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This assignment for a research class, you really need to be familiar with the concepts in order to answer the questions and find the answers from the article.

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Answer all the questions fully based on the other reading attached. This assignment for a research class, you really need to be familiar with the concepts in order to answer the questions and find the answers from the article. 

The format of the paper should be double-spaced, times new roman 12 font, 1 margin.

1) Indicate which article you chose to work with

2) Research Purpose (1 point):

 

What was the primary goal or purpose of this study? Please describe this using your own words.

 

3) Research Hypothesis (1 point):

 

What is/are the researchers’ hypothesis(s)?

 

4) Variables (4 points):

 

a) What are the primary independent variable(s) of interest in the study and how are they operationalized?

 

b) What are the dependent variable(s) and how are they operationalized?

 

5) Sampling (3 points):

 

Describe the sampling procedures and the study sample.  Your description should include:

 

a) What is the sample size?

b) What type of sampling was used – probability or non-probability? Describe the process they used to establish their sample.

c) Provide a general description of the study sample. (ie. important demographic characteristics)

 

6) Threats to validity (4 points):

 

a) Given the sampling procedures and research design, how generalizable are the findings (or too whom are the findings generalizable)? Does the author mention this in the conclusion? If so what do they say? Do you agree? If the authors do not mention this in the conclusion what do you think about the external validity of the findings?

 

b) What is one threat to internal validity that was controlled for and how was it controlled for?

 

7) Results (2 points):

 

a) What are the main results of the study? (Note: Please address the results for all the primary IVs and DVs)

 

8) Conclusions (3 points):

 

a) What do the authors state as the conclusions and implications of the study? Do you agree with the authors? Explain your reason for agreeing or disagree with the authors.

 

9) Limitations (2 Points)

 

a) What is one limitation of this study other than generalizability?

 

