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Social Security Benefits: Outreach, Access, and Recovery (SOAR)

SAMHSA is a partner in a Federal interagency initiative, SSI (Social Security Income)/SSDI (Social Security Disability Insurance) Outreach, Access, and Recovery (SOAR), that helps homeless individuals, most of whom also have serious mental illnesses, access crucial benefits such as housing and treatment.

Launched in 2005, SOAR helps states and communities develop strategies and provide training to case workers who counsel individuals in preparing accurate and complete SSI or SSDI applications.

SOAR’s technical assistance initiative is able to all State’s and works by:

• Encouraging collaboration among key stakeholders
• Facilitating strategic planning to improve access to SSI/SSDI at the State and community levels
• Offering a Train-the-Trainer program, to build the capacity of your state to train front-line staff to assist homeless people with SSA disability applications
• Providing follow-up observation and feedback on the State’s first Stepping Stones to Recovery training
• Delivering on-going support and technical assistance from SOAR TA Team
• Tracking outcomes to ensure long-term support and dissemination of promising practices

Click here for more information on SOAR.

The Substance Abuse and Mental Health Services Administration has recently updated its National Registry of Evidence-Based Programs and Practices (NREPP) website. The newly updated website provides users with a searchable database of evidence-based practices.
This online database provides information on evidence-based practices that will aid in the prevention and treatment of youth in community based settings with mental health and/or substance use disorders. This database can generate specific customized searches to identify the best type of intervention to use for certain target populations and service areas.

To access this database visit http://www.nrepp.samhsa.gov.

WHAT PARENTS OF MENTALLY ILL CHILDREN NEED AND WANT FROM MENTAL HEALTH PROFESSIONALS

Abstract:
Child psychiatric hospitalization is a time of crisis for the parents of a child with a mental disorder. Prior to hospitalization, the child's problematic behavior has escalated. Parents have various types of contact with mental health professionals prior to, during, and after the hospitalization, which influence their ability to care for their child. This paper reports a qualitative descriptive study of what parents need and want from mental health professionals during this time frame. During the study, parents spontaneously talked about what they needed and wanted from mental health professionals, including nursing personnel. The perspectives of 38 parents of 29 hospitalized children were obtained through interviews. Parents identified needing informational, emotional, and instrumental support most often in the interviews. Specific examples from the data are included in this report.

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THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY
The Adverse Childhood Experiences study, authored by Dr. Vincent Felitti and Dr. Robert Anda and funded by the Centers for Disease Control, helps to clarify the underlying, long-term, and multigenerational impact of seven categories of adverse childhood experiences: physical, sexual or psychological abuse as a child, or living as a child in a household with a member who was: mentally ill, imprisoned, a victim of domestic violence, or a substance abuser. In the largely middle-aged, middle-class, educated population who were the subjects of this study, - the largest study of its kind ever done to examine the effects of childhood adversity over the lifespan - only 48% of the population had no categories of adverse childhood experiences. Two-thirds of the women in the study reported at least one childhood experience involving abuse, violence or family strife. One in four was exposed to two categories of abusive experience, and one in 16 to four categories.

The authors found a strong, graded relationship to the number of adverse childhood experience categories and a wide range of physical, emotional, and social problems including: smoking, chronic obstructive pulmonary disease, hepatitis, heart disease, fractures, diabetes, obesity, alcoholism, fifty or more sexual intercourse partners, other substance abuse including IV drug use, depression and attempted suicide, teen pregnancy (including paternity), sexually transmitted diseases, rape, hallucinations, poor occupational health and poor job performance. According to the authors – and to a growing body of research – adverse childhood experiences lead to disrupted neurodevelopment in early childhood which then leads to emotional, cognitive, and social impairment in childhood and adolescence. These impairments leave children vulnerable to the adoption of many different health risk behaviors which lead directly or indirectly to a variety of diseases, various forms of disabilities, and social problems – and eventually early death. The bottom line is that adverse childhood experiences determine the likelihood of the ten most common causes of death in the United States. With an ACE Score of 0, the majority of adults have few, if any, risk factors for the diseases and problems mentioned above. However, with an ACE Score of 4 or more, the majority of adults have multiple risk factors for these problems or the diseases themselves. As the authors of the study state, “ACEs are the leading determinant of the health and social well-being of our nation”. What is remarkable is that the majority of people reading these words will not have heard of this study – arguably the most significant public health study ever done. The press have only given it minimal if any coverage, the government has taken little notice, the President has not held a press conference.

