Child's Reaction to Traumatic Events Scale-Revised CRTES-R

MEASURE NAME: Acronym: CRTES-R Basic Description Author(s): Author Contact: Author Email: Citation: To Obtain: E-mail: Website: Cost per copy (in US $): Copyright: Description: Theoretical Orientation Summary: Domains Assessed: Languages Available: Jones, Russell, T., Ph.D. Russell T. Jones, Ph.D. Professor Department of Psychology Stress and Coping Lab 137 Williams Hall Virginia Tech University Blackburg, VA 24061-0436 rtjones@vt.edu Jones, R. T., Fletcher, K., & Ribbe D. R. (2002). Child s Reaction to Traumatic Events Scale-Revised (CRTES-R): A self-report traumatic stress measure. Available from the author: Russell T. Jones, Ph.D. Dept. of Psychology Stress and Coping Lab 137 Williams Hall Virginia Tech University Blacksburg, VA 24060 rtjones@vt.edu None $0.00 No A 23-item self-report measure designed to assess psychological responses to stressful life events. The measure is based on the Horowitz Impact of Events Scale and was initially modified to assess Intrusion and Avoidance symptoms based on DSM-III-R criteria. The scale was recently modified to include assessment of Arousal and to update the items with regard to DSM-IV criteria. 1. Posttraumatic stress symptoms (child) 2. 3. 4. 5. 6. English, Spanish 1

Age Range: # of Items: Time to Complete (min): Time to Score (min): Periodicity: Response Format: 6.00-18.0 23 10 5 Measure Type: Measure Format: Reporter: Education Level: General assessment Questionnaire Self Children answer items in response to the past 7 days 4-point frequency rating scale: 4-point frequency rating scale: 0=not at all, 1=rarely, 3=sometimes, 5=often Materials Needed: (check all that apply) Material Notes: Yes Paper and pencil Computer Video equipment Testing stimuli Physiological equipment Other The measure can be administered either as a self-report questionnaire or a semistructured interview. Sample Items: Domains Scale Sample Items Total Score Avoidance I tried not to remember. Intrusion I thought about it when I didn't mean to. Notes (additional scales and domains): Information Provided: (check all that apply) Diagnostic information DSM-III Diagnostic information DSM-IV Strengths Yes Areas of concerns/risks Program evaluation information Yes Continuous assessment Yes Raw Scores Standard Scores Percentile Graph (e.g., of elevated scale) Dichotomous assessment Clinical friendly output Written feedback Other Training Training to Administer: (check all that apply) None Via manual/video Prior experience psych testing & interpretation Must be a psychologist Training by experienced clinician (<4 hours) Training by experienced clinician ( 4 hours) 2

Training to Interpret: (check all that apply) Training Notes: None Must be a psychologist Via manual/video Training by experienced clinician (<4 hours) Yes Prior experience psych Training by experienced testing & interpretation clinician ( 4 hours) The author notes that the measure should be administered and interpreted by a trained professional (mental health or public health). Parallel or Alternate Forms Parallel Forms? No Alternate Forms: No Forms for Different Ages: No If so, are forms comparable: Any Altered Versions of Measure: Yes Describe: The CRTES is based on the Horowitz Impact of Events Scale. The scale, originally called the HIES-C, was revised to make items more appropriate for children. Later revisions were conducted to update the scale with respect to DSM-IV criteria. The difference between the CRTES (15 items), and the CRTES-Revised (23 items) appears to be the addition of 8 items that assess for Arousal symptoms (consistent with DSM-IV criteria). Population Used to Develop Measure Information regarding the development of the current 23-item CRTES was not available. The 15-item CRTES was used with 167 children aged 4-20 who had experienced residential fires. Most were aged 8-16; only two were below the age of 6. Of the 145 for whom gender information was available, 76 (52.4%) were girls and 69 (47.6%) were boys (Jones, Fletcher, & Ribbe, 2003). No other data regarding demographics or SES were available. Psychometrics Global Rating (scale based on Hudall Stamm, 1996): Under construction, psychometric evaluation is underway Norms: No For separate age groups: No For clinical populations: No Separate for men and women: No For other demographic groups: No Notes: 3

Clinical Cutoffs: Specify Cutoffs: Used in Major Studies: Specify Studies: Yes A low distress total score is 0-14; moderate distress,15-27; high distress, 28 and higher (Jones et al., 2003). No 4

