SAMHSA Responds to Children's Trauma
By Melissa Capers
When America was attacked on September 11, 2001, among those responding
were the leaders and staff of 18 organizations newly chosen to be
the first grantees of SAMHSA's National Child Traumatic Stress Initiative.
Catalyzed by the urgent need created by the events of September
11, and enabled by SAMHSA funding to collaborate, cooperate, and
respond, these organizations came together immediately and effectively-transforming
the effort from Federal initiative to national service organization
in record time.
"The National Child Traumatic Stress Initiative was developed
to help us learn about and maximize trauma recovery among children,
and the attacks of September 11 were a vivid reminder of just how
essential these programs are," said Robert E. DeMartino, M.D.,
Associate Director of the Program in Trauma and Terrorism within
SAMHSA's Center for Mental Health Services. "Through the grant
application and review process, SAMHSA had access to the very best
people who could respond to the trauma caused by these attacks.
Our job was to call on them and support them in giving their best
to the communities affected."
Funding availability for the National Child Traumatic Stress (NCTS)
Initiative was first announced in May 2001, and grants were awarded
in September of that year. The Initiative aims to improve the standard
of care and access to services for traumatized children and their
families. It is designed to foster collaboration by establishing
a national network of centers that cooperatively identify and develop
effective treatments and services for children affected by trauma;
collect clinical data on child trauma cases and services; develop
resources on trauma for professionals, consumers of mental health
services, and the public; develop trauma-focused public education,
professional training, and field-development activities; and in
so doing, improve treatment and services for all children and adolescents
in the United States who have experienced traumatic events.
The architecture of the NCTS Network created by the Initiative
is embedded in a three-tiered grant structure:
- One grant established a National Center for Child Traumatic
Stress, co-directed by Robert S. Pynoos, M.D., M.P.H., of the University
of California–Los Angeles, and John Fairbank, Ph.D., of Duke
- Five grants supported Intervention Development and Evaluation
Centers to identify, support, improve, or develop effective treatment
and service approaches for different child populations and different
types of trauma. Most of these centers are affiliated with universities
or other academic sites.
- Twelve grants supported Community Treatment and Service
Centers to provide and evaluate treatment and services in community
An infusion of supplemental funding later allowed the NCTS Network
to double in size, to a total of 10 Intervention Development and
Evaluation grantees, and 26 Community Treatment and Service Centers.
According to Dr. Pynoos, the funding structure "provided a
unique opportunity to integrate the scientific rigor of the academic
centers with the wisdom of community-based service providers."
Grants were made for 3-year periods, beginning October 1, 2001.
Grantees were asked to build into their proposal a 6-month planning
period, and to address specifically the ways in which they intended
to collaborate and support the NCTS Network and the National Center
for Child Traumatic Stress.
September 11 Catalyst
The 6-month planning periods that grantees had scheduled were dramatically
cut short by the events of September 11, 2001. Not yet officially
announced when the terrorist attacks took place, the NCTS Network
nevertheless provided a resource of expertise and experience that
quickly mobilized to action.
"Ten minutes after we got notice of our award, we were asked
to establish and lead a Traumatic Bereavement Task Force,"
recalls Judith A. Cohen, M.D., Project Director of the Allegheny
General Hospital Center for Child Abuse and Traumatic Loss, an Intervention
Development and Evaluation grantee.
This Task Force, comprised of New York City NCTS Network sites
and other Initiative sites with related expertise, quickly developed
four main goals:
- To gather and distribute psycho-educational materials on traumatic bereavement in children to mental health professionals, teachers, and parents
- To obtain standardized assessment instruments for childhood traumatic grief
- To compile and assess what treatment materials on traumatic bereavement were available
- To develop a manual for the treatment of preschool children suffering from traumatic bereavement.
Dr. Cohen reports that the Task Force members provided and quickly
accessed a "diverse wealth of information regarding the exposure
of children to traumatic grief." She and her colleagues at
Allegheny General Hospital had already developed treatment manuals
for individual and group treatment of children age 5 to 15. National
Center Co-Director Pynoos had likewise participated in the development
of a group treatment manual for adolescents.
