acknowledgement and validation of feelings, the promise and availability of
forthcoming support and the potential impact of raised awareness and interest in pupil wellbeing
amongst school staff.
Keywords: autogenic training; relaxation; adolescence; mind-body interventions; anxiety.
M
ENTAL HEALTH difficulties in
young people are a serious cause for
concern across the world. The World
Health Organization (WHO) reports that in
half of all cases of mental health conditions,
onset has occurred by the age of 14 years
old; suicide is the third leading cause of
death in 15–19 year olds; and the second
leading cause of death in girls (WHO, 2018).
It is estimated that one in ten children and
young people aged 5–16 years old have
a diagnosable mental health disorder in the
UK alone; and at least one in 12 children
and young people deliberately self-harm
(Young Minds, 2018).
In 2009, the UK government identi-
fied mental health as everyone’s business
(Department of Health; DoH, 2009) and
was specific about prevention and the tran-
sition time between adolescence and early
adulthood. Suggestions for schools include
promoting students’ mental health as part
of ...
PTSD and Allostatic Load: Beneath the skin interrupting the pathways to path...Michael Changaris
This slideshow explores the way that stress leads to biological pathology. It attempts to connect the adverse childhood events study with Bruce McEwen's work on cortisol and stress. It explored the impact of PTSD, early childhood trauma and stress on health and longevity.
This document summarizes a literature review on the management of chronic pain in adolescents. It finds that chronic pain is common in adolescents and is best treated through a multidisciplinary approach using psychological therapies and functional restoration, along with medical care and pharmaceutical interventions as needed. While multidisciplinary care has shown benefits, there is limited high-quality research on pharmacological treatments for chronic pain in adolescents. More research is needed to guide safe and effective use of medications for managing chronic pain in this population.
Practical approaches to doing a primary care psychiatric assessmentpsyhimanshu
This document discusses the importance of conducting psychiatric assessments in primary care settings. It notes that approximately 60% of patients with diagnosable psychiatric disorders initially seek care from primary care physicians rather than mental health professionals. However, primary care physicians often underdiagnose and undertreat mental disorders. The document advocates that primary care physicians should screen patients for common mental disorders like depression and anxiety through brief psychiatric assessments. This is important as untreated mental illness can have significant health, social, and economic impacts. The document provides guidance on effective communication skills and approaches for conducting concise yet informative psychiatric assessments in time-constrained primary care consultations.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
1. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 1
Trust-Based Relational Intervention: A Successful Treatment for Foster Youth with Behavioral
and Emotional Disorders
Elizabeth Torres
Chapman University
Psychology 498-01 MW
17 December 2015
Running head: TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH
2. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 2
Hypothesis
If youth in the foster care system participate in Trust-Based Relational Intervention (TBRI), then
they will be more likely to overcome behavioral and emotional disorders than foster youth who
only receive pharmacologic treatment.
3. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 3
Operational Definitions
Alpha-adrenergic agonists: Clonidine hydrochloride, guanfacine hydrochloride (Fontanella,
Hiance, Phillips, Bridge, & Campo, 2014).
Antipsychotic drugs: Typical (chlorpromazine, hydrochloride, fluphenazine hydrochloride,
mesoridazine) and atypical (risperidone, olanzapine, quetiapine) (Fontanella et al., 2014).
At-risk youth: Youth who have experienced any type of trauma including the following:
physical, sexual, or emotional abuse; neglect; or witnessing domestic violence (Parris et al.,
2015).
Behavior problems: This includes both internalizing behaviors, such as depression, and
externalizing behavior, such as aggression (Juffer & vanIjzendoorn, 2005). Children who are
rested (Purvis, Cross, & Sunshine, 2007), well nourished (Purvis, Cross, G. Kellermann, M.
Kellermann, Huisman, & Pennings, 2006) and feel safe and predictable will start to practice new
behavioral skills.
Biochemical therapy: “Correction of innate or acquired chemical imbalances using amino acids,
vitamins, minerals, and other biochemicals naturally present in the body” (Walsh, Glab, &
Haakenson, 2004, p. 836).
Foster care system: Children taken from abusive or neglectful families are placed in the foster
care system, also known as the Child Welfare System (CWS). The intent is temporary housing
until they are adopted or return home (Lloyd & Barth, 2011).
Mood-stabilizers: Mood-stabilizers include anticonvulsants (carbamazepine, valproic acid,
gabapentin, lamotrigine, and oxcarbazepine) and lithium (dosReis et al., 2011).
4. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 4
Negative emotions: Negative emotions include anger, sadness, disgust, and fear. These
emotions can manifest more strongly in foster children if basic needs – like nutrition, safety, and
attachment – are not met (Purvis, Cross, & Pennings, 2009).
Pharmacologic treatment: Treatment of a disease or disorder by means of any type of
medication, primarily antipsychotic and psychotropic drugs (Donnelly, 2003).
Psychotropic drugs: There are six major categories of psychotropic drugs: (1) antidepressants
and monoamine oxidase inhibitors; (2) antipsychotics; (3) mood stabilizers including
anticonvulsants and lithium; (4) anxiolytics including benzodiazapines and nonbenzodiazapines;
(5) stimulants and other ADHD medications; and (6) alphaadrenergic agonists (Fontanella et al.,
2014).
Stimulants: Methylphenidate, amphetamine, and pemoline (Fontanella et al., 2014).
Trust-Based Relational Intervention: The Trust-Based Relational Intervention (TBRI) is a
program that began in the early 2000s by Karyn Purvis, PhD from the TCU Institute of Child
Development. The intervention targets behaviorally at-risk adopted children. There are three
main principles of this program: Empowering Principles, Connecting Principles, and Correcting
Principles. “Empowering” encompasses Ecology (i.e. predictability and transitions) and
Physiology (i.e. safe touch, nutrition, physical activity). “Connecting” includes Awareness (i.e.
recognizing behavior, eye contact, voice and inflection, etc.) and Engagement (active listening,
playful engagement, etc.). Lastly, “Correcting” addresses Proactive Strategies (emotional
regulation, choices for growth, etc.) and Redirective Strategies (choices for discipline, task
completion, consequences, etc.). This program can be integrated into homes, family camps,
summer camps, orphanages, and schools (Purvis et al., 2009).
5. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 5
Unhealthy child development: There are three factors that lead to unhealthy child development.
The first is maternal deprivation, which occurs when either a child is separated at birth from their
mother or the child does not receive proper care. The second – environmental deprivation –
occurs when postnatal environments do not provide enough sensory stimulation. Lastly, global
deprivation occurs when the environment does not meet basic needs such as proper nutrition,
physical and social stimulation, and good relationships (Purvis, Cross, Federici, Johnson, &
McKenzie, 2007).
6. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 6
TBRI: A Successful Treatment for Foster Youth with Behavioral and Emotional Disorders
In 2006, over 3.5 million children were reported as abused and neglected in the United
States. Out of that number, 905,000 were confirmed victims (US Department of Health and
Human Services, Administration for Children and Families, Children’s Bureau, 2008). About
20% of the victims are put into the foster care (child welfare) system where they are then placed
in either a family or a group home. Oftentimes, the trauma these children experience causes them
to struggle with one or more of many emotional, mental, and behavioral disorders. These are just
some of the disorders foster youth deal with: alcohol abuse, conduct disorder, generalized
anxiety disorder, intermittent explosive disorder, major depressive disorder, major depressive
episode, panic disorder, post-traumatic stress disorder (PTSD), separation anxiety disorder, and
social phobia (Pecora, White, Jackson, & Tamera, 2009). Usually, the recommended treatment is
a combination of pharmacological and psychosocial treatment. Unfortunately, the children who
are medicated tend to only take the medication and do not see a therapist or engage in any sort of
social treatment. Furthermore, the people prescribing medications to foster youth are not trained
psychologists, but are pediatricians, primary care doctors, and nurse practitioners. These doctors
also allow their young patients to get refills without checkups. In addition to this, many of the
youth take multiple psychotropic drugs concurrently. What makes the overmedication of foster
youth most disconcerting is there is little empirical research behind the pharmaceuticals they are
receiving, not to mention the many negative side effects. Some of the side effects are weight
gain, Type-2 diabetes, and dyslipidemia (Pecora et. al, 2009).
Fortunately, there are other treatment options that exclude the use of medications
altogether. One such example is Trust-Based Relational Intervention (TBRI), which focuses on
improving important life habits purely through family training and interpersonal therapy. The
7. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 7
three main principles of this program are Empowering, Connecting, and Correcting. The first
focuses on the health of the individual child by helping with predictability, transitions, safe
touch, and nutrition. The second takes a step further by addressing communication through eye
contact, voice and inflection, recognizing behavior, and active listening. The last principle
focuses on higher thinking and interacting through emotional regulation, choices for growth, task
completion, choices for discipline, and consequences. TBRI helps each child relearn healthy
attachment and positive ways of interacting with themselves and others. I hypothesize that the
foster youth who use programs like TBRI as their only form of treatment will be more likely to
overcome their disorders than youth receiving only pharmacologic treatment.
There is both confirming and disconfirming evidence about my hypothesis. The
disconfirming evidence comes primarily from older studies since providing children with strong
medications is more of a pre-turn-of-the-century concept. Regardless of the time that these
studies were conducted, there is strong research that shows the immediate benefits of medicating
children who seemed unable to escape the pervasiveness of the trauma they experienced in the
past (Donnelly, 2003; Seedat et al., 2002). Indeed, their emotional and behavioral struggles were
able to cause so much dysfunction in their daily lives that their caregivers were willing to give
them strong – yet under-researched – medications in order to get the kids under control.
Caregivers tended to desire a quick-fix solution, which is what prescriptions are known for. A
thing to note about the articles that oppose my hypothesis is that the researchers acknowledged
the small amount of research upon which they based their claims. In fact, between 1980 and
2002, there were no randomized, double-blind, placebo-controlled clinical trials done to test the
efficacy of pharmacologic treatment of children and adolescents with PTSD (Donnelly, 2003).
Unfortunately, the late 90s/early 2000s was the time period that most of the evidence supporting
8. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 8
medicinal treatment of traumatized youth came from. Fortunately, the focus of treatment has
changed in the past decade since many researchers are becoming aware of the pitfalls the old
studies overlooked.
Many new sources have data that indicate foster youth are clearly overmedicated
(Brenner, Southerland, Burns, Wagner, & Farmer, 2013; Barlas, 2008; dosReis, Yoon, Rubin,
Riddle, Noll, & Rothbard, 2011). Foster children are given drugs at double or triple the rate of
kids not in foster care (Korry, 2015). About 59% of foster youth take at least one psychotropic
medication, but many take more than that. Indeed, hundreds take as many as five psychotropic
medications at a time (Brenner et. al, 2014; Korry, 2015). What makes the situation even more
alarming is the fact that thousands of children are receiving doses that exceed Food and Drug
Administration (FDA) guidelines. The FDA is right to disapprove of these strong drugs because
the negative side effects of these prescriptions cannot be ignored. Therefore, as an alternative to
pharmaceuticals, TBRI is a successful treatment option that both treats children without any use
of medications and is supported by lots of research (Purvis, McKenzie, Razuri, Buckwalter,
2014; Purvis, Razuri, Howard, Call, DeLuna, Hall, & Cross, 2015). TBRI provides a hands-on
setting where children can overcome their social and behavioral setbacks instead of masking the
problems through drugs. Nevertheless, the undeniable popularity and effectiveness of
psychotropic drugs are what cause the controversy.
This issue needs to be addressed in order to ensure the well-being of youth both currently
in the foster system and alumni. The fact that so many are currently being prescribed strong
medications without proper research is unacceptable and must be fixed immediately. The more
recent evidence suggesting negative side effects of prescriptions makes the predicament all the
more imperative to review. The difficulties that foster youth face do not have to be a permanent
9. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 9
fixture in their lives. If their caregivers are willing to take the time, the quality of the
relationships of the family can be improved and the child can have a more satisfying life. The
roots of foster youth’s poor behavior can only be solved through a process of undoing and
relearning with trustworthy adults who can restore a healthy attachment and a sense of security.
Even though the process may be lengthy, it is the means through which each foster child can
overcome the past and live a fulfilling life.
10. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 10
Purvis, K.B., Cross, D.R., Dansereau, D.F., & Parris, S.R. (2013) Trust-Based Relational
Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma. Child &
Youth Services, 34:4, 360-386, doi: 10.1080/0145935X.2013.859906
This article is a review of the research behind the Trust-Based Relational Intervention. It
asserts that TBRI is the best treatment for foster children who have experienced severe trauma
and provides examples of how TBRI can be applied in different settings. There were no
hypotheses to be tested.
