Childhood Trauma: Prevalence and Related Behaviors at a Community Mental Health Agency in Michigan Amy Neumeyer, MPH Deborah Willis, PhD, MSW
What do we know about childhood trauma? ~40% exposed to event before age 18 Exposure to potentially traumatic event does not always result in trauma Can be influenced by the type of event Resiliency Multiple traumas compound the impact
What do we know about childhood trauma? For children, experiencing trauma impacts development, emotions, and behaviors in a chronic, long-lasting manner. Health, Behavior, School Performance, Criminal Behavior Treatment may be delayed following the event for a variety of reasons
Detroit-Wayne County Community Mental Health Agency 12,749 children with serious emotional disturbance (SED) served FY11 18 Provider Agencies System of Care How many children that we serve have experienced traumatic events? We have no idea.
The High End User Project: Untreated Trauma Contributes to Service Use Connections- System of Care Special Project, 2010 System partners: Child Welfare, Juvenile Justice, and Community Mental Health Children referred were costing on average $21,339/year Average 8 years in the system, 4.5 different out-ofhome placements 95% had a history of exposure to traumatic events (90% of which had multiple events) 15% reported treatment to address the trauma
High End User Traumatic Events Types of Trauma Multiple Traumas Percentage of Youth 60 50 40 30 20 10 Percentage of Youth 16 14 12 10 8 6 4 2 0 0 1 2 3 4 5 6 7
Building a Trauma-Informed System of Care in Wayne County Trauma-Focused Cognitive Behavioral Therapy Parent Support Partner Training Cross-System Participation Training on possible impact, associated behaviors, and responses to trauma Collaboration with Southwest Michigan Child Trauma Assessment Center (CTAC) Trauma Screening Checklist The Guidance Center Screening Project
The Guidance Center (TGC) One agency within Detroit-Wayne County Community Mental Health provider network Provides behavioral health (adult and children), early childhood, developmental disabilities, juvenile justice, Kids-TALK CAC, & prevention services ~2,100 children 0-18 were served in FY11-12 Main service area: Downriver, MI
Wayne County
TGC Sample characteristics 2,694 children attended an intake appointment between January 1, 2010 and December 31, 2012 53.9% male 74.2% Caucasian, 17.8% African American, 8% Other Average age: 11.6 (range 3-20) 9.8% involved in Juvenile Justice
Trauma Screening Checklist
Results Exposure to Traumatic Events No Trauma Event 35% Trauma Event 65%
Results Exposure to Traumatic Events Number of Events No Trauma Event 35% Trauma Event 65% 4+ 36% 2-3 36% 1 28%
Characteristics of Children by Trauma Event Exposure Traumatic Event No Traumatic Event Average Age 11.8 years 11.6 years Length of Stay* 211 days 198 days Gender* Boys Girls Ethnicity* African American Asian Caucasian Native American Other Hispanic/Latino (*=p<0.05) 52% 48% 16.9% 0.1% 74.4% 8.0% 7.8% 5.5% 59% 41% 20.4% 0.4% 73.5% 0 5.6% 2.7%
Characteristics of Children by Trauma Event Exposure, cont. Diagnosis* Mood Disorder Anxiety Disorder Disruptive Behavior Disorder Attention Deficit Disorder Adjustment Disorder Other Living Arrangement With Parents or Relatives Residential Facility Foster Family Other (*=p<0.05) Traumatic Event 40.5% 16.3% 21.2% 10.9% 5.0% 6.1% 89.4% 1.6% 3.5% 5.6% No Traumatic Event 39.0% 15.1% 19.2% 9.1% 10.1% 7.4% 87.7% 2.2% 3.8% 6.3%
Functioning Levels of Children by Trauma Event Exposure Traumatic Event No Traumatic Event CAFAS Total Score at Intake* 84.9 80.4 CAFAS Subscale Scores at Intake School Home Community Behavior toward Others* Moods and Emotions* Self Harm* Substance Use* Thinking 18.0 16.6 3.5 18.2 19.2 5.3 1.9 2.3 17.8 16.4 3.5 17.3 18.1 4.2 1.1 2.3 (*=p<0.05)
Treatment and Outcomes 21.9% of children with trauma event history were referred to TF-CBT compared to 13.1% of children without event history 23% of children with diagnosed PTSD were referred to TFCBT 51.8% of children with trauma event history improved in functioning at discharge (regardless of treatment), compared to 49.8% of children without event history
Types of Events Percentage 45 40 35 30 25 20 15 10 5 0 N=1,764
Direct vs. Indirect Events Among children with a trauma event history, 60.3% had at least one event happen directly to them Physical Abuse, Sexual Abuse, Emotional Abuse, Neglect Not related to living arrangement, referral source, length of stay, diagnosis (including PTSD)
Age and Functioning Levels of Children by Type of Event Direct Event Indirect Event Average Age* 11.9 11.3 CAFAS Total Score at Intake* 86.4 82.9 CAFAS Subscale Scores at Intake School Home Community Behavior toward Others* Moods and Emotions* Self Harm* Substance Use Thinking 17.8 16.6 3.7 18.2 19.2 5.3 1.9 2.3 18.2 16.5 3.1 17.6 18.8 4.7 1.8 2.1
Exposure to Multiple Events Among the 65% of children that noted traumatic event history, 71.8% had multiple events Number of Events Percentage 30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9
Characteristics of Children by Number of Events 1 2-3 4 or More Average Age 11.4 11.5 11.8 Length of Stay* 212.3 198.6 221 Diagnosis Mood Disorder Anxiety Disorder Adjustment Disorder Disruptive Behavior Disorder Attention Deficit Disorder Other 40.8% 16.5% 7.0% 20.3% 10.2% 5.2% 41.6% 14. 5% 5.5% 20% 10.5% 8.0% 39.1% 17.9% 2.9% 23.3% 12% 5.0% PTSD 11.6% 9.5% 13.6%
Functioning Levels of Children by Number of Events 1 2 or 3 4 or More CAFAS Total Score at Intake* 81.7 85.7 86.2 CAFAS Subscale Scores at Intake School Home Community* Behavior toward Others Moods and Emotions* Self Harm* Substance Use Thinking 18.3 16.5 2.6 17.8 18.7 3.9 1.6 2.3 18.1 16.9 4 18.4 18.9 5.7 1.7 1.9 17.8 16.2 3.5 18.3 19.9 5.7 2.3 2.7
What this means for CMH Practice Use of Electronic Health Record data Results identify some areas for further inquiry yet need more comprehensive assessments Opportunity for early intervention and prevention Trauma-Informed Services
Limitations Validity of the instrument Underreporting by parents Exposure to event does not equal trauma Unknown frequency and severity of trauma, unknown when trauma occurred Sample has limited generalizability to population (Wayne Count CMH s)
Future Questions What other factors influence referral to treatment and diagnosis? What is the relationship between exposure to the traumatic event and actually developing trauma-related symptoms? Does the trauma checklist impact treatment planning? Will reporting be more accurate if trauma checklist is done after a relationship has been established with the family? Are there any relationships between specific behaviors and type of events?