Thriving After Trauma: Supporting Families & Caregivers with Carla Kmett Danielson, PhD

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)**

Read The Transcript

[00:00:08] Gwen Bouchie: From the Medical University of South Carolina, this is Science Never Sleeps, a show that explores the science, the people, and the stories behind the scenes of biomedical research happening at MUSC. I’m your host, Gwen Bouchie. This episode of Science Never Sleeps is about a challenging topic, but it's one that's important to discuss in this episode. We'll be talking about how research is helping us understand treatments that can help children who are negatively impacted by trauma to lead healthy lives into adulthood.

Child trauma definitely isn’t easy to think about. 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, 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 prevent trauma and reduce the impact 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.

Our guest in this episode is Dr. Carla Kmett Danielson. Dr. Danielson is a clinical psychologist and professor at the National Crime Victims Research and Treatment Center within the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina.

Her areas of research and clinical expertise focus on understanding how trauma and stress can lead to mental health problems, particularly in adolescence, and how those exposures may lead to substance use problems and risky sexual behavior. Dr. Danielson is the director of the EMPOWER Program at MUSC, and she is also the developer of Risk Reduction through Family Therapy, also called RRFT, an exposure based integrative treatment for adolescents who experience both PTSD symptoms and substance use problems.

She's currently leading a large-scale randomized control trial evaluation of RRFT funded by the National Institute on Drug Abuse. This episode does discuss traumatic childhood experiences, so please be sure to take care of yourself as you listen.

Stay with us.

[00:02:44] Bouchie:  Dr. Danielson, welcome to Science Never Sleeps.

[00:02:47] Carla Kmett Danielson, PhD: Thank you so much for having me this morning.

[00:02:49] Bouchie: I am really excited about our conversation in this episode because I think it's so important to talk about these issues, and I want to start out by really talking about the broad subject of trauma. I think it's one that certainly a lot of attention has been paid to over the last decade or so, as we've learned about studies like the ACEs study, and we try to learn more about trauma, and how it affects us all, but particularly how it affects children is so important. So can you talk a little bit about trauma, and how it may be different for children.

[00:03:25] Danielson: Absolutely. And I want to emphasize the introduction that you gave did a really nice job of referring to trauma initially as potentially traumatic events. I think we will reduce that to trauma, as we talk throughout today's podcast. But that word ‘potentially’ is really important, because we know that trauma affects everybody differently, and the great majority of people who experience a potentially traumatic event or trauma do not go on to develop mental health problems or experience problems because of that. Majority are resilient, so that's really good news. But there are cases where youth and adults go on to developmental health problems following traumatic event experiences. And those are most of the folks that we'll end up talking about today.

In terms of among those kiddos who are impacted by trauma, I would say we see lots of different clinical presentations, meaning lots of different ways in which we see different types of mental health symptoms in the aftermath of a trauma. So, for example, we often talk about Post-Traumatic Stress Disorder, or PTSD. And within PTSD, we are talking about hyper-arousal, we're talking about re-experiencing or feeling like you're experiencing the trauma again, we’re talking about negative alteration in cognition and feeling - having had experienced the trauma leading to hard feelings, negative thoughts, inaccurate, unhelpful thoughts about yourself, about the world, about others. And then perhaps the most common one is avoidance – not wanting to think about the trauma, talk about the trauma, have memories associated with the trauma. Those are common things that we see in young people who experience trauma.

However, there are also many other types of presentations or problems that we see. Sometimes after somebody has experienced a trauma, those can include depression, substance use behaviors, other forms of anxiety, other types of risky behaviors too, such as running away, school refusal, and risky sexual behavior.

Kids are impacted in many different ways.

[00:06:02] Bouchie: I think the PTSD point is important because we think about PTSD often in adults, particularly when we are thinking about those who have completed military service and have experienced trauma within that. But really it transcends age, and anyone can experience it, particularly children as well.

[00:06:21] Danielson: Correct and with kiddos we sometimes see more irritability. Perhaps we may see avoidance in other forms; I mentioned school refusal as an example, but absolutely we see that in young people as well.

[00:06:38] Bouchie: And school refusal is…

[00:06:39] Danielson: Is not wanting to go to school, or not getting out of bed, not getting into the car, or not getting out of the car when you get to the school, or perhaps not even making it to class while you're at the school.

[00:06:56] Bouchie: Are there certain things that we might see as adults who have children in our lives that we love, who we suspect may have experienced a trauma that we might see? School refusal makes me think of that, because certainly, if you had a kid who was really excited to go to school and suddenly decided that they didn't want to be there anymore, that might be a trigger to think something may need to be looked into. Are there other things that that adults can look at?

