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Module 1 Resources: Understanding the Impact of Trauma

Websites and Online Materials

  1. ACEs Connection. The ACEs Connection is a community practice network. This practice network brings together members to share information on how to use trauma-informed practices to prevent ACEs & further trauma, and to increase resilience.
  2. ACEs primer - great five-minute video that explains ACE Study. What you should know about ACEs. KPJR Films produced a short video to introduce ACEs.
  3. A Conversation With the Psychologist Behind 'Inside Out'. Emotions expert Dacher Keltner, who advised director Pete Docter throughout the making of the new Pixar hit, dives deep into the science of emotion, and tells us how Inside Out could teach Western culture an important lesson.
  4. ACES Too High. Aces Too High is a news site that reports on research about adverse childhood experiences, including developments in epidemiology, neurobiology, and the biomedical and epigenetic consequences of toxic stress. News on how people, organizations, agencies and communities are implementing practices based on the research are highlighted. This includes developments in education, juvenile justice, criminal justice, public health, medicine, mental health, social services, and cities, counties and states.
  5. Addressing trauma as a health risk. Questions about smoking, seat belts or regular exercise are routine at a doctor's office, thanks to the overwhelming data showing that the lives we lead influence our overall health. But one insidious yet common risk factor is rarely addressed: living with trauma.
  6. The Adverse Childhood Experiences (ACE) study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego. More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.
  7. The Adverse Childhood Experiences Study website provides background information about the ACE study, an ACE score calculator, publications, answers to frequently asked questions and a way to connect to others.
  8. Adverse Child Experiences (ACE) score calculator. The ACE Score attributes one point for each category of exposure to child abuse and/or neglect. Add up the points for a Score of 0 to 10. The higher the score, the greater the exposure, and therefore the greater the risk of negative consequences. These consequences are discussed throughout the publications also available for download from the site.
  9. The Adversity Faced in Childhood That Has No Name. Huffington Post. You have heard of physical child abuse, sexual or emotional abuse, losing someone to incarceration or divorce, and others. But one adversity in particular has practically no awareness — Childhood Domestic Violence (CDV) -- which is when a child grows up living in a home with domestic violence.
  10. The Anna Institute. The Anna Institute celebrates and honors the life of Anna Caroline Jennings, by using her artwork and life experience to educate others on the hidden epidemic of childhood trauma and its horrific lifelong impact on society and paths to prevention and healing. This website provides links to articles, an art gallery, information about the ACE study, and more.
  11. Anxiety, Adversity and ACEs. strong>The research shows that 3 or more ACEs led to reporting more anxiety. Anxiety also seems to increase later in life with the additional stressor of life. Patrick Anderson discusses the links between ACEs and Anxiety.
  12. Breaking Through: Video and User's Guide to Understand and Address Toxic Stress. View Head Start National Center on Health’s 20-minute educational video to learn how toxic stress can impact a child’s lifelong health and well-being. Also, find out how Head Start programs and health care professionals can support children and families to help prevent toxic stress. The user-friendly guide shows how best to use this resource. It also includes a breakdown of the video segments by topic area.
  13. Center for Youth Wellness. The Center for Youth Wellness is part of a national effort to revolutionize pediatric medicine and transform the way society responds to kids exposed to significant adverse childhood experiences and toxic stress. Led by founder and CEO Dr. Nadine Burke Harris, the Center for Youth Wellness is a health organization within a pediatric home that serves children and families in the Bayview Hunters Point neighborhood of San Francisco. They were created to respond to an urgent public health issue: early adversity harms the developing brains and bodies of children.
  14. The Child Study Center, NYU Langone Medical Center. The Trauma and Resilience Research Program at the NYU Child Study Center is a national leader in the study and treatment of Post-Traumatic Stress Disorder (PTSD) and other trauma-related disorders among children, adults and families. Its mission is to develop effective intervention and prevention programs for those who are exposed to traumatic events and to understand the role of individual resiliency and community support in the process of recovery.
  15. Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal. The book by Donna Jackson Nakazawa shows the link between Adverse Childhood Experiences (ACEs) and adult illnesses such as heart disease, autoimmune disease, and cancer—it also explains how to cope with these emotional traumas and even heal from them. Donna Jackson Nakazawa shares stories from people who have recognized and overcome their adverse experiences, shows why some children are more immune to stress than others, and explains why women are at particular risk.
