National Child Traumatic Stress Network meets in L.A.

Under the leadership of the National Center for Child Traumatic Stress, a joint coordinating center led by UCLA and Duke University, the network of sites across the nation has been charged with seeking new strategies for addressing childhood trauma and increasing access to services.

Supported by $30 million in federal funding over the next three years, network members are addressing concerns related to a wide range of traumatic events faced by children and adolescents each year. Areas of concern include physical and sexual abuse or assault; natural and man-made disasters; injuries from accidents or animal attacks; chronic, severe or painful medical conditions, or invasive medical procedures; domestic, school or neighborhood violence; traumatic loss of family or friends; kidnapping; and war, terrorism and political oppression.

"This is much more than a mental health initiative. The impact of traumatic events on our children reaches deep into the fabric of everyday life. In working to improve services and access to trauma victims, the network will involve school, police, child welfare, juvenile justice and other child service agencies -- anywhere and everywhere that children and adolescents affected by trauma are likely to surface," said Dr. Robert Pynoos, co-director of the center and UCLA professor of psychiatry.

"In addition, the initiative recognizes the developmental and cultural diversity of children and adolescents, seeking to design a range of programs that address the special needs of America's youngsters at every stage of development and from every kind of ethnic, social and economic background," Pynoos said. "One size does not fit all."

Exposure to traumatic events is common in children and adolescents. In 1998 an estimated 200,000 children were victims of physical child abuse, 100,000 were victims of sexual abuse, and 225,000 were victims of mistreatment. In addition, each year some 140,000 children and adolescents receive treatment for bicycle-related head injuries, 20,000 are hospitalized because of burns, and five of every 100,000 children ages 0--10 are hospitalized for dog bites.

A traumatic event and its immediate aftermath can produce feelings of panic, helplessness, and uncontrollable fear or terror, and lead to a range of acute and chronic traumatic stress reactions.

Psychiatric syndromes associated with exposure to stressful and traumatic events include post-traumatic stress disorder, acute stress disorder and adjustment disorder. Symptoms can include depression, anxiety, chronic or impulsive outbursts of anger, suicide attempts, antisocial behavior, substance abuse, academic difficulties and interpersonal problems.

The severity of stress reactions following exposure to traumatic events can vary greatly. While some children and adolescents are able to cope effectively with the aftereffects through their own resilience and with support from family and others, many face chronic difficulties that impede normal social and psychological development.

"Considerable progress has been made in understanding the prevalence, characteristics, risk factors and consequences of trauma in children and adolescents," Pynoos said. "However, many fundamental questions have not been fully addressed, including how to best identify children most vulnerable to the effects of trauma, the impact of trauma on the development of children, and the underlying biological, psychological and social processes that must be targeted to provide effective care."

The role of UCLA and Duke University as directors of the joint coordinating center is to provide administrative resources, data management, and research and clinical expertise to members of the initiative. In addition, the center will monitor and evaluate the activities of members.

Network members charged with identifying, supporting, improving or developing effective treatment and service approaches include Boston Medical Center; The Early Trauma Treatment Network, UC-San Francisco; Northshore University Hospital, Long Island, N.Y.; Yale University, New Haven, Conn.; and the Allegheny-Singer Research Institute, Pittsburgh.

Network members charged with establishing community practice centers for implementing and evaluating services include Miller Children's Hospital Abuse and Violence Intervention Center, Long Beach, Calif.; The Center for Multicultural Human Services, Falls Church, Va.; Children's Institute International, Los Angeles; Arbour Health Systems, Boston; The Aurora Mental Health Center, Aurora, Colo.; University of Missouri-Kansas City; The Mental Health Corporation of Denver; Mount Sinai Adolescent Health Center, New York; the New Mexico Alliance for Children with Traumatic Stress, Santa Fe, N.M.; the Northwest Ohio Child Trauma Community Practice Center, Toledo, Ohio; Intermountain Health Care, Salt Lake City; and Safe Horizon-Saint Vincent's Child Trauma Care Center, New York.

The grants are funded by the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA).