Potentially traumatic events that children may experience can include psychological, physical, or sexual abuse; community or school violence; racism-related traumas; witnessing or experiencing domestic violence; the sudden or violent loss of a loved one; and military family-related stressors like deployment, parental loss or injury. According to the Substance, Abuse, and Mental Health Services Administration (SAMHSA), more than two-thirds of children report experiencing at least one traumatic event by the age of sixteen.

Trauma affects us all differently, and the same is true for children. Understanding how we can prevent trauma and reduce the impact of trauma when it occurs, is key to reducing other risky behaviors that can negatively impact children and adolescents into adulthood like substance, use and risky sexual behavior.

In this episode, Dr. Carla Kmett Danielson, a clinical psychologist and professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina shares her research into helping at-risk youth respond to trauma and how that research has led to new approaches in clinic today. Danielson has been selected by the International Society for Traumatic Stress Studies as the recipient of the 2023 Robert Laufer Memorial Award for Outstanding Scientific Achievement. Through her research as a member of the National Crime Victims Research and Treatment Center, she developed both the Risk Reduction through Family Therapy (RRFT) and the EMPOWERR Program.

**If your child or family needs help, SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders: 1-800-662-HELP (4357)**

Episode Links:

Substance Abuse and Mental Health Services Administration

National Crime Victims Research and Treatment Center

National Child Traumatic Stress Network

Risk Reduction through Family Therapy (RRFT)

EMPOWERR Program

1

♪

2

From the Medical University

of South Carolina,

3

this is Science Never Sleeps,

4

a show that explores

the science, the people,

5

and the stories

behind the scenes

6

of biomedical research

happening at MUSC.

7

I'm your host, Gwen Bouchie.

8

This episode

of Science Never Sleeps

9

is about a challenging topic,

10

but it's one

that's important to discuss.

11

In this episode,

we'll be talking

12

about how research is

helping us understand treatments

13

that can help children who are

negatively impacted by trauma

14

to lead healthy lives

into adulthood.

15

Child trauma definitely

isn't easy to think about.

16

Potentially traumatic events

that children may experience

17

can include psychological,

physical, or sexual abuse,

18

community or school violence,

19

racism-related traumas,

20

witnessing or experiencing

domestic violence,

21

the sudden or violent loss

of a loved one,

22

and military

family-related stressors

23

like deployment, parental loss,

or injury.

24

According to the Substance Abuse

25

and Mental Health Services

Administration,

26

more than two-thirds

of children report experiencing

27

at least one traumatic event

by the age of 16.

28

Trauma affects us all

differently

29

and the same is true

for children.

30

Understanding

how we can prevent trauma

31

and reduce the impact of trauma

when it occurs

32

is key to reducing

other risky behaviors

33

that can negatively impact

children and adolescents

34

into adulthood

like substance use

35

and risky sexual behavior.

36

Our guest in this episode

is Dr. Carla Kmett Danielson.

37

Dr. Danielson is a clinical

psychologist and professor

38

at the National Crime Victims

Research and Treatment Center

39

within the Department

of Psychiatry

40

and Behavioral Sciences

41

at the Medical University

of South Carolina.

42

Her areas of research

and clinical expertise

43

focus on understanding

how trauma and stress

44

can lead

to mental health problems,

45

particularly in adolescents,

and how those exposures

46

may lead

to substance use problems

47

and risky sexual behavior.

48

Dr. Danielson is the Director

of the EMPOWERR Program at MUSC,

49

and she's also the developer

50

of Risk Reduction

through Family Therapy,

51

also called RRFT,

52

an exposure-based integrative

treatment for adolescents

53

who experience

both PTSD symptoms

54

and substance use problems.

55

She's currently leading

a large-scale

56

randomized controlled trial

evaluation of RRFT,

57

funded by the National Institute

on Drug Abuse.

58

This episode does discuss

traumatic childhood experiences,

59

so please be sure

to take care of yourself

60

as you listen.

61

Stay with us.

62

♪

63

Dr. Danielson, welcome

to Science Never Sleeps.

64

Thank you so much

for having me this morning.

65

I am really excited

about our conversation

66

in this episode

because I think

67

it's so important

to talk about these issues.

68

And I want to start out

by really talking

69

about the broad subject

of trauma.

70

I think it's one that certainly

a lot of attention

71

has been paid to

over the last decade or so

72

as we've learned about studies

like the ACEs study

73

and we try to learn more

about trauma

74

and how it affects us all,

75

but particularly how it affects

children is so important.

76

So, can you talk a little bit

about trauma

77

and how it may be different

for children?

78

Absolutely.

79

And I want to emphasize,

the introduction that you gave,

80

I thought,

did a really nice job

81

of referring to trauma

initially

82

as potentially

traumatic events,

83

and I think we'll reduce that

to trauma

84

as we talk throughout

today's podcast,

85

but that word "potentially"

is really important

86

because we know,

as you emphasized,

87

that trauma affects everybody

differently,

88

and the great majority

of people

89

who experience a potentially

traumatic event or trauma

90

do not go on to develop

mental health problems

91

or experience problems

because of that.

92

Majority are resilient,

93

so that's really,

really good news,

94

but there are cases

where youth and adults

95

go on to develop

mental health problems

96

following traumatic event

experiences.

97

And, so, those are, I think,

most of the folks

98

that we'll end up

talking about today.

99

In terms of among those kiddos

who are impacted by trauma,

100

I would say we see lots

101

of different

clinical presentations,

102

meaning lots of different ways

in which we see

103

different types

of mental health symptoms

104

in the aftermath of trauma.

105

So, for example, we often talk

106

about post-traumatic

stress disorder, or PTSD.

107

And within that, within PTSD,

108

we are talking

about hyperarousal,

109

we're talking

about re-experiencing

110

or feeling like

you're experiencing

111

the trauma again.

112

We're talking about

what is a fancy way of saying

113

negative alteration

and in cognition and feeling,

114

but really having had

experienced the trauma

115

leading to hard feelings,

negative thoughts,

116

inaccurate, unhelpful thoughts

about yourself,

117

about the world, about others,

118

and, then,

perhaps the most common one

119

which is avoidance,

120

so really not wanting

to think about the trauma,

121

talk about the trauma,

122

have memories

associated with the trauma.

123

And, so, those are

common things

124

that we see in young people

who experience trauma.

125

However, there are also many

other types of presentations

126

or problems that we see

127

sometimes after somebody

has experienced a trauma.

128

Those can include depression.

129

Those can include

substance use behaviors.

130

Those can include

other forms of anxiety.

131

Those can include other types

of risky behaviors, too,

132

such as running away,

school refusal,

133

and risky sexual behavior.

134

And, so, really,

135

as you emphasized

in your question,

136

kids are impacted

in many different ways.

137

And I think the PTSD point

is important

138

because we think about PTSD

often in adults,

139

particularly when

we're thinking about those

140

who have completed

military service

141

and have experienced trauma

within that.

142

But really, it transcends age

and anyone can experience it,

143

particularly children as well.

144

Correct. Absolutely.

145

And with kiddos,

we sometimes see

146

more irritability perhaps.

147

We may see avoidance

in other forms.

148

I mentioned school refusal

as an example.

149

But absolutely we see that

in young people as well.

150

And school refusal is...

151

Is not wanting to go to school

152

or actually going all the way

to not getting out of bed,

153

not getting into the car,

not getting out of the car

154

when you get to the school,

155

or perhaps not even

making it to class

156

-while you're at the school.

-Right, right.

157

And is...

158

Are there certain things

that we might see as adults

159

who have children in our lives

that we love,

160

who we suspect may have

experienced a trauma

161

that we might see?

162

School refusal

makes me think of that

163

because, certainly,

if you had a kid

164

who was really excited

to go to school...

165

-That's right.

-...and suddenly decided

166

that they didn't want

to be there anymore,

167

that might be a trigger

to think

168

something may need

to be looked into there.

169

Are there other things

that adults can look at?

170

Yes, and that's

really important.

171

As you emphasized

in your intro as well,

172

unfortunately, experiencing

potentially traumatic events

173

is common.

174

Majority of people,

up to 70 percent,

175

will experience that

176

by the time

they're 18 years old.

177

And, so, we know,

unfortunately,

178

most kiddos will end up

going through

179

something like that.

180

The big question will be

are they impacted by it, right?

181

So what should adults

be looking at?

182

And I would include in that

adults beyond caregivers,

183

teachers as well

184

because that is a window

of opportunity.

185

Our teachers are

just so wonderful.

186

They're spending so much time

with our youth,

187

and so it's a great opportunity

188

to capture when something

is going on

189

that may not otherwise

be observed.

190

So I would say sleepiness.

191

And, again, I know

everything I'm going to say

192

absolutely are not, you know,

193

complete yes, if you see this,

194

this means this youth

has experienced trauma.

195

It's one of many symptoms.

196

And these are also symptoms

that could just be

197

that the kid didn't get

a good night's sleep that night.

198

So let me emphasize that, too.

199

But we do know that nighttime

can be a hard time

200

if you're in a home

201

where there's

domestic violence going on,

202

or if you're in a home,

in a bedroom

203

where perhaps you experienced

sexual abuse,

204

it can lead

to a really hard time

205

going to sleep at night.

206

And, so, then, in turn,

207

they get to school

and they're very tired,

208

so that's something

to think about.

209

Withdrawal.

210

So not wanting to engage

with peers.

211

The other...

212

Particularly if you see

that difference, right?

213

If at one point they were

214

and then they start

to not do so.

215

I would say generally

not answering questions.

216

And again, I have

a 12-year-old son,

217

and he doesn't always love

to answer questions either,

218

but, you know,

if you're trying--

219

maybe you're talking

about family life at home,

220

or you're talking

about other things

221

and you notice, you observe

222

that a kid is having

a hard time talking about that.

223

And caregivers know

their own children a lot.

224

So, same thing,

if you notice a difference

225

in how they had

previously been,

226

could be puberty,

227

or could be

that something has happened

228

that's challenging for them

to talk about.

229

I would say if you suspect

something is going on,

230

you can always use

a gentle intro into it,

231

meaning maybe perhaps talk

about something you read

232

or something

you saw on the news,

233

or something you heard about

234

that is along the lines

of something you suspect.

235

And you can say, "Well, what

are your thoughts about that?"

236

Asking open-ended questions

like that

237

instead of going directly

after, "Did this happen?

238

Did something happen

at school?"

239

And that may be an easier way

for them to see

240

that you're comfortable

talking with those topics.

241

You would expect

that they might have

242

something to say

about those topics

243

and maybe make it

a little bit easier for them

244

to disclose to you.

245

Unfortunately, most kids

who experience trauma

246

don't disclose when it happens,

247

and if they do,

it's often much later

248

than when the incident happens.

249

And, so, again,

as a preventionist,

250

my suggestion would be

251

actually to have

those discussions

252

not as waiting for when you see

signs or symptoms

253

that something may be wrong,

but instead,

254

just being part of

your household conversation.

255

Just like we emphasize

about mental health and coping

256

and substance use and sex,

257

you want to have

those conversations early on

258

and on an ongoing basis

so that in your household,

259

your kiddo knows

that those are safe topics,

260

those are okay topics,

261

and that you are

letting them know

262

if something

were to ever happen,

263

you would want them

to share that with you.

