Now that CPTSD has finally become an official diagnosis in one of two major diagnostic manuals, the WHO ICD-11 (despite the fact that many clinicians accepted it as credible), articles about prevention are beginning to pop up. As that happens they will be added here as this is an crucial piece to efforts to deal with the overall problem of Complex Trauma.
The articles and books listed below are just a sampling of the info available about accountability and/or reparation for relational abuse/neglect. They are meant to give members a sense of the issues involved, the work being done at various levels and some of the successes and failures.
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I like this one because it discusses how imperative it is to reduce the shame and humiliation surrounding Complex Trauma in many sectors by promoting dignity. However, it also suggests that it takes too much time and $$ to work on treating Complex Trauma and that does a whole load of people a huge disservice. It's like saying it's too late for us and that I cannot abide. If we let this attitude stand (and it's out there - it's one reason insurers throw CBT at us, limited sessions = reduced cost but it doesn't do nearly enough), we will never get the relational treatment we need and deserve. So I am totally down with reducing shame and promoting dignity but not just in terms of primary prevention, it needs to be at all stages from prevention to treatment.
Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder by Michael Salter and Heather Hall (2020) - https://sci-hub.se/10.1177/1524838020979667.
Thank you ! I wasn't able to open the link, just to let you know in case of a problem. :blink:
Well now that's strange, I just opened it and it worked fine. :Idunno: Here's the abstract at least. I can send you a copy of the whole article if you'd like, just let me know.
Abstract:
Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by
prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions
that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated
in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged
communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has
been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a
shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including
a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in
CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article
develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of
dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of
preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model
provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk
and prevalence of CPSTD.
Here's a link I came across this morning from the US National Association of School Psychologists called Preventing Childhood Trauma: Guidelines for Administrators and Crisis Teams (https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-safety-and-crisis/mental-health-resources/trauma/preventing-childhood-trauma-guidelines-for-administrators-and-crisis-teams)
Another US link - The US National Child Traumatic Stress Network (https://www.nctsn.org/)
An excerpt:
What Is Child Traumatic Stress?
Children who suffer from child traumatic stress are those who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the events have ended. Traumatic reactions can include a variety of responses, such as intense and ongoing emotional upset, depressive symptoms or anxiety, behavioral changes, difficulties with self-regulation, problems relating to others or forming attachments, regression or loss of previously acquired skills, attention and academic difficulties, nightmares, difficulty sleeping and eating, and physical symptoms, such as aches and pains. Older children may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity.
Children who suffer from traumatic stress often have these types of symptoms when reminded in some way of the traumatic event. Although many of us may experience reactions to stress from time to time, when a child is experiencing traumatic stress, these reactions interfere with the child's daily life and ability to function and interact with others. At no age are children immune to the effects of traumatic experiences. Even infants and toddlers can experience traumatic stress. The way that traumatic stress manifests will vary from child to child and will depend on the child's age and developmental level.
Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (e.g., smoking, eating disorders, substance use, and high-risk activities). Research shows that child trauma survivors can be more likely to have long-term health problems (e.g., diabetes and heart disease) or to die at an earlier age. Traumatic stress can also lead to increased use of health and mental health services and increased involvement with the child welfare and juvenile justice systems. Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and maintaining employment.
Dorado, J.S., Martinez, M., McArthur, L.E. et al. Healthy Environments and Response to Trauma in Schools (HEARTS): A Whole-School, Multi-level, Prevention and Intervention Program for Creating Trauma-Informed, Safe and Supportive Schools. School Mental Health 8, 163–176 (2016). https://doi.org/10.1007/s12310-016-9177-0
Results indicate preliminary support for the effectiveness of the HEARTS program for each of the evaluation questions examined, suggesting that a whole-school, multi-tiered approach providing support at the student, school personnel and system levels can help mitigate the effects of trauma and chronic stress.
Megan R. Garza, Karen Rich & Susan M. Omilian (2019) A Trauma-Informed Call to Action: Culturally-Informed, Multidisciplinary Theoretical and Applied Approaches to Prevention and Healing, Journal of Aggression, Maltreatment & Trauma, 28:4, 385-388, DOI: 10.1080/10926771.2019.1601144
Abstract: The prevalence of trauma and its negative impact on humankind has created a burgeoning awareness of the need for systems that are trauma-informed across the lifespan. A collaborative project with the National Partnership to End Interpersonal Violence (NPEIV) sought out research as a call-to-action to mitigate the impact of trauma. The following is an introduction to a special double-issue focused on theoretical and applied approaches to using trauma-informed care in multi-disciplinary, mental and physical health, criminal justice, school-based, and community settings. Consideration is given to essential issues such as resilience, self-care, and cultural awareness.
