Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network.

TLDR

Many children in the child welfare system experience complex trauma from early caregiver abuse, leading to diverse functional reactions, yet routine trauma screening is uncommon. This study examined trauma histories, posttraumatic stress, and behavioral and emotional problems in 2,251 foster‑care youth referred to a National Child Traumatic Stress Network site. The authors assessed complex trauma exposure (physical, sexual, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral/emotional problems among the sample. Seventy‑four percent of participants reported at least two complex trauma types, 11.7% all five, and those with complex trauma exhibited significantly higher internalizing problems, PTSD, and clinical diagnoses than youth with other trauma histories.

Abstract

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.