The present study examined how exposure to traumatic events affects children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child’s history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, and externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18-month follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.
AchenbachT. M.DumenciL.RescorlaL. A. (2002). Ten-year comparisons of problems and competencies for national samples of youth: Self, parent and teacher reports. Journal of Emotional and Behavioral Disorders, 10, 194–203.
2.
AchenbachT. M.EdelbrockC. S. (1983). Manual for the Child Behavior Checklist and revised child behavior profile. Burlington, VT: T. M. Achenbach.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
4.
AndersonJ. A.WrightE. R.KelleyK.KooremanH. (2008). Patterns of clinical functioning over time for young people served in a system of care. Journal of Emotional and Behavioral Disorders, 16, 90–104.
5.
BickmanL.NoserK.SummerfeltW. (1999). Long-term effects of a system of care on children and adolescents. The Journal of Behavioral Health Services & Research, 26, 185–202.
6.
BurnsB. J.PhillipsS. D.WagnerH. R.BarthR. P.KolkoD. J.CampbellY.LandsverkJ. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 960–970.
7.
Centers for Disease Control and Prevention. (2008). Strategic direction for child maltreatment prevention. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention.
Community Mental Health Services. (2005). Data manual. Phase IV of the CMHS national evaluation: Communities funded in 2002, 2003, and 2004. Washington, DC: U.S. Department of Health & Human Services, Substance Abuse and Mental Health Administration.
10.
CookA.SpinazzolaJ.FordJ.LanktreeC.BlausteinM.CloitreM. . . . van der KolkB. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
11.
CopelandW. E.KeelerG.AngoldA.CostelloE. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577–584.
12.
CrustoC.A.WhitsonM.L.WallingS. N.FeinnR.FriedmanS.ReynoldsJ. . . . KaufmanJ. S. (in press). Posttraumatic stress among young urban children exposed to family violence and other potentially traumatic events. Journal of Traumatic Stress.
13.
de ArellanoM. A.KoS. J.DanielsonC. K.SpragueC. M. (2008). Trauma-informed interventions: Clinical and research evidence and culture-specific information project. Los Angeles, CA: National Center for Child Traumatic Stress.
14.
EatonL. G.DohertyK. L.WidrickR. M. (2007). A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. Arts in Psychotherapy, 34, 256–262.
15.
EpsteinM. H.HarnissM. K.PearsonN.RyserG. (1999). The Behavioral and Emotional Rating Scale: Test-retest and inter-rater reliability. Journal of Child and Family Studies, 8, 319–327.
16.
EpsteinM. H.RyserG.PearsonN. (2002). Standardization of the Behavioral and Emotional Rating Scale: Factor structure, reliability, and criterion validity. Journal of Behavioral Health Services & Research, 29, 208–216.
17.
EpsteinM. H.SharmaJ. (1998). Behavioral and Emotional Rating Scale: A strengths-based approach to assessment. Austin, TX: Pro-Ed.
18.
FairbankJ. A. (2008). The epidemiology of trauma and trauma related disorders in children and youth. PTSD Research Quarterly, 19(1), 1–7.
19.
FelittiV. J. (2009). Adverse childhood experiences and adult health. Academic Pediatrics, 9(3), 131–132.
20.
FelittiV. J.AndaR. F.NordenbergD.WilliamsonD. F.SpitzA. M.EdwardsV. . . . MarksJ. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245–258.
21.
FinkelhorD.OrmrodR.TurnerH.HambyS. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10, 5–25.
22.
FinkelhorD.TurnerH.OrmrodR.HambyS. L.KrackeK. (2009). Children’s exposure to violence: A comprehensive national survey. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.
23.
FosterE. M.StephensR.KrivelyovaA.GyamfiP. (2007). Can system integration improve mental health outcomes for children and youth?Children and Youth Services Review, 29, 1301–1319.
24.
GravesK. N. (2005). The links among perceived adherence to the system of care philosophy, consumer satisfaction, and improvements in child functioning. Journal of Child and Family Studies, 14, 403–415.
