This document summarizes research from the Maltreatment and Adolescent Pathways (MAP) study on trauma experiences of youth involved with child protection services. The study found high rates of different types of trauma among youth in group homes, with 65% reporting experiences all 5 types of maltreatment measured. Trauma symptoms like anxiety, depression and dissociation were common, though rates decreased over time for some youth. Traumatic experiences were correlated with trauma reactions for some youth. The findings support the need for regular, longitudinal trauma-informed assessments of youth and trauma-informed services. Key areas in need of attention are male child sexual abuse, impacts of intimate partner violence exposure, and adolescent dating violence.
Wekerle CIHR Team - Child Sexual Abuse & Adolescent Development: Moving from ...Christine Wekerle
Child Sexual Abuse & Adolescent Development: Moving from Trauma To Resilience - Findings from The Maltreatment and Adolescent Pathways (MAP) Research Study
Risk Reduction Through Family Therapy (RRFT)BASPCAN
An integrative approach to treating substance use problems and PTSD among maltreated youth.
Carla Kmett Danielson PhD
Medical University of South Caolina
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
Wekerle CIHR Team - Child Sexual Abuse & Adolescent Development: Moving from ...Christine Wekerle
Child Sexual Abuse & Adolescent Development: Moving from Trauma To Resilience - Findings from The Maltreatment and Adolescent Pathways (MAP) Research Study
Risk Reduction Through Family Therapy (RRFT)BASPCAN
An integrative approach to treating substance use problems and PTSD among maltreated youth.
Carla Kmett Danielson PhD
Medical University of South Caolina
Contributors: Frank Putnam, MD, UNC at Chapel Hill, NC
William Harris, PhD, Children’s Research and Education Institute
& New School for Social Research, NYC, NY
Alicia Lieberman, PhD, UCSF, San Francisco, CA
Karen Putnam, PhD, UNC at Chapel Hill, NC
Lisa Amaya-Jackson, MD, Duke University, Durham, NC
Freijy - ASBHM - Do interventions based on cognitive dissonance promote healt...Emily Kothe
Freijy, T., & Kothe, E., (2013). Do interventions based on cognitive dissonance promote health behaviour?. Paper presented at the Australasian Society of Behavioural Health and Medicine (ASBHM) 10th Annual Proceedings, Newcastle, Australia
Presentation by Daniel Flannery, Ph.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN
This presentation will present recent research on the links between brain development and neurochemistry, mental health and violence. We will compare traditional treatment programs that focus separately on perpetrators, victims and witnesses with examples of specific, innovative, multi-systemic treatment models that providers have employed in an attempt to break the cycle of violence. Our discussion will revolve around several video vignettes and principles of Trauma-Informed care.
Participants will address the challenges of pilot-tested, “evidence-based practice” versus the “practice-based evidence” of community programs. Treatment challenges related to co-morbid functioning of high-risk individuals will be discussed including substance use, offending, mental health, family functioning and academic achievement. Examples of specific innovative treatment models and local and national data on multi-system involved youth and intervention outcomes will be provided. We will also consider the difficulties and benefits of working in collaborative, community-based coalitions to effect change and how this movement has been affected by policy, resources, and increased demands for accountability.
Wekerle-Ron Joyce Centre Grand Rounds-Boy's and men's health: Child sexual ab...Christine Wekerle
Defines sexual violence and gives info. on prevalence rates, examines emotion dysregulation in at-risk youth, child sexual abuse research findings, and introduces a developing resilience-based app for at-risk youth.
Neuroticism and stressful life events predict religious and spiritual strugglesNick Stauner
(2015, August). Symposium presented at the convention of the International Association for the Psychology of Religion, Istanbul, Turkey.