[00:07:26] Danielson: Yes, and that's really important as you emphasize in your intro as well. Unfortunately, experiencing potentially traumatic events, is common. Most people, up to seventy percent, will experience that by the time they're eighteen years old. Unfortunately, most kiddos will end up going through something like that. The question will be, are they impacted by it? So, what should adults be looking at? And I would include in that adult beyond caregivers, teachers as well, because that is a window of opportunity. Our teachers are just so wonderful. They are spending so much time with our youth, and so it's great opportunity to capture when something is going on that may not otherwise be observed.

So, I would say, um sleepiness. Everything I’m going to say absolutely are not complete “yes, if you see this, this means this youth has experienced trauma.” It’s one of many symptoms, and these are also symptoms that could just be that the kid didn't get a good night’s sleep that night. So let me emphasize that, too.

We do know that nighttime can be a hard time if you're in a home where there's domestic violence going on, or if you're in a bedroom where perhaps you experienced sexual abuse, it can lead to really hard time going to sleep at night. In turn, they get to school, and they are very tired. So that is something to think about.

Withdrawal, so not wanting to engage with peers. Particularly if you see that difference that at one point they were, and then they start to not do so. I would say, generally not answering questions. I have a twelve-year-old, son, and he doesn't always love to answer questions, either. But if maybe you're talking about family life at home, and you notice a kid is having a hard time talking about that. And caregivers know their own children a lot. So same thing, if you notice a difference in how they had previously been, it could be puberty, or could be that something has happened that's challenging for them to talk about.

I would say, if you suspect something's going on, you can always use a gentle intro into it, meaning, maybe perhaps talk about something you read, or something you saw in the news, or something you heard about that is along the lines of something you suspect, and you can say “what your thoughts about that?” instead of asking open-ended questions like or  going directly after “did this happen? Did something happen at school?” That may be an easier way for them to see that you're comfortable talking with those topics. You would expect that they might have something to say about those topics, and maybe make it a little bit easier for them to disclose to you. Unfortunately, most kids who experience trauma, don’t disclose when it happens, and if they do, it's often much later than when the incident happens. And so, as a preventionist, my suggestion would be to have those discussions, not waiting for when you see signs or symptoms that something may be wrong, but instead of it just being part of your household conversation. Just like we emphasize about mental health and coping, and substance use and sex, you want to have those conversations early on and on an ongoing basis, so that in your household your kiddo knows that those are safe topics and that you are letting them know if something were it to ever happen, you would want them to share that with you.

[00:11:03] Bouchie: It's really establishing open lines of communication very early. My background is in sexual abuse prevention, and so we would talk about using proper names for body parts very early because that's what opens up those lines of communication and helps your children to be able to talk to you.

[00:11:26] Danielson: And that can be hard. To me that’s been a surprising thing, to see that it takes some time for caregivers sometimes to get comfortable having those conversations. And that's okay. So that's where why we encourage you to practice saying the words out loud. If you didn't grow up saying penis and vagina, then you might take some time to practice doing that, so that when you talk to your kid about it, you aren't turning red, you aren't stumbling over the words and teaching them that this is something embarrassing to be talking about. Right? Right?

[00:11:56] Bouchie: We’re going to talk more about treatment, and we’re going to come back to that in a bit, but I want to really ask you sort of personally - and this is, you know, Science Never Sleeps is as an opportunity to talk about stories and how researchers came to where they are, and got to study the things they're studying. So as a clinical psychologist, I love the work that you're doing. But I have to ask - is this where you thought you would land? Is it sort of where you always wanted to go? Or did you find a path that brought you here? Tell us a little bit about that story.

[00:12:34] Danielson: Absolutely. I’ll start with the punchline, which is, I absolutely believe that I am exactly where I’m supposed to be and doing exactly what I'm supposed to be doing, and I’m exceptionally blessed to love what I do, which is really important. But no, I did not. You know, when you are eighteen, and you're thinking about these things, this is not what I had initially predicted. I knew psychology was something I wanted to pursue. Actually, theater was something I also was very interested in, but I was the first one in my family to go to college, and my parents said, well you can act without a degree, but you can't do anything else so without a degree. So why don’t we explore a couple things? And so that was one of my great interests. Like many folks who go into psychology, it started with an interest in just talking to people and enjoying supporting people and listening to people.

But I learned really quickly, as I mentioned, we didn't have a long family history of academics and our family. And honestly, I don't think I could point to a single woman, doctor that I knew growing up. So going to undergraduate - I was at Ohio University - was really my first intro to what different career pathways could look like, that would blend. I did always enjoy my science classes, so kind of merge my interest in science and be able to pursue a doctoral degree without having to do cadaver lab, and work with things that involve blood and things like that, so that also felt like a really good fit. But would help me really get more into the depth beyond being able to help people one at a time, more get into the science behind helping people, to understand how best to help people, why people develop mental health problems, and then how to intervene with that was a really exciting opportunity.