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Children and Youth Services Review 84 (2018) 110–117 Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth The impact of a statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma☆ T ⁎ Jessica Dym Bartletta, , Jessica L. Griffinb, Joseph Spinazzolac, Jenifer Goldman Fraserd, Carmen Rosa Noroñad, Ruth Bodiane, Marybeth Toddb, Crystaltina Montagnab, Beth Bartof a Child Trends, United States University of Massachusetts Medical School, United States c Trauma Center at Justice Resource Institute, United States d Child Witness to Violence Project, Boston Medical Center, United States e Massachusetts Department of Children & Families, United States f LUK, Inc., United States b A R T I C L E I N F O A B S T R A C T Keywords: Trauma Complex trauma Trauma-informed care Child welfare Child maltreatment Evidence-based treatment The current study examined the effectiveness of three trauma treatments in the context of a statewide, traumainformed child welfare initiative to improve outcomes for children with complex trauma. Clinicians enrolled 842 children (birth-18 years) involved in the child welfare system within the past year and administered measures at up to three time points (baseline, 6 months, 12 months) to assess children's behavior problems, symptoms of posttraumatic stress disorder (PTSD), and strengths and needs using parent/caregiver, youth, and clinician report measures. The results of four-level regression models specified to account for non-independence of observations within children, and among clinicians and within agencies, indicated that trauma treatment was associated with significant improvements in child behavior problems, PTSD symptoms, strengths, and needs. However, results differed by treatment model, with optimal outcomes for children receiving Attachment, SelfRegulation and Competency (ARC) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Positive findings across multiple child outcomes suggest that trauma treatment is an effective means of improving the developmental trajectories of children with complex trauma, but that each model has specific strengths and weaknesses that should be taken into account when selecting a treatment model for this population. 1. Introduction Child abuse and neglect is a widespread societal problem that often has devastating effects on children's development that persist into adulthood (Widom, Czaja, Bentley, & Johnson, 2012). In 2015, an estimated 4 million referrals for maltreatment were made to child protective services involving 7.2 million children (U.S. Department of Health & Human Services, n.d.). While individual child outcomes vary depending on the age of the child, the nature of the maltreatment, the relationship between the child and the perpetrator, and the balance of risk and protective factors in the child's life, research shows that the consequences of maltreatment can span multiple developmental domains and include negative alterations to brain structure and functioning, difficulties forming attachments, posttraumatic stress, internalizing and externalizing behaviors, and chronic health problems (Institute of Medicine & National Research Council, 2014; Leenarts, Diehle, Doreleijers, Jansma, & Lindauer, 2013). While in the child welfare (CW) system, children may endure additional experiences of separation and loss in foster care. These chronic, interpersonal adversities that begin early in life are often referred to as complex trauma, and are associated with impairments in biology, attachment, affect regulation, behavioral control, cognition, and self-concept (Kisiel, Fehrenbach, Small, & Lyons, 2009; Spinazzola et al., 2013). Not surprisingly, children in the CW system are considerably more likely to require mental health (MH) services compared to non-maltreated children (Yanos, Czaja, & Widom, 2010). Several therapeutic models have been developed to treat complex trauma and to promote positive developmental trajectories among maltreated children. Few have been rigorously evaluated, and they have shown varying levels of effectiveness (Leenarts et al., 2013). ☆ Acknowledgements: Funding provided by the Administration for Children and Families, Children's Bureau, Grant No. 90C01057. The Massachusetts Department of Children and Families served as the Principal Investigator. ⁎ Corresponding author at: 56 Robins Street, Acton, MA 01720, United States. E-mail address: jbartlett@childtrends.org (J.D. Bartlett). https://doi.org/10.1016/j.childyouth.2017.11.015 Received 31 July 2017; Received in revised form 11 November 2017; Accepted 12 November 2017 Available online 13 November 2017 0190-7409/ © 2017 Elsevier Ltd. All rights reserved. Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. derived from the intended usage indications, empirical evidence-base, and history of successful implementation of each model with children and caregivers within and across three contextual parameters: developmental stage, caregiver involvement and primary clinical presentation (Fraser et al., 2014). Clinicians administered assessments at baseline (i.e., onset of treatment), 6, 12, and 18 months, or until treatment was complete or treatment was terminated. The protocol took approximately 1 hour to administer, although the length of time varied depending upon whether youth were old enough (≥ 8 years) to complete self-report measures and whether parents or other caregivers opted to complete some of the measures while waiting for the session to begin. In the study sample, 44.89% (n = 378) children and youth received ARC, 35.99% (n = 303) received TF-CBT, and 18.76% (n = 158) received CPP. Children averaged 9.14 years at enrollment (SD = 4.66; Range = 0–18 years); ARC M(SD) = 10.25 (4.13), Range = 2–18 years; CPP M(SD) = 3.38 (1.53), Range = 0–7 years; and TF-CBT M(SD) = 10.69 (4.06), Range = 3–18. Over half of children (53.92%) were female. Approximately 4.35% were Hispanic, 70.31% were White, 18.65% were African-American, 1.7% were American Indian or Alaskan Native, 1.31% were Asian (others unknown); respondents were given the option to select as many categories and combinations of race/ethnicity as applied. Over one third (38.24%) were using psychotropic medication at baseline. Approximately 43.59% of children were in the legal guardianship of their parent and 38.12% were in state custody. Almost one quarter resided in foster homes (23.63%). The most common types of trauma they experienced were within the caregiving system (e.g., physical abuse, neglect, caregiver impairment; M = 5.2 out of 20 types) (http://www.nctsn.org/nctsn_assets/dcri/ NCTSN_CCDS_Trauma_DetailVersion_4Final%20.pdf, n.d.). Moreover, little is known about how they compare to one another in producing their intended outcomes. To our knowledge, only one study has been conducted previously comparing outcomes of different trauma treatments for children involved in the child welfare system. Weiner, Schneider, & Lyons (2009) compared three treatment models (ChildParent Psychotherapy [CPP], Trauma-Focused Cognitive Behavioral Therapy [TF-CBT], and Structured Psychotherapy for Adolescents Responding to Chronic Stress [SPARCS]), two of which are included in the current study (CPP and TF-CBT), and found they were equally