264

Right, it's really establishing

265

open lines of communication

very early.

266

My background

is in sexual abuse prevention,

267

and so we would talk

about using proper names

268

-for body parts very early...

-Correct.

269

...because that's what opens up

270

those lines of communication

271

and help your children

be able to talk to you.

272

So, yeah, definitely having

those open lines

273

-from a young age is essential.

-And that can be hard.

274

To me, that's been

a surprising thing

275

is to see that...

276

...it takes some time

for caregivers sometimes

277

to get comfortable

having those conversations,

278

and that's okay, so that's why

we encourage you to practice

279

saying the words out loud.

280

If you didn't grow up

saying "penis" and "vagina,"

281

then you might take some time

to practice doing that

282

so that when you talk

to your kid about it,

283

you aren't turning red,

you aren't stumbling

284

over the words

and teaching them

285

that this is something

embarrassing

286

to be talking about.

287

Right, right.

288

So, this is--we're going

to talk more about treatment

289

and, you know, we're going

to come back to that in a bit,

290

but I want to really ask you

sort of personally,

291

and this is, you know,

Science Never Sleeps

292

is an opportunity

to talk about stories

293

and how researchers, you know,

kind of came to where they are

294

and got to study

the things they're studying.

295

And, so,

as a clinical psychologist,

296

I am really--I love the work

that you're doing,

297

but I have to ask,

298

is this where you thought

you would land?

299

Is it sort of where

you always wanted to go?

300

Or did you find a path

that you brought you here?

301

Tell us a little bit

about that story.

302

Yeah, absolutely.

303

I'll start with the punchline,

which is I absolutely believe

304

that I am exactly

where I'm supposed to be--

305

exactly where

I'm supposed to be

306

and doing exactly

what I'm supposed to be doing,

307

and I'm exceptionally blessed

to love what I do,

308

which is really important.

309

But, no, I did not.

310

You know, when you are 18

311

and you're thinking

about these things,

312

this is not what I had

initially predicted.

313

I knew psychology was something

I wanted to pursue.

314

Actually, theater was something

315

I also was very interested in,

316

but I was the first one

in my family to go to college.

317

And my parents said, "Well,

you can act without a degree,

318

but you can't do anything else,

so--without a degree,

319

so let's--why don't we explore

a couple things?"

320

And, so, that was

one of my great interests.

321

And like many folks

who go into psychology,

322

it started with an interest

in just talking to people,

323

enjoying supporting people,

and listening to people.

324

But I learned really quickly,

as I mentioned, I didn't...

325

we didn't have

a long family history

326

of academics in our family

and honestly,

327

I don't think I could point

to a single woman doctor

328

that I knew growing up.

329

And, so,

going to undergraduate--

330

I was at Ohio University--

was really my first intro

331

to what different

career pathways could look like

332

that would blend.

333

I did always enjoy

my science classes.

334

I kind of merged

my interest in science,

335

be able to pursue

a doctoral degree

336

without having to do

cadaver lab

337

and work with things

that involve blood

338

and things like that.

339

So that also felt

like a really good fit,

340

but would help me really get

more into the depth

341

beyond being able

to help people one at a time.

342

More get into the science

behind helping people

343

to understand how best

to help people,

344

why people develop

mental health problems,

345

and then how to intervene

with that

346

just was a really, really

exciting opportunity.

347

So, what I learned about that

academic research pathway

348

in undergrad, thanks

to my honors thesis advisor,

349

Dr. Arkes,

350

that was really what started me

down that path.

351

And, so, but in

my doctoral program

352

at Case Western

Reserve University,

353

I was working

with Dr. Eric Youngstrom,

354

who was my wonderful,

brilliant advisor

355

in the area of bipolar disorder

356

and unipolar depression

in youth,

357

and with a particular emphasis

or interest,

358

I will say for my part,

in high-risk adolescents.

359

So, as I spent time

with high-risk adolescents

360

and talking with them

about their histories,

361

one theme that kept coming up

was trauma,

362

that the great majority of them

experienced trauma

363

and it was clearly

a significant element

364

as part of their history

when they would talk

365

about their depression

or their bipolar symptoms.

366

And, so, that led me to want

to learn more about that.

367

And, so, in clinical psychology,

368

we do our one-year residency

369

before we get

our doctoral degree.

370

And, so, I was very fortunate

to match here at MUSC,

371

which is truly the best place

in the country

372

if you want to learn

about how to treat

373

traumatic stress symptoms,

374

if you want to learn

about research in this.

375

Dr. Dean Kilpatrick,

who is the Director

376

of the National

Crime Victims Center,

377

founded the--we call it

the NCVC almost 50 years ago.

378

I think we're at the

45-year anniversary coming up.

379

And, so, he's really one

of the forerunners

380

in learning,

teaching people and learning

381

how best to assess trauma,

382

how to ask people about

that-- you can ask that,

383

help train some

of the foreleaders

384

in treatment development

and so on.

385

So, anyway, fortunate enough

to land here

386

for my internship year.

387

And my plan had been

to learn about that

388

and take it back to Cleveland.

389

But, you know, that saying

that life is what happens

390

when you're busy making plans,

right?

391

And in my first month or so,

392

on one of my rotations

at the CVC

393

included going over

394

to Dee Norton

Child Advocacy Center,

395

where we would staff

a lot of cases

396

in the community of youth

who had experienced abuse.

397

And I can still remember

sitting around that table,

398

and it's a multidisciplinary

effort, right?

399

So you have child advocates,

400

you have school representation,

401

you have child

protective services often,

402

sometimes police, certainly

mental health represented,

403

and it was just

a really incredible experience

404

to see everybody

coming together as a team

405

to truly work together

to help a child, a family.

406

And there was a lot of passion.

407

And I'm Italian--I'm

half Italian,

408

but the Italian side

is kind of forward for me,

409

so it was a very good fit

for my personality to see that,

410

that passion,

that advocacy going on.

411

And it was really

in that moment

412

that I knew

that this was my path.

413

You know, kind of the science

behind traumatic stress

414

but also very, very applied

on the ground.

415

And, of course,

the fact that we are

416

in Charleston, South Carolina,

doesn't hurt either.

417

The weather isn't too bad here.

418

I do like the sunshine.

419

So those things

kind of came together.

420

And, really, it was from there.

421

You know,

while I was an intern,

422

one of the things

that we struggled a lot with

423

at the CVC

were the adolescents

424

who presented more--

less with PTSD forward

425

and more

with those risk behaviors.

426

And some of the things

that were said

427

which were very, very true

were, you know,

428

"We deliver, we implement

evidence-based treatments here

429

at the CVC, and we don't have

an evidence-based treatment

430

for co-occurring substance use

and PTSD, for example.

431

So, we need to refer out,

432

get the substance use piece

addressed,

433

and then come back

for the trauma piece."

434

And, you know, at the time,

435

I just spent a lot of time

reflecting on,

436

"Well, but what if the trauma

is a driving factor, right,

437

for the substance use?"

438

And, so, that was really

what was the birth

439

of the next 15 years

of my career

440

of one of the primary paths

of my research

441

which has been focused

on development and evaluation

442

and, now, at this point,

implementation

443

of evidence-based treatment

for co-occurring substance use

444

-and PTSD in youth.

-Right.

445

And so that's where

I want to go next,

446

but before we go there,

I want to ask about your lab.

447

So you land at MUSC,

you did your preliminary work,

448

you got to the point

where you have your own lab now

449

and it's called

the Invictus Lab.

450

-Yes.

-Tell us about your lab.

451

Yes, so Invictus,

if folks are familiar

452

with Henley's poem, Invictus,

453

it was my father's

favorite poem,

454

and so it was one

I was very familiar with.

455

And one of the things

that, as I mentioned,

456

there's a lot of kids

who are resilient after trauma,

457

a lot of young people

who are resilient,

458

but there are youth

who still need to learn

459

that they have the capacity

to be resilient

460

and how to be resilient.

461

And in the Invictus poem,

the last two lines focus on:

462

"I am the master

of my fate:

463

I am the captain of my soul."

464

It begins with

"out of the darkness, I rise,"

465

you know,

and then kind of comes back

466

to this very positive,

inspirational component.

467

And I really feel

like that is what the whole--

468

everything in the lab

that we do is about that,

469

is about how do we help

young people

470

learn to best become

the master of their fate

471

and the captain of their soul?

472

And we can do that

through prevention,

473

we can do that--

474

How do we do prevention?

475

Well, we need

to better understand

476

what are the targets

for prevention

477

after somebody experiences

a trauma?

478

We can do that

through treatment,

479

and we can do that through

really bringing services

480

to other people.

481

And, so, all of that

is part of our work.

482

So just how do we bend

those trajectories

483

in positive ways to do so?

484

So we talked about trauma.

485

Let's talk for a second

about resilience

486

because that's sort of the...

487

the antidote to some degree

to trauma.

488

Talk a little bit

about resilience.

489

What is that,

how do we gain it,

490

where does it come from,

491

particularly in the lives

of children?

492

Yes, and I like

that question a lot

493

because I think that that's

a really important emphasis.

494

Every child, every family,

every caregiver has strengths

495

and what those are

look different.

496

And so I would argue

there's not one definition

497

for resiliency for any

particular family, right?

498

But it's can we find

the strengths

499

and capitalize

on those strengths

500

so that people are able

to accomplish

501

their everyday tasks?

502

We talk about functioning a lot.

503

How does

a mental health problem,

504

mental health symptoms

impact daily functioning?

505

Are you able to go to school

and learn,

506

and have friendships,

507

and enjoy

your family relationships?

508

Are you able to, if you have

interests and hobbies

509

in any given area,

are you able to engage in that

510

and celebrate that?

511

I'm also, you know,

like to think about

512

people looking forward, right?

513

Forward is a pace,

and so even if somebody...

514

You know, for one person

resiliency might be,

515

"Oh, I want to go all the way

and become

516

a psychologist myself

and help people."

517

Well, for some people,

that resiliency might be

518

finishing high school, right?

519

When you were

discussing earlier

520

working with

the National Crime Victims

521

Research and Treatment Center

here at MUSC,

522

you made a point to mention

that the treatments

523

that are used at MUSC

are evidence-based,

524

and tell us

a little bit about that.

525

And, then, I'd like you to talk

526

about the evidence-based

treatments

527

that you have been working on

as a researcher

528

and understanding

how they work.

529

Wonderful question.

530

I'm so glad you asked.

531

Just like we test medications,

right, to figure out

532

if something is going to work

and help treat a problem

533

through randomized

controlled trials,

534

clinical trials,

where we compare

535

one medication

to another medication,

536

and we figure out

which one works better

537

for a given problem,

538

we do the same thing

with therapy,

539

with talking therapy.

540

And that's really important

541

because we want people

to be able to maximize

542

their resources when they meet

with a clinician,

543

that they are using that time

to engage in a treatment

544

that we know that works.

545

And so I really like

to emphasize that point.

546

For consumers out there,

just know

547

that when you are seeking

mental health services

548

for yourself

or for your youth,

549

it's important to ask

what treatments

550

a clinician is skilled in

and applies

551

because you want to make sure

that they offer the treatment

552

that would be helpful

for your particular problem,

553

in this case, trauma.

