The National Child Traumatic Stress Network (NCTSN) Baseline Demographic and Clinical Characteristics Matthew D. Kliethermes Ph.D. 1, Steven E. Bruce Ph.D. 1, Stacey Haynes 1, Ally Burr-Harris Ph.D. 1, and the principal investigators and program directors of the National Child Traumatic Stress Network 1 University of Missouri-St. Louis This study is supported by SAMHSA grant XXXX NMeanSD % Above Cutoff (PTSD Overall ≥ 38) PTSD Criterion B Raw Score (Reexperiencing) N/A PTSD Criterion C Raw Score (Avoidance) N/A PTSD Criterion D Raw Score (Arousal) N/A PTSD Overall Raw Score % Table 1: UCLA PTSD Reaction Index NMeanSD % Above Cutoff (PTSD Overall ≥ 60) Validity: Underresponse Hyperresponse Clinical: Anger % Anxiety % Depression % Posttraumatic Stress % Dissociation: % Fantasy Overt Dissociation Table 2: TSCC-A Scales Table 3: CBCL Measures NMeanSD % Above Cutoff (PTSD Overall ≥ 65) Emotionally Reactive* % Withdrawn* % Aggressive Behavior** % Anxious / Depressed** % Attention Problems** % Externalizing Behaviors** % Internalizing Behaviors** % Somatic Complaints** % Sleep Problems** % Total Score** % Rule-Breaking Behavior*** % Social Problems*** % Thought Problems*** % Withdrawn / Depressed*** % Children Aged 1½ to 5 Children Aged 6 to 18 Figure 1: Prevalence of Trauma Types in Youths Figure 2: Current Legal Guardian Gender% Male48.2 Female51.6 Abstract Objective: Established in 2001, the National Child Traumatic Stress Network (NCTSN) is a collaborative of 70 research and treatment centers throughout the United States funded by the Substance Abuse and Mental Health Services Administration. Its purpose is to improve the quality and availability of therapeutic services for youth exposed to trauma. A major goal of NCTSN has been to create a national data set consisting of information about services provided to youth at NCTSN centers. Methods: Data were drawn from intakes of 2118 traumatized youth who received services at a NCTSN treatment center. Analyses were conducted to provide demographic and clinical characteristics of these children and adolescents Results: Participants reported high levels of traumatic events, including sexual abuse (19.4%), physical abuse (23.2%), witnessing domestic violence (39.9%) and traumatic loss (44.4%). Results also indicated that various emotional and behavioral difficulties (e.g., symptoms of posttraumatic stress), were prevalent in the sample. For example, nearly one-third of participants met or exceeded the suggested cutoff scores on PTSD measures. Half of the sample also had reported emotional and behavioral difficulties. Conclusion: Results indicated that domestic violence and traumatic loss appear to be among the most common reasons that participants presented for trauma-focused services. This study suggests that along with symptoms of posttraumatic stress, children exposed to trauma experience a broad range of emotional and behavioral difficulties, which are suggestive of compromised developmental status. Method Participants  2118 children (age 3-19 M = 9.19 years old) participating in the NCTSN Core Data Set (CDS) and presenting for trauma-focused services were included in this study  The data utilized in this project was submitted from the 29 NCTSN treatment centers to the CDS during the time period of May 2004 through February  Inclusion Criteria: Presence of lifetime exposure to at least one traumatic event.  The CDS includes information related to demographics, domestic environment, service utilization, trauma exposure history, and severity of emotional and behavioral difficulties.  Measures  f  Intake data collection was standardized across all NCTSN treatment centers and consisted of a baseline information form designed by NCTSN and standardized assessment measures (i.e., CBCL, TSCC, UCLA PTSD RI).  Only baseline intake data was analyzed for the purpose of this project. Results Demographic Characteristics Many participants were no longer in the legal or physical custody of their biological parents (see Figures 2 and 3). 19% of participants were in state custody (see Figure 2). Recent Treatment/Service Usage Participants made frequent use of medical services (see Figure 5) Linkage to various social and mental health services in the month prior to assessment was common (see Figure 5). Types of Traumatic Experiences “Reportable” forms of child trauma were common (see Figure 1). Domestic violence and traumatic loss/bereavement were the most common traumatic experience (See Figure 1). Caregiver impairment was endorsed by approximately 1/3 of the sample (see Figure 1). Clinical Characteristics As defined by results of standardized assessment measures (i.e., CBCL, TSCC-A, UCLA PTSD RI). Large percentages of participants presented with clinically significant difficulties on multiple CBCL scales (See Table 3) Over one fourth of the sample was experiencing clinically significant symptoms of PTSD (see Table 1). Large portions of the sample met or exceeded a T-score of 60 on the Posttraumatic Stress (31.2%) and Dissociation (24.3%) subscales of the TSCC-A, as well as other non-directly trauma-related scales (see Table 2). Conclusions The primary support systems appear to have been compromised for many of the participants, which likely contributed to their need or trauma-focused treatment services. The results appear to confirm that children who present for trauma- focused treatment tend to experience deficits across multiple areas of functioning (e.g., social, academic, behavioral, etc.). The results highlight the need for assessment and treatments services aimed at addressing “non-traditional forms of child trauma (i.e., traumatic loss, domestic violence, impaired caregiver). Symptoms of posttraumatic stress were clearly evident; however, many participants also experience a broad range of emotional and behavioral difficulties that may not be initially identified as trauma- related (e.g., somatic complaints, interpersonal difficulties, noncompliance). Trauma exposure in children appears to represent a “developmental insult” and hinders the capacity to develop competencies in a variety of areas. Future Directions This study represents an initial description of participants in the CDS. It is anticipated that future research using the CDS will take a variety of directions including the following:  Longitudinal treatment outcome data  Impact of situational characteristics (e.g., trauma type, participant gender) on symptom presentation  Impact of situational characteristics on treatment outcome Table 4: Gender Figure 3: Adult Type in the Home Figure 4: Primary Residence Table 5: Ethnicity Ethnicity% Hispanic / Latino12.7 Indian2.1 Asian1.7 African-American40.4 Hawaiian0.1 Caucasian45.0 Unknown13.9 N = 2118