In a way, it is simple, “Hurt people, hurt people” and the solution is to stop the infliction of pain on children. But I recognize that the road from childhood adversity to adult disease is a complex one, and the solutions to the problem of child maltreatment will be similarly complex because the solutions must successfully address virtually every social problem we have. After so many years of immersion in this knowledge, it all seems so obvious to me, and the solutions farther away than ever because the solutions are not medical or even social – they are economic and political. The ACEs study has received so little attention because it is so straightforward and clear in the enormity of its implications. In the present political climate I see no indication that we will mobilize the resources required to devote ourselves to what is needed – a Manhattan Project directed at minimizing childhood adversity, not building more weapons of mass destruction.

For more information about the ACEs study click here: or visit http://www.sanctuaryweb.com/main/ACEs%20Study.htm

STATE APPROACHES TO PROMOTING YOUNG CHILDREN’S HEALTHY MENTAL DEVELOPMENT
Executive Summary
Children's healthy social and emotional development is essential to school readiness, academic success, and overall well-being. Services that support young children's healthy mental development can reduce the prevalence of developmental and behavioral disorders which have high costs and long-term consequences for health, education, child welfare, and juvenile justice systems.

As part of the Assuring Better Child Health and Development (ABCD II) program, the National Academy for State Health Policy (NASHP) surveyed Medicaid, maternal and child health, and children's mental health agencies in all 50 states and the District of Columbia to gather information on how states are addressing the healthy mental development of children ages birth to three. The objective of the survey was to identify critical issues, common approaches to addressing them, and innovative approaches that might be useful to states participating in the ABCD II Consortium and to other states as well. NASHP received survey results from 101 respondents representing all 50 states and the District of Columbia.

Key Findings

• In just over half of the states (26), at least one agency reported recommending specific screening tools to detect young children who may be delayed, or at risk of delay, for social emotional development. The most frequently recommended screening tools are the Ages and Stages Questionnaire (ASQ), the Ages and Stages Questionnaire: Social and Emotional (ASQ:SE), the Denver Developmental Screening Test, and the Parents' Evaluation of Developmental Status (PEDS).
• The majority of states (32) reported reimbursing for the use of screening tools, usually through Medicaid programs.
• States reported that providers raise a number of concerns regarding screening for social emotional development. A lack of referral resources, insufficient payment, and a lack of expertise are the most commonly cited concerns.
• Half of Medicaid agencies that responded (16 of 32) reimburse for services for children who are at risk of delays in social emotional development but who do not have a diagnosis. However, many respondents (6) did not know whether their states reimburse for these children.
• Various resources are available in the states to assist primary care providers who identify a child in need of further assessment or in-house follow up. Mental health consultation was mentioned most frequently (48 percent), followed by state-funded care coordinators (33 percent), public health nursing consultation (30 percent), and lists of organizations for physician referrals (27 percent). However, these low percentages suggest that none of these resources are readily available.
• Respondents to the survey noted that children with mild or subtle emotional and behavioral disorders obtain care through a variety of agencies: private primary care providers, local health departments, early intervention, community mental health centers, school systems, or community programs. However, many respondents indicated that these children often do not receive services, either because they do not qualify or the programs lack resources to treat the children.
• Medicaid and mental health agencies reported some collaboration with each other but each reported less collaboration with early intervention agencies. Collaboration tends to be in the form of regularly scheduled meetings to share information and jointly developed policies and projects. Many states are involved in comprehensive strategic planning efforts that may assist state agencies in enhancing collaboration with each other and with private partners.
• Most state agencies do not actively encourage or reimburse for screening for maternal depression by pediatric providers. Medicaid agencies are likely to reimburse for treatment for maternal depression but usually only for women who are Medicaid beneficiaries.
• Most states do not require special infant mental health certification for individuals who work with (45), or bill for working with (42), infants.
• Just over half (26) of all states reported providing education or information to primary care providers to encourage them to focus on young children's early mental health development. Nearly half of respondents (48 percent) indicated that other organizations in their states provide training. They consider on-site training and in-person conferences to be the most effective mechanisms, but they tend to use fairly traditional methods to provide information, most commonly through dissemination of materials. Nevertheless, states are adopting new formats such as learning collaboratives and in-office training.
• Respondents perceive their state's system as most able to serve young children with severe mental health issues and least able to serve young children with mild mental health issues.
• States report that healthy mental development of children ages birth to three might not be the highest priority of state agencies for the following reasons: lack of funding for this particular issue, lack of system capacity to address the issue, higher prioritization of other issues for this age group, or higher prioritization of other populations.
• The report illustrates many opportunities for improving the systems of care for young children's social emotional development. Respondents mentioned many areas in which information sharing among states could be useful.