554

So, in evidence-based treatment,

555

or also called empirically

supported treatment,

556

is a treatment

that has undergone

557

that rigorous evaluation of

a randomized controlled trial,

558

an RCT, and has been compared

559

to at least one other treatment

560

and has been shown

to work better

561

than if you did

the other treatment.

562

And, so, the treatment,

as I mentioned,

563

at the National Crime Victims

Center as an intern

564

that, at that time,

that we didn't have that,

565

an evidence-based treatment

for co-occurring--

566

for adolescents

with co-occurring PTSD symptoms

567

and substance use.

568

And, so, that was

really the opportunity

569

to figure out

what do we need to do

570

to develop that?

571

And the really good news

was at that time, though,

572

we did and still today have

evidence-based treatments

573

for PTSD symptoms in youth,

574

trauma-focused

cognitive behavioral therapy.

575

TF-CBT is one of our most

evidence-based treatments

576

for PTSD, for really

any child mental health problem.

577

There are well over 20

randomized controlled trials

578

at this point

evaluating and showing

579

that TF-CBT works.

580

And, so...

581

And, then, in parallel,

582

we have evidence-based

treatments

583

for adolescent

substance use problems.

584

And, in fact one of them,

multi-systemic therapy,

585

also came from a lot of work

586

led by Scott Hangler

here some years ago,

587

and so what my thought was,

588

we don't need

to reinvent the wheel.

589

Why don't we integrate

these treatments

590

that have these interventions

that we know work

591

or are based on principles

that we know work.

592

And really, that's what I did.

593

I was very fortunate

to be able to work

594

with the developers of TFCBT

595

and the developer of MST,

as well as others

596

who worked with

revictimization prevention,

597

who worked with risky

sexual behavior,

598

and really just came up with

599

a structured strategy

within a treatment

600

for clinicians to be

able to address

601

these multiple

problems that we see

602

after an adolescent

experiences trauma.

603

RRFT has seven components:

604

psycho-education and engagement,

605

family communication,

606

coping,

607

substance use,

608

PTSD,

609

and revictimization

risk reduction.

610

However, for example,

during the pilot trial,

611

we did not have family

communication

612

as its own component, however,

613

that was part of the feedback

from the clinicians

614

and from doing my own work,

615

I also served as a clinician

616

as I was developing

this treatment to really--

617

that's the best way

to figure out

618

what works and what

doesn't, right?

619

And so then the next step was

620

a small pilot

randomized control trial

621

funded through NIDA,

622

a (K) award I was

very fortunate to receive,

623

and then onto what

turned out to be my first RO1.

624

An RO1 is a large research grant

625

that is focused on science.

626

That is a pretty good--

627

sure thing is strong language,

628

but in order for NIH

to give you an RO1,

629

they need to feel pretty good

that you're gonna

630

do the science well and that

it's gonna work out.

631

So that was also

done here at MUSC,

632

and so that is what

led to, actually,

633

the publication in

JAMA Psychiatry,

634

where we were able to share

results with the world

635

that RRFT, Risk Reduction

through Family Therapy,

636

does in fact work,

is efficacious

637

in reducing

substance use problems

638

and PTSD for adolescents with

these co-occuring problems.

639

And so that was

very, very exciting,

640

and now we have another RO1.

641

We're working with a team

642

at the University

of Colorado, Denver,

643

with my co-principal

investigator, Dr. Paula Riggs,

644

who's a child and adolescent

psychiatrist,

645

in implementing RRFT in Denver,

646

which is--

647

adds another interesting element

648

is that marijuana

is legalized in Colorado

649

and not for youth, however,

650

data suggests that areas that

have legalized marijuana,

651

that impacts things in terms

of rates and severity.

652

And so, we're very excited

to see how that turns out.

653

So the RRFT really is about

654

leveraging the family unit.

655

It is family therapy,

656

so it's about empowering,

657

supporting the family unit

658

to sort of build

that resilience.

659

Yes, however I would probably--

660

if I could go back

in time and name it

661

something a little bit broader

than that, I would,

662

because really, we focus on

663

the child's ecologies

and family.

664

So, ecologies are the systems,

665

right, we don't exist as

individuals in a vacuum.

666

So, we have

the individual layer,

667

and this comes from

Bronfenbrenner by the way,

668

this is a-- for those

of you listening

669

who are Bronfenbrenner fans,

this will sound very familiar.

670

So we have an individual layer,

671

and then a family layer

outside of that,

672

and then we have a peer

layer outside of that,

673

and then we have a school

layer outside of that,

674

and then we have a community

layer outside of that.

675

And really what RRFT does

is focuses on,

676

for that particular kid,

for that particular family,

677

what are the specific risk

and protective factors

678

for substance use, for PTSD.

679

And we focus on reducing

the risk factors

680

and promoting

the protective factors.

681

So family can

look very different.

682

I mean, we can do RFT--

683

Of course our goal

is to have a youth

684

who has a caregiver

for us to work with,

685

but sometimes, that caregiver is

686

a staff member at a group home.

687

Sometimes that caregiver

is a foster parent.

688

Sometimes that caregiver is

689

not somebody that we ever

get to work with directly,

690

but we work with the youth

on family communication skills

691

such that they are--

692

many of these youth, even if

they are in families--

693

from families from

whom they're separated

694

who aren't able

to take care of them,

695

many of them end

up deciding at 18

696

to go back into those families,

697

or still have communication

with the families,

698

which is also understandable,

699

and so, how do we

help build the resiliency

700

and be able to cope with having

701

these relationships with people

702

that have complicating factors.