Reliability: Type: Rating Statistics Min Max Avg Test-Retest-# days: Internal Consistency: Inter-Rater: Parallel/Alternate Forms: Acceptable Cronbach's alpha 0.86 0.86 0.86 Notes: There are no reliability data for the current 23-item CRTES-R. However, given that the difference between this and the earlier CRTES is the addition of 8 items to tap Arousal, it is likely that the scales share reliability at least with regard to Avoidance and Intrusion scales. Reliability data for the original 15-item CRTES are as follows: 1. Jones, Fletcher, & Ribbe (2003) reported alphas for a sample of 167 children between the ages of 4 and 20 years who had experienced residential fires: Total Scale=.86, Avoidance=.77, Intrusion=.85. The following reliability data have been reported for the HIES-C: 1. Jones, Ribbe, & Cunningham (1993) reported alphas for a sample of children who had experienced a hurricane: Total Scale=.85, Avoidance=.72, Intrusion=.84. 2. Cunningham, Jones, & Yang (1994) reported alphas for a sample of African-American children living in a high-crime, low-income neighborhood: Total Scale =.73, Avoidance =.73, Intrusion =.68. Content Validity: The CRTES is based on the Horowitz Impact of Events Scale. The scale, originally called the HIES-C, was revised to make items more appropriate for children. Later revisions were conducted to update the scale with respect to DSM-IV criteria. The difference between the CRTES (15 items), and the CRTES-Revised (23 items) appears to be the addition of 8 items that assess for Arousal symptoms (consistent with DSM-IV criteria). Construct Validity: (check all that apply) Validity Type Convergent/Concurrent Discriminant Sensitive to Change Intervention Effects Longitudinal/Maturation Effects Sensitive to Theoretically Distinct Groups Factorial Validity Notes: Not known Not found Nonclinical Clinical Samples Samples Diverse Samples This is a relatively new measure that is still under construction, and psychometrics are being gathered within the context of an NIMH-funded study. For an earlier version of the measure, the authors reported that symptomatology as assessed using the HIES-C was associated with degree of perceived danger 5

and life threat (Jones, Ribbe, Cunningham, & Weddle, 1993). Jones et al. (2003): Data collected, using the 15-item CRTES with 167 children who had experienced residential fires, were subjected to a principle axis factor analysis with a varimax rotation followed by a promax rotation revealed. The analyses revealed the presence of 2 factors based on a screen plot. Factors accounted for 46.54% of the variance and were labeled as follows: 1) Intrusion (35.49% of variance), and 2) Avoidance (11.04% of the variance). The authors reasoned that lower variance may have been found for Avoidance due to the difficulty children have in reporting these symptoms. The factor analysis supports the distinction between the avoidance and intrusion scales of the CRTES, although there was considerable overlap of loadings on both factors and two items failed to load on either factor above 0.40. A higher order factor analysis resulted in a single factor, providing support that the measure assesses a single PTSD dimension. Boys and girls did not differ on their total CRTES scores or on the Avoidance subscale, but girls scored significantly higher than did boys on Intrusion. Child s age was not correlated with total or subscale scores. Criterion Validity: (check all that apply) Measures used as criterion: Not known Not found Nonclinical Clinical Samples Samples Predictive Validity: Postdictive Validity: Diverse Samples Sensitivity Rate(s): Specificity Rate(s): Positive Predictive Power: Negative Predictive Power: Notes: Sensitivity and Specificity were determined through an ROC analysis with total CRTES scores compared to diagnosis based on the DICA. A cutoff of 29 or above for the 15 items was identified as having good Sensitivity (83.3%) and Specificity (70.5%). Limitations of Psychometrics and Other Comments Regarding Psychometrics: 1. While earlier versions of the measure have been researched with data showing evidence of reliability, the current version has no published data in peer-reviewed journal articles. 2. As noted above, additional psychometrics are being gathered through an NIMH-funded study. Consumer Satisfaction No data were available. 6

Languages Other than English Language: Translation Quality (check all that apply) 1= Has been translated 2= Has been translated and back translated - translation appears good and valid. 3= Measure has been found to be reliable with this language group. 4= Psychometric properties overall appear to be good for this language group. 5= Factor structure is similar for this language group as it is for the development group. 6 = Norms are available for this language group. 7= Measure was developed for this language group. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Spanish 1 2 3 4 5 6 7 Yes Use with Trauma Populations Populations for which measure has demonstrated evidence of reliability and validity: Physical abuse Sexual abuse Neglect Yes Yes Natural disaster Accidents Imprisonment Terrorism Immigration related trauma Kidnapping/hostage Use with Diverse Populations Population Type: Domestic Violence Community violence Medical trauma 1 1. Developmental disability 2. Disabilities 3. Lower socio-economic status 4. Rural populations 5. 6. Notes (including other diverse populations): Witness death Assault War/combat Degree of Usage: (check all that apply) Traumatic loss (death) Other USE WITH DIVERSE POPULATIONS RATING SCALE 1. Measure is known (personal communication, conference presentation) to have been used with members of this group. 2=Studies in peer-reviewed journals have included members of this group who have completed the measure. 3=Measures have been found to be reliable with this group. 4=Psychometric properties well established with this group. 5=Norms are available for this group (or norms include a significant proportion of individuals from this group) 6=Measure was developed specifically for this group. 2 3 4 5 6 7