Bisson, J. I., Berliner, L., Cloitre, M., Forbes, D., Jensen, T. K., Lewis, C., Monson, C. M., Olff, M., Pilling, S., Riggs, D. S., Roberts, N. P., & Shapiro, F. (2019). The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process. Journal of traumatic stress, 32(4), 475–483. https://doi.org/10.1002/jts.22421
Over the last two decades, treatment guidelines have become major aids in the delivery of evidence-based care and improvement of clinical outcomes. The International Society for Traumatic Stress Studies (ISTSS) produced the first guidelines for the prevention and treatment of posttraumatic stress disorder (PTSD) in 2000 and published its latest recommendations, along with position papers on complex PTSD (CPTSD), in November 2018.
Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of clinical nursing, 28(7-8), 1100-1113. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14735
Conclusions - Prevention is the most effective intervention approach for intergenerational transmission of trauma. Prevention requires trauma-specific interventions with adults and attachment-focused interventions within families. Preventative strategies need to target individual, relationship, familial, community and societal levels, as addressing and preventing trauma requires a multipronged, multisystemic approach.
Salter, Michael, Conroy, Elizabeth, Dragiewicz, Molly et al (2020) A deep wound under my heart": Constructions of complex trauma and implications for women's wellbeing and safety from violence. Project Report. Australia's National Research Organisation for Women's Safety Limited (ANROWS), Sydney. http://eprints.lincoln.ac.uk/id/eprint/41961/
Abstract:
This project sought to develop a comprehensive picture of how complex trauma is being constructed in public policy and practice, and how it is viewed by women with experiences of complex trauma. The research found that at the policy level, complex trauma overlaps with frameworks on violence against women and mental health. However, the impact of complex trauma is not comprehensively addressed by these frameworks, which contributes to the fragmented response to women in distress. It demonstrated that there is a strong need for a whole-of-government commitment to the implementation and coordination of trauma-informed practice across sectors. The report includes recommendations for policy and practice.
Chamberlain C, Gee G, Brown SJ, et al (2019). Healing the Past by Nurturing the Future—co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study. BMJ Open 9:e028397. doi: 10.1136/bmjopen-2018-028397
Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma.
Miller-Karas, E. (2023). Building Resilience to Trauma: The Trauma and Community Resiliency Models. Rutledge.
Description:
During and after a traumatic experience, survivors experience a cascade of physical, emotional, cognitive, behavioral, relational, and spiritual responses that can make them feel unbalanced and threatened. The second edition of Building Resilience to Trauma explains common responses from a biological perspective, reframing the human experience from one of shame and pathology to one of hope and biology. Using two evidence-informed models of intervention that are trauma-informed and resiliency-informed—the Community Resiliency Model (CRM) and the Trauma Resiliency Model (TRM)—chapters distill complex neuroscience into understandable concepts and lay out a path for fostering short- and long-term healing.
CRM develops natural leaders who share wellness skills throughout communities as primary prevention, and TRM focuses on training mental health professionals to reprocess traumatic experiences. Studies have demonstrated that the models' use leads to significant reductions in depression and anxiety, and both models also lead to increases in well-being. The models restore balance after traumatic experiences and can be used as tools to cultivate well-being across cultures and abilities throughout the lifespan.
Isobel, S., Goodyear, M., & Foster, K. (2019). Psychological Trauma in the Context of Familial Relationships: A Concept Analysis. Trauma, Violence, & Abuse, 20(4), 549–559. https://doi.org/10.1177/1524838017726424
Abstract
Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.
Chafouleas, S. M., Johnson, A. H., Overstreet, S., & Santos, N. M. (2015). Toward a Blueprint for Trauma-Informed Service Delivery in Schools. School Mental Health, 8(1), 144–162. doi:10.1007/s12310-015-9166-8 Also https://sci-hub.se/10.1007/s12310-015-9166-8
Abstract - Recognition of the benefits to trauma-informed approaches is expanding, along with commensurate interest in extending delivery within school systems. Although information about trauma-informed approaches has quickly burgeoned, systematic attention to integration within multitiered service delivery frameworks has not occurred yet is essential to accurate, durable, and scalable implementation. In addition, there is a critical need to concurrently build a strong evidence base regarding trauma-informed service delivery in schools. In this paper, the literatures on trauma informed approaches and multitiered frameworks for school-based service delivery are connected with the goal to provide suggestions toward building blueprints for trauma-informed service delivery in schools.
