FITT

 

FITT Model: Impact on the Child

  • Summary
  • Assessment Measures
  • Interventions
  • References

 

Summary

The impact of trauma on children and adolescents is also well documented within the literature. Mounting evidence suggests that children and adolescents growing up in urban poverty are more likely than those growing up in other contexts to experience multiple traumas and significant adverse life events; and thus develop complex symptoms of traumatic distress at disproportionate rates. Repeated exposure creates a complicated set of reactions that occur before, during, and after traumatic events and carries long-term developmental risks. Standardized instruments are available for assessing posttraumatic stress disorder (PTSD) and related behavior problems in child and adolescents including semi-structured interviews (K-SADS and CAPS-CA) and self-report measures (UCLA PTSD Index for DSM IV). Cognitive behavioral treatments for children and adolescents with PTSD have proven efficacy although efficacy studies have not included sufficient samples of children and adolescents growing up in urban poverty to be conclusive. Further effectiveness or practice research is needed to guide the delivery of services to this highly impact, underserved population.

 

Assessment of Impact on the Child

Note: Recommend the use of a full trauma history screen covering a broad range of event types, such as the TESI or the first section of the UCLA PTSD Index. The recommended instruments are consistent with the NCTSN Core Data Set.

Name of Instrument Author(s) Domains Assessed Age Range  Source/Form (self report, lab, observation, other) # of items Time Cost Training Required Where to obtain  Psychometric Properties Other comments:  
Traumatic Events Screening Inventory for Children – Brief Form (TESI-C-Brief) & Parent Report (TESI-PR) Ribbe, D. 1996; Ford et al., 2000 A measure of experiencing and witnessing of traumatic events for children. TESI-C-Brief covers 16 categories of events arranged hierarchically. 3-18 years Interview format or as self-report; parent-report 15 20-30 minutes Free  Familiarity w/administration, scoring guidelines, and interpretation Link to PDF at NCPTSD: Click Here Some evidence for reliability and validity  
Trauma Exposure Screening Inventory-Parent Report Revised (TESI-PRR) Ghosh, et al., 2002 A measure of experiencing and witnessing of traumatic events for young children. Includes traumas more frequently occurring to young children ( i.e., animal attacks, prolonged or sudden separations and intense family conflict). 0-6 years Interview format or parent-report  24 15 minutes Free Familiarity w/administration, scoring guidelines, and interpretation Request from: Chandra.ghosh@ucsf.edu Not reported  Available in English and Spanish.
Violence Exposure Scale for Children-Preschool Version (VEX-PV) Fox & Leavitt, 1995 A measure of experiencing and witnessing of traumatic events for young children. 4-10 years Interview format with children 15 20 minutes Free Training by experienced clinician, <4 hours.  Request from: Ariana Shahinfar, Ph.D.; Department of Psychology; University of North Carolina - Charlotte; 9201 University City Blvd.; Charlotte, NC 28223 Some evidence for reliability and validity Questions administered in story format illustrated w/pictures. Includes three validity questions. Child endorses whether an event has happened to him or her never, 1 time, a few times, or lots of times. Available in English, Hebrew, & Spanish. 
Violence Exposure Scale for Children-Preschool Version-Revised Parent Report (VEX-RPR) Fox & Leavitt, 1995 This measure asks questions related to violence exposure. Parents of preschool children age 4-6 Interview format with parents 22 Not specified Free Minimal training required Request from: Ariana Shahinfar, Ph.D.; Department of Psychology; University of North Carolina - Charlotte; 9201 University City Blvd.; Charlotte, NC 28223 Not reported  Measure does not assess other posttraumatic exposure, such as accidents or loss–separation from a caregiver. It does not ask specifically if the violence is within the home between relatives or in the community at large.
Clinician Administered PTSD Scale for Children (CAPS-CA) Nader et al., 1994 A measure of DSM IV diagnostic criteria for PTSD. The measure determines exposure to events meeting DSM-IV criterion, frequency and intensity for the 17 symptoms in criteria B, C, and D, and criterion E, the 1-month duration requirement. 8-15 years Semi-structured interview 36 45 minutes Informal version free from NCPTSD. From publisher: $104.50 initial kit. $3.80/ interview booklet (pkgs of 10) Training manual or Training CD-ROM  Request from National Center for PTSD: Click Here
OR Purchase from Western Psychological Services
Strong evidence for reliability and validity The CAPS-CA is administered to the child by a researcher or clinician. CAPS-CA includes iconic representations of the behaviorally anchored 5-point frequency and intensity rating scales, opportunities to practice with the format before questions, and a standard procedure for identification of the critical 1-month period for current symptoms. 