Abstract:
Recent research has demonstrated that religious and spiritual struggle (RSS) plays an important role in the relationship between religion and well-being. To what extent might RSS arise from personality and environmental stress? We hypothesized that neuroticism and stressful life events predict RSS independently and interact as well, such that neuroticism strengthens the link between stress and struggle. Regression analyses of factor scores from 2,719 undergraduates in USA revealed independent effects of neuroticism and stressful past experiences on six kinds of RSS, but no interactions emerged. Thus personality and experience may both affect RSS additively. Neuroticism better predicted most struggles, especially ultimate meaning struggles, but stress predicted demonic and interpersonal struggles slightly more. Mediation analyses also explored indirect effects. Some trait theorists claim that essential traits precede environmental factors causally, suggesting that neuroticism may lead to stress; conversely, stress could increase state neuroticism. Hence we considered both as possible mediators of each other’s effects. All indirect pathways achieved significance, but most had very weak effect sizes. Given weaker direct effects of stress in general, any indirect effects mediated by neuroticism would appear more substantial. Longitudinal work may help resolve this causal ambiguity.
Freijy - ASBHM - Do interventions based on cognitive dissonance promote healt...Emily Kothe
Freijy, T., & Kothe, E., (2013). Do interventions based on cognitive dissonance promote health behaviour?. Paper presented at the Australasian Society of Behavioural Health and Medicine (ASBHM) 10th Annual Proceedings, Newcastle, Australia
Presentation by Daniel Flannery, Ph.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN
This presentation will present recent research on the links between brain development and neurochemistry, mental health and violence. We will compare traditional treatment programs that focus separately on perpetrators, victims and witnesses with examples of specific, innovative, multi-systemic treatment models that providers have employed in an attempt to break the cycle of violence. Our discussion will revolve around several video vignettes and principles of Trauma-Informed care.
Participants will address the challenges of pilot-tested, “evidence-based practice” versus the “practice-based evidence” of community programs. Treatment challenges related to co-morbid functioning of high-risk individuals will be discussed including substance use, offending, mental health, family functioning and academic achievement. Examples of specific innovative treatment models and local and national data on multi-system involved youth and intervention outcomes will be provided. We will also consider the difficulties and benefits of working in collaborative, community-based coalitions to effect change and how this movement has been affected by policy, resources, and increased demands for accountability.
Wekerle-Ron Joyce Centre Grand Rounds-Boy's and men's health: Child sexual ab...Christine Wekerle
Defines sexual violence and gives info. on prevalence rates, examines emotion dysregulation in at-risk youth, child sexual abuse research findings, and introduces a developing resilience-based app for at-risk youth.
Neuroticism and stressful life events predict religious and spiritual strugglesNick Stauner
(2015, August). Symposium presented at the convention of the International Association for the Psychology of Religion, Istanbul, Turkey.
Abstract:
Recent research has demonstrated that religious and spiritual struggle (RSS) plays an important role in the relationship between religion and well-being. To what extent might RSS arise from personality and environmental stress? We hypothesized that neuroticism and stressful life events predict RSS independently and interact as well, such that neuroticism strengthens the link between stress and struggle. Regression analyses of factor scores from 2,719 undergraduates in USA revealed independent effects of neuroticism and stressful past experiences on six kinds of RSS, but no interactions emerged. Thus personality and experience may both affect RSS additively. Neuroticism better predicted most struggles, especially ultimate meaning struggles, but stress predicted demonic and interpersonal struggles slightly more. Mediation analyses also explored indirect effects. Some trait theorists claim that essential traits precede environmental factors causally, suggesting that neuroticism may lead to stress; conversely, stress could increase state neuroticism. Hence we considered both as possible mediators of each other’s effects. All indirect pathways achieved significance, but most had very weak effect sizes. Given weaker direct effects of stress in general, any indirect effects mediated by neuroticism would appear more substantial. Longitudinal work may help resolve this causal ambiguity.
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The linkages among childhood maltreatment, adolescent mental health, and self...Christine Wekerle
The linkages among childhood maltreatment, adolescent mental health, and self-compassion: The Maltreatment and Adolescent Pathways (MAP) Longitudinal Study
Director del Centro de Excelencia para rl Desarrollo de la Primera Infancia de la Univerisdad de Montreal, Canadá en el Seminario Internacional “El Impacto de la Educación Inicial”, organizado por JUNJI, Unicef y el Ministerio de Hacienda.