The article begins by addressing the need for trauma treatment in the foster care system
and continues for the remainder of the paper by explaining the intervention in detail. A study
conducted at Harvard University in 2005 found that children in the U.S. foster care system live
with the trauma they have experienced in the form of post-traumatic stress disorder (PTSD) at a
rate that is more than two times the rate of war veterans (Pecora, White, Jackson, & Wiggins,
2009). Early trauma impacts the rest of a child’s development and tends to cause alterations in
their brain chemistry as well as the development of unhealthy attachment styles, dysfunctional
coping behaviors, and other problem behaviors. Usually, foster children are treated through the
traditional medical model, including medication and frequent visits to a therapist’s office. This,
however, is not the most effective method because the best treatment takes place in the place
where the problems begin – the home. There are three main factors that are necessary in order to
treat complex trauma: (a) development of safety, (b) promotion of healing relationships, and (c)
teaching of self-management and coping skills (van der Kolk & Courtis, 2005). These three
pillars reflect the three TBRI principles, which are (a) Empowerment (attention to physical
needs), (b) Connection (attention to attachment needs), and (c) Correction (attention to
11. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 11
behavioral needs). These three principles address the internal and external needs of the child,
both of which are necessary for the best possible healing.
This article relates to my hypothesis because it clearly points to TBRI as the best
treatment of traumatized foster children. All of its principles revolve around interpersonal and
inner healing techniques that do not require any medication. In fact, the authors emphasize that
certain physical changes like increased physical exercise, improved sleep, and hydration can
decrease the need for medications for other illnesses like asthma and ADHD. Even though there
is no specific mention of a measured comparison between TBRI and psychotropic/antipsychotic
drugs, the article does show very strong evidence in favor of TBRI. Although TBRI may not be
the easiest or the quickest treatment, it appears that it will result in the longest-lasting change.
+4
12. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 12
Seedat, S., Stein, D. J., Ziervogel, C., Middleton, T., Kaminer, D., Emsley, R. A., & Rossouw,
W. (2002). Comparison of response to a selective serotonin reuptake inhibitor in children,
adolescents and adults with posttraumatic stress disorder. Journal Of Child And
Adolescent Psychopharmacology, 12(1), 37-46. doi:10.1089/10445460252943551
The purpose of this article was to examine differences in two groups’ responses to
citalopram – an SSRI that is very selective for serotonin reuptake inhibition. The hypothesis
tested for a decrease in PTSD symptoms in the participants.
The sample for this study was 24 children and adolescents (ages 10-18, 16 girls and 8
boys) and 14 adults (ages 19+, with seven men and seven women) with a diagnosis of
moderately severe PTSD (assessed by a Clinical Global Impression Severity [CGI-S] score of ≥
4). The participants were also measured by the either the Clinician-Administered PTSD Scale
(CAPS) or the Clinical-Administered PTSD Scale-Children and Adults (CAPS-CA). Any
subjects who also met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
(DSM-IV) criteria for psychotic disorder, bipolar disorder, organic disorder, or substance
abuse/dependency within the previous six months were not allowed to participate. Participants
weren’t excluded if they had a comorbid mood or anxiety disorder, so long as PTSD was the
primary diagnosis. The participants had two weeks to discontinue their current mediations
(benzodiazepines or antidepressants). Participants were not allowed to attend psychotherapy
during the course of the study. The two main measures were: (1) a change in the mean from
baseline PTSD symptoms defined by CAPS or CAPS-CA and (2) changes in CGI scores.
Paired t tests revealed significant changes between baseline and endpoint for both CAPS
and CGI-S scores. Among the child/adolescent group, there was a mean reduction by 54% in
13. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 13
CAPS-CA total scores (t = 9.88, p < 0.001). Among the adult group, there was a mean reduction
by 39% in CAPS total scores (t = 6.4, p < 0.001). Children/adolescents actually improved more
than adults.
This article relates to my hypothesis because it supports the use of pharmacological
treatment in children with PTSD while I propose that no medication be a part of their treatment.
Although these were not children in the foster care system necessarily, foster children tend to be
diagnosed with PTSD a majority of the time. Therefore, the children in this study are a sufficient
comparison due to their similarity to foster children. It especially contradicts my hypothesis
because the researchers made sure to mention that no additional psychotherapy was allowed
during the course of this experiment. This means that the positive results were only based on
what citalopram was responsible for. Overall, this article provides a secure argument for the
safety and efficacy of SSRIs (e.g. citalopram) in pediatric populations and the general use of
medication as a treatment.
-3
14. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 14
Purvis, K., Cross, D., Federici, R., Johnson, D., & McKenzie, L. (2007). The Hope Connection: a
therapeutic summer day camp for adopted and at-risk children with special socio-
emotional needs. Adoption & Fostering, 31(4), 38-48 11p.
The purpose of this article was to meet socio-emotional needs of adopted and at-risk
children deprived of healthy development through a therapeutic summer camp program called
The Hope Connection. The researchers expected the camp to help treat the children’s attachment,
pro-social behavior, and sensory processing problems, since these are three areas of
psychological development that are affected due to the lack of healthy child development.
The camp consisted of 19 children (ages 4-13) living in the United States who had
histories of early deprivation and/or maltreatment. Out of the total sample size, 16 were adopted
from orphanages in Eastern Europe. The children were split up into two groups based on age,
with 5.7 being the mean age of the younger group and 10.7 for the older group. The summer
camp program lasted for two weeks and was broken up into two sessions, the first session for
younger kids and the second for older kids. The days lasted from 8:30am to 3:30 pm. Each child
was paired with a “buddy,” an undergraduate student who was trained to use therapeutic
techniques, bond with their younger buddy, and model appropriate behavior. All the activities
chosen for camp were designed to be (a) attachment rich, (b) sensory rich and (c) behaviorally
structured. Assessments of children’s progress included parent report and child report measures.
Parent report instruments consisted of pre- and post-test versions of the Child Behavior Checklist
(CBCL), Beech Brook Attachment Disorder Checklist (Beech Brook), and Randolph Attachment
Disorder Questionnaire (RADQ). Child report was assessed by evaluating their pre- and post-
camp drawings of their families through analyzing the overall mood of the picture.
15. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 15
The CBCL tests displayed that mostly all internalizing and externalizing behaviors
decreased after the camp. There was a main effect for the anxious/depressed the aggressive
behavior subscales. Beech Brook and RADQ indicated a significant increase in positive
attachment behaviors (F(1,12) = 9.35, p = .010), and a complementary decrease in negative
attachment behaviors (F(1,12) = 8.01, p = .015). Child reports displayed similar outcomes.