703

Right, right.

704

And giving them

the skills that they need

705

to be able

to navigate those spaces.

706

Correct, but again,

707

when, oftentimes we are able,

708

we're fortunate to be able

to work with some caregiver,

709

and in those circumstances,

710

we really work with

empowering the caregiver

711

that they have the capacity

712

to return to whatever

treatment goals they have.

713

Oftentimes, it's about repairing

714

the relationship with the youth,

715

helping the youth

have a healthy future.

716

Many of these caregivers have

their own trauma history.

717

Many of these caregivers are

at their end of their rope,

718

very understandably, because

719

they have had a lot

of trials and tribulations

720

to get to this point

with their teen, right?

721

And so, part of our work in RRFT

722

is building their

parenting efficacy again,

723

that they have

the capacity to do this

724

and that it isn't that they

are part of the problem,

725

it's that they're the most

critical part of the solution.

726

Right.

727

In substance use,

728

and this is true

for adolescents or adults,

729

we unfortunately have

a lot of high relapse rates.

730

While treatment's in place,

people do well.

731

When treatments are removed,

732

we tend to see symptoms return.

733

And short of treatment being

a lifelong process,

734

which is really hard

for that to be the case,

735

what our goal in RRFT then,

736

and this really comes

from MST principles,

737

is that generalization,

738

that long term

sustainability of the skills.

739

And so, as much as our--

740

as dedicated as our RRFT

clinicians are,

741

most of them are unlikely

to adopt these kids

742

and bring them home with them,

so, in lieu of that,

743

in lieu of them being able to be

in their lives forever,

744

who will be in their

lives forever?

745

Who can be the ones

to help sustain

746

the gains that they have made,

and, you know,

747

work with them

on making good choices

748

when it comes

to being in parties

749

and being around marijuana

750

and other forms of substances

and pills and whatnot.

751

Right, right.

752

I was first introduced

to you and your work

753

as I was learning

754

more about the CHARM study,

755

which is another great study

756

around understanding

how best to serve

757

children and their families.

758

Tell us about Charm.

759

Very excited to be able to talk

with you about the CHARM study,

760

which stands for the Charleston

Resiliency Monitoring Study.

761

That is something

that I wanted to say,

762

out of the gates, has been

a great team effort,

763

as most of my research has been.

764

I think that, if that's okay

765

for me to interject that here,

766

that the study of trauma

is very much a team science,

767

it requires a team science,

which means everybody,

768

from experts

from different fields

769

to our staff members,

770

our research assistants,

our project coordinators.

771

Everybody is such a critical,

critical part of this team.

772

So everything that

I'm talking about today

773

is truly the result of teamwork,

774

and I wish that

I could give a shout out

775

to every single person

who has been on my team

776

and all of my collaborators,

but we would be here all day,

777

because that is how

fortunate I have been.

778

That is how many

wonderful experts

779

we have here at MUSC and beyond.

780

We know that when

somebody experiences

781

a potentially traumatic event,

that not everybody goes on

782

to developmental health

problems, right?

783

But some do.

784

What we don't know

785

in fine grain detail,

786

is exactly why that is, right?

787

What are the mechanisms?

788

What are the pathways

that promote resiliency

789

after an event

has been experienced,

790

versus people going

on to develop

791

anxiety disorders...

792

depression, substance use.

793

And so, really,

794

CHARM is about helping us

795

better understand that pathway

796

from child maltreatment

in particular,

797

but other forms

of trauma as well,

798

onto anxiety disorders

799

and other forms

of mental health problems.

800

With a particular mechanism

that we have focused on,

801

which, the fancy word is

802

threat related negative

valence systems,

803

but that is a fancy

way of saying,

804

"How do we process threat?"

805

So, we are trying

to understand

806

that if after somebody has

experienced traumatic events,

807

somebody has experienced

child maltreatment,

808

how does that impact their

threat processing

809

and then in turn, does that

altered threat processing

810

potentially lead to these

811

outcomes that we talked about,

812

these mental health outcomes.

813

How we go about doing that,

814

or how we've gone about studying

that is multifaceted.

815

This is something that our

funder for this study,

816

the National Institute

for Mental Health, NIMH,

817

has really put

forward this matrix,

818

this conceptualization

of how to best approach

819

research questions

within mental health.

820

It's called RDOC system,

821

the research domain criteria,

822

so this is an RDOC study.

823

So that means,

when we're studying

824

this pathway

of threat processing,

825

we're doing it

in many different ways.

826

We're doing it

through neuro imaging,

827

we're doing it through

psychophysiology,

828

so EEG, startle.

829

We're looking

at blinks, for example,

830

in the face of a stressor,

831

and were looking

at cortisol reactivity.

832

Of course, we're doing

clinical interviewing

833

that has to do

with trauma history,

834

that has to do with mental

health symptoms and so on.

835

And so, what that means is that

836

very, very, very proud

of and grateful

837

for the youth and the families

838

who have participated

in this study,

839

because those lab

visits could be

840

up to eight hours at a time

when they came in.

841

And so, importantly,

842

for us to understand these

questions best,

843

we need to look

at these things overtime,

844

so this is what we call a

longitudinal study.

845

So, at baseline,

846

meaning the first time that

we assess these kids,

847

they were in third,

sixth, and ninth grade.

848

We were very fortunate

849

to recruit 364 youth

850

and their caregivers

to participate,

851

and then, we followed them up

852

two different times

after that in person

853

as well as intermediate

phone calls

854

to check in

regarding trauma history

855

and new onset

of mental health symptoms.

856

And so, in those

in person visits,

857

we would bring them

into the scanner,

858

and subject them to tasks

859

that had to do with--

860

attention to different

types of pictures,

861

some that might

elicit positive emotions,

862

some that might

elicit negative emotions,

863

some more neutral.