  16. Childhood Stress Linked to Serious Cardiovascular Impairment in Adulthood. A new study conducted by Finland researchers has revealed that early childhood stress could lead to a hardening of arteries or atherosclerosis in later adult life, a serious condition that can lead to heart attack, stroke, or even death.
  17. Childhood Trauma Increases Risk of Adult Mental Illness Because of Long-term Immune System Changes. The study found heightened inflammation across three blood biomarkers in adults who had been victims of childhood trauma. High levels of inflammation can lead to serious and potentially life-threatening conditions such as type-2 diabetes, cardiovascular disease as well as the onset of psychiatric disorders.
  18. The Children Taken from Home for a Social Experiment. BBC. In the 1950s, a group of Inuit children were taken from their families in Greenland to be re-educated as model Danish citizens. More than 60 years later, they want the Danish government to apologize for an experiment that did enormous damage.
  19. Domestic Abuse May Affect Children in Womb. Domestic violence can affect children even before they’re born, indicates new research by Michigan State University scientists. The study is the first to link abuse of pregnant women with emotional and behavioral trauma symptoms in their children within the first year of life. Symptoms include nightmares, startling easily, being bothered by loud noises and bright lights, avoiding physical contact and having trouble experiencing enjoyment.
  20. Effects of Early Life Adversity on Brain Growth Measured with Imaging. A new study shows how adverse experiences within the first six years of life lead to higher levels of childhood internalizing symptoms and variations in brain growth in adolescent males
  21. Explaining the Brain to Children and Adolescents. Dr. Allison Sampson Jackson draws from Dr. Dan Siegel, the Hawn Foundation, Joseph LeDoux and many others who have helped to understand the importance of knowing and sharing with others the ways in which the “upstairs” and “downstairs” brain impact our ability to learn and change behavior. This video combines the learning from these 3 sources to demonstrate in “layman’s” terms how to help ourselves, teens, and young children understand their upstairs and downstairs brains and what happens when we experience a threat. Dr. Jackson also highlights how calming strategies, such as mindfulness, impact the different parts of the brain.
  22. Facts on Traumatic Stress and Children with Developmental Disabilities. National Child Traumatic Stress Network (NCTSN). Adapted Trauma Treatment Standards Work Group. 2004. This document highlights facts on traumatic stress in children with developmental disabilities, including incidence of trauma, special characteristics of the population that influence trauma, possible reasons of higher incidence of mental illness, suggestions for modifying evaluation and therapy for this population, special diagnostic considerations, and suggestions for therapy.
  23. Family Wellness Warriors Initiative (FWWI). The Family Wellness Warriors Initiative (FWWI) seeks to address the devastating problems of domestic violence, abuse, and neglect in the Alaska Native community. Its purpose is to equip organizations and individuals to effectively address the spiritual, emotional, mental, and physical effects of domestic violence, abuse, and neglect. The Family Wellness Warriors Initiative targets the Alaska Native and American Indian populations of Alaska, but all individuals, regardless of race, gender, or religion are encouraged to apply for our events.
  24. Generation of Hope: Future of Native health depends on kids. Infant mortality among Wyoming’s native population is more than double that of white Wyoming. Professionals from a host of different disciplines, cultures and organizations are committed to improve health outcomes through understanding ACEs.
  25. How Childhood Trauma Can Make You a Sick Adult. The CDC-Kaiser Permanente Adverse Childhood Experiences Study found that survivors of childhood trauma are up to 5,000 percent more likely to attempt suicide, have eating disorders, or become IV drug users. Dr. Vincent Felitti, the study's co-founder, details this remarkable and powerful connection in a video produced by Big Think.
  26. Healing Neen – feature length. After surviving a childhood of abuse and neglect, Tonier “Neen” Cain lived on the streets for two nightmarish decades, where she endured unrelenting violence, hunger and despair while racking up 66 criminal convictions related to her addiction. Incarcerated and pregnant in 2004, treatment for her lifetime of trauma offered her a way out... and up. Her story illustrates the consequences that untreated trauma has on individuals and society at-large, including mental health problems, addiction, homelessness and incarceration. Today, she is a nationally renowned speaker and educator on the devastation of trauma and the hope of recovery.
  27. How the legacy of slavery affects the mental health of black Americans today. Events like Charleston put a spotlight on the growing body of literature that looks not only at the United States’ failure to have authentic conversations about slavery and its legacy but also at the mental health impact of forgiving acts of white racism and repressing justifiable feelings of anger and outrage – whether these are horrific acts of terrorism or nuanced microaggressions.