Schedule for Affective Disorders and Schizophrenia for School Age Children – Present (K-SADS-P/L) Kaufman J, Birmaher B, Brent D, Rao U, Ryan ND., 1995 Diagnostic interview keyed to DSM-IV. 6-18 years Semi-structured interview 82 in screening interview; 28 in supplement mood symptoms 2.5-3 hours for whole; 30 minutes for PTSD section Free for research and not-for-profit clinical use.  Requires significant training Varies by version, but the following link provides information for access: Click Here Some evidence for reliability and validity (as specifically related to PTSD diagnoses) The interviews are conducted by trained clinicians and includes both parent and child interviews. Since meeting full diagnostic criteria for PTSD in children may underestimate pathology creating significant distress and functional impairment, the diagnosis can be scored as definite, probable, or not present. Vila et al (1999) also presents a definition for subclinical PTSD used with the K-SADS.
UCLA PTSD Index for DSM-IV Pynoos et al., 1998 Instrument keyed to DSM-IV PTSD symptoms for youth who report traumatic stress experiences. (If a separate trauma screen is used only the symptom questions are needed.) 7-12 years Self-report or interview format; parent report version also exists. 22 (symptom related)  20-30 minutes Free Familiarity w/administration, scoring guidelines, and interpretation. Power point training available via NCTSN website. Request from: UCLA PTSD Index for DSM-IV: UCLA Trauma Psychiatry Service; 300 Medical Plaza;
Los Angeles, CA 90095-6968. Phone: (310) 206-8973 Email: HFinley@mednet.ucla.edu
Strong evidence for reliability and validity An Overall PTSD Severity Score is calculated by summing the scores for each question that corresponds to a DSM-IV Symptom and a PTSD Severity Subscore is calculated for Criterion B, C, and D Symptoms. A score of 2 on each of the 17 questions is considered as the symptom cutoff score for each question and a score >22 is considered the cutoff for moderate PTSD.
Trauma Symptom Checklist for Children (TSCC) Briere, J., 1996 A measure of PTSD and related symptoms, including those related to complex trauma disorders [41]. TSCC comprises 2 validity scales and 6 clinical subscales (Anxiety, Depression, Anger, Posttraumatic Stress, Sexual Concerns, Dissociation). 8-16 years Self-report 54 (Version A - 44 items; no reference to sexual concerns) Less than 20 minutes $158 initial kit (manual, 25 booklets, 50 profile forms). $2.36 /test booklet (pkgs of 25). $1.24/profile form (pkgs of 25) Familiarity w/administration, scoring guidelines, and interpretation Psychological Assessment Resources Strong evidence for reliability and validity TSCC-A excludes the sexual symptoms. The TSCC has demonstrated good reliability and validity; the normative sample included children from inner city environments. A parent-report version is available for younger children (TSCYC). 
Trauma Symptom Checklist for Young Children (TSCYC) Briere, J., 2000 The instrument contains eight clinical scales: Posttraumatic Stress-Intrusion (PTSI), Posttraumatic Stress-Avoidance (PTS-AV), Posttraumatic  Stress-Arousal (PTS-AR), Sexual Concerns (SC), Dissociation (DIS), Anxiety (ANX), Depression (DEP), and Anger/Aggression (ANG).  3-12 years Caregiver report  90 Less than 20 minutes $200 initial kit (manual, 25 interview booklets, 25 profile forms, 25 answer sheets per age range). $1.28/booklet, $1.76/answer sheets, $1.28/ profile forms (all pkgs of 25 each). Familiarity w/administration, scoring guidelines, and interpretation Psychological Assessment Resources Strong evidence for reliability and validity The instrument rates symptom based on how frequently it has occurred in the last month on a 4-point scale. 
Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record Scheeringa & Zeanah, 1994 Interview and observation of the primary caretaker and the child, includes interview for caregiver's own PTSD symptoms. Symptoms measured by the interview include those similar to the Diagnostic Classification of Mental and Developmental Disorders in Infancy and Early Childhood (DC: 0–3). Includes 18 DSM-IV criteria.   0-7 years Parent administered interviews by highly trained clinician 29 45 minutes Free Training by experienced clinician, >4 hours Contact author: Michael Scheeringa
1440 Canal Street, TB52
Tidewater Building, 10th Floor
New Orleans, LA 70112
OR mscheer@tulane.edu 
Some evidence for reliability and validity.  Child plays in room with standard toy set, Caregiver-child free play, Examiner-child free play, Caregiver in room, filling out questionnaires, Examiner-guided trauma reenactment play, Due to overlap of criteria sets, this totals 26 different criteria.