This briefing overviews the research on the extent, consequences, risks and prevention strategies for family violence with a focus on preventing family violence in North Carolina.
Adolescence is a key period for intervention among at-risk populations of youth, as this is when risk-taking behaviors tend to emerge. The Sustainable Development Goals for achieving 2030 youth health targets outline two issues central to reduce risks of gendered violence, sexual violence (SV) and adolescent sexual risk taking: (1) gender equity and (2) mental health promotion education. Only half of women reported having the autonomy to make their own decisions regarding sexual relations, usage of contraception and access to health care services. In developing countries women and children are extremely vulnerable to sexual violence which thereby places them at increased risk for contracting STIs from the perpetrator, as well as pregnancy as a result of SV. Undocumented minors; unaccompanied minors; refugees; child soldiers; youth post natural disasters; orphans; street-involved youth; and youth without parental care or financial means who are exposed to dangerous people or places are most vulnerable to sexual violence. UNICEF states that ending cases of new HIV infections by 2030 is unlikely, due to large concentrations of new infections occurring in areas where transactional sex, child sexual exploitation, drug use, street involved youth and SV are prevalent. Adverse Childhood Experiences (ACEs), which include forms of childhood maltreatment, increase the risk of contracting STIs. In particular, sexual abuse is linked with increased likelihood for risky sexual behavior, making victims vulnerable to poor sexual health outcomes.7 Protecting youth from exposure to SV and providing adolescents with sexual and mental health education are central to promoting resilience in youth.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes a...Christine Wekerle
Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers
Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)
Russell A. Barkley.
Clinical Professor of Psychiatry Medical University of South Carolina, Charleston SC, and Research Professor, Departament of Psychiatry Suny Upstate Medical University Syracuse, NY.
Similar to The Maltreatment and Adolescent Pathways (MAP) Research Study (20)
INDIGENOUS YOUTHS’ RELATIONSHIPS WITH WATER: TRAUMA, ADVOCACY & RESILIENCEChristine Wekerle
Indigenous communities often experience disproportionate access to clean, safe drinking water. For youth water insecurity may lead to adverse mental health effects, referred to as 'water anxiety'. However, water resilience actions such as advocacy and youths' responsibilities to water, may have the potential to mitigate potential mental health effects associated with 'water anxiety'.
Positive psychology evolved from a recognition that the clinical encounter is often over-focused on concerns and problems, and that positive actions may not have a central role in the treatment plan. With youth, many issues - treatment compliance, help-seeking, impulsive self-harm, high risk-taking - may be ameliorated with a plan of positive actions. The technology that are youths' worlds may deliver some of these therapeutics. Resilience may be galvanized when inner resources interacts with external resources. This talk will introduce the evidence-based components of a resilience in youth App, JoyPop, and open discuss for research use in clinical populations.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Investigating the Path from Child Maltreat...Christine Wekerle
Investigating the Path from Child Maltreatment to Alcohol Problems in a Sample of Child Welfare-Involved Youth
Sherry Stewart, Tristan Park, Kara Thompson, Mohammed Al-Hamdani, Amanda Hudson, Christine Wekerle, Savanah Smith (CIHRTeamSV)
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
Shannon Stewart, Yasmin Garad, Natalia Lapshini
ISPCAN Jamaica 2018 - Personality-targeted Interventions for Building Resilie...Christine Wekerle
Personality-targeted Interventions for Building Resilience against Substance Use and Mental Health Problems among Adolescents Involved in Child Welfare System
Hanie Edalati, Patricia Conrod
Resilience Knowledge Mobilization and the ResilienceInYouth AppChristine Wekerle