  28. How Trauma and Resilience Cross Generations. Genetics describes DNA sequencing, but epigenetics sees that genes can be turned on and off and expressed differently through changes in environment and behavior. Rachel Yehuda is a pioneer in understanding how the effects of stress and trauma can transmit biologically, beyond cataclysmic events, to the next generation. She has studied the children of Holocaust survivors and of pregnant women who survived the 9/11 attacks. But her science is a form of power for flourishing beyond the traumas large and small that mark each of our lives and those of our families and communities.
  29. Kids and Trauma: Science Trumps Handcuffs. Janet Rosenzweig discusses recent stories of children being placed in handcuffs for misbehaving.
  30. Letters from Death Row: The Biology of Trauma. TexasObserver. New studies show that trauma biologically alters the brains of young boys in ways that affect their adult behavior.
  31. Love, a Low Tech Solution: TED Talk by ACEs Connection Member Laura Peterson  After a decade of working with children suffering severe emotional health issues, Laura knew that conventional methods weren't making the kind of change she wanted to see. So, she set out to change that. Laura's big idea is to reach the world’s neediest and youngest children with the simplest, most cost-effective forms of healing available - love.
  32. Maltreated children’s brains show ‘encouraging’ ability to regulate emotions. Children who have been abused or exposed to other types of trauma typically experience more intense emotions than their peers, a byproduct of living in volatile, dangerous environments.
  33. Mental Health Surveillance Study: Correlates of Lifetime Exposure to One or More Potentially Traumatic Events and Subsequent Posttraumatic Stress among Adults in the United States. Forman-Hoffman VL, Bose J, Batts KR, Glasheen  C, Hirsch E, Karg RS, Huang LN, Hedden SL. SAMHSA, 2016, no pagination specified. Adults with exposure to one or more lifetime potentially traumatic events were more likely to be older, to be non-Hispanic/Latino white, to be veterans, or to have certain health conditions (asthma, high blood pressure, sinusitis, ulcer, anxiety, and depression).
  34. Nadine Burke Harris: How childhood trauma affects health across a lifetime 
    Childhood trauma isn't something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect, and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who've experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.
  35. NE Michigan Adverse Childhood Experiences Survey The most Common Form of Adversity: Emotional Abuse. Tina Marie Hahn shares the results of the Northeast Michigan Trauma-Informed Community Action Group's ACEs survey.
  36. PBS documentary -- "Raising of America: Early Childhood and the Future of Our Nation" This clip and blog found at ACEsConnection.com is taken from the documentary series that investigates PTSD among the urban population. The blog provides an opportunity to read about the series and find a screening near you.
  37. Poor Children experiencing Trauma early in life are at High Risk to become Adults with Poor Life Outcomes: Element of Play to the Rescue. This study tests the association between adverse childhood experiences (ACEs) and multidimensional well-being in early adulthood for a low-income, urban cohort, and whether a preschool preventive intervention moderates this association.
  38. Researchers Find Abuse, Neglect Cause Toxic Stress in Children. Years of research show that the maltreatment of children actually causes the brain to develop differently.
  39. SAMHSA – HRSA Center for Integrated Health Solutions: Trauma. The Substance Abuse and Mental Health Services Agency (SAMHSA)-Health Resources Services Administration (HRSA) Center for Integrated Health Solutions provides webinars and resources to help the general public understand what is trauma and how it can impact an individual.
  40. The Science of Suffering: Kids are inheriting their parents' trauma. Can science stop it? New Republic. November 16, 2014. This article highlights the trauma experienced by refuges, holocaust survivors, Native Americans, and other populations, and how their trauma has been passed on to the second generation. The article summarizes research that provides the scientific basis for this “transmission” of trauma and how it can help understand how trauma is passed on and why some individuals are more resilient than others.
  41. Trauma is a Gateway Drug. If drug use is a risk-taking factor, and we know that trauma is an indicator for premature risk taking, how can we start to change the direction of conversation to healing trauma.
  42. Strike a Pose to Build Confidence. Body language affects how others see us, but it may also change how we see ourselves. Social psychologist Amy Cuddy shows how “power posing” — standing in a posture of confidence, even when we don’t feel confident — can affect testosterone and cortisol levels in the brain, and might even have an impact on our chances for success. This TED talk provides helpful suggestions!
  43. Symptoms Of Menopause May Be Worse For Women Who Experience Verbal, Emotional Abuse. Abuse in all its forms is associated with adverse health outcomes — but can more recent abuse worsen menopause? A new study presented during this year’s annual meeting of The North American Menopause Society (NAMS) in Las Vegas may have proved that it could.