This article supports my hypothesis because the methods used in this study clearly
advocate for a non-medicated treatment style that utilizes the same basic outline as the Trust-
Based Relational Intervention (TBRI). The three areas of psychological development that they
focused on (attachment, pro-social behavior, and sensory processing) are almost identical to the
three principles of TBRI (connection, correction, and empowerment). In the introduction, the
authors made a point to mention that at-risk children usually receive drug treatments that “can be
ineffective and even detrimental” and assert that their summer camp method is overall more
effective and better for these children. Lastly, Dr. Karyn Purvis – one of the creators of TBRI –
was very active in this report on the Hope Connection.
+3
16. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 16
Fontanella, C., Hiance, D. h., Phillips, G., Bridge, J., & Campo, J. (2014). Trends in
Psychotropic Medication Use for Medicaid-Enrolled Preschool Children. Journal Of
Child & Family Studies, 23(4), 617-631.
The purpose of this article was to examine recent and specific trends in the use of
psychotropic medication for very young children from 2002-2008. The secondary purpose was to
examine the context in which medications are prescribed.
The researchers conducted a longitudinal analysis of preschool children who had been
prescribed psychotropic medication and were enrolled in Ohio’s Medicaid program from 2002-
2008. Medicaid originally had 751,637 children with these specifications in 2002 but the number
increased to 954,976 in 2008. There were three categories through which a child could qualify
for Medicaid: (1) children whose family income was at or below 200% of the federal poverty
level (CFC); (2) children with a disabling condition whose family income was at or below 64%
of the poverty level (ABD); and (3) children in foster care, the adoption system, or institutional
placements – such as facilities for the mentally retarded. Children who had at least one
prescription claim for a psychotropic medication were used (n = 23,019). The researchers then
examined certain demographic predictor variables such as age, gender, race/ethnicity, Medicaid
eligibility category (CFC, ABD, or foster care), and area of residence. They also analyzed
clinical predictor variables such as primary diagnosis, number of psychiatric disorders, number
of medications, and comorbidity of disorders.
The results showed that the rate of psychotropic medication use only slightly increased
from 1.7 to 1.9% between 2002 and 2008. On the other hand, the use of stimulants, alpha-agonist
medications, and antipsychotics more than doubled from .2% to .5%. Shockingly, 63.4% of the
17. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 17
children received their mental health diagnoses from a non-specialty provider like nurse
practitioners, primary care doctors, and pediatricians. They also found that the kids who were
most likely to receive psychotropic medications were older, white, male, disabled, and in foster
care.
This article supports my hypothesis because despite the focus on medications, these
authors stress the importance of psychosocial treatment. Through their findings, they found that
psychosocial services are very underused, even though they technically should be a part of a
child’s treatment. Indeed, most preschool children who are advised to use both medication and
psychosocial services as their treatment only receive the former. Furthermore, most preschoolers
do not receive another mental health assessment before getting a refill of their prescription. The
researchers recognize the shortage of child mental health specialists and call for an increased
involvement of trained psychologists in the mental diagnoses of children instead of primarily
relying on pediatricians or primary care doctors. The results of this article clearly show that there
is an overuse of psychotropic medications among preschoolers and point to a greater reliance on
interpersonal and psychosocial therapy.
+3
18. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 18
Walsh, W. J., Glab, L. B., & Haakenson, M. L. (2004). Reduced violent behavior following
biochemical therapy. Physiology & Behavior, 82835-839.
doi:10.1016/j.physbeh.2004.06.023
The purpose of this study was to test the effectiveness of biochemical therapy on people
with a wide array of behavior disorders. The goal was to help the participants minimize their
violent behavior, including physical assaults and destroying property.
There were 207 participants in the study (149 males and 58 females) whose ages ranged
from 3 to 55, with a median age of 11.5. They were included in the study because they had been
diagnosed for at least 4 months with either attention-deficit disorder, conduct disorder,
oppositional-defiant disorder, or another behavior disorder. Upon admittance to the study, each
participant went through a chemical analysis to reveal chemical imbalances in their body so that
proper medication could be prescribed. A certain combination of amino acids, vitamins, and
minerals were developed for each subject based on this analysis. Many of the common chemical
imbalances found among the sample included the following: (a) low levels of amino acids,
vitamins, minerals, or glucose; (b) high levels of lead, cadmium, or other toxic metals; (c)
elevated or depressed blood histamine; and (d) elevated serum copper or depressed plasma zinc.
All the participants who were already taking other medications or receiving other therapies were
asked to continue throughout the duration of the study. Each participant attended a follow-up
visit 4 to 8 months after the initiation of the treatment to see the effectiveness of the supplements
on violent behavior.
The results showed that statistical significance was discovered for both reduced
frequency of assaults (t=7.94; p<0.001) and reduced destructive incidents (t=8.77, p<0.001).
19. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 19
Among the assaultive patients, 58% were able to eliminate the behavior altogether. Similarly,
53% of the destructive patients completely eliminated the behavior.
This article refutes my hypothesis because it clearly advocates for the increased
utilization of biochemical treatments for people with behavior disorders. Although it does not
directly mention foster kids, most of the children in the foster care system have many of the same
behavior disorders as the participants in this study. This study also can be applied to my
hypothesis because a majority of the people in the study were children. In fact, the results found
that this treatment was most effective for children under age 14. Furthermore, the researchers
claim in the introduction that chemical imbalances in the body may cause just as much harm (if
not more) to the mind as certain environmental influences like poverty and abuse, suggesting that
psychosocial therapy are not the best treatment option. Data like this certainly provides a strong
support for the quick-fix option of medications/supplements.
-3
20. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 20
Donnelly, C. L. (2003). Pharmacologic treatment approaches for children and adolescents with
posttraumatic stress disorder. Child And Adolescent Psychiatric Clinics Of North
America, 12(2), 251-269. doi:10.1016/S1056-4993(02)00102-5
The purpose of this article was to review pharmacologic treatment of posttraumatic stress
disorder (PTSD) in children and adolescents. The researcher asserted that despite a lack of
thorough and empirical research examining the affects of medication on children with PTSD,
there is enough research to indicate that medical treatment plays an important role in recovery.