This presentation outlines an exploratory knowledge mobilization study where research-based and evidence-based posts were shared on instagram (@resilienceinyouth) to see if instagram was a feasible outlet for resilience knowledge mobilization. Research conducted by researchers in the CIHRTeamSV grant was shared on instagram via links to ResearchGate. The development of a resilience-based app for youth is described and an overview of its features is given.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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The Maltreatment and Adolescent Pathways (MAP) Research Study
1. Christine Wekerle, Ph.D. Pediatrics, McMaster University
Email: wekerc@mcmaster.ca
Twitter: @DrWekerle
The Maltreatment and
Adolescent Pathways (MAP)
Research Study
ResilienceInYouth Initiative
Website: www.in-car.ca
International Journal of Child
and
Adolescent Resilience
YouTube: ResilienceInYouth
Twitter: ResilienceInYouth
@ResilienceInYou
Instagram: ResilienceInYouth
2. Assessment of resilience capacities
• “…in the lexicon of strengths, it is as
wrong to deny the possible as it is to
deny the problem” (Saleeby, p.297)
• Focus on trauma, impairment, health
and resilience
• The value of youth perspective
3. GRACE as reflecting post-traumatic growth
• Resilience is generated by interaction of individual with
resources (person x environment)
– Among US adolescents, 22% have mental health problems with impairment
(Merikangas et al., 2010)
• Adolescent develop favours risk-taking as part of the
autonomy process and competence
• However, decision-making “prudence” is developing into
the mid-20s.
• Adolescence is a window of risk, but also resilience
– Social connectedness
– Conceptual thinking (open to reflective thinking)
– Identity formation
5. The Resilience Journey:
7 STEPS to GRACE in
TEDxHamilton Talk
① Acknowledging Adversity *
② Crafting Daily Resilience Practice *
③ Shifting Perspectives & Mindsets
④ Reaching Out For Help
⑤ Transforming Your Burden Into Beauty
⑥ Managing Stress Storms
⑦ Emerging & Extending Your Grace
6. Addressing Adversity –Service-to-Need Match
Do We Know What Youth are Coping With?
5As: ask, advise, assess, assist, and arrange
• Few surveys capture trauma events and responses
• Wade et al. (2014): 120 diverse urban youths – focus groups
(http://pediatrics.aappublications.org/content/134/1/e13.full)
• Trauma “events are emotionally difficult to deal with and cause
stress”
• Youth Self-Generated Most Stressful Events (next slide)
What is our response to youth trauma events?
• Cdn adolescents investigated < other ages
• Youth with Internalizing problems > advanced to on-going services;
• Externalizing problems > out-of-home and grouped care (Fast et al., 2014)
http://www.sciencedirect.com/science/article/pii S0190740914002680
7. ACE Events (8)
(Wade et al., 2014)
No. of Youth Responses Prior ACE category (10)
Community Stressors
Neighborhood crime,
violence, and death
Negative/adult behavior in the
neighborhood
57
50
Personal Stressors
Child abuse (any) 33
Physical, psychological, sexual
abuse; emotional, physical
neglect; exposure to IPV
Economic Hardship
Not enough money
Lack non-monetary resource
35
31
Family members abusing
alcohol and drugs
Lack of love and support in the
family
Single-parent home
37
33
30
Substance abuse in home
Criminal activity in home
Divorce/Separation
Mental illness in home
8. Maltreatment and Adolescent Pathways (MAP)
Study
• One of the first Canadian longitudinal studies to capture
the experiences of youth involved with child protection
services across the type of services
• Participatory Action Framework (Caseworkers)
• Randomly selected from active caseloads
• Data collection from caseworkers and youth 2003-2010
• Longitudinal - Tested every 6 months for 3 years
• Broad-based assessment: cognitive issues, mental
health, substance use, adolescent dating violence,
health risk behaviours, and resilience
10. Measure: Childhood Trauma Questionnaire (CTQ) (Bernstein
& Fink, 1998)
• 28 items
• 5 subscales: emotional abuse, physical abuse, sexual
abuse, emotional neglect, and physical neglect
• Severity ranges:
1. none-minimal
2. Minimal-moderate
3. moderate-severe
4. severe-extreme
• Generally very satisfactory psychometric properties
• More reliable compared to other methods of assessing
childhood maltreatment such as staff observations and
parental reports (Grassi-Oliveira et al., 2014).
