1. The National Child Traumatic Stress Network The National Child Traumatic Stress Network is supported through funding from the Donald J. Cohen National Child Traumatic Stress Initiative, administered by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration.

2. National Child Traumatic Stress Network Mission Statement The mission of the National Child Traumatic Stress Network (NCTSN) is to raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States.

3. Type of Personal Physical Exposure to the WTC Attack Among NYC Public School Students, Grades 6-12: Ground Zero Compared to the Remainder of the City ( New York City Board of Education, 2002)

4. Type of Exposure to Family Member due to the WTC Attack among NYC Public School Students, Grades 6-12: Ground Zero Compared to the Remainder of the City ( New York City Board of Education, 2002)

5. Type of Previous Traumatic Exposure Among NYC Public School Students, Grades 6-12: Ground Zero Compared to the Remainder of the City ( New York City Board of Education, 2002)

6. Range of Traumatic Events Trauma embedded in the fabric of daily life –Child abuse and maltreatment –Domestic violence –Community violence and criminal victimization –Medical trauma –Traumatic loss –Accidents/fires

7. Range of Traumatic Events Humanitarian crises –Natural and man-made disasters Earthquakes Floods, mudslides Hurricanes Tornadoes Volcanic eruptions Major transportation accidents Industrial accidents Technological disasters –Catastrophes of human origin Armed conflicts/wars Genocide Terrorist attacks

8. Prevalence of exposure to the range of traumatic events in the general population of children Nationally representative survey of 12-17 year old youth reported lifetime prevalence of sexual assault (8%), physical assault (17%) and witnessing violence (39%) (Kilpatrick, Saunders & Resick, 1998). Longitudinal general population study of children and adolescents (9-16 years) in Western North Carolina found that one-quarter (25.1%) experienced at least one potentially traumatic event by age 16, 6% within the past three months (Costello, Erkanli, Fairbank & Angold, in press)

9. Elementary and middle school children in inner city (n=500): 30% witnessed a stabbing, 26% witnessed a shooting (Bell & Jenkins, 1993). Middle and Junior High school students (n=2,248) in urban school system: 41% reported witnessing a stabbing or shooting in the past year (Schwab-Stone et al., 1995). High School students (n=3,735) in six schools in two states. Relatively high rates of exposure in the past year that varied by location and size of the high school. Males: 3%-33% reported being shot or shot at, 6% - 16% attacked with knife. Females: Lower reported rates of victimization, higher rates for sexual abuse or assault (Singer et. al., 1995). Rates of Exposure to the Range of Traumatic Events in School Surveys

10. Student Exposure-Santana H.S. % (n) Physically Injured.8 (9) Shooter Spoke Directly at Me.5 (6) Directly Witnessed Someone Get Shot19 (219) Shooter shot directly at me4 (43) Saw Someone Wounded or Killed39 (452) Gave First Aid or Support to Injured2 (22) Heard Gun Shots but Didn’t See Anything35 (410) Witnessed First Aid to Injured9 (100) Only Saw People Running18 (205)

12. Biological Studies of Child and Adolescent Traumatic Stress Structural brain development Neurophysiology Neurohormones

13. Link between Violence Exposure and Chronic PTSD with: Substance Abuse Reckless Behavior High-risk Sexual Behavior Gang Participation Disturbances in Academic Functioning (Kilpatrick, Saunders & Resick, 1998)

14. Violence and Trauma affects school performance –Children with life threatening violence exposure Lower GPA More negative comments in permanent record More absences –Children with Depression and Posttraumatic Stress Disorder Even Lower GPA More absences

15. History of either physical or sexual abuse associated with : * Higher incidence of early illness * Faster cycling frequencies * Lifetime Axis I and II disorders, including lifetime history of alcohol and substance abuse * Higher prevalence of medical illness * Pattern of increasing severity of mania in those who reported history of physical abuse (Early physical and sexual abuse associated with adverse course of bipolar illness. Leverich et al., Biol. Psych., 2000)

18. Mental HeaIth Intervention Improves Grades Improvement in grades significant p<0.05

19. General Barriers to Care System Lack of insurance Poor continuity in insurance coverage Poor Medicaid reimbursement rates Provider shortage Lack of provider training in evidence-based treatments Community Residential instability (i.e., homeless, foster care children) Geographic distance from programs (i.e., rural areas) Parent / Family attitudes, knowledge, and beliefs about signs of common mental health problems and mental health services for children Poverty Education Poor social support Poor family functioning / high stress

20. Specific Issues Pertaining to Child and Adolescent Trauma Better Education and Training for Parents, Students, School Personnel, Community Agencies, Health and Mental Health Practitioners, Law Enforcement, Child Protective, Child Welfare, and Victim Witness Staff, and Others Responsible for the Care and Supervision of Children

21. Specific Issues Pertaining to Child and Adolescent Trauma - Better Surveillance and Screening Inclusion in Medicaid Early Periodic Screening, Diagnosis, and Treatment Systematic Screening in Child Service Settings

22. Specific Issues Pertaining to Child and Adolescent Trauma Expand Resources and Build Capacity for Child, Adolescent, and Family Trauma Services

23. Specific Issues Pertaining to Child and Adolescent Trauma - Integration of Child and Adult Trauma Services

24. Specific Issues Pertaining to Child and Adolescent Trauma - Improve Funding of Case Managers

25. Specific Issues Pertaining to Child and Adolescent Trauma Integration of Child and Adolescent Trauma Evaluation and Treatment Services into Efforts to Develop Integrated Service Systems

26. Specific Issues Pertaining to Child and Adolescent Trauma Advantages of Providing School- based Trauma Related Services

27. Specific Issues Pertaining to Child and Adolescent Trauma Better Integration of Mental Health Services in School Crisis and Disaster Preparedness, Response and Recovery Programs

28. Insurance Parity for Childhood Trauma Mental Health Services Within the Wider Scope of Child and Adolescent Mental Health Disorders

29. The NCTSN will raise public awareness of the scope and serious impact of child traumatic stress on the safety and healthy development of our nation’s children and families. We will improve the standard of care by integrating developmental and cultural knowledge to advance a broad range of effective services and interventions that will preserve and restore the future of our nation’s traumatized children. We will work with established systems of care, including the health, mental health, education, law enforcement, child welfare and juvenile justice systems, to ensure that there is a comprehensive continuum of care available and accessible to all traumatized children and their families. We will address the needs of children across the developmental spectrum, from infancy through the school-aged years into the beginning years of young adulthood. We will be a community dedicated to collaboration within and beyond the Network to ensure that widely shared knowledge and skills create a national resource to address the problem of child traumatic stress. The Vision of the NCTSN

30. Five Foci of Trauma-Grief Focused Intervention Traumatic Experience(s) Trauma and Loss Reminders Traumatic Bereavement Adversities and Current Stresses Developmental Progression

31. National Child Traumatic Stress Initiative Network Sites LOS ANGELES Category I - National Center MA CT NY PA NM UT CO MO OH VA Category II – 2001 Intervention Development and Evaluation Centers Category III – 2001 Community Treatment and Service Centers Category II – 2002 Intervention Development and Evaluation Centers Category III – 2002 Community Treatment and Service Centers See Other Map ME FL AL CA OR WA IL DC