effective in reducing symptoms and improving child functioning. However, this study was limited to children in out-of-home care, which represents less than one-quarter of children reported to child protective services (U.S. Department of Health & Human Services, n.d.). We examined the effects of three widely disseminated trauma treatments—Attachment, SelfRegulation, and Competency (ARC) (Kinniburgh, Blaustein, Spinazzola, & van der Kolk, 2005), Child-Parent Psychotherapy (Lieberman & Van Horn, 2004), and Trauma-Focused Cognitive Behavioral Therapy (Cohen, Mannarino, & Deblinger, 2006)—on children's functioning (PTSD symptoms; behavior problems; needs and strengths). Treatment models were selected based on promising research of their effectiveness with complexly traumatized children, the projects' commitment to providing treatment to children from birth to age 18, and the availability of trainers to provide technical assistance and training in each model. Treatment was provided through a statewide trauma-informed care initiative implemented in CW, the Massachusetts Child Trauma Project (MCTP). See Bartlett et al. (2016) and Fraser et al. (2014) for additional information on implementation and first-year outcomes. 1.1. The Massachusetts Child Trauma Project Multipronged, systemic efforts are essential to creating a traumainformed CW system that effectively addresses complex trauma, yet there are few statewide initiatives such as MCTP. Central to the MCTP approach is trauma-informed care (TIC) infused throughout the service delivery system. MCTP's goals were to: (a) improve identification and assessment of children exposed to complex trauma; (b) build MH services to deliver trauma-specific, evidence-based treatments and practices in community agencies serving CW involved children; (c) increase referrals of children to trauma treatment; and (d) increase caregivers' awareness and knowledge of child trauma. 2.2. Trauma treatment models Three cohorts of clinicians, each in different regions of the state, were trained from 2012 to 2014 (one cohort per year) to provide one or more of the trauma treatment models through Learning Collaboratives, which included face-to-face learning sessions, monthly telephone coaching calls, supervisor coaching calls, and senior leader sustainability calls. Clinicians began to offer treatment to children and youth following the basic training for each model and continued to provide treatment throughout the four-year implementation period (2012–2016), as clinically indicated. Additional details on the implementation of each model are provided below. 1.2. Current study The current study examined the effectiveness of three communitybased trauma treatments with CW involved children and youth. We assessed whether participation in treatment predicted positive child outcomes and compared outcomes by treatment model. We hypothesized that children and youth would exhibit more positive functioning, including reductions in PTSD symptoms, problem behaviors, and needs, and improvement in strengths following treatment. We also conducted an exploratory investigation of differential effects on child outcomes by treatment model. 2.3. Attachment, self-regulation, and competency (ARC) ARC is a comprehensive, clinical objectives-driven intervention framework for children and youth who have experienced complex trauma. It is grounded in attachment theory, the effects of childhood traumatic stress on development, and resilience building. ARC is guided by three integrative strategies, eight primary clinical targets or building blocks, and one overarching goal of trauma experience integration (Blaustein & Kinniburgh, 2010; Kinniburgh et al., 2005). It was designed for children and youth age 2–21 years; in MCTP it was offered to children 3–18 years of age. Clinicians were trained through a 12-month Learning Collaborative (LC). A randomized controlled trial (RCT) of ARC is underway, and several observational studies derived from program evaluation have shown that it is a promising, evidence-informed clinical intervention (Achenbach & Rescorla, 2001; Arvidson et al., 2011; Hodgdon, Kinniburgh, Gabowitz, Blaustein, & Spinazzola, 2013; Pynoos, Rodriguez, Steinberg, Stuber, & Frederick, 1998). 2. Method 2.1. Sample and procedures A total of 842 children in one of three trauma treatments participated in the evaluation. The study utilized a convenience sample. Clinicians (n = 323) were trained in one or more trauma treatment model and provided guidance on how to recruit eligible children: birth18 years, English or Spanish speaking who had families involved in the CW system within a year of referral to MH agencies. MH agencies with clinicians that offered more than one treatment model were trained to pair children and youth with a treatment model based on their age and individual needs. Guidelines for treatment model selection were 2.4. Child-Parent Psychotherapy (CPP) CPP is a long-term dyadic attachment-based treatment model developed for children from birth to five years old that address trauma as 111 Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. Table 1 Regression models examining change in posttraumatic stress symptoms (UCLA PTSD Index), by treatment model. Parent version Re-experiencing ARC TF-CBT Both Avoidance/numbing ARC TF-CBT Both Arousal ARC TF-CBT Both Severity ARC TF-CBT Both T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 Child version B SE −0.669 −1.818⁎ −0.966 ~ −2.417⁎⁎ −0.799⁎ −2.188⁎⁎⁎ −0.848 ~ −1.697 ~ −1.983⁎⁎⁎ −0.239 −1.340⁎⁎⁎ −0.954 −0.829⁎ −2.077⁎⁎⁎ −1.260⁎⁎ −0.733 −1.044⁎⁎⁎ −1.484⁎⁎ −2.402⁎ −5.553⁎⁎ −4.200⁎⁎ −3.626 ~ −3.201⁎⁎⁎ −4.719⁎⁎⁎ 0.456 0.819 0.554 0.916 0.358 0.616 0.511 0.915 0.595 0.986 0.391 0.671 0.360 0.634 0.418 0.693 0.279 0.475 1.041 1.860 1.326 2.190 0.841 1.443 p n ES B SE p n ES – 0.684 0.203 0.507 0.165 0.452 0.159 0.321 0.388 – 0.257 − 2.527⁎⁎⁎ − 3.584⁎⁎⁎ − 2.918⁎⁎⁎ − 2.817⁎⁎⁎ − 2.677⁎⁎⁎ − 3.266⁎⁎⁎ − 1.297⁎ − 2.931⁎⁎ − 2.928⁎⁎⁎ − 2.285⁎ − 2.068⁎⁎⁎ − 2.668⁎⁎⁎ − 1.700⁎⁎⁎ − 2.701⁎⁎⁎ − 1.843⁎⁎⁎ − 1.591⁎ − 1.726⁎⁎⁎ − 2.103⁎⁎⁎ − 5.359⁎⁎⁎ − 9.406⁎⁎⁎ − 8.279⁎⁎⁎ − 7.128⁎⁎⁎ − 6.725⁎⁎⁎ − 8.294⁎⁎⁎ 0.403 0.742 0.500 0.789 0.321 0.538 0.563 1.008 0.599 0.944 0.422 0.699 0.401 0.724 0.423 0.671 0.299 0.498 1.148 2.035 1.246 1.962 0.865 1.425 < 0.001 0.000 < 0.001 < 0.001 < 0.001 < 0.001 0.029 0.004 < 0.001 0.016 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.018 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 249 0.081 0.008 0.026 < 0.001 0.098 0.062 0.001 0.808 0.001 0.155 0.024 0.001 0.003 0.291 < 0.001 0.002 0.021 0.003 0.002 0.098 < 0.001 0.001 237 – 205 – 442 – 236 – 205 – 440 – 237 – 205 – 442 – 236 – 205 – 440 – 0.453 0.669 0.569 0.549 0.511 0.624 0.204 0.476 0.494 0.386 0.343 0.443 0.401 0.645 0.413 0.357 0.401 0.489 0.380 0.684 0.619 0.533 0.497 0.614 0.202 0.512 0.317 – 0.259 0.368 0.200 0.463 0.351 0.303 0.266 0.393 215 456 236 208 436 241 211 444 234 207 433 Note. B = unstandardized regression coefficient, SE = standard error, n = sample size, ES = effect size (Cohen's d). T2 = 6 months; T3 = 12 months. The symbol “–” indicates the sample size was too small to analyze. ⁎⁎⁎ p < 0.001. ⁎⁎ p < 0.01 ⁎ p < 0.05. ~ p < 0.01. in PTSD symptoms, depression, and behavior problems in youth, and reduced caregiver depression