Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment

Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth's mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress.

METHODS

This is a study of 130 youth ages 7-18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic.

RESULTS

A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment.

IMPLICATIONS

The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth's response to pandemic conditions.

Development and Preliminary Validation of the University of Minnesota's Traumatic Stress Screen for Children and Adolescents (TSSCA)

Child and adolescent exposure to potential trauma experiences is pervasive. Given the prevalence, deleterious mental and physical effects, and economic cost of trauma exposure, child- and family-service systems are adopting trauma-informed approaches, including practices like trauma screening. Although a number of trauma-focused screening and assessment measures exist for youth, the majority are lengthy and inappropriate for universal administration. This study describes the development and preliminary validation of the Traumatic Stress Screen for Children and Adolescents (TSSCA), a six-item screening measure for trauma exposure and traumatic stress symptoms. Using two samples of youth presenting at community practice settings (n₁ = 134, n₂ = 137), reliability, discriminative validity, and criterion-related validity were calculated for the TSSCA. Results support the TSSCA as an empirically derived, reliable, and valid screening measure for exposure to trauma and symptoms of traumatic stress for youth ages 7 to 18.

The Boy Who Was Hit in the Face: Somatic Regulation and Processing of Preverbal Complex Trauma

Examination of novel treatment for complexly traumatized youth, in particular, those exposed to preverbal trauma, is necessary given challenges associated with effective intervention for this population. Therapies that facilitate somatic regulation have demonstrated benefit for some trauma survivors. The current article briefly reviews the emerging literature on symptoms of and treatments for complex and preverbal child trauma and describes Sensory Motor Arousal Regulation Therapy (SMART), an intervention for child and adolescent trauma with preliminary empirical support. SMART aims to enhance sensory motor engagement and promote affective, behavioral and physiological regulation using somatic regulation and sensory integration techniques. Utilizing case study methodology, the article illustrates application of SMART in treatment of a latency-aged child with history of exposure to complex and preverbal traumatic experiences. Case analysis suggests the potential contribution of enhanced somatic regulation in traumatized children toward increased relational engagement, behavioral and emotional regulation, and trauma processing.

Equine Facilitated Therapy for Complex Trauma (EFT-CT)

Emerging research suggests that Equine Facilitated Psychotherapy (EFP) may be beneficial for traumatized youth. In addition, complex trauma (i.e., multiple and/or prolonged developmentally adverse traumatic events which are typically interpersonal in nature) treatment research is still growing and there is a need for the development and examination of novel treatments for youth with complex trauma histories. The current article describes a promising EFP model for this population called Equine Facilitated Therapy for Complex Trauma (EFT-CT). EFT-CT embeds EFP practices within Attachment, Regulation and Competency (ARC), an extant evidence-based complex trauma treatment framework for children and adolescents. The authors provide three case studies using both observational data provided by clinicians, as well as longitudinal measures of psychosocial functioning, to illustrate the potential promise of EFT-CT. The article concludes with a discussion about implications for EFP treatment and research.

Effects of the child-perpetrator relationship on mental health outcomes of child abuse: it's (not) all relative

The present study was conducted to better understand the influence of the child-perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress-trauma systems therapy approach to preventing dropout

BACKGROUND

  This study aimed to obtain preliminary evidence for the extent to which a novel intervention embedded within a systems-oriented treatment model [trauma systems therapy (TST)] engages and retains traumatized children and their families in treatment.

METHOD

  Twenty youth who had prominent symptoms of posttraumatic stress were randomly assigned to receive TST or care as usual (CAU).

RESULTS

  At the 3-month assessment, 90% of TST participants were still in treatment, whereas only 10% of CAU participants remained. Within-group analyses of TST participants demonstrated significant reductions in posttraumatic stress and aggression as well as a slight improvement in home safety.

CONCLUSIONS

  These preliminary findings point to the need to utilize effective engagement approaches to retain traumatized children and their families in treatment.