Oral, R., Ramirez, M., Coohey, C. et al. Adverse childhood experiences and trauma informed care: the future of health care. Pediatr Res 79, 227–233 (2016). https://doi.org/10.1038/pr.2015.197
Abstract
Adverse childhood experiences (ACEs) are related to short- and long-term negative physical and mental health consequences among children and adults. Studies of the last three decades on ACEs and traumatic stress have emphasized their impact and the importance of preventing and addressing trauma across all service systems utilizing universal systemic approaches. Current developments on the implementation of trauma informed care (TIC) in a variety of service systems call for the surveillance of trauma, resiliency, functional capacity, and health impact of ACEs. Despite such efforts in adult medical care, early identification of childhood trauma in children still remains a significant public health need. This article reviews childhood adversity and traumatic toxic stress, presents epidemiologic data on the prevalence of ACEs and their physical and mental health impacts, and discusses intervention modalities for prevention.
Jaffe, P. (2018). Children exposed to domestic violence: Current issues in research, intervention, prevention, and policy development. (https://books.google.ca/books?hl=en&lr=&id=Ont0DwAAQBAJ&oi=fnd&pg=PT16&dq=intervention+and+prevention+complex+trauma&ots=pTi1ah0pjg&sig=4D9f0KmGvsw6xxR1szAvtOAv49Y#v=onepage&q=intervention%20and%20prevention%20complex%20trauma&f=false) Routledge.
Holmes, C., Levy, M., Smith, A. et al. A Model for Creating a Supportive Trauma-Informed Culture for Children in Preschool Settings. J Child Fam Stud 24, 1650–1659 (2015). https://doi.org/10.1007/s10826-014-9968-6 Also https://sci-hub.se/10.1007/s10826-014-9968-6
Abstract The all too common exposure of young children to traumatic situations and the life-long consequences that can result underscore the need for effective, developmentally appropriate interventions that address complex trauma. This paper describes Head Start Trauma Smart (HSTS), an early education/mental health cross-systems partnership designed to work within the child's natural setting—in this case, Head Start classrooms. The goal of HSTS is to decrease the stress of chronic trauma, foster age-appropriate social and cognitive development, and create an integrated, trauma-informed culture for young children, parents, and staff. Created from a community perspective, the HSTS program emphasizes tools and skills that can be applied in everyday settings, thereby providing resources to address current and future trauma. Program evaluation findings indicate preliminary support for both the need for identification and intervention and the potential to positively impact key outcomes.
Cook, A., Morton, S., & Henderson, F. (2023). Interrogating assumptions about the relationship between service providers and recipients: Learning from a new service for survivors of In Care Abuse. Evaluation and program planning, 97, 102260. https://doi.org/10.1016/j.evalprogplan.2023.102260
Abstract
Understanding the dynamic relationship between service providers and the people who use their services is key to effective evaluation. This paper presents a practical approach to embedded evaluation that can be used by services to interrogate assumptions about relationships. The approach includes a simple framework for developing theories of change that centres relational aspects of the change process. This framework is complemented by a structured approach to surfacing risks and assumptions. Using the example of the evaluation of Future Pathways, a new and ground breaking service provided to people who experienced abuse or neglect as children In Care in Scotland, the paper describes how this approach was used in practice. Focusing in on assumptions identified by the service around trust, the paper describes the process undertaken to interrogate these assumptions through data collection with people using the service and staff. This process led to rich learning to support the development of the service as well as the identification of new elliptical assumptions. The paper concludes by sharing reflections on the learning from this work for the wider evaluation community highlighting the need for evaluators to take a relational approach to interrogating assumptions about relationships.
AP News, June 2021, UN experts call on Holy See to do more against child abuse (https://apnews.com/article/united-nations-child-abuse-sexual-abuse-by-clergy-religion-aa1c565ced09fcaf273074fddf2dbd87)
GENEVA (AP) — Independent human rights experts working with the United Nations have urged the Vatican to do more to stop and prevent violence and sexual abuse against children, citing "persistent allegations of obstruction and lack of cooperation" from the Catholic Church, the U.N. human rights office said.
The four experts, in a letter dated April 7 but only made public on Monday, faulted efforts by the church "to protect alleged abusers, cover up crimes, obstruct accountability of alleged abusers, and evade reparations due to victims." In general terms, the experts alleged bids were made by some church members to undercut efforts in national legislatures to prosecute child sex offenders, and cited lobbying attempts to limit how long former child victims can report the crimes after they become adults. The experts said the violations had allegedly been committed over decades in many countries with tens of thousands of victims.
"We note with great concern the apparent pervasiveness of child sexual abuse cases and the apparent systematic practice of covering up and obstructing the accountability of alleged abusers belonging to the Catholic Church," the experts said. The four experts are working under various mandates from the U.N.-backed Human Rights Council. Though they do not work for the United Nations or speak for the world body, they do receive some administration support from the U.N human rights office.
The Vatican didn't immediately make any public comment about the letter. It has been heavily criticized by abuse victims in many countries over failing to discipline or remove bishops or other members of the hierarchy implicated in cover-ups of allegations.