and increased competencies (Cary & Mcmillen, 2012). In MCTP, clinicians were trained through a 12-month LC and delivered treatment to children ages 3–18 years. it affects the parent-child relationship with explicit sensitivity to contextual factors that may affect that relationship. The goal of CPP is to support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child's MH and development. Therapeutic sessions involve the child and parent or primary caregiver together (Lieberman & Van Horn, 2004). In MCTP, CPP was delivered to young children 0–6 years of age and initially (first two of three cohorts) disseminated through a 12-month LC. In the third cohort, the training period increased to 18 months to accommodate new requirements from model developers for acquiring core knowledge and clinical competencies (assessment, reflective practice, bimonthly consultation). CPP has five RCTs showing reductions in behavior problems, PTSD symptoms, lower avoidance, resistance, and anger, as well as improvements in attachment security and maternal PTSD symptoms (http:// www.nctsnet.org/nctsn_assets/pdfs/promising_practices/cpp_general.pdf, n.d.; Lieberman, Ghosh Ippen, & Van Horn, 2006; Lieberman, Horn, & Ippen, 2005; Lieberman, Weston, & Pawl, 1991; Toth, Rogosch, Manly, & Cicchetti, 2006). 3. Measures 3.1. Child and family demographics We used project-developed survey questions to assess child age, sex, race, ethnicity, legal guardian, residence, referral source, and psychotropic medication use. 3.2. Childhood trauma exposure We assessed children's exposure to trauma using the General Trauma Information Form of the clinician-administered Core Clinical Characteristics (CCC) developed by the National Child Traumatic Stress Network (NCTSN) (Blaustein & Kinniburgh, 2010). Items on this form ask whether the child has experienced 20 different types of trauma (19 specified types and “other”): sexual maltreatment/abuse; sexual assault/rape; physical maltreatment/abuse; physical assault; emotional abuse; neglect; domestic violence; war/terrorism/political violence (inside U.S.); war/terrorism/political violence (outside U.S.); medical illness/trauma; serious injury/accident; natural disaster; kidnapping; traumatic loss/bereavement; forced displacement; impaired caregiver; extreme interpersonal violence; community violence; school violence; and other. Endorsements were summed to determine total number of trauma types experienced. No psychometric properties are available for this checklist. 2.5. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) TF-CBT is a components-based, phase-oriented, evidence-based treatment that incorporates elements of cognitive-behavioral, attachment, exposure therapy, and family therapy models to address the unique needs of trauma-affected children.11(p32) TF-CBT has been used successfully to treat children with a variety of trauma experiences, including complex trauma (Cohen, Mannarino, Kliethermes, & Murray, 2012). TF-CBT components are summarized by the acronym PRACTICE: Psychoeducation and Parenting skills, Relaxation, Affective regulation, Cognitive coping skills, Trauma Narration, In vivo mastery, Conjoint child-parent sessions, and Enhancing Safety and Future Development.11(p33) TF-CBT is the most rigorously tested trauma treatment for children, with over 21 RCTs to date, showing significant reductions 112 Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. Table 2 Regression models examining change in trauma symptomology (YCPC), by treatment model. Re-experiencing ARC CPP TF-CBT All Avoidance/ numbing ARC CPP TF-CBT All Arousal ARC CPP TF-CBT All Functional impairment ARC CPP TF-CBT All Severity ARC CPP TF-CBT All T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 B SE p n ES − 1.820⁎ − 0.537 − 0.138 − 1.218 − 0.099 − 4.102⁎⁎ − 0.730~ − 1.897⁎ − 2.363⁎⁎ − 1.710 − 0.215 1.088 − 1.687⁎ − 3.301⁎ − 1.357⁎⁎ − 1.845⁎ − 1.493⁎ 1.305 − 1.272~ − 2.728~ − 3.164⁎⁎⁎ − 4.578⁎⁎⁎ − 1.792⁎⁎⁎ − 1.631~ − 3.549⁎⁎⁎ 1.040 − 2.264⁎⁎ − 1.236 − 3.010⁎ − 4.344⁎ − 2.879⁎⁎⁎ − 1.571 − 5.625⁎⁎ − 1.475 − 1.606 − 2.347 − 4.905⁎ − 11.913⁎⁎⁎ − 3.775⁎⁎⁎ − 5.355⁎ 0.797 1.445 0.547 1.316 0.902 1.464 0.435 0.854 0.867 1.558 0.645 1.571 0.844 1.335 0.488 0.942 0.702 1.322 0.667 1.634 0.734 1.191 0.431 0.854 0.979 1.839 0.770 1.981 1.280 1.993 0.572 1.140 2.026 3.586 1.641 3.953 2.141 3.394 1.159 2.231 0.022 0.710 0.801 0.354 0.912 0.005 0.094 0.026 0.006 0.272 0.738 0.489 0.046 0.013 0.005 0.050 0.033 0.324 0.057 0.095 < 0.001 < 0.001 < 0.001 0.056 < 0.001 0.572 0.003 0.533 0.019 0.029 < 0.001 0.168 0.006 0.681 0.328 0.553 0.022 < 0.001 0.001 0.016 118 0.353 – – – – 0.689 0.134 0.349 0.471 – – – 0.315 0.617 0.276 0.376 0.320 – 0.251 0.538 0.614 0.889 0.361 0.328 0.539 – 0.347 – 0.448 0.647 0.433 – 0.456 – – – 0.332 0.808 0.283 0.402 142 76 336 117 136 75 328 117 141 76 334 117 144 76 335 115 132 74 321 Table 3 Regression models examining changes in child behavior (Child Behavior Checklist), by treatment model. Internalizing ARC CPP TF-CBT All models Externalizing ARC CPP TF-CBT All models Total Problems ARC CPP TF-CBT All models T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 T2 T3 B SE p n ES − 4.806⁎⁎⁎ − 8.150⁎⁎⁎ − 4.280⁎ − 2.293 − 4.489⁎⁎⁎ − 4.171⁎⁎⁎ − 4.675⁎⁎⁎ − 5.817⁎⁎⁎ − 3.319⁎⁎⁎ − 4.620⁎⁎⁎ − 3.502 ~ − 2.108 − 3.608⁎⁎⁎ − 4.654⁎⁎⁎ − 3.553⁎⁎⁎ − 4.328⁎⁎⁎ − 4.409⁎⁎⁎ − 6.370⁎⁎⁎ − 3.941⁎ − 3.966 − 4.276⁎⁎⁎ − 4.782⁎⁎⁎ − 4.428⁎⁎⁎ − 5.482⁎⁎⁎ 0.828 1.502 0.000 0.000 0.787 1.294 0.566 1.016 0.760 1.393 1.933 4.617 0.872 1.432 0.575 1.038 0.769 1.402 1.803 4.310 0.825 1.355 0.560 1.007 < 0.001 < 0.001 0.013 0.579 < 0.001 0.001 < 0.001 < 0.001 < 0.001 0.001 0.070 0.648 < 0.001 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.029 0.357 < 0.001 < 0.001 < 0.001 < 0.001 353 0.452 0.766 0.377 – 0.498 0.463 0.453 0.563 0.297 0.413 0.263 – 0.343 0.442 0.311 0.379 0.422 0.611 0.319 – 0.471 0.526 0.424 0.525 138 279 770 353 138 279 770 353 138 279 770 Note. B = unstandardized regression coefficient, SE = standard error, n = sample size, ES = effect size (Cohen's d). T2 = 6 months; T3 = 12 months. ⁎⁎⁎ p < 0.001. ⁎ p < 0.05. ~ p < 0.01. Symptom frequency in the past two weeks is rated on a 4-point Likert scale; for Functional Impairment symptoms, caregivers indicate the extent to which each symptom “gets in the way.” Suggested cutoff scores are ≥ 26 (“probable diagnosis”) and ≥ 4 (“functional impairment”). The YCPC symptom items have demonstrated good test-retest reliability and predictive validity in a clinical interview format (Scheeringa, n.d.). Several items have questionable applicability for children under the age of three; accordingly, findings for children in the lower age limit are considered exploratory (Scheeringa, 2017). Note. B = unstandardized regression coefficient, SE = standard error, n = sample size, ES = effect size (Cohen's d); T2 = 6 months; T3 = 12 months. ⁎⁎⁎ p < 0.001. ⁎⁎ p < 0.01. ⁎ p < 0.05. ~ p < 0.10. 