  44. Through the Eyes: Children, Violence, and Trauma. This video discusses how violence and trauma affect children, including the serious and long-lasting consequences for their physical and mental health; signs that a child may be exposed to violence or trauma; and the staggering cost of child maltreatment to families, communities, and the Nation. Victims lend their voices to this video to provide first-hand accounts of how their exposure to violence as children affected them.
  45. Trauma, Change and Resilience. In this TEDx Talk, Dr. Megan McElheran describes the changes that happen when an individual has a traumatic experience. She explores the concept of a pre-trauma world view and a post trauma world view with its shift in thinking, disconnection, and isolation as a means of control. She further explains the antidote to this isolation is re-engagement with connection, transformation, and finally healing. 
  46. Trauma experiences change the brain even in those without PTSD. Science Daily. Trauma may cause distinct and long-lasting effects even in people who do not develop PTSD, according to research. It is already known that stress affects brain function and may lead to PTSD, but until now the underlying brain networks have proven elusive.
  47. Trauma Measures Review Database. NCTSN. Consult the NCTSN database of reviews of tools that measure children's experiences of trauma, their reactions to it, and other mental health and trauma-related issues.
  48. Trauma: The Heart of the Matter. HuffingtonPost. When we read about sexual abuse and assault incidents in the news, what is often missing is information about the long-term impact of those experiences, particularly trauma.
  49. The Truth About ACEs. The Robert Wood Johnson Foundation is part of a growing network of leaders working to increase awareness and understanding of the impact of adverse childhood experiences (ACEs) and the need to develop effective innovative interventions. Learn more about ACEs and share the infographic with others.
  50. Why Do Some Poor Kids Thrive? Researchers tracked hundreds of students in Baltimore to find out what top achievers had that others didn’t. Despite the challenge of growing up in tough areas with few resources, thousands of inner city kids manage to excel academically. But even some students who seem to thrive early on run a significant risk of faltering on their quest for college degrees or the elite jobs they once envisioned. So what’s the deciding factor behind kids who meet their potential and those who wind up falling short?
  51. Who Needs to Pay Attention to the ACE Study? This blog from the Georgetown University National Technical Assistance Center for Children’s Mental Health provides background on the Adverse Childhood Experiences Study and recent publications about why it is important and what the implications are.
  52. Why Stress From Your Childhood Is Hurting Your Health Today + How To Heal. Scientists are breaking down, on a biochemical level, how stressors we face when we're young catch up with us when we're adults — predisposing us to autoimmune disease, heart disease, cancer, diabetes, migraines, and asthma.

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Downloadable Documents

  1. Assessing Trauma in Individuals with ID (PDF 1,3KB). The presentation slides from a webinar by Brian D. Tallant, LPC, Aurora Mental Health Center, Aurora, CO, hosted by the Association of University Centers on Disabilities (December 2014), highlight the prevalence and severity of abuse and neglect for people who have intellectual disabilities, diagnostic overshadowing of trauma symptoms, sources of particular vulnerability, and tools that are used to assess trauma in individuals with IDD.
  2. The Adverse Childhood Experiences (ACE) Study. Ness CD (2009). This brief discusses important aspects of the ACE study, including the definition of an ACE, how to calculate your ACE score, health conditions that are tied to ACE exposure, and how to address ACEs in child-serving systems.
  3. Adverse Childhood Experience (ACE) Questionnaire. This 10-item questionnaire was used to help study participants determine their ACE score. It has since been translated into French, German, Icelandic, Norwegian, Spanish, and Swedish.
  4. Adverse Childhood Experiences – Looking at how ACEs affect our Lives & Society (CDC) [Infographic]. The infographic shows how Adverse Childhood Experiences (ACEs) affect an individual’s life. From the data gathered, visual information about participant gender, race, age, education, and commonality are provided. Visuals on how ACEs affect health and society are provided.
  5. Adverse Childhood Experiences & Public Health in Washington: The Face of a Chronic Public Health Disaster. Results from the 2009 Behavioral Risk Factor Surveillance System. July 2, 2010. Washington State Policy Council. This report was prepared by Drs. Robert Anda and David Brown. Information about how ACEs have shaped the lives of children in Washington State is included in this report.