So, what I learned about that academic research pathway in undergrad, Thanks to my honor's thesis advisor, Dr. Arkis, that was really what started me down that path. In my doctoral program at Case Western Reserve University, I was working with Dr. Eric Youngstrom, who is my wonderful, brilliant adviser in the area of bipolar disorder and unipolar depression in youth, and with a particular emphasis or interest, I will say for my part, in high-risk adolescents.

So, as I spent time with high-risk adolescents and talking with them about their histories, one theme that kept coming up was trauma. The great majority of them experienced trauma, and it was clearly a significant element as part of their history when they would talk about their depression or their bipolar symptoms. That led me to want to learn more about that. And so, in clinical psychology we do our one-year Residency before we get our Doctoral degree, and so I was very fortunate to match here at MUSC, which is truly the best place in the country if you want to learn about how to treat traumatic stress symptoms and if you want to learn about research in this. Dr. Dean Kilpatrick, who is the director of the National Crime Victim Center, founded the – we call it the NCVC – almost fifty years ago. I think we're in the forty-five-year anniversary coming up, so he is really one of the forerunners in teaching people and learning how to best to assess trauma, how to ask people about that, help train some of the leaders in treatment development, and so on.

So, anyway, fortunate enough to land here for my internship year and my plan had been to learn about that and take it back to Cleveland. But you know that saying that life is what happens when you're busy making plans right, and in my first month or so one of my rotations at the CVC included going over to Dee Norton Child Advocacy Center, where we would staff a lot of cases in the community of youth who had experienced abuse and I can still remember sitting around that table, and it's a multidisciplinary effort. Right? So, you have, child advocates, school representation. You have child protective services, often, sometimes police, certainly mental health is represented, and it was just a really incredible experience to see everybody coming together as a team to truly work together to help a child, a family. There was a lot of passion – and I’m half Italian, but the Italian side is kind of forward for me – so it was a very good fit for my personality to see that that passion and that advocacy going on. It was really in that moment that I knew that this was my path – the science behind traumatic stress but also very applied on the ground.

And of course, the fact that we are in Charleston, South Carolina doesn't hurt either. The weather isn't too bad here. I do like the sunshine, so things kind of came together and really it was from there. While I was an intern one of the things that we struggled a lot with at the CVC were the adolescents who presented less with PTSD forward and more with those risk behaviors, and some of the things that were said which were very true, were that we deliver evidence-based treatments here at the CVC, and we don't have an evidence-based treatment for co-occurring substance use and PTSD, for example. So, we will we need to refer out get the substance use piece addressed, and then come back for the trauma piece. And you know, at the time, I just spent a lot of time reflecting on “but what if the trauma is a driving factor for the substance use?” so that was really the birth of the next fifteen years of my career, of one of the primary paths of my research, which has been focused on development and evaluation. And now at this point, implementation of an evidence-based treatment for co-occurring substance use in PTSD.

[00:19:19] Bouchie: So that’s where I want to go next, but before we go there, I want to ask about your lab. So, you landed at MUSC, you did your preliminary work, you got to the point where you have your own lab now, and it's called the Invictus Lab. Tell us about your lab.

[00:19:36] Danielson: Yes, so Invictus - if folks are familiar with Henley's poem, Invictus - It was my father's favorite poem, so it was one I was very familiar with, and one of the things that – as I mentioned that there's a lot of kids who are resilient after trauma, and young people who are resilient – but there are youth who still need to learn that they have the capacity to be resilient and how to be resilient. And in the Invictus poem, the last two lines focus on “I am the master of my fate. I am the captain of my soul” and it begins with “Out of the darkness I rise,” and then kind of comes back to this very positive, inspirational component. And I really feel like everything in the lab that we do is about that. About how do we help young people best become the master of their fate and their captain of their soul, and we can do that through prevention, we can do that by butter understanding what the targets for prevention after somebody are experiences a trauma. We can do that through treatment, and we can do that through really bringing services to other people, and so that all of that is part of our work. So just how do we bend those trajectories and positive ways to do so?

[00:21:01] Bouchie: So we talked about trauma. Let's talk for a second about resilience, because that's sort of the antidote to some degree to trauma. Talk a little bit about resilience. What is that? How do we gain it? Where does it come from? Particularly in the lives of children?

