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Biomedical subjects

Judith A Cohen

Publications and source records attributed to Judith A Cohen.

18 recordsLinked to original sources
PubMed2006

Disseminating early interventions following trauma.

Dissemination of effective early interventions following trauma is necessary to ensure the provision of the best possible care in a timely manner. To achieve this, agreement from all key stakeholders is required regarding the messages to be disseminated and the means of dissemination. This article is based on a National Institute of Mental Health sponsored symposium on the dissemination of early interventions at the 21st annual meeting of the International Society for Traumatic Stress Studies in Toronto in 2005. The current knowledge base regarding the effectiveness and dissemination of early interventions (defined here as those that are begun within the first 3 months after exposure) following trauma for children, adolescents, and adults is considered.

Adolescent↗
PubMed2006

A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG).

OBJECTIVE: This pilot study evaluated outcomes for a modified 12-session protocol of cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG) conducted between March 2004 and October 2005. CTG is an emerging condition characterized by a combination of posttraumatic stress and unresolved grief symptoms. This two-module treatment model consisting of sequential trauma- and grief-focused components was shortened from a previously presented 16-session protocol. METHOD: Thirty-nine children ages 6 to 17 years old with CTG and their parents received the modified 12-session protocol of CBT-CTG. CTG and posttraumatic stress disorder (PTSD) symptoms were assessed at pretreatment, after the trauma-focused module, and after the grief-focused module (at posttreatment). Child depression, anxiety, and behavioral symptoms, as well as parental depression and PTSD symptoms, were assessed at pre- and posttreatment. RESULTS: Children reported significant improvement in CTG, PTSD, depression, and anxiety, and parents reported significant improvement in children's PTSD, internalizing and total behavior problems, and their personal PTSD symptoms. Although PTSD significantly improved only during the trauma-focused module of treatment, CTG improved significantly during both trauma- and grief-focused modules of treatment. Child satisfaction and parent satisfaction for this treatment protocol were also high. CONCLUSIONS: These findings suggest that the shortened CBT-CTG protocol, which is similar in the number of sessions to what many community child bereavement programs offer, may be acceptable and efficacious for this population. The CBT-CTG model requires further evaluation in randomized, controlled treatment trials.

Adolescent↗
PubMed2006

A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVE: To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. METHOD: A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. RESULTS: Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. CONCLUSIONS: Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT.

Caregivers↗
PubMed2006

Assessment of posttraumatic stress symptoms in children who are medically ill and children presenting to a child trauma program.

To test the utility of the UCLA posttraumatic stress disorder (PTSD) Index for DSM-IV (U-PTSD-I)(c) for predicting PTSD diagnosis in children with and without medical illnesses. The U-PTSD-I and a standard psychiatric interview were administered to medically ill children (n = 76) and children who experienced other traumatic events (n = 31). We found U-PTSD-I's sensitivity and specificity was better in the nonmedical illness cohort. Only intrusion symptoms were significantly associated with the diagnosis of PTSD in the medically ill. In conclusion, the U-PTSD-I performs better among general trauma versus medically ill patients. Intrusion symptoms should be focused on when assessing PTSD in medically ill children.

Adolescent↗
PubMed2005

Treating sexually abused children: 1 year follow-up of a randomized controlled trial.

OBJECTIVE: To measure the durability of improvement in response to two alternative treatments for sexually abused children. METHOD: Eighty-two sexually abused children ages 8-15 years old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy (NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. DATA ANALYSIS: Intent-to-treat and treatment completer repeated measures analyses were conducted. RESULTS: Intent-to-treat indicated significant group x time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. CONCLUSION: This study provides additional support for the durability of TF-CBT effectiveness.

Adolescent↗
PubMed2005

Community outreach program for child victims of traumatic events: a community-based project for underserved populations.

Behavioral and cognitive behavioral treatment interventions have been shown to be effective for the treatment of trauma-related problems in children. However, many children and families in need of treatment do not have adequate access to services and do not have access to effective, evidence-based treatment services. The present article describes a community-based program that provides in-home and in-school treatment services, based on behavioral and cognitive behavioral approaches to addressing trauma-related emotional and behavioral problems in children.

Adaptation, Psychological↗
PubMed2005

Treating traumatized children: current status and future directions.