Many respondents expressed interest in learning more about specific models and best practices, among them:

• mechanisms for increasing the number of providers qualified to care for infants;
• Medicaid payment, blended funding, and other funding for these services;
• interagency collaboration;
• cost-benefit studies;
• provider education on screening, referral, and treatment;
• the use of DC:0-3™ (the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, used in some states to diagnose very young children and crosswalked to ICD-9 codes);
• comparison of state strategic early childhood plans; and
• child Find approaches.

Citation

State Approaches to Promoting Young Children's Healthy Mental Development: A Survey of Medicaid, Maternal and Child Health, and Mental Health Agencies, Jill Rosenthal, M.P.H., and Neva Kaye, National Academy for State Health Policy and The Commonwealth Fund, December 2005

For the full article visit http://www.cmwf.org/publications/publications_show.htm?doc_id=325120

NAMI POLICY RESEARCH INSTITUTE TASK FORCE REPORT
CHILDREN AND PSYCHOTROPIC MEDICATIONS

Executive Summary
In 2003, NAMI’s Policy Research Institute (NPRI) convened a task force of experts and stakeholders to consider issues related to the use of psychotropic medications for children and adolescents. Since then, the issue has exploded in the nation’s headlines, but not necessarily with the kind of precision that medical issues require. Our nation is currently experiencing a public health crisis in the number of youth with mental illnesses that fail to receive any treatment or services. The U. S. Surgeon General has warned that approximately 80% of youth with mental illnesses fail to receive any treatment or services.
We have made major scientific advances in understanding how to properly diagnose and treat mental illnesses in children, but more needs to be done. The prevalence of mental illnesses in children and adolescents is significant and on the rise.

About 1 in 10 children in the U.S. suffers from a mental illness severe enough to cause impairment. Research shows that reaching children with mental illnesses early with appropriate treatment significantly improves their long-term prognosis. Conversely, the failure to provide treatment has tragic consequences. After careful deliberations, the task force developed the following four recommendations to guide policy, legislation and research:

1. The National Institute of Mental Health (NIMH) must make research on early onset mental illnesses and the use of psychotropic medications in children a priority and increase funding, accordingly. On this point, another NPRI Task Force on Serious Mental Illness Research has issued a separate report noting that for children and adolescents, there is “little correlation” between what treatments are known to work and what is actually implemented in the mental health care system.”

2. One size does not fit all when it comes to treating mental illnesses. All children and adolescents with mental illnesses must have access to evidence-based assessments and interventions (EBI) and quality care. The EBI system should require clinicians to continually improve care by using the most current evidence and research to make decisions about the most appropriate medication and treatment on an individualized basis.

3. Families, child-serving professionals and other stakeholders must receive information and education about the diagnosis and treatment of early onset mental illnesses. This should include information about the early warning signs of these illnesses and the appropriate use of psychotropic medications for children: Psychotropic medications for young children should be used only when anticipated benefits outweigh risks. Parents should be fully informed and decisions made only after carefully weighing these factors. Children and adolescents must be closely monitored and frequently evaluated as the side effects common to some medications can be particularly difficult for children. At the same time, psychotropic medications can be lifesaving.

4. Policymakers generally should not interfere with the right of access to treatment, the patient provider relationship, or the promotion of partnerships for treatment between parents, providers, and other child-serving professionals. Any legislative or regulatory consideration related to the use of psychotropic medications for children and adolescents must be guided by science. Action should be taken only after obtaining testimony from qualified and well recognized medical and mental health professionals and on the basis of sound scientific research.

Children and adolescents represent our nation’s hope for the future. Mental illnesses, like all childhood illnesses, should be detected early and children should receive effective and appropriate care targeted to their individual needs. Our nation should protect children from harm, while also ensuring that those with mental illnesses receive the most effective treatment and services. Their future depends on it.

Click here to access the full report.

Rethinking Human Services: The Challenge of Institutional Culture in Human Services Integration

In a series of articles for The Rural Monitor, Tom Corbett, Ph.D. tackles several challenges to achieving service integration. Through exploration of the norms, values, and behavioral patterns that shape the way an agency functions and makes decisions, he focuses on the problematic challenge of incompatible institutional cultures.