  6. Adverse Childhood Experiences in NSCAW. National Survey of Child and Adolescent Well-Being Research Brief. No. 20. OPRE Report #2013-26. Stambaugh LF et al. National Data Archive on Child Abuse and Neglect. United States. Administration for Children and Families. Office of Planning, Research and Evaluation. 2013. This brief uses data from the second cohort of National Survey of Child and Adolescent Well-Being (NSCAW II) to examine the prevalence of adverse childhood experiences in a nationally representative study of children reported for maltreatment to the child welfare system CWS.
  7. Adverse Childhood Experiences, Alcoholic Parents, and Later Risk of Alcoholism and Depression. Anda RF et al., Psychiatric Services. 2002;53:1001-1009. The study examined how growing up with alcoholic parents and having adverse childhood experiences are related to the risk of alcoholism and depression in adulthood. The study found that children in alcoholic households are more likely to have adverse experiences. The risk of alcoholism and depression in adulthood increases as the number of reported adverse experiences increases regardless of parental alcohol abuse.
  8. The Amazing Brain: Trauma and the Potential for Healing. Linda Burgess Chamberlain for the Institute for Safe Families. This infographic makes 5 main points: the child adapts to constant trauma, trauma interferes with learning, PTSD affects brain development, trauma leads to other health problems, and healthy relationships with caring adults can protect children from the effects of trauma.
  9. An Unhealthy Dose of Stress: The Impact of Adverse Childhood Experiences and Toxic Stress on Childhood Health and Development.
    This white paper is intended to be a resource as well as a call to action to promote the health and well-being of children by recognizing, preventing, and healing toxic stress in children exposed to ACEs. The paper provides background on toxic stress and its impact on early childhood development.
  10. Behavioral control blunts reactions to contemporaneous and future adverse events: Medial prefrontal cortex plasticity and a corticostriatal network. Maier S.F. 2014. Neurobiology of Stress. Recently, it has become clear that the experience of behavioral control over adverse events produces enduring changes that reduce the effects of subsequent negative events, even if they are uncontrollable and quite different from the original event controlled. This review focuses on the mechanism by which control both limits the impact of the stressor being experienced and produces enduring, trans-situational “immunization”. Importantly, the joint occurrence of control and adverse events seems to produce enduring plastic changes in the topedown inhibitory mPFC system such that this system is now activated by later adverse events even if they are uncontrollable, thereby reducing the impact of these events. Other issues are discussed that include a) whether other processes such as safety signals and exercise, that lead to resistance/resilience, also use the mPFC circuitry or do so in other ways; b) whether control has similar effects and neural mediation in humans, and c) the relationship of this work to clinical phenomena.
  11. The Body can Change the Score: Empirical Support for Somatic Regulation in the Treatment of Traumatized Adolescents. Warner, Spinazzola, Westcott, Gunn, Hodgdon, 2014, Journal of Child & Adolescent Trauma. Traumatized adolescents have pervasive problems with self-regulation and often have difficulties in language-based treatment models. This paper provides preliminary empirical support for the efficacy of Sensory Motor Arousal Regulation Treatment (SMART), a treatment model which targets somatic regulation as an avenue to behavioral and emotional regulation. A case vignette illustrates the intervention model. This pilot study suggests the contribution somatic regulation can make to stabilization and skills building in complex trauma treatment for adolescents
  12. Bruce Perry on Helping Children Recover from Trauma. September 5, 2013. This webinar was provided by the National Council for Behavioral Health. In this webinar, Dr. Perry discusses how trauma affects a young child’s brain neurodevelopment.
  13. CDC Morbidity and Mortality Weekly Report: Adverse Childhood Experiences Reported by Adults – Five States, 2009. This report provides the reader with statistics on adult reports of Adverse Childhood Experiences from five states-Arkansas, Louisiana, New Mexico, Tennessee, and Washington.
  14. Childhood maltreatment is associated with altered fear circuitry and increased internalizing symptoms by late adolescence. Proceedings of the National Academy of Sciences of the United States of America. Herringa RJ, Birn RM, Ruttle PL, Burghy CA, Stodola DE, Davidson RJ, et al. (2013). This study shows that maltreatment predicts lower prefrontal–hippocampal connectivity in females and males but lower prefrontal–amygdala connectivity only in females. Altered connectivity is shown to mediate the development of internalizing symptoms. The results highlight the importance of fronto–hippocampal connectivity for both sexes in internalizing symptoms following maltreatment. The additional impact on fronto–amygdala connectivity in females may help explain their higher risk for anxiety and depression.