Child and Adolescent Needs and Strengths - Trauma Exposure and Adaptation Version (CANS-TEA) Lyons, J., 2009 Assesses 12 areas: Trauma History, Traumatic Stress Symptoms, Regulation of Emotions, Regulation of Behavior, Other Behavioral Health Concerns, Attachment Difficulties, Problem Modifiers, Stability of Social Environment, Child Strengths, Functioning, Acculturation.  4-18 years Clinician administered interview 70 5-10 minutes, in addition to a quality clinical assessment  Free Three options available: in person, web-based training systems, and online training certification. Information available at: Click Here Contact: Melanie Buddin Lyons; phone: 847-501-5113; fax: 847-501-5291; email: Mlyons405@aol.com Some evidence for reliability and validity.  The instrument rates symptom that have occurred in the past 30 days on a 4 point scale that translate immediately into action levels (0=no evidence, 1=history or sub-threshold, 2=causing problems, consistent w/diagnosable disorder, 3=causing severe/dangerous problems). The tool can be used to assess the individual youth and the family. 
Child Behavior Checklist (CBCL) Achenbach, T. M. & Edelbrock, C. 1991 The instrument measures 8-9 subscales that can be collapsed into Internalizing, Externalizing, and a Total Problem Score. 6-18 years; 1.5 - 5 year forms also available Primary caregiver report 118 15 minutes $0.50/response form (pkgs of 50); $295 initial electronic scoring kit and data management software, includes manual Familiarity w/administration, scoring guidelines, and interpretation ASEBA  Well validated Requires a parent to rate, on a three-point scale, each of 118 problems as they are perceived to reflect the child's behavior over the past six months. Statistical data on reliability and validity have been well established and are reported elsewhere. The clinical cut-off score for the CBCL is a T-score of 63 or greater with 60-63 considered in the borderline range of psychopathology. Teacher report also available. 
Global Appraisal of Individual Needs - Short Screener  (GAIN-SS)  Dennis, M. L., Feeney, T., Stevens, L. H., & Bedoya, L., 2006 The GAIN-SS is designed to screen general populations to quickly and accurately identify adolescents & adults as having 1+ behavioral health disorders and a need for referral to some part of the behavioral health treatment system. It also serves as an easy-to-use quality assurance tool across diverse field-assessment systems for staff with minimal training or direct supervision. Can serve as a periodic measure of change over time in behavioral health.  Teens & adults Self or staff administration with paper and pen, on a computer, or on the web. 20 5 minutes Free Familiarity w/administration, scoring guidelines, and interpretation Available from: Click Here Some evidence for reliability and stability  Widely used in SAMHSA programs. Can be used with children as young as ten, although they may need some assistance understanding terms. 
Juvenile  Inventory for Functioning Reynolds, C.R., & Kamphaus, R.W., 2004 Assesses 10 domains of functioning (school/job, feelings, home life, dealing with bad feelings, family life, alcohol and drugs, friends, thinking, neighborhood, health) Teens & parents Computer self-administered interview    up to 30 minutes  Unable to locate Unable to locate Unable to locate Unable to locate  A screening tool based on the CAFAS. Youth & caregiver report versions available. Program generates a service plan upon completion of the interview. 
Behavior Assessment System for Children - Second Edition (BASC-2)  Reynolds, C.R., & Kamphaus, R.W., 2004 Behaviors, thoughts, emotions; also adaptive & maladaptive behaviors in home, school, and community settings 2 years - 21 years, 11 mo  Self-report, teacher rating, parent rating, structured developmental history, classroom observation Varies by version; typically at least 100  15 minutes $91.75 for manual; $1.15/computer entry form; $1.38/hand score forms (25 per pkg). Computer scoring programs range from $267 - $906 Familiarity w/administration, scoring guidelines, and interpretation Pearson Assessment  Strong evidence for reliability and validity  
Structured Interview for Disorders of Extreme Stress Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., Kaplan, S., & Resick, S., 1997 Complex PTSD may not be fully normed: regulation of affect and impulses, attention or consciousness, self-perception, perception of the perpetrator, relations with others, somatization, systems of meaning Teens & adults Structured interview, self report version also available  48 Not reported $50 for assessment packet (includes 2 other measures) and $50 for scoring program. $90 for both.  Unable to locate The Trauma Center at JRI: Click Here Some evidence for reliability and validity Assesses 6 domains of Disorders of Extreme Stress NOS. Purchase also includes the Traumatic Antecedents Questionnaire (TAQ), and a self-administered PTSD scale. 
Child Dissociative Checklist Putnam, F.W, Helmers, K., Horowitz, L.A., & Trickett, P.K. , 1993 Dissociative amnesia, rapid shifts in demeanor & abilities, spontaneous trance states, hallucinations, identity alterations, aggression/sexualized behaviors. A score higher than 12 is evidence of pathological dissociation. Child  Parent report  20 5 minutes Free Familiarity w/administration, scoring guidelines, and interpretation Available from: Click Here Strong evidence for reliability and validity Age, gender, and parental role difference have been found: younger children and girls have higher symptoms than boys and older children, and mothers rate boys higher than girls.