Beginning with the assertion that each program or agency possesses a culture that touches on everything important to what it does, the author addresses issues that often arise when blending together service programs that draw upon radically different traditions and ways of operating.

Access the complete article on line at http://www.raconline.org/newsletter/pdf/winter06.pdf#page=6 .

Positive Youth Development for Children with Mental Health Problems

Improved access to opportunities for positive development through recreation and educational programs is an important element of models of community-based comprehensive care for children with mental health problems. This study is an analysis of secondary data obtained from a sample of 9 to 11 year old children receiving outpatient public mental health services in Philadelphia. The researchers hypothesized that participation in youth development activities would be associated with “such factors as family resources, child functioning, and family functioning” (p. 143).

Source: Keller, T. E., Bost, N. S., Lock, E. D., & Marcenko, M. O. (2005). Factors associated with participation of children with mental health problems in structured youth development programs. Journal of Emotional and Behavioral Disorders, 13(3), 141-151.

To access the complete article please visit http://www.rtc.pdx.edu/pgDataTrends.shtml and click on the title.

Exploring the Relationship Between Race/Ethnicity, Age of First School-Based Services Utilization, And Age of First Specialty Mental Health Care for At-Risk Youth

While schools have the potential to play a major role in the timely identification and treatment of youth at risk for emotional and behavioral problems, it is unfortunate that this has not been achieved in actual practice. Many studies have indicated a lag of from two to four years between age of onset and age of first service for emotional and behavioral problems (Kutash, Duchnowski & Friedman, 2005). The consequences of this lag in the delivery of school-based services may be further exacerbated because such services often are a gateway to needed mental health services in the mental health specialty system. This article sheds light on that relationship by investigating the age at which a youth first received school-based or specialty mental health services and the race/ethnicity of the youth. Results revealed that Non Hispanic White youth receive school-based and specialty mental health services at earlier ages than minority youth. Among all groups, results suggest that the younger a youth receives school-based services, the sooner the youth will receive specialty mental health services.

Participants (N = 1,552) were active in at least one of the following service sectors: mental health (53.5%); child welfare (33.5%); juvenile justice (29.5%); schools (SED; 15.6%), and alcohol/drug treatment (3.5%). Youth were an average age of 13.9 (SD = 3.4) years, and most were males (66%). Almost 40% of the sample was Non Hispanic White. Latinos (31%) comprised the next largest racial/ethnic group, followed by
African Americans (22%) and Asian/Pacific Islanders (7%). A modified version of the Services Assessment for Youth and Adolescents (SACA) was used to identify lifetime service use, including inpatient and outpatient specialty mental health service use and school-based mental health services. The Children’s Global Assessment Scale (C-GAS) measured functional impairment.

Results are for youth already being served by at least one service system. Seventy percent of the sample had used school-based services and 77% had used outpatient specialty mental health services; 61% of those using both services reported having received school-based services first (or during the same month in which specialty mental health services were first used). Minority youth under the age of six were less likely than Non-Hispanic Whites to receive school-based services. Similarly, Asian Pacific Islanders and Latino youths between the ages of 6-10 years were less likely to receive school-based services than were Non Hispanic Whites. African Americans, Asian Pacific Islanders and Latinos were less likely than Non Hispanic Whites to receive any school-based services overall. Further, Non Hispanic White youth received specialty mental health services at younger ages than did minorities.

Age at first receipt of school-based services also predicted use of additional mental health services. That is, youth under six years of age who received school-based services received specialty mental health services at younger ages when compared to older youth. This trend continued with older age groups as well. Results suggest that the earlier a youth receives school-based services, the earlier the youth will receive specialty mental health services, regardless of level of functioning. Results also suggest that minority youth under the age of 11 are less likely to receive either school-based or specialty mental health services when compared to Non Hispanic White youth. With regard to racial/ethnic status, it is unclear which cultural factors influence this relatively late receipt of services. According to the authors, some minority groups seek more informal avenues for mental health problems (i.e., traditional healers, pastors, etc.) than do Non Hispanic Whites, and this may explain the significant differences found in this study between Non Hispanic service use and minority service use (see Data Trends #101). However, the authors also call for greater effort among school staff to identify minority children in need of services.

Whites, and this may explain the significant differences found in this study between Non Hispanic service use and minority service use (see Data Trends #101). However, the authors also call for greater effort among school staff to identify minority children in need of services.