The article provided a thorough discussion of PTSD, including its symptoms, the
neurobiology involved, comorbidity, and useful medications. The author began by discussing the
complexity of PTSD. When one accounts for all the possible symptoms that meet the criteria for
diagnosis of PTSD, there are about 1750 possible combinations (American Psychiatric
Association, 2013). This makes it very difficult to medicate appropriately. Thus, psychologists
need to be very careful to tailor medical treatment based on each child. Usually, the treatment of
one symptom (i.e. sleep deprivation) can lead to the treatment of other related symptoms. When
trauma occurs in early life, the central nervous system, physical development, and the
neuroendocrine and immunologic systems are affected. There may also be dysregulation in the
hypothalamic-pituitary axis and cortisol secretion. Overall, neurobiological deficiencies lead to
three symptom clusters of PTSD: re-experiencing, avoidance, and hyperarousal. The focus of
pharmacologic treatment is hyperarousal. By calming this, other symptoms that would otherwise
be hidden (like depression) are unmasked. Many children do not respond to psychotherapeutic
interventions such as Cognitive Behavioral Therapy, making the need for medication even
greater. Some medications the author suggested were adrenergic, dopaminergic, serotonergic,
21. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 21
gamma-aminobuyric acid, and opioid agents. All of these at least address hyperarousal
symptoms but many also help re-experiencing and avoidance symptoms. Out of them all, the
author claimed that SSRIs and tricyclic antidepressants were the best first choice. In summary,
Donnelly concluded that medication could be a rational and safe manner to treat PTSD in
childhood.
This article refutes my anti-medication hypothesis very strongly due to its exhaustive list
of studies showing the efficacy and usefulness of medications in childhood PTSD. Even though
the paper did not directly relate to foster children, it can be applied to my paper because rates of
PTSD are found to be significantly higher among kids and adolescents in the foster care system
than normal youths (Pecora, White, Jackson, & Wiggins, 2009). The author cited lots of research
that showed the positive effects that medications have on children and adolescents, putting the
argument in favor of pharmacologic treatment. For example, one study found improvement in
anxiety, concentration, mood, and behavioral outbursts in every child in the sample after the
introduction of adrenergic agents (Perry, 1994). In a similar study, 13 out of 18 subjects
experienced remission of their PTSD symptoms due to dopaminergic agents (Horrigan &
Barnhill, 1996). Studies like this provide a strong argument for a quick fix, reliable treatment
through medication.
-4
22. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 22
Purvis, K. B., McKenzie, L. B., Becker Razuri, E., Cross, D. R., & Buckwalter, K. (2014). A
Trust-Based Intervention for Complex Developmental Trauma: A Case Study from a
Residential Treatment Center. Child & Adolescent Social Work Journal, (4), 355.
This article is a case study about 16-year-old Rachel who found herself in the foster
system at age 12 after a long history of abuse and neglect. She did not respond to traditional
residential treatment plans and was deemed by different residences one of the most difficult
children they ever had to deal with. The Trust-Based Regional Intervention (TBRI) was applied
to her situation to help her learn healthy attachment.
Rachel’s intervention was a combination of the traditional TBRI method and a treatment
individualized for her specific situation. At the point of intervention, her life consisted of
physical, sexual, and emotional abuse from her time in Bulgaria. She was treated as a gypsy and
neared death by starvation many times. She lived with an American family for six months before
being admitted to a residential treatment center (RTC) due to numerous threats and attempts to
harm herself or others in her family. Rachel’s specific treatment was carried out in three phases.
Phase 1 was focused only on teaching her healthy relationship skills. This included physically
close proximity to either the main researcher, her adoptive mother, or one of the RTC staff
members at all times, mimicking the beginning of a relationship between mother and infant. By
keeping within 36 inches, the caregivers were able to assure Rachel that she would be attended to
immediately. If physical constraint was necessary, it was done by trained RTC staff other than
the ones assigned to her – not her primary caregivers. Phase 2 took a step further by challenging
her to achieve small goals to self-regulate. Phase 3 was a transition to the RTC’s traditional
treatment program, while continuing to use TBRI principles. She remained in Phase 1 and 2 for
two months each.
23. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 23
Over the course of the 10 months preceding the intervention, Rachel had about 6.3
restraints and 6 seclusions per month. In the 6 months after TBRI, the numbers dropped to 2.5
restraints and 2.2 seclusions per month. Her neurochemical levels also increased dramatically
over the course of the treatment. For example, one year after she began TBRI, her serotonin
levels rose over 500%.
This article supports my hypothesis a great deal. It clearly advocated for TBRI over any
pharmacological treatment. Even though it did not explicitly degrade medications, there was no
pharmacological usage at all during the intervention. After reading the description of the
difficulties Rachel faced, she certainly would have been the perfect candidate for many
medications, yet transformation was found through only interpersonal relationships. The data
about the rise in her neurotransmitter levels showed that even chemical imbalances could be
treated naturally without the help of pharmaceuticals. Although TBRI is a lengthy and
complicated process, it is exceedingly more useful in teaching traumatized youth how to interact
with others and themselves. TBRI aims to strengthen the person and increase their quality of life
by giving them lifelong relational skills that can also increase their self worth. This is by far the
more beneficial route to healing.
+5
24. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 24
dosReis, S., Yoon, Y., Rubin, D., Riddle, M., Noll, E., & Rothbard, A. (2011). Antipsychotic
Treatment Among Youth in Foster Care. Pediatrics, 128(6), E1459-E1466.
The purpose of this article was to compare antipsychotic treatment among foster youth
with other youth eligible for psychological, physiological, and development impairment. They
specifically focused on youth receiving medications “concomitantly,” meaning multiple
prescriptions were being taken at once for a long period of time.
The sample was 16,969 youths younger than 20 years old who were enrolled in a Mid-
Atlantic state Medicaid program. Each participant in the sample had at least one claim with a
psychiatric diagnosis and at least one antipsychotic claim in 2003. “Antipsychotic treatment”
was operationally defined as any concomitant use of at least two antipsychotics for more than 30
days. There were three Medicaid program categories: foster youth (n=2310), disabled youth
(Supplemental Security Income; SSI; n=8787), and Temporary Assistance for Needy Families
(TANF; n=3631). The subcategories of the foster youth group were foster care/Supplemental
Security Income, foster care/TANF, and foster care/adoption. The medications that this study
targeted were stimulants, antidepressants, antipsychotics, and mood-stabilizers. The psychiatric
illnesses that were included were attention deficit hyperactivity disorder (ADHD), anxiety,
autism, bipolar, conduct disorder, depression, oppositional defiant disorder, psychoses,
schizophrenia, and substance abuse. In order to measure concomitant use, they examined two
variables on each pharmacy claim: (1) medication-dispensing date and (2) the days of medication
supplied. For usage to be concomitant, at least two antipsychotics needed to be taken on the same
day for greater than 30 days.
The results showed that concomitant usage and length of usage of antipsychotics were
overall greater in foster care in comparison with TANF and SSI. For example, the average
25. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 25
antipsychotic use for foster care ranged from 222 to 110 days and only 135 to 101 days in TANF
(p<.001). Overall, concomitant usage among all foster care groups was 34.7% in comparison to
19% in TANF (p<.001). This percentage is the same as the percentage for SSI, which is
remarkable because the youth in SSI are disabled.