The Traumatic Bereavement Task Force members reviewed the two treatment
manuals and provided critical feedback and suggestions to assure
cultural sensitivity and to incorporate the special aspects of the
September 11 attacks. The manuals were then revised and distributed
to more than 200 child trauma treatment professionals in New York
City; Washington, DC; Pennsylvania; and other areas.
At the request of the Task Force, guidelines for treating traumatic
grief in preschool children were developed by another Initiative
grantee, the Early Trauma Treatment Network at the University of
California at San Francisco, under the leadership of Alicia Leiberman,
Ph.D. These guidelines were reviewed in fall 2002 with the aim of
distributing them to professionals this summer.
Task Force member organizations also used SAMHSA support to leverage
funding from the New York Office of Mental Health Services, the
New York Times Fund, and the Silver Shield Foundation. Through combining
these funding sources, Traumatic Bereavement Task Force members
were able to conduct and videotape "train the trainer"
workshops for professionals who treat New York City children, and
to begin randomized treatment trials of Dr. Cohen's manual. Robin
Goodman, Ph.D., and Elissa Brown, Ph.D., of the New York University
Child Study Center (another Intervention Development and Evaluation
Center) are conducting the randomized trials of the manual in collaboration
with Dr. Cohen and her colleague, Anthony Mannarino, Ph.D., in Pittsburgh.
"It is incredible," says Dr. Cohen. "In less than
a year, a manual was developed, revised, and distributed. More than
100 kids have been evaluated thus far, and a controlled research
study is underway." According to Dr. Cohen, "This is the
first known randomized and controlled trial specifically evaluating
the impact of alternative treatments on childhood traumatic grief."
September 11 brought "unanticipated pressure to bear"
on the NCTS Network, reports Dr. Cohen, with results that might
be compared to the results of fission, or the way that pressure
transforms a seam of coal into a diamond. In the same way, the urgency
of September 11 formed an immediate culture of collaboration and
cooperation. Grantees based in New York City began to work together
in an accelerated way, and the Traumatic Bereavement Task Force
brought together professionals from grantee organizations across
the country in a way that would not have happened in the absence
of such an emergency.
The NCTS Network functions through a web-like structure of task
forces and committees, through which various grantee organizations
communicate and collaborate on projects of special interest, particular
needs of the Network, and/or particular issues in child traumatic
In addition to the Traumatic Bereavement Task Force, the Network
supports a Forensic Medical Examination Working Group to establish
ways to begin immediate therapeutic interventions for children receiving
forensic medical examinations for sexual abuse, and a Complex Trauma
Task Force to explore approaches to the assessment and treatment
of children and adolescents with complex trauma histories.
Several committees focus on cross-cutting issues including data
operations, measures, and training. The Child Sexual Abuse Task
Force and Early Childhood Training Task Force each seek to enhance
trauma treatment for children in these defined target populations.
These task forces and committees necessarily overlap. Grantees
in the Forensic Medical Examination Working Group, for example,
clearly have a special interest in the work of the Child Sexual
Abuse Task Force, and may even serve both groups. Similarly, grantees
working on developing a training curriculum for childcare providers
will likely access the expertise of network members addressing various
traumas in order to develop the best blend of age appropriate, trauma-specific
information. These multiple and varied linkages keep the NCTS Network
cohesive, and prevent development of exclusive pockets of interest
The relatively recent emergence of the field of child traumatic
stress helps to invigorate the NCTS Network. "The treatment of child
traumatic stress is a fairly young field," explains Dr. Pynoos.
"It was not until the late 1970s that professionals even began talking
directly to children affected by trauma." From that point on, professionals
recognized the need to communicate with one another, share knowledge,
gain a greater understanding of how trauma affects children, and
establish effective treatments designed specifically for traumatized
children and adolescents.
Reflecting on the influence of the September 11 attacks, Dr. Pynoos
observes, "In the same way that wars have brought attention
to the effects of combat trauma, the events of September 11 have
brought to the forefront the horrific impact of trauma on children,
as well as on adults."
As the healing from September 11 is woven more completely into
the fabric of the Nation's life, the task of the National Center
and the NCTS Network will be to continue their original mission
of education, training, and service, and to assure that the national
learning that resulted from this tragedy is not lost as time passes.
For more information about the work of the National Center for
Child Traumatic Stress and the National Child Traumatic Stress Network,
click on "The National Child Traumatic Stress Network."
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