Although schools have been called a de facto mental health services provider, results from this study suggest that schools have more work to do in identifying young children with emotional and behavioral needs; this is especially the case for minorities. The authors suggest that school staff, mental health staff, and educators “come together to examine the pathways for early intervention within their schools” (p. 194).

Reference
Kutash, K., Duchnowsi, A. J., & Friedman, R. M. (2005). The system of care 20 years later. In M.H. Epstein, K. Kutash & A.J. Duchnowski, Outcomes for children and youth with emotional and behavioral disorders and their families:
Programs and evaluation best practices, 2nd ed. (pp. 3-22). Austin: Pro-Ed.
For more information, contact kutash@fmhi.usf.edu or visit http://rtckids.fmhi.usf.edu.
Click here to access the complete article.

ASSESSING CHILDREN’S MENTAL HEALTH: VALIDITY ACROSS CULTURAL GROUPS

Culture has a profound influence both on how mental health symptoms are expressed and on how they are assessed and interpreted by clinicians. As the U.S. population grows in diversity, critical examination of the validity of commonly used standardized mental health assessment tools for different cultural groups is essential. This paper “examines the equivalence of the BPI [Behavior Problem Index] across a sample of African American, Hispanic, and non-Hispanic White children drawn from the 1998 mother-child data file of the NLYS [National Longitudinal Survey of Youth]” (p. 583). |

The BPI is a 28-item instrument measuring a range of child behaviors. This widely used screening tool was developed “as a more concise and time-effective measure of child behavior and mental health problems than the CBCL [Child Behavior Checklist]” (p. 579).

Method
The study sample is drawn from the NSYL, a national U.S. data set. This mother-child data includes maternal reports of their children’s behavior and development. A sub-sample of 1691 children, with valid BPI scores in 1988 was selected for this between group comparative analyses. Of the families represented, only one child per family was included by random selection. The sample was 51% male and 49% female. Children’s ethnicity was described as White (52.63%), African-American (28.21%), and Hispanic (19.16%), based on the mother’s self-reported primary ethnic identification. Children’s ages ranged from 4 to 14, with an average age of 10.45 years.

The researchers explored the possibility of cultural bias in the BPI by using multigroup confirmatory factor analysis to compare the operation of the measure across the three ethnic groups (White, African-American, and Hispanic). The analytic procedures involved a series of steps to take account of the different ways in which the BPI might be used. This includes its use as a global measure of behavior problems (one-factor model), as a measure of internalizing and externalizing behaviors (two-factor model), and as a measure of different dimensions of behavior problems (six-factor model) based on the six subscales (antisocial, anxious/depressed, dependent, headstrong, hyperactive, and peer problems).

Results
The analyses revealed statistically significant differences among the three ethnic groups for each of the three models tested, indicating that the BPI did not operate in the same way for children from the three groups described in this sample. The analysis identified the following non-equivalent items: “does not feel sorry for misbehaving,” “trouble getting along with teachers,” “too fearful or anxious,” “demands a lot of attention,” “feels worthless or inferior,” “unhappy sad, or depressed,” “demands a lot of attention,” “easily confused/in a fog,” and “trouble with obsessions.” The results also suggested that patterns of difference varied by ethnic group.

Discussion & Conclusions
The authors conclude from this study that the “standard BPI subscales are valid principally for White children” (p. 585). Overall, the results indicate ethnicity-based differences in the BPI, when used both as a global measure and as a multidimensional measure of behavioral problems for children aged 4 and 14 years. This has important implications for both practice and research. Valid measurement plays an important role in children’s mental health assessment, diagnosis, intervention, and treatment evaluation. Culturally biased screening tools may contribute to the well-documented problem of disparities in mental health care.

As acknowledged by the authors, there is also a need for additional research with other populations that takes account of social, economic, and developmental variables in addition to cultural factors. Nevertheless,it is crucial that practitioners and researchers attend to cultural bias as a source of measurement error even when using instruments that have been standardized. Valid measures are essential. The authors propose that “until cultural considerations are integrated thoroughly into the initial phase of instrument development, there will be a need for more studies that investigate the cross-cultural validity of measures that are assumed to be equal” (p. 586). It is also important to recognize both the value and limitations of culture generalizations. Culture is dynamic, and increasing numbers of families belong to more than one ethnic group. Accurate assessment of children’s mental health requires not just valid instruments, but also collaborative relationships between families and practitioners. The development of such relationships is likely to require a focus not just on problem behaviors, but also on child and family strengths.