This article supports my hypothesis because it provided lots of strong data against the
usage of antipsychotic medications. The authors pointed out the issue that concomitant
antipsychotic use among children is absolutely not empirically supported. This is consistent with
many of the other articles I have read up to this point. They also discussed the fact that many
medications like second-generation antipsychotics (SGAs) – one of the more popular
prescriptions – have lots of adverse side effects among children. Such side effects include weight
gain, Type-2 diabetes, and dyslipidemia. What is just as disconcerting is that these effects have
been reported to be 2.3 to 5.3 times greater among children and adolescents who receive multiple
antipsychotics at the same time. Still worse, more than half of the children in foster care do not
receive a medical evaluation (Correll, 2009). Clearly, antipsychotic diagnoses are being abused
and little evidence supports their distribution to children. This backs up my hypothesis, which
suggests a complete absence of pharmacologic treatment.
+4
26. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 26
Purvis, K., Razuri, E., Howard, A., Call, C., DeLuna, J., Hall, J., & Cross, D. (2015).
Decrease in Behavioral Problems and Trauma Symptoms Among At-Risk Adopted
Children Following Trauma-Informed Parent Training Intervention. Journal Of Child &
Adolescent Trauma, 8(3), 201-210. doi:10.1007/s40653-015-0055-y
This study was the first research project to use a randomized sample, pre-post design with
a control group to test the effectiveness of TBRI. It had already been used in intensive home
programs, residential treatment centers, and schools, but it had not been used in an experiment.
The researchers hypothesized that behavioral problems and trauma symptoms would decrease for
at-risk adopted children whose parents participated in a TBRI trauma-informed parent-training
program.
The study consisted of 96 adoptive parents who were interested in learning how to care
for their adopted children with traumatic histories. Eligible participants were parents of children
who had either been adopted domestically or internationally, were between the ages of 5 and 12,
and had lived with that family for at least one year. There were 48 participants in the treatment
group and 48 in the control group. The control group participants were matched to those in the
treatment group based on the child’s age, sex, adoption type (domestic vs. international) and age
at adoption. All participants took an online pretest before the intervention as well as online
posttest two weeks afterwards. They also completed the Strengths and Difficulties Questionnaire
(SDQ) and Trauma Symptoms Checklist for Young Children (TSCYC) pre- and post-
intervention. The treatment group attended a 4-day TBRI parent training (6 hours per day) that
taught them the TBRI program and how they could incorporate it into their homes. The control
group received no information on TBRI until after the experiment. All participants completed the
posttest as well as the SDQ and TSCYC two weeks after the intervention.
27. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 27
The results revealed significant interaction effects for time (pre and post) and treatment
group in four of the five SDQ subscales (p<.01). The caregiver reports on four of the nine
TSCYC scales also showed significant interaction effects for time and group. Overall, TSCYC
scales showed a significant decrease in total difficulties for the treatment group (Mpre =18.90,
SD=6.83; Mpost =16.90, SD=6.64) but not for the control group (Mpre=17.69, SD=5.46;
Mpost=18.08; SD=5.87).
This article strongly supports my hypothesis because it demonstrated the effectiveness of
TBRI, which operates without any medicinal influence. Besides the stark differences between the
treatment group and the control group, the results also confirmed that TBRI could take effect
quite quickly. Indeed, changes in SDQ and TSCYC scores began to decrease after only two
weeks. TBRI is extremely helpful because it targets families in addition to individual foster
children. This allows change to take place within the family environment, which tends to be the
root cause to many behavioral problems and traumatic symptoms. Even if the foster child’s new
family does not cause any additional trauma, it can still be a negative environment if the family
does not know how to respond to the child’s traumatic outbursts when they do occur. Therefore,
TBRI is a far more effective – and less expensive – treatment for foster children than any kind of
pharmacologic treatment.
+5
28. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 28
Parris, S., Dozier, M., Purvis, K., Whitney, C., Grisham, A., & Cross, D. (2015). Implementing
Trust-Based Relational Intervention in a Charter School at a Residential Facility for At-
Risk Youth. Contemporary School Psychology (Springer Science & Business Media
B.V.), 19(3), 157. doi:10.1007/s40688-014-0033-7
This study examined the implementation of TBRI in a charter school at a residential
facility for at-risk youth. They hypothesized that TBRI would result in improvements in
behavior.
The researchers selected a charter school in Texas where youth had been placed due to a
variety of reasons including abuse/neglect, family violence, parent-child conflict, difficulties at
school, and behavioral issues. Involved in the study were 138 students (n=138), grades 7-12.
The intervention began in August 2011 when TBRI trainers worked with the administrators to
incorporate TBRI principles into the school system. Prior to the following school year, TBRI was
implemented more strongly by means of seminars and training days for the school staff. Data
were collected through interviews with school staff and administrators about their personal
observations and experiences, and through school incident reports. Focus groups were also held
throughout the study with the researchers and school staff. The groups were held one month
before the second year of TBRI implementation, three months after implementation, and one
month after the year was completed. The different techniques that were utilized followed the
three TBRI principles (empowering, connecting, and correcting). Firstly, the effective
empowering principles were hydration at all times, multiple snack times, fidgets (e.g., silly putty,
stress balls) and the removal of conflict triggers (e.g., always eating indoors). Secondly,
connecting principles like relationship building, healthy touch, and affirmations were also found
29. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 29
to be helpful. Lastly, different types of discipline like “compromises” and “redo’s” were popular
correcting principles.
During the first focus group before the second year of TBRI, participants noticed that the
students had begun to discuss problematic issues with the staff, used less profanity, were less
likely to complain, and fought less. Upon completion of the second year of TBRI, data showed
significant decreases in negative behavior: 68% in referrals for physical aggression, 88% in
referrals for verbal aggression, and 95% in referrals for disruptive behavior.
This article supports my hypothesis because the results clearly displayed a large
improvement in the children’s behavior due to the success of TBRI and its principles. As
previously stated, TBRI does not utilize any medications whatsoever. Thus, this significant
improvement took place entirely through psychosocial therapy. The results of this article are very
important to my hypothesis because they displayed the efficacy of TBRI. TBRI is something that
not only works in a select few individual foster youth, but can have impact over a hundred at-risk
youth. Furthermore, this study provided strong evidence that TBRI can be applicable both in
family life and outside it – that is, in a school environment. This is also extremely important
because normally, children are prescribed medication to help them behave in class, but now it is
clear that medications are not vital for good school behavior. Lastly, this experiment suggested
that TBRI is a treatment that never ceases to improve behavior. As long as the child is a recipient
of TBRI principles, they will continue to get better.
