Ellen Gerrity - Mental Health America

The National Child Traumatic Stress Network
Ellen Gerrity, Ph.D.
Associate Director and Senior Policy Advisor
National Center for Child Traumatic Stress
Associate Professor, Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Mental Health America Webinar
Upstream Services: A Response to Sandy Hook
April 4, 2013
Child Traumatic Stress
as a Public Health Problem
Two of every three children will witness or
experience a traumatic event before the
age of 16 (Copeland et al., 2007).
One in five children experience some form of
child maltreatment (Finkelhor et al., 2009)
3.3 million children reported to child
protective services in 2008 (CDC, 2010).
What is traumatic stress?
• Exposure to events that involve threats of injury, death, or
danger where intense terror, anxiety, and helplessness is
• Can occur via direct experience or witnessing event, or
hearing about an event
• Reactions vary with age, but even very young children
experience intense reactions
Variety of Traumatic Events
• Trauma may be embedded in daily life, may be chronic
or acute event:
– Child abuse and maltreatment
– Domestic violence
– Community violence and criminal victimization
– Sexual assault
– Medical trauma
– Traumatic loss and bereavement
– Accidents/fires
– Natural disasters
– War/Terrorism/Political Violence
Common Symptoms of Traumatic Stress
Children may suffer severe emotional and developmental
consequences from exposure to trauma and violence
Sleep problems, including nightmares
Intrusive thoughts or flashbacks
Numbing of emotions
Avoidance of reminders of trauma
Anger and irritability
Poor concentration
Depressive symptoms
Anxiety and behavior problems
Long-Term Consequences of
Trauma Exposure During Childhood
Without Effective Treatment:
• Serious adult psychiatric difficulties, including
depression, anxiety disorders, and suicidal behaviors
• Overutilization of medical services
• ACES study - 4 or more childhood traumas may result
in risk behaviors, health consequences, shortened
Adverse Childhood Experiences Study (ACES)*
Felitti et al. 1998
National Child Traumatic Stress Network
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.
National Child Traumatic Stress Network
• Funded in 2000 (Children’s Health Act)
• Rapid Change (9/11/Increased Growth/Cutbacks)
• Innovative Collaborative Network Structure:
•UCLA-Duke University National Center for Child
Traumatic Stress (Category I)
•22 Intervention Development and Evaluation
Centers (Category II)
•56 Community Treatment and Service Centers
(Category III)
•90 Affiliate (formerly funded) members
• Trauma mission includes all trauma types, all service
systems, all professional disciplines, all ages, and a
strong cultural and family perspective throughout
• Includes a wide range of traumatic experiences, including
physical and sexual abuse; domestic, school, and
community violence; natural disasters, terrorism, or
military family challenges; and life-threatening injury and
NCTSN Activities
• Range of activities including: intervention development
and adaptation; training in many forms (Learning
Collaborative systems change, in-person, web-based);
product development; public awareness; evaluation and
data analysis; policy work; and service delivery
• Far-reaching family and consumer program at all levels of
the program
• Embedded cultural competence and translations work
throughout the development of products and training
• Strong collaborative model
How is NCTSN making a difference?
• Over 350,000 children served through direct contact;
improvements after treatment and services
• Hundreds of thousands of professionals trained
• Over 40 evidence-based treatments and promising practices
• Over 200 products for parents/caregivers, youth,
professionals, general public, policymakers, media
• Network response to national crises, including Sandy Hook
NCTSN Core Data Set on >14,000 Children
Diverse group of children with complex histories and problems: 77 %
reporting exposure to more than one trauma type
Developmental issues are important to trauma and recovery
Notable functional impairments and clinical diagnoses (PTSD, depression,
anxiety, academic problems)
Like ACES, # of traumas are associated with serious outcomes
High rates of service utilization (child welfare, special education, mental
health) prior to entering treatment - opportunities for early intervention
Effectiveness of the NCTSN: Children’s problems improve with treatment
“You don’t shoot at children.”
NCTSN Sandy Hook Community Support
Network mobilization
Death notification
Crisis Center staffing/Crisis Hotline training
Governor’s Commission/School District support
Sandy Hook students and teachers/Other schools
Trauma Resources (posted at http://www.nctsn.org/traumatypes/terrorism), including Psychological First Aid for Schools
Federal and State policymaker support
Healthcare community coordination and training
Preparedness/Evidence-based practices
Long term planning
For more information about the NCTSN
and what was presented today:
Ellen Gerrity, PhD
[email protected]

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