11. Breaking Down MAP Child Sexual Abuse Experiences
• From initial assessment (N=561) – Grouping into CSA experiences using youth self-
report (CTQ/CEVQ) and Caseworker Report
Females (n=145; 49%) Males (n=70; 27%)
Using CTQ
Fondling 54% 45%
Molested 47% 38%
“I was 55% 41%
sexually
abused.”
Agreement 37% 5%
s/ Caseworker
http://www.nspcc.org.uk/globalassets/documents/research-reports/social-workers-
knowledge-confidence-child-sexual-abuse.pdf
2014 Brady et al. NSPCC report – challenges of workforce in specific trauma
assessment areas like CSA
12. Prevalence and Severity of Traumatic Experiences
(baseline)
Type of Abuse None or
Minimal
Low to
Moderate
Moderate to
Severe
Severe to
Extreme
Emotional
abuse
36% 17 % 15 % 32%
Physical
abuse
45% 6% 14% 35%
Sexual Abuse 66%
(none)
5% 7% 22%
Emotional
Neglect
25% 23% 13% 39%
Physical
Neglect
43% 10% 18% 29%
64%
55%
34%
75%
57%
13. Demographics
(MAP Group Home Analysis-Milne et al., 2016)
Baseline (n=144) 6 months (n=104) 18 months (n=42)
Gender 44.5% female * *
Age 15.7 yrs. (avg.) (range13-18
yrs.)
16.24 yrs.
(range 13-18 yrs.)
17.4 yrs. (avg.) (range
16-19 yrs.)
Ethnicity (%) Caucasian - 34
Black – 23
Bi-racial – 30
Other - 13
Current placement Group home -100% Group home – 59% Group home -15%
CAS status (%) Crown – 62
Society – 25
Interim/Temp. – 12
Comm./vol. – 1
Average length of
time in CAS
4.9 yrs.
(range 0-9.5 yrs.)
5.8 yrs.
(range 1-18 yrs.)
6.7 yrs.
(range 2-17 yrs.)
Average moves past
5 years
2.81 (0-5 moves)
14. Results: Youth Traumatic Experiences (Milne et al.)
Per CTQ:
Maltreatment was reported by 86% (n=124) of youth in group
home care
• Emotional abuse - 64%
• Physical abuse - 55%
• Sexual abuse - 34%
• Emotional neglect - 75%
• Physical neglect – 57%
**65% of youth reported experiencing all 5 maltreatment
types
15. Youth Traumatic Reactions
From Ontario Incidence Study of Reported Child Abuse and Neglect, highest Caseworker
Report of Emotional Harm with Intimate Partner Violence (IPV) Exposure and Child Sexual
Abuse (CSA);www.cwrp.ca
Trauma Symptoms: Anxiety/fears, anhedonic/dysphoric, angry/ aggressive, dissociative
symptoms; as problems w/ sleep, eating, concentration, substance use,
reckless/avoidant behavior, self-harm/ suicidality;
See: http://advancedtrauma.com/ConnorFord2014ClinicalPediatrics_1_.pdf
16. Measure: Trauma Symptom Checklist for
Children (TSCC) (Briere, 1996)
• Youth self-report (54 items)
• Target audience: 8-16 years
• Subscales: Anxiety, depression, anger, posttraumatic
stress, dissociation
• Most commonly used trauma assessment tool for children
and adolescents in clinical settings (Elhai, Gray, Kashdan, &
Franklin, 2005)
• Normed on large samples (n=3,008) of racially and socio-
economically diverse populations (Evans, Briere, Boggiano, &
Barret, 1994; Friedrich & Jaworksi, 1995; Singer et al., 1995).