+5
30. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 30
Brenner, S. s., Southerland, D., Burns, B., Wagner, H., & Farmer, E. (2014). Use of Psychotropic
Medications Among Youth in Treatment Foster Care. Journal Of Child & Family
Studies, 23(4), 666-674.
The purpose of this article was to describe the use of psychotropic medications among
youth in treatment foster care (TFC), which is a community-based intervention for youth with
emotional, behavioral, and mental health problems. They aimed to find the prevalence of
psychotropic medication use and polypharmacy among foster care youth.
Data was collected from youth in TFC in a southeastern state between 2003 and 2008.
Fourteen TFC agencies were chosen at random for the purposes of this study. The participants
were 247 youth (ages 2-21; M=13.0, SD=3.8) and their foster care parents. Of the TFC youth,
32% were white, 58% were African American, and 25% were other races. The data for this study
came from interviews with all treatment parents. They were asked to report if their TFC youth
had taken any type of medicine for emotional or behavioral issues in the past two months and
whether or not they were still taking them. The two indicators of “questionable polypharmacy”
were two or more medications within the same class, and/or three or more psychotropic
medications. They also completed the Strengths and Difficulties Questionnaire (SDQ) to
evaluate the severity of psychopathology among the children. Psychotropic medications were
broken up into five categories: (1) antidepressants; (2) ADHD/stimulants; (3) antipsychotics; (4)
non-antipsychotic mood stabilizers/antimanic agents; and (5) anxiolytics (antianxiety
medication). The types of analyses used included logistic regression, Chi squares, and t tests.
The results displayed that about 59% of the sample youth took psychotropic medications
within the two months prior to the studies. Of this percentage, 61% took two or more
medications. The 59% that took medications had significantly higher SDQ scores (M= 17.2,
31. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 31
SD=6.2) compared to youth not taking medication (M= 14.1, SD= 7.4; t = -3.04, p<.01). There
were no differences in SDQ scores for youth on “any polypharmacy” versus “questionable
polypharmacy.”
This study supports my hypothesis in a couple important ways. Firstly, the statistics on
questionable polypharmacy brought some key issues to light. The fact that SDQ scores were
similar for both the “any polypharmacy” and “questionable polypharmacy” groups shows that
foster youth are unreasonably medicated. Children participating in “questionable polypharmacy”
act the same as other children yet receive amounts of medication that are unreasonable and even
hazardous. Furthermore, this same group of children was both less likely to have seen a
psychiatrist within the two months they were prescribed medications and less likely to be
receiving other services outside of the medications. Secondly, the researchers of this study also
compared rates of psychiatrist visits in TFC youth to youth in outpatient settings and found that
the latter group received psychotropic prescriptions from non-psychiatrists. This puts foster
youth in extreme danger. Overall, this article is compatible with my hypothesis because the
researchers called for a decrease in presence of psychotropic medications and an increase in
usage of other psychosocial services.
+3
32. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 32
Emslie, G. J., Heiligenstein, J. H., Wagner, K. D., Hoog, S. L., Ernest, D. E., Brown, E., & ...
Jacobson, J. G. (2002). Fluoxetine for acute treatment of depression in children and
adolescents: a placebo-controlled, randomized clinical trial. Journal Of The American
Academy Of Child And Adolescent Psychiatry, (10), 1205.
The purpose of this article was to measure the effects of fluoxetine – a selective serotonin
reuptake inhibitor (SSRI) – on children and adolescents with major depressive disorder (MDD).
The researchers hypothesized that fluoxetine would be a safe and effective treatment for these
youth.
The study took place over nine weeks and had a sample size of 219, which included 122
children (aged 8 to <13 years) and 97 adolescents (aged 13 to <18 years). All participants had a
diagnosis of nonpsychotic major depression disorder. The study began with an interview process
where participants and their caretakers met separately with a researcher once a week for three
weeks before treatment began. Next, participants were given a placebo for a week and if any
improvements occurred, they were eliminated from the study. The rest of the participants were
randomly assigned to either the placebo group or the treatment group. The placebo-treated (PT)
patients were told to take three tablets once daily for 9 weeks. The fluoxetine-treated (FT)
patients were given the same instructions. For the first week, the capsules distributed to FT
patients consisted of two placebo tablets and one 10mg fluoxetine tablet. For weeks 2 through 9,
they were given one placebo tablet and two 10mg fluoxetine tablets. This was done to test ensure
20mg of fluoxetine would be effective and well tolerated. All patients returned for efficacy and
adverse effects assessments at weeks 1, 2, 3, 5, 7, and 9. At each meeting, patients were assessed
33. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 33
by patient, parent, and clinician reports using the Children’s Depression Rating Scale-Revised
(CDRS-R) and the Clinician’s Global Impressions (CGI) Severity scales.
The results were in favor of the hypothesis. In regards to efficacy, FT patients had a
significantly higher mean change in CDRS-R score (p <.001). Significantly more FT patients
(41.3%) than PT patients (19.8%) met criteria for remission (p <.01). Half of all FT patients
(52.3%) were rated as very much improved (CGI score of 1 or 2) compared to one third of PT
patients (36.8%; p = .028). In regards to safety, there was no significant difference between FT
and PT patients reporting headaches as a side effect (p = .273).
This study refutes my hypothesis very strongly. Even though this particular article does
not apply directly to foster kids, it can be applied to my hypothesis because MDD is the most
common mental health disorder among foster youth (Pecora, White, Jackson, & Wiggins, 2009).
The results displayed the efficacy and safety of SSRIs in youth with MDD. Indeed, the data
showed that FT patients improved significantly more than the PT patients. Even though the main
reported side effect was headaches, the placebo group also experienced headaches. This might
even suggest that headaches are merely a side effect of MDD, not medication. This data makes a
strong case for SSRIs and their use in youth who have experienced trauma.