  15. Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder. Proceedings of the National Academy of Sciences of the United States of America. Mehta D, Klengel T, Conneely KN, Smith AK, Altmann A, Pace TW, et al. (2013). This article discusses how epigenetic marks can be shaped by adverse childhood experiences. Epigenetics describes changes that occur in gene expression not because of changes in DNA sequence but because of other causes, such as the environment.
  16. Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. From the American Academy of Pediatrics Policy Statement. Pediatrics, 2012;129(1):e224-e231. The authors discuss how pediatricians can play a role in addressing childhood adversity, including screening children and families and educating families about the dangers of long-term toxic stress.
  17. The Effects of Childhood Stress on Health Across the Lifespan. CDC 2008. This report documents the ways that stress can affect a child’s physical and mental health. Strategies to screen, assess, and treat toxic stress in children are also presented.
  18. Gender Differences in the Longitudinal Impact of Exposure to Violence on Mental Health in Urban Youth. Zona K, Milan S. Journal of Youth Adolescence. 2011;40:1674-1690. This study discusses how violence impacts young men and women. This study found that although boys report more exposure to violence, girls that experienced violence were more likely to experience dissociative symptoms.
  19. Helping foster and adoptive families cope with trauma - American Academy of Pediatrics. This guide is targeted towards individuals who are either foster parents or adopting a child from the foster care system. It provides a guide on how to address toxic stress, how to identify trauma, and how to respond to trauma.
  20. Improving Care for Children Through Trauma Screening. Issue Brief No. 31, May 8, 2014. Child Health and Development Institute of Connecticut, Inc. This issue brief provides information about the prevalence of child trauma, screening for trauma, and addressing the consequences of trauma. Best practices are highlighted throughout the document.
  21. Life Events Checklist for DSM-5 (LEC-5). The Life Events Checklist for DSM-5 (LEC-5) is a self-report measure designed to screen for potentially traumatic events in a respondent's lifetime. The LEC-5 assesses exposure to 16 events known to potentially result in PTSD or distress and includes one additional item assessing any other extraordinarily stressful event not captured in the first 16 items.
  22. Parents' Pasts and Families' Futures – Using Family Assessments to Inform Perspectives on Reasonable Efforts and Reunification. Smithgall et al., 2012. This report describes the study conducted in partnership between the Illinois Department of Children and Family Services and the US Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. The study explores the relationship between parents’ childhood experiences and their current functioning as well as what caseworkers and clinicians see as the initial prognosis for these families and the reunification and reentry outcomes for their children.
  23. Recognizing resilience: Learning from the effects of stress on the brain. McEven, B.S., Gray, J.D., & Nasca, C. 2014. Neurobiology of Stress. As the central organ of stress and adaptation to stressors, the brain plays a pivotal role in behavioral and physiological responses that may lead to successful adaptation or to pathophysiology and mental and physical disease. In this context, resilience can be defined as “achieving a positive outcome in the face of adversity”. The goal is to recognize those biological changes that underlie flexible adaptability, and to recognize gene pathways, epigenetic factors and structural changes that indicate lack of resilience leading to negative outcomes, particularly when the individual is challenged by new circumstances. Early life experiences determine individual differences in such capabilities via epigenetic pathways and laying down of brain architecture that determine the later capacity for flexible adaptation or the lack thereof. Reactivation of such plasticity in individuals lacking such resilience is a new challenge for research and practical application. Finally, sex differences in the plasticity of the brain are often overlooked and must be more fully investigated.
  24. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study (http://www.theannainstitute.org/ACE%20folder%20for%20website/4RCH.pdf). Felitti VJ, et al., 1998. This is the original ACE study conducted by Drs. Vincent Felitti and Robert Anda. 17,000 Kaiser Permanente members answered questions about their adverse childhood experiences. The study found, among others, that if a person experienced 4 or more adverse childhood experiences, then they were more likely to have serious health problems such as heart disease and strokes.
  25. Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care. Pennsylvania Office of Mental Health and Substance Abuse Services. February 2006. This report provides information about the challenges of child trauma and how to address those challenges through trauma-informed care. Information about the characteristics of the child, trauma exposure, risk and protective factors, and consequences are discussed. The report also highlights trauma-informed care components, strength-based approaches, use of the public health model, and policy issues. 
  26. Review of Child and Adolescent Trauma Screening Tools.
    Crandal B. & Conradi L. (2013). Review of Child and Adolescent Trauma Screening Tools. San Diego, CA: Rady Children's Hospital, Chadwick Center for Children and Families.