 

References

Achenbach, T. M. & Edelbrock, C. (1991). Manual for the Child Behavior Checklist. University of Vermont Department of Psychiatry: Burlington, VT.

Ambrosini, P. J. (2000). Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). Journal of the American Academy of Child & Adolescent Psychiatry 39, 49-58.

Bernstein, D. P. & Fink, L. (1998). Child Trauma Questionnaire Manual. San Antonio, TX: The Psychological Corporation.

Briere, J. (1996). Manual for the Trauma Symptom Checklist for Children (TSCC). Lutz, FLA: Psychological Assessment Resources.

Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, J., Gil, E., Hanson, R., & Ernst, V. (2001). The Trauma Symptom Checklist for Young Children (TSCYC): reliability and association with abuse exposure in a multi-site study. Child Abuse Neglect, 25, p. 1001-14.

Cohen, J. A., et al., Measuring treatment outcomes with the Trauma Symptom Checklist in sexually abused children with multiple trauma histories. submitted.

Connely, C., & Amaya-Jackson, L. (2002). Post-Traumatic Stress Disorder in children and adolescents: Epidemiology, diagnosis, and treatment options. Pediatric Drugs, 4, 159-170.

Dennis, M.L., Chan, Y-.F., & Funk, R.R. (2006). Development and validation of the GAIN Short Screener (GAIN-SS) for psychopathology and crime/violence among adolescents and adults. The American Journal on Addictions, 15(supplement 1), 80-91.

Dennis, M. L., Feeney, T., Stevens, L. H., & Bedoya, L. (2006). Global Appraisal of Individual Needs–Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-SS Version 2.0.1. Bloomington, IL: Chestnut Health Systems. Retrieved on August 10, 2009 from http://www.chestnut.org/LI/gain/GAIN_SS/index.html.

Carrion, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology or PTSD symptoms in youth. Journal of American Academy of Child and Adolescent Psychiatry, 41, 166-173.

Ford, J. D., Racusin, R., Ellis, C. G., Daviss, W. B., Reiser, J., Fleischer, A., et al. (2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Child Maltreatment, 5, 205–218.

Fox, N. A., & Leavitt, L. A. (1995). The Violence Exposure Scale for Children-VEX (PreschoolVersion). College Park, MD: Department of Human Development, University of Maryland.

Ghosh-Ippen, C., Ford, J., Racusin, R., Acker, M., Bosquet, K., Rogers, C., et al. (2002). Trauma Events Screening Inventory-Parent Report Revised. San Francisco: The Child Trauma Research Project of the Early Trauma Network and The National Center for PTSD Dartmouth Child Trauma Research Group.

Graham-Bermann, S. A., Howell, K. H., Habarth, J., Krishnan, S., Loree, A., & Bermann, E. A. (2008). Toward assessing traumatic events and stress symptoms in preschool children from low-income families. American Journal of Orthopsychiatry, 78(2), 220-228.

Hodges, K. (2003). Juvenile Inventory for Functioning.

Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. D. (1995). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version 1.0 (K-SADS-PL).

Kaufman, J., Birmaher, B., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980-988.

Kendall, P. C., et al. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67, 285-99.

Lyons, J. S. (2009). Communimetrics: A theory of measurement for human service enterprises. New York: Springer.

Milner, J. S. (1990). An Interpretive Manual for the Child Abuse Potential Inventory, Psytec Corp.