25.
HarrisW. W.LiebermanA. F.MaransS. (2007). In the best interests of society. Journal of Child Psychology and Psychiatry, 48, 392–411.
26.
HoltJ. K. (2008). Modeling growth using multilevel and alternative approaches. In O’ConnellA. A.McCoachD. B. (Eds.), Multilevel modeling of educational data (pp. 111–159). Charlotte, NC: Information Age.
27.
IckovicsJ. R.MeadeC. S.KershawT. S.MilanS.LewisJ. B.EthierK. A. (2006). Urban teens: Trauma, posttraumatic growth, and emotional distress among female adolescents. Journal of Consulting and Clinical Psychology, 74, 841–850.
28.
KaufmanJ. S.ShahS.BowlerS.WhitsonM. L.FeinnR.TebesJ. K. (2008, March). Predictors of adjustment for children served in a system of care. Paper presented at A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.
29.
KesslerR. C.SonnegaA.BrometE.HughesM.NelsonC. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
30.
KoS. J.SpragueC. M. (2007). Creating trauma-informed child-serving systems. Los Angeles, CA: National Child Traumatic Stress Network.
31.
KolkoD. J. (1996). Individual cognitive behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322–342.
32.
LeslieL. K.HurlburtM. S.LandsverkJ.BarthR.SlymenD. J. (2004). Outpatient mental health services for children in foster care: a national perspective. Child Abuse & Neglect, 28, 699–714.
33.
Macro International. (2007). Systems of care evaluation brief: Characteristics of children in systems of care who have experienced trauma. Washington, DC: National Mental Health Information Center.
34.
McCloskeyL. A.WalkerM. (2000). Posttraumatic stress in children exposed to family violence and single-event trauma. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 108–115.
35.
McDonaldR.JourilesE. N.Ramisetty-MiklerS.CaetanoR.GreenC. E. (2006). Estimating the number of American children living in partner-violent families. Journal of Family Psychology, 20, 137–142.
36.
MiechR.AzurM.DusablonT.JowersK.GoldsteinA. B.StuartE. A. . . . LeafP. J. (2008). The potential to reduce mental health disparities through the comprehensive Community Mental Health Services for Children and Their Families Program. Journal of Behavioral Health Services & Research, 35, 253–264.
37.
O’ConnellA. A.McCoachD. B. (2008). Introduction: Pedagogy and context for multilevel models. In O’ConnellA. A.McCoachD. B. (Eds.), Multilevel modeling of educational data (pp. 3–10). Charlotte, NC: Information Age.
38.
RaudenbushS. W.BrykA. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.
39.
RaudenbushS. W.BrykA. S.CongdonR. (2004). HLM: Hierarchical linear and nonlinear modeling statistical software (Release 6.02). Lincolnwood, IL: Scientific Software International.
40.
SharfsteinS. (2006). New task force will address early childhood violence. Psychiatric News, 41(3), 3.
41.
SingerJ. D.WillettJ. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY: Oxford University Press.
42.
StroulB. A.FriedmanR. M. (1986). A system of care for severely emotionally disturbed children & youth. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.
43.
TebesJ. K.BowlerS. M.ShahS.ConnellC. M.RossE.SimmonsR. . . . KaufmanJ. S. (2005). Service access and service system development in a children’s behavioral health system of care. Evaluation and Program Planning, 28, 151–160.
44.
Thrive Initiative. (2008). Thrive: Working Together For a Brighter Tomorrow. Retrieved August 5, 2009 from http://www.thriveinitiative.org/
45.
Van der KolkB. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401–408.
46.
WalrathC. M.YbarraM. L.SheehanA. K.HoldenE.BurnsB. J. (2006). Impact of maltreatment on children served in community mental health programs. Journal of Emotional and Behavioral Disorders, 14, 143–156.
47.
ZeanahP. D.BaileyL. O.BerryS. (2009). Infant mental health and the “real world”—Opportunities for interface and impact. Child and Adolescent Psychiatric Clinics of North America, 18, 773–787.