  27. Self-Regulation and Toxic Stress: Foundations for Understanding Self-Regulation from an Applied Developmental Perspective (2MB). Murray DW, Rosanbalm K, Christopoulos C, and Hamoudi A. OPRE Report #2015-21, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services (2015). provides a comprehensive framework for understanding self-regulation in context, using a theoretical model that reflects the influence of biology, caregiving, and the environment on the development of self-regulation
  28. Services for Families of Infants and Toddlers Experiencing Trauma (3MB). This brief summarizes what is known about the impact of trauma on infants and toddlers, and the intervention strategies that could potentially protect them from the adverse consequences of traumatic experiences. Interventions that are highlighted support parents to provide the stable and nurturing caregiving that is responsive to the child’s general developmental needs and that promotes children’s sense of safety and security.
  29. Survey finds teen, young mothers using Crittenton services have alarmingly high ACE scores. 2012. This article highlights insights and experiences from Crittenton agencies, which serve teenage and young women, many of whom are pregnant or parenting. The teenage and young mothers who are Crittenton clients have experienced up to seven times the levels of childhood trauma of a normal population. This finding is discussed in relation to findings from the Adverse Childhood Experience Study.
  30. Trauma Assessment Measures.
    This document provides a list of measures that are brief, easy to administer and readily available to screen for trauma as well as additional measures that may be useful for further assessment, depending on the needs of a particular child and family.
  31. NEAR@Home Toolkit: A Guided Process to Talk about Trauma and Resilience in Home Visiting, ThriveWA.org   Home visitors are interested in bringing information about ACEs to families but worry about causing harm. The NEAR@Home toolkit addresses these concerns.
  32. Wisconsin Behavioral Risk Factor Survey - Draft Poverty and Neglect Survey Questions. This document contains a series of questions about poverty-related adverse experiences, including questions about hunger, homelessness, health care access, clothing, feeling safe and protected, number of caring adults, parental education, and single parenthood.
  33. The UCLA PTSD Reaction Index for DSM-V is a self-report questionnaire to screen for exposure to traumatic events and assess PTSD symptoms in school-age children and adolescents. The link provides access to a video and PowerPoint describing the administration and scoring of the UCLA PTSD Reaction Index for DSM-V.
  34. Understanding adolescent and family influences on intimate partner psychological violence during emerging adulthood and adulthood. Lohman BJ et al. Journal of Youth Adolescence. 2013;42:500-517. This study examined how psychological intimate partner violence is transmitted across generations.  The results show that exposure to parent–to–child psychological violence during adolescence is a key predictor of intimate partner violence throughout adulthood. In addition, negative emotionality and the number of sexual partners in adolescence predicted intimate partner violence in both emerging adulthood and adulthood.
  35. Understanding the Effects of Maltreatment on Brain Development (https://www.childwelfare.gov/pubs/issue_briefs/brain_development/brain_development.pdf).
    This issue brief from the Child Welfare Information Gateway provides information on the effects of abuse and neglect on brain development. The issue brief includes implications of brain development on trauma-informed practice and treatment. Understanding the neurobiology underlying challenging behavior, and the child’s individual experiences, are valuable tools in effectively treating the child.
  36. Understanding Toxic Stress in Young Children. Navsaria D. Healthy Child Care America. This slideshow discusses brain development during early childhood, factors that can influence brain development, and how to support the development of a child’s brain.
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Additional References

  1. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk (2014). Bessel van deer Kolk has spent over 3 decades working with survivors. In this book, he transforms our understanding of traumatic stress, revealing how it literally rearranges the brain's wiring - specifically areas dedicated to pleasure, engagement, control and trust. He shows how these areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies. Based on Dr. Van der Kolk's own research and that of other leading specialists, "The Body Keeps the Score” offers proven alternatives to drugs and talk therapy - and a way to reclaim lives.
  2. Breaking the links in intergenerational violence: an emotional regulation perspective. Siegel JP. Family Process. 2013; 52:163-178. This journal article focuses on emotion regulation as an approach to break the cycle of intergenerational trauma. The study calls for the use of a trauma-informed approach to screen and assess individuals with emotion regulation problems and explores approaches to treatment.
  3. Childhood Disrupted: How Your Biography Becomes Your Biology, And How You Can Heal  Donna Jackson Nakazawa shares stories from people who have recognized and overcome their adverse experiences, shows why some children are more immune to stress than others, and explains why women are at particular risk. Groundbreaking in its research, inspiring in its clarity, Childhood Disrupted explains how you can reset your biology—and help your loved ones find ways to heal.
