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The past two decades have witnessed an increase in programs targeting children and youth impacted by traumatic events, with a heightened focus on ensuring that all such programs and relevant service systems are trauma informed. While such efforts are laudable, trauma-informed care (TIC) is defined in a number of ways, limiting evaluation of these initiatives, specifically as they relate to the potential for improved outcomes or reduced costs often used to advocate for TIC. Widespread interest in TIC, despite an apparent dearth of empirical research, served as the impetus for this special section. Our goal was to identify the most rigorous empirical studies available. These six papers were selected based on their inclusion of a definition of TIC, focus on at least one component of TIC in a child-serving system, and availability of empirical data demonstrating the effectiveness of their efforts. In addition to introducing these papers, we share preliminary data from a brief, anonymous survey of child-serving professionals across various systems and roles to obtain feedback about definitional and conceptual issues related to TIC. While this special section provides a representation of available empirical work, significant gaps between research and practice of TIC remain, with important implications for future work.

In recent years, there has been an increase in the number of children diagnosed with Reactive Attachment Disorder (RAD). There is considerable disagreement about what this entity actually entails and, in particular, what types of assessments and interventions to use with these children and families. Children with a history of maltreatment (i.e., physical, sexual, emotional abuse, and/or severe neglect) are particularly likely to receive this diagnosis, because the behavior problems often seen in these children are presumed to stem from the maladaptive relationships they have had with abusive caregivers. However, many children are receiving this diagnosis because of behavior problems that clearly extend beyond the DSM-IV criteria for RAD. Perhaps the most concerning consequence of the RAD diagnosis is the emergence of novel treatments that lack a sound theoretical basis or empirical support, and may potentially be traumatizing and dangerous to the child. Thus, the purpose of this article is to review and synthesize what is known about RAD and attachment disorders and to discuss implications for treatment.

Cover -- Contents -- List of Contributors -- Foreword -- Preface -- PART I: Initial Contact with the Abused Child -- 1 Identification, Mandated Reporting Requirements, and Referral for Mental Health Evaluation and Treatment -- 2 Psychosocial Assessment in Child Maltreatment -- PART II: Evidence-Based Treatments -- 3 Trauma-Focused Cognitive Behavioral Therapy -- 4 Parent-Child Interaction Therapy in Child Welfare Settings -- 5 SafeCare: A Prevention and Intervention Program for Child Neglect and Physical Abuse -- 6 Evidence-Based Practices for Working with Physically Abusive Families: Alternatives for Families: A Cognitive Behavioral Therapy -- 7 Empowering Families: Combined Parent-Child Cognitive Behavioral Therapy for Families at Risk for Child Physical Abuse -- 8 Early Intervention for Abused Children in the School Setting -- 9 Family Foster Care for Abused and Neglected Children -- 10 Kinship Care -- PART III: Special Populations and Special Topics -- 11 The Sanctuary Model: Rebooting the Organizational Operating System in Group Care Settings -- 12 Cultural Considerations for Assessment and Treatment in Child Maltreatment Cases -- 13 Trauma Systems Therapy: An Approach to Creating Trauma-Informed Child Welfare Systems -- 14 The Abused Student Cornered: School Bullying amidst Trauma -- 15 Cognitive Processing Therapy with Adolescents -- 16 Risk Reduction through Family Therapy -- 17 Children and Adolescents with Sexual Behavior Problems -- PART IV: Short- and Long-Term Medical Treatment -- 18 Medical Management of Sexual Abuse: A Therapeutic Approach -- 19 Treatment of Physical Child Abuse -- 20 Intervening with Families When Children Neglected -- 21 Failure to Thrive and Maltreatment -- PART V: Education, Training, Dissemination, and Implementation in Communities.

Purpose: Broker professionals serve an important intermediary role in improving service access for youth but are often trained separately from clinicians. Community-Based Learning Collaboratives (CBLCs) include specific training/implementation strategies to foster collaboration and build community capacity for EBPs. Methods: The current study examined changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration among 63 brokers. Brokers reported significant positive changes in trauma-related knowledge, practices, organizational culture, and interprofessional collaboration following CBLC participation. Results: Hierarchical regression analyses indicated statistically significant improvements in knowledge of treatment planning/case monitoring ( r = .41) and organizational culture ( r = .30) as significant predictors of changes in brokers' use of child trauma evidence-based practices following CBLC participation. Discussion: Findings emphasize tailoring training to include topics and strategies most relevant to participants' day-to-day responsibilities.

This study examined therapists' perceived competence in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and its association with youth treatment outcomes (posttraumatic stress and depression). Participants included 99 community therapists enrolled in a TF-CBT-focused Learning Collaborative (LC), along with one of their randomly selected TF-CBT training cases. Analyzed data included: 1) caregiver/youth-reported posttraumatic stress and depressive symptoms, pre- and post-treatment, and 2) therapist-perceived competence with TF-CBT components across treatment delivery. Youth- and caregiver-reports indicated large, significant pre- to post-treatment decreases in youth posttraumatic stress ( ds = 1.10–1.30, ps < .001) and depressive symptoms ( d = 1.01, p < .001). Higher therapist-perceived competence with TF-CBT predicted positive treatment responses for posttraumatic stress ( ds = 0.38–0.39, ps = .03) and depression ( d = 0.25), though only the former association was significant ( ps = .03 vs. p = .15). Findings highlight the need to monitor and improve therapists' competencies to enhance clinical outcomes for trauma-exposed youth and suggest that LCs may be an effective training/implementation model to help achieve those critical goals.