Milner, J.S. (1994). Assessing physical child abuse risk: The Child Abuse Potential Inventory. Clinical Psychology Review, 14, 537-583.

Mirza, K. A., Bhadrinath, B. R., et al. (1998). Post-traumatic stress disorder in children and adolescents following road traffic accidents. British Journal of Psychiatry 172, 443-7.

Nader, K. O., Kriegler, J. A., Blake, D. D., & Pynoos, R. S. (1994). Clinician Administered PTSD Scale for Children (CAPS-C). Boston: National Centre for PTSD.

Pelcovitz, D., van der Kolk, B., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (1997). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress, 10, 3-16.

Putnam, F. W., Helmers, K., Horowitz, L. ., & Trickett, P. K. (1993). Development, reliability, and validation of a child dissociation checklist. Child Abuse and Neglect, 17, 731-41.

Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). UCLA PTSD Index for DSM-IV.

Reynolds, C. R., & Kamphaus, R. W. (2004). BASC-2 Behavior Assessment System for Children, second edition manual. Circle Pines, MN: American Guidance Service.

Ribbe, D. (1996). Psychometric review of Traumatic Event Screening Instrument for Children (TESI-C), in Measurement of Stress, Trauma, and Adaptation, B.H. Stamm, Editor. Sidran Press: Lutherville, MD. p. 386-387.

Scheeringa, M. S., Peebles, C. D., Cook, C. A., & Zeanah, C. H. (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 52-60.

Scheeringa, M. S., & Zeanah, C. H. (1994). PTSD Semi-Structured Interview and Observational Record for Infants and Young Children. NewOrleans, LA: Department of Psychiatry and Neurology, Tulane University Health Sciences Center.

Stallard, P., Velleman, R., & Baldwin, S. (1999). Psychological screening of children for post-traumatic stress disorder. Journal of Child Psychology and Psychiatry, 40, 1075-1082.

Stover, C.S. & Berkowitz, S. (2005). Assessing Violence Exposure and Trauma Symptoms in Young Children: A Critical Review of Measures. Journal of Traumatic Stress, 18, 707–717.

Vila, G., Porche, L. M., et al. (1999). An 18-month longitudinal study of posttraumatic disorders in children who were taken hostage in their school. Psychosomatic Medicine 61, 746-754.

Winters, N. C., Collett, B. R. & Myerss, K. M. (2005). Ten-Year Review of Rating Scales, VII: Scales Assessing Functional Impairment. Journal of American Academy of Child and Adolescent Psychiatry, 44, 309-338.

Zlotnick, C., & Pearlstein, T. (1997). Validation of the Structured Interview for Disorders of Extreme Stress. Comprehensive Psychiatry, 38, 243-247.

 

Interventions

Treatment Name

Developer(s)

Essential Elements

Research Evidence & Outcomes

URL for Additional Information

Trauma Focused  Cognitive Behavioral Therapy (TF-CBT)

Cohen, Mannarino , Berliner, & Deblinger (2000)

Psychoeducation and parenting skills; relaxation techniques; Affective Expression and Regulation; Cognitive Coping and Processing; Trauma Narrative; In vivo Exposure,  Conjoint parent/child  Sessions,  Enhancing Personal Safety and Future Growth.

Effectiveness of TF-CBT has been well established in several randomized, controlled clinical trials.  Studies have indicated TF-CBT reduces targeted internalizing symptoms (e.g., PTSD, depression, anxiety, self-blame) as well as sexualized and other externalizing behaviors (e.g., defiance, oppositionality).

http://www.nctsn.org/nctsn_assets/pdfs/promising_
practices/TF-CBT_fact_sheet_3-20-07.pdf

Cognitive Behavioral  Intervention for Trauma in Schools (CBITS)

RAND Corporation, the Los Angeles Unified School District, and UCLA

Education about reactions to trauma; relaxation training; cognitive therapy, real life exposure, stress or trauma exposure; social problem-solving.

Two published studies (Ngo et al., 2008; Morsette et al., 2009)

http://www.nctsnet.org/nctsn_assets/pdfs/
CBITSfactsheet.pdf

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)

 

Mindfulness, Problem-solving, Meaning Making, Relationship-building/Communication skills, distress tolerance, psycho-education on stress and trauma.

Pilot data and case studies suggest that it is a promising practice.

http://www.nctsnet.org/nctsn_assets/pdfs/
promising_practices/SPARCS_fact_sheet_3-21-07.pdf