  4. Childhood Trauma Questionnaire: A Retrospective Self-Report (CTQ).
    This page is a link to purchase the Childhood Trauma Questionnaire, to be used for children ages 12 and older.
  5. Factors Associated with Trauma and Posttraumatic Stress Disorder Among Homeless Youth in Three U.S. Cities: The Importance of Transience.
    Bender K et al. Journal of Traumatic Stress. 2010;23(1):161-168. This study examined correlates of trauma and PTSD among homeless youth with a focus on the impact of homeless culture, substance addiction, and mental health challenges. Results indicated that 57% of respondents had experienced a traumatic event and 24% had met the criteria for PTSD.
  6. Intergenerational Cycles of Trauma and Violence: An Attachment and Family Systems Perspective. Pamela C. Alexander. This book published in December 2014 explores the conditions under which children, as a function of their own abuse, become abusive themselves. That experiences from childhood affect our behavior in adulthood, especially in the ways we treat our children and intimate partners, is generally accepted. Indeed, theories of intergenerational transmission of violence indicate that if we ourselves have been abused and neglected as children, we will likely be abusive and neglectful to others close to us—thus extending the cycle across generations. However, many individuals who were maltreated as children do not replicate this cycle, and such models make little sense of the individual raised in a “good family” who is violent either as a child or as an adult. These discontinuities of cycles of violence and trauma have challenged professionals and nonprofessionals alike. However, broadening our vision and attending to new areas of research can help to illuminate this conundrum and open up new avenues of intervention. In this book, Pamela Alexander does just that.
  7. Intergenerational Transmission of Trauma: Exploring Mother-Infant Prenatal Attachment.
    Schwerdtfeger KL & Goff BSN. Journal of Traumatic Stress. 2007;20(1):39-51. This study explored the relationship between trauma and past parental attachment behaviors of 41 expectant mothers and the subsequent development of attachment and bonding with their unborn child. Results suggest that trauma history, in general, does not negatively impact expectant mothers' current prenatal attachment with their unborn child. However, interpersonal trauma history does appear to have negative effects on prenatal attachment. These results point to the importance of understanding the role of interpersonal trauma exposure on prenatal attachment
  8. Mitigating Intergenerational Trauma within the Parent-Child Attachment.
    Fried J. The Australian and New Zealand Journal of Family Therapy. 2012;33(2):114-127. Nine-year-old Ben was said to hate women. His mother was terrified he'd ‘grow up a woman basher’. This paper describes the work done with Ben and his family at the Hobart Child and Adolescent Mental Health Service using predominantly three therapeutic modalities: Theraplay, Family Attachment Narrative Therapy and Dyadic Developmental Psychotherapy. The work enabled Ben's mother to navigate the aftermath of her own trauma history in order to heal Ben's attachment trauma.
  9. Psychometric properties of the UCLA PTSD Reaction Index: Part I.
    Steinberg et al. Journal of Traumatic Stress. 2013;26:1-9. This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys.
  10. Psychometric properties of the UCLA PTSD Reaction Index. Part II.
    Investigating factor structure findings in a national clinic-referred youth sample. Elhai et al. Journal of Traumatic Stress. 2013;26:10-18. This study examined the underlying factor structure of the UCLA PTSD Reaction Index (PTSD-RI) using data from 6,591 children/adolescents exposed to trauma, presenting for treatment at any of 54 National Child Traumatic Stress Network (NCTSN) centers.
  11. Screening homeless youth for histories of abuse: Prevalence, enduring effects, and interest in treatment.
    Keeshin BR, Campbell K. Child Abuse and Neglect. 2011;35:401-407. The goal of this study was to identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse. Results showed histories of abuse are common among homeless youth and a majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse.
  12. Vulnerability and Resilience in Childhood Trauma and PTDS: Scott Cicero is co-author of the book chapter Vulnerability and Resilience in Childhood Trauma and PTSD in Post-traumatic Syndromes in Childhood and Adolescence which looks at clustering resilience and vulnerability factors into a classification system by groups as one approach to understanding these characteristics in the development of PTSD. Resilience and vulnerability characteristics in the development of PTSD are multifactorial, requiring an understanding of biological, environmental, psychological/developmental, and social variables. It is also critical to understand how previous experience, stressor-related features, and cognitive attributes contribute to the clinical presentation when working with these individuals.
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