Mental health interventions for children experiencing trauma and externalizing behaviors

This presentation will describe play-based and cognitive –behavioral therapy techniques for assisting children with processing traumatic experiences and outcomes of trauma-based therapy in a community mental health setting. Theoretical underpinnings of the trauma interventions including cognitive behavioral therapy, non-directive play therapy, and relational cultural therapy will be described. Outcomes data, focusing on problem behaviors and child functioning also will be presented. Forty-two children between the ages of 7 to 12 years of age with PTSD and comorbid acting out behavior problems have been enrolled. At intake, the mean score for the Global Assessment of Functioning Score (DSM-IV) was 53.61, SD = 5.70, minimum = 4, maximum = 65. This indicated significant problems in maintaining normal functioning. Mean level of number of problems as rated by therapists on the Ohio Scales was 33.78, SD = 12.86, minimum = 0, maximum = 61, providing further evidence of problems in psychosocial functioning. Problem scores as rated on the Therapist forms of the Ohio Scales did not indicate significant differences by gender or primary diagnosis (PTSD, Conduct Disorder, Other) at intake, 3, and 6 months. However, GAF score at intake was significantly related to outcomes with poorer functioning on the GAF being related to continued behavior problems over time. In one preliminary analysis, females were rated by therapists as exhibiting higher numbers of problem behaviors than males. Resilience factors were increased as a result of participation in therapy, and resilience may be independent from psychosocial problems experienced in the aftermath of trauma.