864

Same thing true with our

psychophysiology tasks,

865

and we were looking

at things like,

866

how does the brain respond

when you make a mistake,

867

which has been argued that

868

that's a form of a threat,

869

when you make a mistake,

870

as well as how

does somebody respond,

871

like, that's the startle piece,

872

when you are

presented with things

873

that you may not expect,

874

as well as starling images

875

that you may expect, and so on.

876

So, it's a lot of data!

877

As I mentioned,

so this is three

878

in person visits over

a two year period,

879

as well as those two

intermediate phone calls.

880

And we are just

now at the stage,

881

I'm very thrilled to say we are

done with data collection,

882

but as you can imagine,

during the pandemic,

883

this was going on,

884

and so there were some

challenges there,

885

but also, with our challenges

come silver linings,

886

and so one of the unique things

887

we're really gonna

be able to talk about

888

is impact of pandemic

889

as a potential

significant stressor

890

as well for these families,

891

so we did assess

how pandemic affected

892

their lives over

the past two years as well,

893

and so we'll have

an opportunity to also see

894

how that may or may

not have impacted things

895

in this relation between trauma,

896

child maltreatment,

and mental health problems.

897

That's really great,

because I do think

898

we're on the front end

899

of what is the research

going to yield

900

around the pandemic,

and the impact that it had

901

in lots of different ways.

902

I mean, we can make a list

of all of the ways

903

that humans were

impacted by the pandemic.

904

But, I think

particularly children

905

is really an important

question to answer,

906

to kind of understand how did--

907

all kinds of things,

whether it was

908

the perceived health threat

of that scary thing,

909

or losing loved ones,

910

or being separated from their

peers for such a long period,

911

so that's really great,

912

because that's--

913

that's research that's yet

to be really out there.

914

And one thing

that we do know well

915

in the child trauma

research arena

916

is that impact

of trauma is cumulative.

917

And so--

918

as you experience more trauma,

more adversities,

919

you're more likely to develop

920

mental health

problems following.

921

And so, I think

the pandemic stressor

922

is something that we hypothesize

923

will end up being

something that added

924

accumulation

potentially to impact.

925

And anecdotally, we heard that

926

when we were interviewing our

families and talking to families

927

during the height

of the pandemic,

928

a lot of folks would

mention things like,

929

"You know, I've never

thought about--" or,

930

"It's been a long time since

I've thought about this trauma.

931

It didn't really impact me, but

now that we're going through

932

the stressors of the pandemic,"

in their own language,

933

"I'm thinking about it all the

time and I don't understand why.

934

Why is it bothering me now, it

didn't bother me before?"

935

And that's very normal.

936

So it heightened

their sensitivity

937

to stressors that had

happened previously.

938

So I think we do have

939

an opportunity to learn

a lot of that.

940

We do know that

a national state of emergency

941

has been declared

for child mental health

942

across the country,

that was jointly declared

943

by the American Academy

of Pediatrics,

944

the Child and Adolescent--

945

American Academy of Child

and Adolescent Psychiatry,

946

and the American

Hospital Association, so--

947

It's clear enough that

there has been an impact

948

that that was declared

949

We definitely see

published reports

950

of increased opiate overdoses,

951

we see--

952

again, this is anecdotally,

953

clinicians and even

our own clinic

954

on wait lists that

we've never seen,

955

at least in the 20 years

that I've been here,

956

I have never seen our wait list

957

at the level it is right now,

958

just to keep up with

the number of referrals

959

that kept coming in.

960

And I know all of our

community clinicians

961

are in similar positions, so--

962

And all of us are just

incredibly dedicated

963

to ensure that everybody

964

who needs service gets service.

965

So we work a lot with

our community partners,

966

the schools,

967

child advocacy centers,

968

to make sure that, you know,

969

if we can't get

to a kid immediately,

970

that we'll figure out where

971

we can connect

them with services.

972

Right, we do focus on research

on Science Never Sleeps,

973

but I think you just talked

about service,

974

and I think that's

important, because

975

particularly in the space

that you're in,

976

it really is about

translational research

977

where it's moving towards,

978

how do we provide this service

979

that ultimately

improves the lives

980

of children, their families--

981

And we can also talk

about the downstream,

982

you know, generational

positive impacts

983

that this kind

of thing can have.

984

So I wanna ask about EMPOWERR,

985

which really is more

of an extension of the research.

986

It's services that

have been derived

987

from what we've learned

through research,

988

so can you talk

a little about EMPOWERR?

989

Yes,

990

I really enjoy talking

about EMPOWERR,

991

because, as I mentioned earlier,

992

I'm a preventionist at heart,

993

and I think,

at the end of the day,

994

of course, our goal is

995

to ultimately prevent

mental health problems

996

after folks experience

traumatic event experience

997

as well as other general

life stressors if we can.

998

Unfortunately, many youth

999

do not line up

for prevention services,

1000

and so, we have to be creative

in how we think about

1001

bringing prevention

to the community.

1002

EMPOWERR actually came from

1003

a call from SAMHSA

1004

in 2007,

1005

and I remember that because

1006

I remember

my daughter being about

1007

nine months old when I was

1008

pulling my all-nighters

to write this grant.

1009

To be able to bring prevention,

1010

HIV and substance use prevention

services to our community,

1011

so it wasn't specific

to trauma per se,

1012

but, given those base rates

I talked about trauma,

1013

there's certainly a lot

of overlap there.

1014

But I had learned,

1015

I didn't know this, and I think

1016

many people don't know this,

1017

that our HIV acquisition rates

here in South Carolina,

1018

including in the Charleston

surrounding area,

1019

are quite high with regard--

1020

compared to national rates.