3.5. Child behavior problems To assess behavioral problems, we used the parent/caregiver report on the Child Behavior Checklist (CBCL), including the preschool version for children 1.5–5 years (Achenbach & Rescorla, 2001) and the schoolage version for children aged 6–18 years (Achenbach & Edelbrock, 1983). The CBCL is a standardized measure of children's behavioral problems with good psychometric properties (e.g., reliability, convergent and discriminative validity of scales; Chronbach's alpha = 0.71 for somatic problem items and 0.89 for conduct problem items) (Nakamura, Ebesutani, Bernstein, & Chorpita, 2009) consisting of 113 items scored on a 3-point scale. Subscales include Internalizing, Externalizing, and Total Problem Behaviors (cutoff = 63). 3.3. PTSD symptoms in older children To assess trauma among older children (aged 7–18), we used the University of California, Los Angeles Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) (Pynoos et al., 1998). The measure is a 48-item semi-structured interview assessing child exposure to 26 types of trauma and DSM-IV PTSD diagnostic criteria. The Parent Version was used for children < 8 years; both the Child and Parent Versions were used for children 8–18 years. The PTSD-RI has good psychometric properties (e.g., Chronbach's alpha = 0.90; test-retest inter-item agreement = 94%; intra-class correlation coefficient = 0.93) (Steinberg, Brymer, Decker, & Pynoos, 2004). 3.6. Child/youth needs and strengths Type and severity of clinical and psychosocial factors impacting treatment decisions and outcomes were assessed via provider report on the Child and Adolescent Needs and Strengths–Mental Health (CANSMental Health) (Lyons, 1999). Needs and strengths are rated on a 3point scale. Subscales include: Life Domain Functioning, Better Behavior and Fewer Emotional needs, Fewer Risk Behaviors, Greater Child Strengths/Resources, and Greater Caregiver Strengths/Resources. Clinicians also completed two modules of the CANS-Trauma Comprehensive (CANS-Trauma)(Kisiel et al., 2011): Characteristics of Trauma 3.4. PTSD symptoms in young children The 42-item Young Child PTSD Checklist (YCPC) (Scheeringa, n.d.), a caregiver report questionnaire, assessed PTSD stress symptoms and functional impairment in children ages 1–6 years (trauma exposure was assessed separately, as described above). The YCPC comprises items from the Diagnostic and Statistical Manual of Mental Disorders (DSMV) and from empirical studies of traumatic stress in young children. 113 Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. Table 4 Regression models examining change in children's strengths and needs (CANS), by treatment model. Time Point Life domain functioning ARC CPP TF-CBT All Child behavior and emotional needs ARC CPP TF-CBT All Child risk behaviors ARC CPP TF-CBT All Child strengths ARC CPP TF-CBT All Caregiver resources & needs ARC CPP TF-CBT All Trauma characteristics ARC CPP TF-CBT All Trauma adjustment ARC CPP TF-CBT All T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 T2 T3 T2 T2 T3 T2 T3 Young children Youth B SE p n ES B SE p n ES −2.588⁎ – −2.523⁎⁎ −2.956⁎ – −2.489⁎⁎⁎ – −3.268⁎⁎⁎ – −2.021⁎⁎⁎ −2.762⁎ – −2.137⁎⁎⁎ – −1.845⁎⁎⁎ – −0.706⁎ −1.995⁎⁎ – −0.899⁎⁎ – −0.193 – −0.933~ −0.760⁎ – −0.763⁎ – 0.482⁎ – −0.737~ 0.437 – −0.573 – 3.071⁎ – 0.120 −0.455 – 0.567 – −2.117⁎ – −0.648~ −1.931⁎ – −0.995⁎⁎ – 1.190 – 0.726 1.181 – 0.573 – 0.713 – 0.525 1.127 – 0.439 – 0.434 0.030 – 0.001 0.012 – < 0.001 – < 0.001 – < 0.001 0.014 – < 0.001 – < 0.001 0.030 0.002 – 0.001 – 0.833 – 0.060 0.030 – 0.040 – 0.017 – 0.077 0.552 – 0.101 – 0.020 – 0.865 0.815 – 0.379 – 0.015 – 0.057 0.012 – 0.002 – 0.465 – 0.397 0.504 – 0.406 – 0.742 – 0.455 0.511 – 0.465 – 0.677 – 0.329 0.640 – 0.376 – – – 0.208 0.224 – 0.184 – – – 0.257 – – 0.200 – 0.874 – – – – – – 0.912 – 0.300 0.633 – 0.424 – − 0.634⁎⁎ − 1.047⁎ 0.177 − 1.321⁎⁎⁎ − 2.374⁎⁎⁎ − 0.909⁎⁎⁎ − 1.556⁎⁎⁎ − 0.664⁎⁎ − 0.792⁎ − 1.470⁎ − 1.933⁎⁎⁎ − 2.533⁎⁎⁎ − 1.202⁎⁎⁎ − 1.507⁎⁎⁎ − 0.613⁎⁎ − 0.842⁎ − 1.346⁎ − 0.802⁎⁎ − 1.176⁎ − 0.679⁎⁎⁎ − 0.911⁎⁎ − 0.846⁎⁎ − 0.765 0.804 − 1.156⁎⁎ − 2.242⁎⁎⁎ − 0.913⁎⁎⁎ − 1.324⁎⁎ − 0.104 0.111 0.640 − 0.310 − 0.457 − 0.147 − 0.024 − 1.550⁎⁎⁎ − 1.579⁎⁎ − 1.354⁎ − 1.707⁎⁎⁎ − 2.362⁎⁎ − 1.596⁎⁎⁎ − 1.907⁎⁎⁎ − 0.785⁎⁎⁎ − 1.427⁎⁎⁎ − 0.705 − 0.875⁎⁎⁎ − 1.519⁎⁎⁎ − 0.814⁎⁎⁎ − 1.435⁎⁎⁎ 0.241 0.430 0.928 0.302 0.548 0.187 0.337 0.215 0.375 0.623 0.295 0.532 0.173 0.308 0.199 0.347 0.604 0.266 0.478 0.157 0.278 0.292 0.517 1.192 0.356 0.643 0.223 0.401 0.197 0.352 0.508 0.275 0.512 0.159 0.290 0.326 0.589 0.588 0.373 0.686 0.238 0.435 0.146 0.263 0.480 0.169 0.316 0.108 0.198 0.009 0.015 0.862 < 0.001 < 0.001 < 0.001 < 0.001 0.002 0.035 0.014 < 0.001 < 0.001 < 0.001 < 0.001 0.002 0.015 0.025 0.003 0.014 < 0.001 0.001 0.004 0.139 0.593 0.001 < 0.001 < 0.001 0.001 0.599 0.750 0.648 0.261 0.371 0.355 0.934 < 0.001 0.007 0.014 < 0.001 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.131 < 0.001 < 0.001 < 0.001 < 0.001 349 0.325 0.631 – 0.274 – 0.915 – 0.496 0.350 – 0.372 – 0.202 – 0.416 0.734 – 0.349 – 1.317 – 0.713 1.942 – 0.644 – 0.867 – 0.340 0.766 – 0.319 – 27 – 97 16 – 140 – 26 – 97 16 – 139 – 26 – 96 16 – 138 – 26 – 95 16 – 137 – 26 – 96 16 – 138 – 26 – 92 16 – 134 – 26 – 94 16 – 136 – 0.152 0.250 – 0.318 0.570 0.220 0.376 0.182 0.217 0.500 0.513 0.672 0.327 0.410 0.166 0.228 0.521 0.222 0.326 0.187 0.251 0.191 – – 0.238 0.461 0.197 0.286 – – – – – – – 0.260 0.265 0.268 0.288 0.399 0.269 0.322 0.351 0.640 – 0.418 0.726 0.376 0.662 34 278 662 348 34 278 661 348 34 278 661 349 34 278 662 344 33 278 651 347 30 274 652 345 31 271 648 Note. B = unstandardized regression coefficient, SE = standard error, n = sample size, ES = effect size (Cohen's d). T2 = 6 months; T3 = 12 months; “–” indicates the sample size was too small to analyze; T3 CPP outcomes were not analyzed due to small sample size. ⁎⁎⁎ p < 0.001. ⁎⁎ p < 0.01. ⁎ p < 0.05. ~ p < 0.10. assessments; fewer completed 12-month assessments (e.g., 438 caregivers completed the baseline measure of older children's trauma symptoms, and 49 caregivers completed a 12-month assessment; 343 caregivers completed the baseline measure of young children's trauma symptoms, and 23 caregivers completed the 12-month assessment). Given that both ARC and TF-CBT are typically shorter-term interventions, this type of missingness was expected for these models, though not for CPP, a considerably longer intervention. We fit models for each outcome, by treatment model and across treatment models. We did not analyze 12-month outcomes on the CANS for CPP, as the sample size was too small. Covariates included child age and sex, total trauma types, psychotropic medication use (yes/no), and custody status (parent, other adult, state, other). Effect sizes (ES) represent the effect Experience (type, closeness to perpetrator, frequency, duration, force) and Adjustment to Trauma (reaction to potentially traumatic/adverse experiences). The manual states that items represent targets of intervention, and traditional psychometrics may not apply. However, at least one study found support for validity of the subscales as outcomes (Alamdari & Kelber, 2016). 4. Analytic plan For each outcome, four-level regression models were specified to account for non-independence of observations within children (repeated assessments), and among clinicians and within agencies. Few children completed 6-month assessments compared to baseline 114 Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. 