Empirical knowledge regarding effective treatments for traumatized children has increased in the past decade, yet much still remains unknown. There is growing support for the efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) for treating PTSD, depressive, and behavioral problems in sexually abused children, and evidence that suggests that this treatment is effective for children exposed to other types of trauma, and for multiply traumatized children. Few other psychosocial treatments have been adequately studied to date. Open psychopharmacological studies have identified several promising medication classes for traumatized children but these need to be tested in randomized, placebo controlled trials. No empirical studies have evaluated the efficacy of early interventions provided to children in the acute aftermath of mass disasters or terrorist acts. More research is needed to test potentially effective treatments for traumatized children, and to identify optimal methods for disseminating and implementing evidence-based treatments to community practitioners.

Child↗
PubMed2004

Adolescent weight loss during treatment with olanzapine.

Antipsychotic medications are increasingly used in adolescents for a variety of psychiatric difficulties, including psychosis, bipolar disorder, and aggression. Weight gain is a significant side effect of neuroleptics, which may limit adolescents' compliance with these medications. This report presents a case of significant weight loss while on olanzapine, with a body mass index (BMI) falling from 25 to 19.5 during 8 months of treatment. Possible mechanisms for this effect are discussed.

Adolescent↗
PubMed2004

A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVE: To examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse. METHOD: Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse. RESULTS: A series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. CONCLUSIONS: This study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.

Adolescent↗
PubMed2004

Treating childhood traumatic grief: a pilot study.

OBJECTIVE: To examine the potential efficacy and specific timing of treatment response of individual child and parent trauma-focused cognitive-behavioral therapy for childhood traumatic grief (CTG), a condition in which trauma symptoms impinge on the child's ability to successfully address the normal tasks of grieving. METHOD: Twenty-two children and their primary caretakers received a manual-based 16-week treatment with sequential trauma- and grief-focused interventions. RESULTS: Children experienced significant improvements in CTG, posttraumatic stress disorder (PTSD), depressive, anxiety, and behavioral problems, with PTSD symptoms improving only during the trauma-focused treatment components and CTG improving during both trauma- and grief-focused components. Participating parents also experienced significant improvement in PTSD and depressive symptoms. CONCLUSIONS: The timing of improvements in CTG and PTSD symptoms lends support to providing sequential trauma- and grief-focused interventions and to the concept that CTG is related to but distinct from PTSD. The results also suggest the benefit of individual treatment for CTG and for including parents in the treatment of CTG. Randomized, controlled trials are needed to further test the efficacy of this treatment model.

Adolescent↗
PubMed2004

Treatment of childhood traumatic grief.

Childhood traumatic grief (CTG) is a condition in which trauma symptoms impinge on children's ability to negotiate the normal grieving process. Clinical characteristics of CTG and their implications for treatment are discussed, and data from a small number of open-treatment studies of traumatically bereaved children are reviewed. An empirically derived treatment model for CTG is described; this model addresses both trauma and grief symptoms and includes a parental treatment component. Future research directions are also addressed.

Attitude to Death↗
PubMed2003

Treating acute posttraumatic reactions in children and adolescents.

The impact of providing early interventions to acutely traumatized children is not yet known. No research has examined the potential benefits or harm of providing brief psychosocial interventions to children in the immediate aftermath of trauma exposure. Three studies have documented the efficacy of providing trauma-focused, cognitive-behavioral therapy (TF-CBT) to symptomatic children within 1-6 months of experiencing sexual abuse. Several controlled and open studies of traumatized children with chronic posttraumatic stress disorder have provided additional support for TF-CBT interventions; however, the optimal dosage and critical components of TF-CBT for traumatized children have not been determined. Only one randomized controlled pharmacologic trial has been conducted for acutely traumatized children; open studies of various pharmacologic treatments are limited by methodologic shortcomings but suggest that there are promising agents for evaluation in future controlled trials. The importance and feasibility of conducting early screening of trauma-exposed children is discussed, and recommendations for research priorities are presented.

Adolescent↗
PubMed2003

Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents.