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REPORT: U.S. SCHOOLS PROVIDING MAJORITY OF MENTAL HEALTH SERVICES

Public schools provide much of the mental health services that school-aged children receive in the United States, that according to the Substance Abuse and Mental Health Services Administration’s (SAMSHA) first national survey of mental health services in schools. The study, School Mental Health Services in the United States 2002-2003, details the most prevalent mental health problems as identified by schools, the quality of mental health services the schools provide, and the issues surrounding the administration of these services.

Nearly three quarters of schools ranked “social, interpersonal or family problems” as the top mental health problem among students. Schools reported that these problems also consumed the most resources. Other problems identified by school officials include aggression or disruptive behavior, behavior problems associated with neurological disorders and anxiety and adjustment issues.

In an effort to identify students with problems, 87 percent of schools provide assessment for emotional or behavioral problems, behavior management consultation and crisis intervention. The survey found that school counselors, school nurses and school psychologists provide most mental health services. “Early identification of mental illness can alleviate some of the strain on school resources,” explains Laurie Flynn, Executive Director of the Columbia University TeenScreen Program. “Students can get the help they need before the severity of the problem escalates.

While the study shows that schools are responding to the mental health needs of students, the report also illustrates that need often outweighs the resources available. Schools cite families’ financial constraints and the school’s own limited resources for mental health services as the most common obstacles to improving school-based services. One-third of school districts surveyed experienced a decrease in funding for mental health services while two-thirds reported their need for services increased.

SYSTEMS OF CARE: A FRAMEWORK FOR SYSTEM REFORM IN CHILDREN’S MENTAL HEALTH

Recently, there have been renewed calls for reform in the delivery of children’s mental health services. In September of 2000, the Surgeon General of the United States sponsored a conference exploring needed changes in children’s mental health and issued a “national action agenda” (U.S. Public Health Service, 2000). A symposium on the subject was held at the Carter Center in November of 2001, also resulting in action steps for reform.

Increasingly over the past 15 years, the concept and philosophy of a “system of care” has provided a guide and organizing framework for system reform in children’s mental health. As the field has begun to consider the action steps needed to improve children’s mental health services in today’s environment, much consideration also is being given to examining how the system of care concept has evolved and how it remains useful as a framework for reform. Though some have questioned the utility of the system of care approach and the place of systems of care in future children’s mental health reform, others have contended that misunderstandings of the system of care concept itself underlie some of these questions and that the concept and philosophy continue to provide a valuable framework for reform.

The purpose of this issue brief is to re-examine system reform in children’s mental health, clarify what the system of care concept is, and explore the continued relevance of the system of care concept and philosophy as a framework for reform. Four questions are addressed:

• What kind of system reform is needed for children’s mental health care?
• What is the actual meaning of the system of care concept?
• Why should we continue to use the system of care concept and philosophy as a framework for system reform in children’s mental health?
• How can we achieve our system reform goals in children’s mental health?

Click here to access the complete article.

CHALLENGES AND OPPORTUNITIES IN CHILDREN’S MENTAL HEALTH: A VIEW FROM FAMILIES AND YOUTH

This report documents critical issues in children's mental health policy and service delivery from the perspective of the key stakeholders—families and youth. Based on a meeting to inform a 50-state policy study, the report highlights innovative ways in which families and youth are engaged in research, policy, and advocacy strategies to improve the mental health, school success, living situation, and community engagement of children and youth facing mental health challenges. Full text document.

THE SANCTUARY MODEL OF ORGANIZATIONAL CHANGE FOR CHILDREN'S RESIDENTIAL TREATMENT

This paper describes The Sanctuary Model ® of organizational change as applied to children’s residential treatment, a trauma-informed method for creating or changing an organizational culture in order to more effectively provide a cohesive context within which healing from psychological and social traumatic experience can be addressed. The theoretical underpinnings of the model are addressed, with an emphasis on the parallel process nature of chronic stress as seen in the behavior of children and of staff, as well as the organization as a whole. A description of the process involved in creating a healthier therapeutic community is described. Full text document.

DISORDERS OF EXTREME STRESS: THE EMPIRICAL FOUNDATION OF A COMPLEX ADAPTATION TO TRAUMA

Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSMIV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD.
These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology. Full text document.

DEVELOPMENTAL TRAUMA DISORDER

this article identifies the following educational objectives:

• Identify emotional triggers and patterns of re-enactment in traumatized children.
• Discuss the spectrum of developmental derailments secondary to complex trauma exposure.
• Describe patterns of accommodation in traumatized children.

Full text document.