5.5. Child and adolescent needs and strengths of a one unit standard deviation change in the outcome for a unit change in time. Given a high rate of clinician turnover and non-response (40% of discharge assessments were missing), we used maximum likelihood estimation (ML) to address missing data. To ensure that selection of ML was a reasonable approach, we conducted sensitivity analyses comparing ML results to complete-case analysis on a selection of outcomes; the effects were similar in direction and magnitude, but ML offered more power to detect significant effects, reducing Type II error. Results from the CANS (YCANS, OCANS, CANS-Trauma) are presented in Table 4. Clinicians reported that young children exhibited significant improvements in Life Domain Functioning, Behavior/Emotional Needs, and Child Strengths at 6 months. ARC and TF-CBT clinicians reported improvements in Life Domain Functioning, Behavior/ Emotional Needs, Child Risk Behaviors, and Caregiver Strengths/Resources at 6 months. On the OCANS, clinicians indicated improvements in children's Life Domain Functioning, Behavior/Emotional Needs, Child Risk Behaviors, and Child Strengths/Resources at 6 and 12 months. Findings were comparable for TF-CBT. Results for ARC were significant for Life Domain Functioning, Behavior/Emotional Needs, and Child Risk Behaviors at both time points, and for Child Strengths/ Resources at 6 months. Children in CPP showed improvements in Behavior/Emotional Needs and Child Risk Behaviors at 6 months. Across models, young children showed improved Trauma Adjustment and Trauma Characteristics at both time points. However, those in ARC had fewer Trauma Characteristics at 6 months compared to baseline. Children in ARC and TF-CBT had better Trauma Adjustment at 6 months and fewer Trauma Characteristics and better Trauma Adjustment at both time points. Children in CPP showed fewer Trauma Characteristics at 6 months. 5. Results 5.1. Participation in treatment The average number of sessions for all models combined was approximately 27 sessions (n = 354; M = 26.83; SD = 24.60; Range = 1–185). Children in CPP averaged 16 sessions (n = 49; M = 16.00; SD = 20.33; Range = 2–123), children in TF-CBT averaged 21 sessions (n = 132; M = 21.14; SD = 15.82; Range = 1–91), and children in ARC averaged 29 sessions (n = 173; M = 33.31; SD = 29.20; Range = 2–185). 5.2. PTSD symptoms–youth 6. Discussion Results for the UCLA PTSD Index are presented in Table 1. Parents reported that children had less severe PTSD symptoms, arousal, and reexperiencing symptoms from baseline to 6 and 12 months, regardless of model. They reported less severe avoidance/numbing symptoms at 6 months. ARC parents reported less severe symptoms at both follow-up time points; TF-CBT parents reported less severe symptoms among children and youth at 6 months. Engagement in each treatment predicted fewer re-experiencing symptoms at 12 months. Parents/caregivers with children in TF-CBT reported significantly fewer avoidance/numbing symptoms at 6 months. Those with children in ARC and TF-CBT indicated reductions in arousal symptoms at 6 months; children in ARC had reduced symptoms at 12 months (see Table 1). Youth (8–18 years) reported a decrease in symptom severity, reexperiencing, avoidance/Numbing, and arousal symptoms from baseline to both follow-up time points. ARC and TF-CBT youth reported reductions in re-experiencing, avoidance/numbing, and arousal symptoms at 6 and 12 months. In the current study, we hypothesized that trauma treatment would have substantial benefits for children and youth in the CW system, including improvements in posttraumatic stress, behavior problems, needs, and strengths. Trauma treatment predicted positive child/youth outcomes across multiple domains, as reported by multiple sources: youth, parents/caregivers, and clinicians. By 6 months, we found reductions in parent/caregiver and youth reported symptoms of PTSD, improvements in parent/caregiver reported child behavior problems and improvements in strengths and needs of children/youth for both younger and older children. At 12 months, the association between trauma treatment and symptomatology were less consistent, with positive findings only for avoidance/numbing symptoms. This may be explained in part by high clinician turnover and/or family attrition, resulting in small sample sizes. Alternatively, children who remained in treatment 12 months may have experienced challenges (e.g., less successful therapy; complex/severe clinical issues). Family members also may not have revealed symptoms until they established trust with clinicians and understood experiences as symptoms of trauma. It is also possible that the positive effects of treatment diminish over time. 5.3. PTSD symptoms–young children 6.1. Differences by treatment model Parent/caregiver report on the YCPC overall indicated improvements in young children's symptom severity and avoidance/numbing at 6 and 12 months, and in arousal and functional impairment at 6 months. Children in ARC had less severe symptoms at 6 and 12 months for re-experiencing, avoidance/numbing, arousal symptoms, and functional impairment at 6 months. Children in TF-CBT had significantly reduced avoidance/numbing symptoms, arousal symptoms, and functional impairment. Functional Impairment at both time points, and for re-experiencing symptoms at 12 months. Children in CPP had less Functional Impairment at 6 months (Table 2). A unique feature of this study is that we examined findings across three trauma treatments: ARC, CPP, and TF-CBT. Results demonstrated that ARC and TF-CBT predicted significant reductions in child behavior problems across all domains at both time points. Positive findings for CPP were found for Internalizing and Total Problem Behaviors at 6 months. We also found differential effects on symptoms of PTSD. At 6 and 12 months, youth in ARC and TF-CBT had better outcomes for re-experiencing, arousal, and severity. Only TF-CBT was associated with improvements in avoidance/numbing. Parents/caregivers of older children reported fewer improvements than youth. Perhaps their positive internal experiences were not easily detectable, or adults may have had a lower threshold for their symptoms. Results for younger children were mixed. Children in ARC and TFCBT exhibited less avoidance/numbing, arousal, and functional impairment at 6 months, and those in ARC had fewer re-experiencing symptoms, but CPP treatment predicted only reduced Functional 5.4. Child behavior problems Across models, children had fewer Total Problem, Internalizing, and Externalizing Behaviors from baseline to both follow-up time points, as did children ARC and TF-CBT separately. Children in CPP experienced fewer Total Problem and Internalizing Behaviors by 6 months (Table 3). 