1021

South Carolina has

been in the top ten

1022

for many years with regard

1023

to new HIV acquisition rates.

1024

And so, it was very

important to think about

1025

how might we parlay

this into our opportunity

1026

that we have in working in that

community, working with schools,

1027

working with the Department of

Juvenile Justice, for example.

1028

And so, that was

that first grant,

1029

that we were fortunate

to get funded,

1030

to implement these prevention

services in the community.

1031

Since then, we have been

fortunate to receive

1032

a range of grants

building on that program

1033

and form even more

community partnerships:

1034

Palmetto Community Care,

1035

our Infectious Diseases

Department here at MUSC,

1036

Roper, many, many

partners in the community.

1037

And so, we have

worked to also expand

1038

to local colleges,

1039

Dr. Alyssa Rheingold,

who's one of my colleagues,

1040

has helped lead that work

with young adults,

1041

we do, for example,

community testing,

1042

HIV testing events for that.

1043

And most recently, we--

1044

SAMHSA has multiple branches,

prevention branch,

1045

but also offer

a treatment branch,

1046

and I mentioned earlier

the Family Tree Grant.

1047

And so, here at MUSC,

1048

we were fortunate to be

one of only 18

1049

places across the country

who were awarded this grant.

1050

And Family Tree, as it implies,

1051

is that we're focusing not just

on, in this particular case,

1052

adolescents with

substance use problems,

1053

but also the branches

of that tree,

1054

which include caregivers,

1055

right, and other

community aspects.

1056

And so, we were fortunate

to receive that.

1057

That actually provides funding

for RRFT clinicians

1058

and clinicians who

are implementing

1059

evidence based treatments

for substance use disorders,

1060

but do not have the co-occuring

traumatic stress piece,

1061

and that's housed in our

1062

Center for Drug and Alcohol

Programs, our CDAP program,

1063

who are very much

a partner on this.

1064

And so, we're very fortunate

1065

to have those

resources in place now

1066

to be able

to implement those services.

1067

Those-- we have just launched

within the past--

1068

about six months, maybe?

1069

And we are already

close to wait list

1070

slash on wait list

for those clinicians.

1071

So, as we suspected,

1072

there's a huge demand for this.

1073

And so, we're very grateful

for any opportunity

1074

to have these resources

1075

to be able to fund

us to do this.

1076

As I mentioned before,

the Glenn Family Foundation

1077

also has been

an opportunity for us

1078

to be able to provide some

of these services

1079

in the community that

otherwise would not

1080

be possible without those funds.

1081

Along those lines, we have

a long road ahead of us.

1082

We are so excited

1083

about the gains we have

been able to make

1084

in the science

and in the services,

1085

so we are grateful for--

1086

the generous contributions,

1087

whether that be from the NIH,

1088

from other foundation funding,

1089

SAMHSA, on through

private donors.

1090

And so, if anyone is listening

and are wondering,

1091

"What is it that I can really do

1092

to make a difference

with my resources?"

1093

We are always open

and looking for resources

1094

to be able to further

what we can do

1095

with these research

questions that we have

1096

and with the services

we like to provide,

1097

and can contact me.

1098

Because at the end of the day,

1099

it's about improving

the lives of children,

1100

which ultimately

help us all as adults

1101

live happier, healthier lives.

1102

A hundred percent,

1103

I can't emphasize

that point enough.

1104

These youth grow up

to be adults.

1105

They grow up to be contributing

members of our society,

1106

or would like to be contributing

members of our society.

1107

What PTSD

and Substance Use Disorder

1108

and other forms of mental health

look like in adults

1109

is that much more

impairing, right?

1110

It's that much more difficult

1111

to do those daily

functioning tasks

1112

I was talking about earlier.

1113

It's not attending school,

it's getting to work,

1114

it's paying your bills,

1115

it's being able

to become parents

1116

and be able to sometimes stop

1117

intergenerational transmission

of trauma that we see.

1118

And so, it's just

such a great opportunity

1119

when we have

the ability to intervene

1120

earlier in life,

rather than waiting

1121

for these things

to come up as adults.

1122

And we could get

into the numbers,

1123

it is in the billions

and billions of dollars

1124

the degree to which

it is estimated

1125

that the United States

is impacted

1126

by Substance Use Disorder

and mental health problems.

1127

And so, any prevention

that we engage in,

1128

any financial contributions

that we receive

1129

certainly play out tenfold

in the long run for society.

1130

Right.

1131

Thank you so much

for being with us

1132

on Science Never Sleeps,

Dr. Danielson!

1133

Thank you so much, Gwen!

1134

I can't tell you

how much I appreciate

1135

the opportunity

to talk about the science,

1136

talk about the work

that we have done.

1137

My team and I are very grateful

1138

for you to be able to bring

1139

the message out to the public,

1140

because it doesn't

do anybody any good

1141

sitting in journals,

1142

sitting in our conference rooms

1143

where we talk

about these things.

1144

So we are working

hard to get this--

1145

We are working hard

to really think about

1146

how to get this

to the very people

1147

who we're hoping to serve,

1148

so thank you so much

for being a vehicle for that.

1149

We've been talking

to Dr. Carla Kmett Danielson

1150

about her research on supporting

children and adolescents

1151

who've experienced trauma.

1152

Have an idea for a future

episode of Science Never Sleeps?

1153

Click on the link in our show

notes to share with us.

1154

Science Never Sleeps is produced

by the office

1155

of the Vice President

for Research

1156

at the Medical University

of South Carolina.

1157

Special thanks to the Office

of Instructional Technology

1158

for support on this episode.

1159

♪