OBJECTIVE: Child abuse is a risk factor for developing Posttraumatic Stress Disorder (PTSD) and subsequent Substance Use Disorder (SUD). The purpose of this review is to summarize current knowledge about effective treatments for adolescent abuse-related PTSD, SUD, and the co-occurrence of these conditions. METHOD: The literature on empirical treatment studies for these conditions in adolescence was reviewed, summarized, and synthesized. RESULTS: Randomized controlled studies of abuse-related PTSD and SUD in adolescents have supported the efficacy of cognitive behaviorally-based individual and family treatment components. Components overlap considerably in empirically supported treatments for each disorder. An integrated treatment approach is described for use in adolescents with abuse-related PTSD and SUD, with recommendations for optimizing services for this population and for future research. CONCLUSIONS: The available evidence on effective treatments suggests that integrated PTSD- and SUD-focused cognitive-behavioral and family treatment for adolescents with comorbid abuse-related PTSD and SUD may optimize outcomes for this population.

Adolescent↗
PubMed2003

Psychosocial and pharmacological interventions for child crime victims.

Children may develop a variety of difficulties following victimization, including posttraumatic stress disorder (PTSD), other anxiety symptoms, depressive disorders, externalizing symptoms, or substance use disorders. Some children appear to be resilient in the face of victimization and do not report significant difficulties. A growing number of treatment studies for child abuse victims has supported the efficacy of trauma-focused cognitive-behavioral therapy (CBT); however, more research is needed to determine the critical components and optimal dosage of CBT, and to evaluate the efficacy of this approach for other groups of child crime victims. Psychopharmacological treatments are widely used for childhood PTSD, but little research has evaluated such treatments. Treatment guidelines and future directions are discussed.

Adolescent↗
PubMed2003

Combating the nursing shortage. Vermont's call to action.

This article describes the centrality of the nursing leadership role in Vermont's statewide efforts to combat the nursing shortage, particularly the establishment of a Blue-Ribbon Commission and an Office of Nursing Workforce Research, Planning, and Development. Recommendations by the Blue-Ribbon Commission along with its progress to date are presented. The role of the Office of Nursing Workforce Research, Planning, and Development is described in accomplishing the recommendations of the Blue-Ribbon Commission. These efforts have been cumulative, characterized by innovation and unprecedented collaboration between stakeholders representing nursing, public health, health care administration, education, and the political and private sectors. Lessons for replication are underscored.

Fellowships and Scholarships↗
PubMed2002

Trauma in children and adolescents: risk and treatment of psychiatric sequelae.

The recent wave of terrorism affecting the United States and other countries raises concerns about the welfare of children and adolescents. This review is designed to address such concerns by summarizing data from two scientific areas. First, a series of recent studies examine psychiatric outcomes over time in children exposed to various forms of trauma. This review summarizes data on the various psychiatric consequences of childhood exposure to trauma, with specific emphasis on identifying factors that predict psychiatric outcome. Prior studies suggest that level of exposure, evidence of psychopathology before trauma exposure, and disruption in social support networks consistently emerge as strong predictors of psychopathology following exposure to trauma. Hence, clinicians might monitor children exposed to trauma most closely when they present with these risk factors. Second, a series of randomized controlled trials documents the beneficial effects of cognitive behavioral therapy (CBT) in children exposed to sexual abuse. When combined with other data from open studies and controlled trials in nontraumatized children, these studies suggest that CBT represents a logical therapeutic option for children developing anxiety symptoms following the recent wave of terrorism. In terms of psychopharmacological treatments, data from randomized controlled trials in traumatized children have not been generated, but recent studies in other groups of children exhibiting symptoms of anxiety or depression suggest the utility of selective serotonin reuptake inhibitors.

Child↗
PubMedDate not supplied

Middle school students' perceptions of an ideal career and a career in nursing.

Many strategies are currently needed to address a profound nursing shortage that is threatening health care quality. One strategy is to increase the interest of youth in the profession of nursing. Middle school students' perception of nursing offers important clues toward successful recruitment of the next generation of nurses. The focus of this exploratory study was to compare a convenience sample of 301 male and female middle school students' perceptions of an ideal career versus a career in nursing. A post hoc analysis of variations by gender was also done. Perceptions of nursing and the ideal career were measured with an instrument developed by May, Champion, and Austin (1991), which has been assessed for reliability and validity in previous studies. Data were analyzed descriptively and inferentially, by using paired t tests and Bonferroni adjustments to control for multicolinearity. The respondents voiced statistically significant differences between nursing and the ideal career in key variables related to autonomy, respect, compensation, and "busyness." When comparing boys with girls, however, there was more congruence between boys' perception of nursing and ideal career than girls'. Implications for the development of timely and effective nursing recruitment campaigns targeting middle school students are offered.

Adolescent↗