-3
34. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 34
Discussion
The youth in the foster care system have been taken from their families due to some level
of inadequate parenting (Lloyd & Barth, 2011). Most children who have experienced out-of-
home care have experienced trauma, and the symptoms of trauma – like emotional and
behavioral problems – can persist or get worse over time (Purvis et al., 2015). In response to
these problems, the usual solution is a combination of prescription medications – typically
psychotropic drugs – and psychosocial therapy (Brenner et al., 2013). Unfortunately, most of the
children who receive a prescription for psychotropic drugs do not follow through with the
psychosocial element and continue getting refills without approval from a psychiatrist or child
mental health specialist (Fonatella et al., 2014). This means that many foster youth are not
receiving the proper treatment they need to begin the healing process. They only get half of the
treatment. Clearly, there are not enough restrictions in place to ensure this does not happen
because the caregivers of foster youth are finding ways around doctoral supervision. The fact
that many youth are taking such strong medications without proper monitoring means they are in
danger. Being on a medication for too long has ramifications for the body, especially for
children’s bodies (dosReis et al., 2011). Furthermore, research is beginning to indicate negative
side effects that psychotropic drugs have on children. These side effects include weight gain,
Type-2 diabetes, and dyslipidemia (dosReis et al., 2011). These effects are two to five times
greater among children and adolescents who receive multiple antipsychotics at the same time, as
many foster children do (Brenner et al., 2014). There is, however, emerging evidence that
TBRI’s purely psychosocial approach is just as effective – if not more so – than medications.
Therefore, it was hypothesized in this study that TBRI would be a more efficacious treatment for
foster youth with emotional and behavioral disorders.
35. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 35
In this study, eight articles were found in support and four were found in refute. The
strongest articles on the support side were about TBRI and its positive effects after it was
implemented in a case study, a seminar for families, and a charter school. These articles had
astounding results. The problem behaviors decreased significantly in all of the youth who were
studied that received TBRI either through their caregivers, schoolteachers, or the researchers
themselves. The articles in refute were various studies or analyses about certain psychotropic
medications and the benefits that they have. All of these were average in strength because none
of them referred directly to foster youth. Unfortunately, there are not any articles that explicitly
compare the effects of purely pharmaceutical treatment to pure TBRI. That being said, the
studies that were found all point to psychosocial therapy as the more beneficial and safe of the
two treatment styles, and the results of the studies on TBRI clearly point to its effectiveness in
healing. Overall, research is starting to suggest a decrease in the amount of medications
prescribed and greater focus on treatments like TBRI. Therefore, the hypothesis can be accepted
because TBRI and other psychosocial treatments are better treatments for foster and at-risk youth
with emotional and behavioral difficulties.
There were some limitations of the articles utilized for this study. Of the four
articles about TBRI interventions, two did not use a p-value to test any significant changes post-
intervention (Parris et al., 2015; Purvis et al., 2014). Even though statistical significance is
desirable to validate a treatment method, it cannot be denied that the changes that took place in
both studies were quite large. The articles about TBRI also neither controlled for any usage of
pharmaceuticals nor made any mention of which participants were medicated at the time (Parris
et al., 2015; Purvis et al., 2007; Purvis et al., 2014; Purvis et al., 2015). This could mean the
children who were involved in the intervention did not improve only through TBRI, but through
36. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 36
the confounding variable of prescription medications. Nevertheless, the article about the TBRI
parent intervention is one of the strongest articles because it utilized a randomized sample, pre-
post design with a control group, and the results displayed significant effects for the treatment
group (Purvis et al., 2015). The support articles that were given a score of either a four or a five
were rated highly because the methods used and results that followed created certainty that TBRI
can be generalized to all traumatized youth between the ages of 3 and 14. The samples of each
article represented boys and girls of many races and ethnicities within that age range. It cannot
be generalized to older teens and adults because more research needs to be done to test the
effects of TBRI on this population.
One of the main flaws in the articles that refuted the hypothesis was that the data used to
help draw conclusions came from studies prior to the year 2000 (Emslie et al., 2002; Donnelly,
2003; Seedat et al., 2002; Walsh et al., 2004). This was especially apparent in the analysis of
pharmacologic treatment for children with PTSD (Donnelly, 2003). These four articles can
almost be disregarded because it is quite difficult to find any research after the year 2000 that
condones pharmacologic treatment for traumatized youth.
These analyses are crucial for the safety and well-being of foster youth in the United
States. If it wasn’t for the analysis of the available data, foster youth would continue receiving
medications that are both under-supported by research and unapproved by the FDA. Even the
studies and analyses in refute of the hypothesis recognize the lack of specific data on the long-
term effects of psychotropic medications in traumatized youth (Emslie et al., 2002; Donnelly,
2003; Seedat et al., 2002; Walsh et al., 2004). Unfortunately, many medical professionals
continue to prescribe strong drugs for children without strong support from research.
37. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 37
Inspection of the refute articles caused another question to emerge: what is the intended
purpose of medications in a pediatric setting? Ideally, the child takes a medication for the brief
period of time that is needed to heal. They should not take medications indefinitely, yet this is
what is occurring. Children certainly should not become dependent on strong psychotropic drugs
because their developing bodies can be impaired. Data from a TBRI study showed how certain
effects that were thought to only take place through medication (changes in neurotransmitter
levels) could also occur through psychosocial therapy (Purvis, McKenzie, Becker, Cross, &
Buckwalter, 2014). This is extremely important to the area of psychology because it is now
known that alterations in brain chemistry are possible without pharmaceuticals. This is only
logical because the original changes that occurred in traumatized youth’s brains were a result of
interpersonal interactions. Thus, the best way to undo the damage that was done is through the
same way it happened in the first place.
Fortunately, the overmedication of foster children and adolescents has been brought to
the attention of society as a whole. Laws have been passed that limit the distribution of
psychotropic drugs to foster youth (Korry, 2015). This is a step forward, but even though there is
an increase in awareness of overmedication, there needs to be an increased redirection of
treatment. Limiting prescription medications is helpful, but it does not solve the difficulties
foster youth face. There needs to be greater focus on the benefits of psychosocial therapies like
TBRI. TBRI is a relatively new treatment method that should be publicized. One way this can
be done is through further research utilizing TBRI in order to make medical professionals and
insurance companies cognizant of its efficacy.
There are many studies that can ensure that this awareness occurs. First, research should
be done comparing the cost of pharmaceuticals to the cost of implementing the TBRI program.
38. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 38
The only cost would be the initial seminar to teach parents and schoolteachers how to
incorporate TBRI into their own homes or classrooms. In comparison to the cost of each refill of
a psychotropic drug, the expense would be extremely low. Second, an experiment should be
conducted to compare the long-term behavioral and emotional changes of foster youth taking
pharmaceuticals versus youth involved in TBRI. Last, there should be a longitudinal study on
foster youth following the initial implementation of TBRI. This would make it possible to see
how long the TBRI principles continue to have an effect on the difficulties that foster youth
have. Clearly, there is still much to be done to make TBRI a common practice, but this new
direction of treatment for foster youth is one that will restore peace and security in their lives.
39. TBRI: A SUCCESSFUL TREATMENT FOR FOSTER YOUTH 39
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