Clinical Assessment & Treatment: Identifying ACEs and risk of toxic stress to inform treatment in California, USA (https://www.acesaware.org/ace-fundamentals/clinical-assessment-and-treatment/)
Bravo to CA, USA! GPs are now screening for ACEs as part of regular exams!
Clinicians routinely gather information from patients about their medical history, family history, and any specific health concerns during the primary care visit. Incorporating ACEs and toxic stress into the conversation involves reviewing the patient's ACE screening results, asking about protective factors – including toxic stress mitigation strategies – that may be present, and taking note in the physical exam of any neurologic, endocrine, metabolic, or immune findings that could be associated with ACE-Associated Health Conditions.
If you go to the site you'll see their motto is "ACES - screen, treat, heal." This is a huge step forward in prevention, intervention and treatment of trauma related symptoms. Let's hope other states and countries for that matter follow the lead of CA.
Kaitlin Fondren, Monica Lawson, Ruth Speidel, Christina G. McDonnell, Kristin Valentino, Buffering the effects of childhood trauma within the school setting: A systematic review of trauma-informed and trauma-responsive interventions among trauma-affected youth, Children and Youth Services Review, Volume 109, 2020, https://doi.org/10.1016/j.childyouth.2019.104691
(https://www.sciencedirect.com/science/article/pii/S0190740919308588)
Abstract
Exposure to trauma during childhood is highly prevalent. This review seeks to evaluate the current state of the literature in regard to trauma-informed care within the school setting. A number of models have been put forth to describe broad trauma-informed approaches integrated within school systems, which incorporate trauma-sensitive care and practices within the broader structure of an organization. The goal of this paper was to systematically review papers detailing relevant interventions to the provision of trauma-informed and trauma-responsive practices within schools. Using a three-tiered system of service delivery as our organizing framework (where the level of support increases across tiers depending on the student's individual needs), the research that has evaluated the efficacy of trauma-informed interventions is reviewed. Results indicated that much of this work has been exclusively conducted within one level of a three-tiered system that comprises a trauma-informed approach to the school setting. Although there is a foundation of research on interventions applied within specific tiers, few studies have sought to integrate the tiers to test the effectiveness of a fully trauma-informed model within the educational system and most that have integrated the three tiers do not include statistically rigorous evaluations of program effectiveness, such as randomized control trials. A basic model for trauma-informed schools with considerations for intervening directly with students is provided as well as recommendations for future research, which is necessary to inform clear, specific models for fully integrated trauma-informed schools.
From the US Centres for Disease Control: CDC: Childhood Trauma Is A Public Health Issue And We Can Do More To Prevent It (https://cptsd.org/forum/index.php?action=post;topic=15152.15;last_msg=131102) By Rhitu Chatterjee 2019. The agency points to the need for efforts at every level: state, community, family and individual.
Excerpt:
Schuchat noted that positive childhood experiences and relationships are known to buffer against the stress of trauma and strengthen resilience. "It might be a parent, it might be a teacher, it might be a neighbor, but having a stable, reliable person in your life can help you at that individual level with resilience," said Schuchat. "That stability and nurturing will help you when you have a stress or a difficult problem [because you] have an outlet and a reliable way to process it and seek help if you need to."
In fact, supportive, nurturing relationships and environments for both children and families are at the heart of prevention, according to the report, which describes six approaches to prevention. Those approaches include strengthening economic support for families, helping parents and youth better handle stress, as well as improved access to primary care to screen, identify and address childhood trauma when it occurs.
Physicians have an important role in mitigating the effects of childhood trauma, Schuchat noted. "Clinicians are busy and may or may not incorporate ACEs into their practice, but we think it's very important that they do." For example, pediatricians can screen parents and children for childhood trauma and practice trauma-informed care, so as to address the potential health effects of trauma. "There are various programs that can be used in primary care offices or [by] pediatricians," said James Mercy, the director of the CDC's division of violence prevention, and an author of the new report. "These provide ways that these offices can organize their efforts around identifying and intervening around child maltreatment and other adversity."
Resilience - https://kpjrfilms.co/resilience/about-the-film/
The child may not remember but the body remembers.
Researchers have recently discovered a dangerous biological syndrome caused by abuse and neglect during childhood. As the new documentary Resilience reveals, toxic stress can trigger hormones that wreak havoc on the brains and bodies of children, putting them at a greater risk for disease, homelessness, prison time, and early death. While the broader impacts of poverty worsen the risk, no segment of society is immune. Resilience, however, also chronicles the dawn of a movement that is determined to fight back. Trailblazers in pediatrics, education, and social welfare are using cutting-edge science and field-tested therapies to protect children from the insidious effects of toxic stress—and the dark legacy of a childhood that no child would choose.