• Some concerns re: highly correlated scales
17. Severity of traumatic reactions at baseline, 6 & 18 months
(non-clinical, subclinical & clinical levels)
*PER the TSCC
Baseline (%) 6 months (%) 18 months (%)
Non Sub Clin Non Sub Clin Non Sub Clin
Anxiety 82 8 10 86 7 7 91 7 2
Depression 78 10 12 90 6 4 85.5 2.5 12
Anger 83 4 13 89 5.5 5.5 100 0 0
PTS 81 11 8 82 12.5 5.5 85 10 5
Dissociation 78 10 12 70 20 10 85 12.5 2.5
20. Crafting A Daily Resilience Practice
•Exercise/Fitness
•Healthy Nutrition
•Deep Breathing/Sleep
•Social Connectedness
•Self-compassion
Goals: Reducing everyday
traumatic stress reactivity and increasing emotion
regulation, self-efficacy, and social support
22. TAKE-AWAYMESSAGES
• Findings support the need to conduct regular
(preferably longitudinal) trauma-informed and
strengths-based assessments in child welfare services
(and youth population for comparison – using same
measures)
• Trauma events need to be broadly captured to include
youth-identified stress (perceived) and literature-based
• Trauma-informed service and placement decisions
• Child welfare youth may “fall through cracks” for
adolescent/transitional services by virtue of age
• Needs: Male child sexual abuse; IPV impacts;
adolescent dating violence
23. Thank you for your
attention!
Questions or Comments?
Editor's Notes
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry,49(10): 980–9.
ACE research supports dose-response w/ 4+ ACES and much more heightened risk for adult health risk behaviors and chronic Illness.
. Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. 2003;160(8):1453–1460 CrossRefMedlineWeb of ScienceGoogle Scholar
. ↵ Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004;113(2):320–327 Abstract/FREE Full Text
. ↵ Brown DW, Anda RF. Adverse childhood experiences: origins of behaviors that sustain the HIV epidemic. AIDS. 2009;23(16):2231–2233
Adverse Childhood Experiences of Low-Income Urban Youth
Roy Wade Jr, Judy A. Shea, David Rubin, and Joanne Wood
Pediatrics 2014; 134:1 e13-e20; published ahead of print June 16, 2014, doi:10.1542/peds.2013-2475
The Maltreatment and Adolescent Pathways (MAP) study is a three-year longitudinal epidemiological study led by Christine Wekerle. CPS agencies in . large urban centre in Ontario.
Study involved a battery of self-report questionnaires to be completed by youth every six months for three years. The aim of the measures was to assess: (1) four key outcome domains (mental health problems/disorders; substance abuse; risky sexual practices; dating violence); (2) selected resiliency factors (interpersonal competence, sports involvement, etc.); and (3) potential mediators (e.g., alcohol and violence outcome expectancies) and moderators (e.g., maltreatment characteristics including severity and type) of the child maltreatment–adolescent outcome relationship.
The MAP study is guided by a community-researcher partnership, with an inter-disciplinary advisory board comprised of CPS workers, agency researchers, and university- or hospital-based clinicians and researchers. The aim of the MAP advisory board was to ensure practices that maximally supported youth, and to ensure that research participation was not harmful to youth (Wekerle, 2007).
As expected CSA rates lower than other forms of maltreatment, but still quite high when considering male/female combined – large proportion(65%) in the severe to extreme range
63% of females / 17% of males (almost 4 times)
Can already see here the co-occurrence with other maltx and potential for poly-victimization – generally 4 or more traumas (and these aren’t including grief/loss/exposure to violence, etc.)
**Participant numbers varied substantially between measures – highest count for completed measures was CTQ.
*A lot of missing data – missing questions or measures that some youth did not complete
Slightly lower than in pilot study but higher than what is found among the general population.
Supports literature that has found high rates of maltreatment experiences, often in combination. This can lead to complex trauma…
Clinical and subclinical levels of traumatic reactions decreased considerably (20-100%)
FROM BASELINE:18 MONTHS (including clinical and subclinical)
Anxiety: 18:9 (half)
Depression: 22:14.5 (a third)
Anger: 17:0 (WOW!)
PTS: 19:15 (a fifth)
Diss: 22:15 (a third)