Pros and Cons/Qualitative Impression Pros: 1. The measure is based on a well-known measure for assessing PTSD symptomatology in adults. 2. An earlier version has been used with children who have experienced fires. Few other measures have been used for this specific trauma group. 3. Preliminary psychometrics for the 15-item measure are promising with regard to Specificity and Sensitivity. 4. There is a Spanish version of the measure. 5. The measure is free. 6. The measure is brief. Cons: 1. The measure has recently been altered to assess for symptoms of Arousal, consistent with the DSM-IV. While this change is potentially useful, additional psychometrics are needed on the reliability and validity of this altered version. In addition, the original version has not been widely used or researched. Research is needed on test-retest reliability and convergent and discriminant validity with other PTSD measures. 2. The measure has not been widely used compared to other trauma symptom measures. 3. The items appear to be asking about symptomatology with regard to one specific event. Although this is a common feature of many trauma questionnaires, this may be problematic for children who have experienced multiple traumas. 4. While the measure is said to be for children aged 6-18, younger children may have difficulty with the wording and with concepts assessed. Research is needed to determine the extent to which younger children comprehend the items and are able to report on these internal experiences using these questions. 8

References (Representative sampling of publications, presentations, psychometric references) Published References: A PsychInfo search (7/05) of "Child's Reaction to Traumatic Events Scale" or CRTES anywhere revealed that it has been referenced in 7 peer-reviewed articles. The articles are listed below. 1. Cook-Cottone, C. (2004). Childhood posttraumatic stress disorder: Diagnosis, treatment, and school reintegration. School Psychology Review, 33(1), 127-139. 2. Foa, E.B., Johnson, K.M., Feeny, N.C., & Treadwell, K. R.H. (2001). The child PTSD symptom scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376-384. 3. Gurwitch, R.H., Kees, M., & Becker, S.M. (2002). In the face of tragedy: Placing children's reactions to trauma in a new context. Cognitive & Behavioral Practice, 9(4), 286-295 4. Ohan, J.L., Myers, K., & Collett, B.R. (2002). Ten-year review of rating scales. IV: Scales assessing trauma and its effects. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1401-1422. 5. Phelps, L.F., McCart, M.R., & Davies, W.H. (2002). The impact of community violence on children and parents: Development of contextual assessments. Trauma Violence & Abuse, 3(3), 194-209. 6. Ruggiero, K.J., Morris, T.L., & Scotti, J.R. (2001). Treatment for children with posttraumatic stress disorder: Current status and future directions. Clinical Psychology: Science & Practice, 8(2), 210-227. 7. Saxe, G., Chawla, N., Stoddard, F., Kassam-Adams, N., Courtney, D., Cunningham, K., et al. (2003). Child stress disorders checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8), 972-978. Unpublished References: A PsychInfo search (7/05) of "Child's Reaction to Traumatic Events Scale" or CRTES anywhere revealed that it has been referenced in 1 conference and 0 dissertations. The author provided the following unpublished articles. 1. Cunningham, P.B., Jones, R.T., & Yang, B. (1994). Impact of community violence on African-American children and adolescents in high violence crime neighborhoods: Preliminary findings. Poster presented at the Seventh Annual Research Conference, A System of Care for Children s Mental Health: Expanding the Research Base, Tampa, FL. 2. Jones, R.T., Ribbe, D.P., Cunningham, P.B., & Weddle, D. (1993). Predictors of child and adolescent functioning. Paper presented in the symposium entitled Children s Responses to Natural Disaster. Presented at the 101st Annual American Psychological Association Convention, Toronto, Ontario, Canada. 3. Jones, R.T., Fletcher, K., & Ribbe, D.R. (2003). Child s Reaction to Traumatic Events Scale: Sensitivity & Specificity. Paper presented at the Nineteenth Annual Meeting of the International Society for Traumatic Stress Studies, Chicago, IL. 9

Number of Published References: (based on author provided information and a PsychInfo search, not including dissertations) Number of Unpublished References: (based on a PsychInfo search of unpublished doctoral dissertations) 7 3 Author Comments: Since the measure is currently undergoing psychometric evaluation, the author requests that users share their results with his lab. The author provided feedback on this review, which was integrated. Citation for Review: Editor of Review: Last Updated: PDF Available: Lorinda Ho Chandra Ghosh Ippen, Ph.D. 7/15/2005 yes This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. 10