115 Children and Youth Services Review 84 (2018) 110–117 J.D. Bartlett et al. behaviors, and functioning, and used multiple informants (http:// www.nctsn.org/trauma-types/complex-trauma/assessment, n.d.). Positive findings across multiple child outcomes suggest that trauma treatment is an effective means of improving the developmental trajectories of children in the CW system with complex trauma, but that each model may have strengths and weaknesses. More rigorous examination utilizing a control group would be useful for verifying these differences and further specifying variation in outcomes among the treatment models. The results of this study suggest that both ARC and TF-CBT are worthy of federal, state, and local investments to improve the adjustment of children exposed to trauma and to decrease the likelihood of poor functioning later in life—moving beyond a focus on child safety and permanency to include an emphasis on child wellbeing. Despite our findings, CPP has undergone rigorous study and found to be effective in reducing behavior problems, PTSD symptoms, and attachment security (http://www.nctsnet.org/nctsn_assets/pdfs/ promising_practices/cpp_general.pdf, n.d.; Lieberman et al., 1991; Lieberman et al., 2005; Lieberman et al., 2006; Toth et al., 2006). Additional research is needed to inform treatment with young children, particularly infants and toddlers, and to identify the most salient outcome measures during this developmental period (Jones Harden, n.d.). Furthermore, a cost-benefit analysis by treatment model and developmental stage would be important to determining how best to allocate funding for treatment among children and youth in the child welfare system. Finally, future research on the mechanisms that underlie successful treatment (moderators and mediators) would be useful for understanding key characteristics of treatment (e.g., dosage, fidelity), families, and their environments (e.g., risk and protective factors) that promote resilience among children with complex trauma. Nevertheless, the current study findings add to a growing body of literature that strongly suggests the need for trauma-focused policies and practices, such as trauma screening upon entry into CW, and funding to support a trauma-informed child welfare and mental health services.6(p14) Such steps will be essential to building responsive service systems that promote healing and recovery in this highly vulnerable population. Impairment. At 12 months, only TF-CBT was associated with decreased symptoms of PTSD. Findings on children's strengths and needs similarly varied by model. Clinicians reported that young children improved in Life Domain Functioning, Behavior/Emotional Needs, and Risk Behavior at 6 months. Children's Adjustment to Trauma improved for those in ARC and TF-CBT, but only children in TF-CBT had improvements in strength and resources. Results for older children were similar, except that clinicians across models reported significantly fewer trauma characteristics, and children in both ARC and TF-CBT had greater Strengths/ Resources. Only children in TF-CBT had greater Child Strengths/ Resources. None of the treatments had significant findings for Caregiver Strengths/Resources Trauma Characteristics at 12 months. It is possible that treatment did not influence such outcomes, yet positive findings on other measures completed by caregivers and youth suggest this is not the case. Perhaps clinicians continued to identify trauma symptoms and family problems to justify continued service provision. Overall, the most pronounced improvements were among children in ARC and TFCBT. 6.2. Study limitations There are several study limitations that warrant consideration when interpreting our findings. First, the study did not use an experimental design or a comparison group, and we cannot attribute causality. A second challenge was the high level of turnover in MH agencies. While turnover is common in the field (Morse, Salyers, Rollins, MonroeDeVita, & Pfahler, 2012), the fact that many clinicians did not complete discharge assessments with families is problematic. We used appropriate statistical methods to account for missing data, yet findings still may over-represent children served by clinicians who remained with their agencies while underrepresenting children who terminated when clinicians left their agencies. Third, because only CPP was appropriate for children under age three, some sample sizes were too small for analysis. The absence of significant findings for CPP also may have other explanations, such as insufficient dosage. Most families participated in fewer than the 20–32 sessions recommended by model developers (M = 16 sessions) (Lieberman & Van Horn, 2004). In addition, over half (56%) of children in CPP were age three or younger (versus 3% and 1% in ARC and TF-CBT, respectively). Perhaps the YCPC captured symptom expression in children 3–6 years but overlooked symptom expression in younger children. A study is currently underway to investigate these issues further. Cost and feasibility issues also precluded the use of caregiver-child relationship measures (Crowell & Feldman, 1988), which may have been more appropriate for assessing CPP outcomes. Implementation changes in CPP training during the project also may have affected the results. Therefore, we recommend caution when interpreting results that include children ages birth to three. Another limitation is that we were not able to assess inter-rater reliability among clinicians, who may have differed in their approach to administering study measures. Evaluators did, however, take steps to address this issue, including: conducting a two-hour training for clinicians on the measures prior to the study, offering guidance on monthly consultation calls, and providing ongoing support through a dedicated email address. Finally, the fact that MH clinicians administered the measures during treatment rather than researchers reduced the study burden for families, but introduces potential reporter bias. In addition, as we did not utilize a measure of fidelity, we cannot be certain that the models were consistently implemented as intended. References Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist and revised behavior profile. Burlington: University of Vermont Department of Psychiatry. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. Alamdari, G., & Kelber, M. S. (2016). The child and adolescent needs and strengths as an outcome measure in community mental health: Factor analysis and validation of the short form. Community Mental Health Journal, 52(8), 1118–1122. Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., ... Blaustein, M. E. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child and Adolescent Trauma, 4(1), 34–51. Bartlett, J. D., Barto, B. L., Griffin, J. L., Fraser, J. G., Hodgdon, H., & Bodian, R. (2016). Trauma-informed care in the Massachusetts Child Trauma Project. Child Maltreatment, 21(2), 101–112. Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation and competency. New York, NY: Guildford. Cary, C. E., & Mcmillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757. Cohen, J. C., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford. Cohen, J. C., Mannarino, A. P., Kliethermes, M., & Murray, L. A. (2012). Trauma-focused CBT for youth with complex trauma. Child Abuse & Neglect, 36(6), 528–541. Crowell, J. A., & Feldman, S. S. (1988). Mothers' internal models of relationships and children's behavioral and developmental status: A study of mother-child interaction. Child Development, 59, 1273–1285. Fraser, J. G., Griffin, J. L., Barto, B. L., Lo, C., Wenz-Gross, M., Spinazolla, J., ... Bartlett, J. D. (2014). Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts Child Trauma Project. 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Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health, 39(5), 341–352. Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the child behavior checklist DSM-oriented scales. Journal of Psychopathology and Behavioral Assessment, 31, 178–189. Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). UCLA PTSD reaction index for DSM-IV. Los Angeles, CA: UCLA Trauma Psychiatry Program. Scheeringa M. Young Child PTSD Checklist. Measurement instrument database for the social science. www.midss.ie (Published 2012). Accessed April 15, 2017. Scheeringa, MS personal communication, February 22, 2017. Spinazzola, S., Habib, M., Knoverek, A., Arvidson, J., Nisenbaum, J., Wentworth, R., ... Kisiel, C. (2013). The heart of the matter: Complex trauma in CW. CW360 Traumainformed CW Practice (pp. 8–9). St. Paul, MN: Center for Advanced CW Studies in CW, School of Social Work, University of Minnesota. Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Current Psychiatry Reports, 6, 96–100. Toth, S. L., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2006). The efficacy of toddlerparent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006–1016. U.S. Department of Health & Human Services, Administration for Children and Families, Children's Bureau. Child maltreatment 2015. http://www.acf.hhs.gov/programs/cb/ research-data-technology/statistics-research/child-maltreatment. (Published 2015). Accessed February 5, 2017. Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31, 1199–1205. Widom, C., Czaja, S., Bentley, T., & Johnson, M. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30 year follow-up. American Journal of Public Health, 102(6), 1135–1144. Yanos, P. T., Czaja, S. J., & Widom, C. S. (2010). A prospective examination of service use by abused and neglected children followed up into adulthood. Psychiatric Services, 61(8), 796–802. Core clinical characteristics trauma detail form. National Traumatic Stress Initiative. http://www.nctsn.org/nctsn_assets/dcri/NCTSN_CCDS_Trauma_DetailVersion_4Final %20.pdf. (Published 2010). Accessed April 15, 2017. http://www.nctsn.org/trauma-types/complex-trauma/assessment. Trauma-informed interventions CPP: General Information. National Child Traumatic Stress Network (NCTSN) Web site. http://www.nctsnet.org/nctsn_assets/pdfs/ promising_practices/cpp_general.pdf (Published April 2012). Accessed January 09, 2017. Institute of Medicine & National Research Council (2014). New directions in child abuse and neglect research. Washington, DC: The National Academies Press. Jones Harden B. Services for families of infants and toddlers experiencing trauma. Network of Infant/Toddler Researchers, Office of Planning, Research, and Evaluation, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/ default/files/opre/opre_nitr_brief_v07_508_2.pdf (Published 2015). Retrieved April 16, 2017. Kinniburgh, K., Blaustein, M., Spinazzola, J., & van der Kolk, B. (2005). Attachment, selfregulation, and competency: A comprehensive framework for intervention with childhood complex trauma. Psychiatric Annals, 35(5), 424–430. Kisiel, C., Lyons, J. S., Blaustein, M., Fehrenbach, T., Griffin, G., Germain, J., ... Ellis, H. (2011). Praed Foundation, & NCTSN. Child and adolescent needs and strengths (CANS) manual: The NCTSN CANS comprehensive – Trauma version: A comprehensive information integration tool for children and adolescents exposed to traumatic events. Chicago, IL: Praed Foundation/Los Angeles. CA & Durham, NC: NCTSN. Kisiel, C. L., Fehrenbach, T., Small, L., & Lyons, J. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in CW. Journal of Child and Adolescent Trauma, 2, 143–160. Leenarts, L. E. W., Diehle, J., Doreleijers, T. A. H., Jansma, E. P., & Lindauer, R. J. L. (2013). Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: A systematic review. European Child & Adolescent Psychiatry, 22(5), 269–283. Lieberman, A., & Van Horn, P. (2004/2016). Don't hit my mommy: A manual for childparent psychotherapy with young witnesses of family violence. Washington, DC: Zero to Three Press. Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2006). Child-parent psychotherapy: 6month follow-up of a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(8), 913–918. Lieberman, A. F., Horn, P. V., & Ippen, C. G. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241–1248. 117 Answer all the questions fully based on the other reading attached. This assignment for a research class, you really need to be familiar with the concepts in order to answer the questions and find the answers from the article. The format of the paper should be double-spaced, times new roman 12 font, 1 margin. 1) Indicate which article you chose to work with 2) Research Purpose (1 point): What was the primary goal or purpose of this study? Please describe this using your own words. 3) Research Hypothesis (1 point): What is/are the researchers’ hypothesis(s)? 4) Variables (4 points): a) What are the primary independent variable(s) of interest in the study and how are they operationalized? b) What are the dependent variable(s) and how are they operationalized? 5) Sampling (3 points): Describe the sampling procedures and the study sample. Your description should include: a) What is the sample size? b) What type of sampling was used – probability or non-probability? Describe the process they used to establish their sample. c) Provide a general description of the study sample. (ie. important demographic characteristics) 6) Threats to validity (4 points): a) Given the sampling procedures and research design, how generalizable are the findings (or too whom are the findings generalizable)? Does the author mention this in the conclusion? If so what do they say? Do you agree? If the authors do not mention this in the conclusion what do you think about the external validity of the findings? b) What is one threat to internal validity that was controlled for and how was it controlled for? 7) Results (2 points): a) What are the main results of the study? (Note: Please address the results for all the primary IVs and DVs) 8) Conclusions (3 points): a) What do the authors state as the conclusions and implications of the study? Do you agree with the authors? Explain your reason for agreeing or disagree with the authors. 9) Limitations (2 Points) a) What is one limitation of this study other than generalizability?
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Surname 1
Student’s Name
Professors Name
Course
Date
Research Concepts
Article
The impact of a statewide trauma-informed care initiative in child welfare on the well-being of
children and youth with complex trauma
Research Purpose
The article focuses on the study of examining the efficiency of three trauma treatments in
a trauma informed child welfare system aimed at improving the outcomes for children with
complex trauma.
Research Hypothesis
The researchers hypothesized that children would display positive functioning including
reducing symptoms such as PTSD, control the behavior problems, and improving the treatment
strengths. Trauma treatment enables to improve the development trajectories of children with
complex trauma.
Variables
Through a Child Trauma Project, the authors were trying to find out on the systematic
efforts that are vit...


Anonymous
Excellent resource! Really helped me get the gist of things.

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