[00:21:19] Danielson: I like that question a lot because I think that that's a really important emphasis. Every child, every family, every caregiver, has strengths, and what those are look different. I would argue there's not one definition for resiliency, for any particular family. But it’s can we find the strengths and capitalize on the strengths so that people are able to do accomplish their everyday tasks. We talk about functioning a lot – how does a mental health problem or mental health symptoms impact daily functioning? Are you able to go to school and learn and have friendships and enjoy your family relationships? If you have interests and hobbies in any given area, are you able to engage in that, and celebrate that? I also like to think about people looking forward. Forward is a pace, and so for one person, resiliency might be oh, I’m going to go all the way and become a psychologist myself and help people. Well for some people that resiliency might be finishing high school, right?

[00:22:35] Bouchie: When you were discussing earlier working with the National Crime Victims and Treatment Center here at MUSC, you made a point to mention that the treatments that are used at MUSC are evidence-based. Tell us a little bit about that and then I’d like you talk about the evidence-based treatments that you have been working on as a researcher and understanding how they work.

[00:22:59] Danielson: Wonderful question! I’m so glad you asked. Just like we test medications to figure out if something is going to work and help treat a problem through randomized controlled trials, clinical trials, where we compare one medication to another and we figure out which one works better for a given problem, we do the same thing with talking therapy. That’s really important because we want people to be able to maximize their resources. When they meet with a clinician that they are using that time to engage in a treatment that we know works. I really like to emphasize that point with consumers out there, that when you’re seeking mental health services for yourself or your youth, it’s important to ask what treatments a clinician is skilled in and applies because you want to make sure they offer the treatment that would be helpful for your problem, in this case trauma. In evidence-based treatment, also called empirically supported treatment, is a treatment that has undergone that rigorous evaluation of a randomized controlled trial, RCT, and has been compared to at least one other treatment and has been shown to work better than if you did the other treatment.

The treatment at the NCVC when I was an intern, at that time we didn’t have an evidence-based treatment for adolescents with co-occurring PTSD symptoms and substance use. So that was the opportunity to figure out what we needed to do to develop that. The really good news was that time and still today, we have evidence-based treatments for PTSD symptoms in use. Trauma Focused Cognitive Behavioral Therapy, TFCBT, is one of our most evidence-based treatments for PTSD, for really any child mental health problem. There are well over 20 randomized controlled trials at this point evaluating and showing the TFCBT works. And then, in parallel, we have evidence-based treatments for adolescent substance use problems, in fact one of them, multisystemic therapy, also came from a lot of work led by Scott Henggeler here some years ago. My thought was we don’t need to reinvent the wheel, why don’t we integrate these treatments that we know work or based on principles that we know work, and that’s what I did. I was very fortunate to be able to work with the developers of TFCBT and the developer of MST, as well as others who worked with revictimization prevention and risky sexual behavior and came up with a structured strategy within a treatment for clinicians to be able to address these multiple problems that we see after an adolescent experiences trauma.

[00:26:21] Danielson: RRFT has seven components – psychoeducation and engagement, family communication, coping, substance use, PTSD, and revictimization risk reduction. However, for example, during the pilot trial, we did not have family communication as its own component. That was part of the feedback from the clinicians and from doing my own work – I also served as a clinician while developing this treatment. That’s the best way to figure out what works and what doesn’t right? So, the next step was a small pilot randomized controlled trial funded through NIDA, a K award I was very fortunate to receive and then what turned out to be my first R01. An R01 is a large research grant that is focused on science that is a – sure thing is a strong language – but for the NIH to give you an R01, they need to feel pretty good that you’re going to do the science well and that it’s going to work out. So that was also done here at MUSC and that is what led to the publication in JMA (?) Psychiatry and that is where we were able to share results with the world that RRFT, risk reduction through family therapy, does in fact work and is efficacious in reducing substance use problems and PTSD for adolescents with these co-occurring problems, so that was very exciting.

Now we have another R01, we’re working with a team at the University of Colorado Denver with my co-principal investigator, Dr. Paula Riggs, who is a child and adolescent psychiatrist, in implementing RRFT in Denver. Another interesting element is that marijuana is legalized in Colorado, not for youth, however, data suggests that areas that have legalized marijuana, that impacts things in terms of rates and severity. We’re really excited to see how that turns out.

[00:28:33] Bouchie: So, the RRFT really is about leveraging the family unit, it is family therapy, so it’s about empowering, supporting the family unit to build that resilience.

[00:28:48] Danielson: Yes, however, if I could go back in time and name it something broader than that I would, because really we focus on the child’s ecologies and family. Ecologies are the systems, we don’t exist as individuals in a vacuum - we have the individual layer, and this comes from Bron from Brenner, we have a family layer outside of that and then we have a peer layer outside of that and then a school layer and a community layer. Really what RRFT does is focus on for that particular kid, for that particular family, what are the specific risks and protective factors for substance use, for PTSD. We focus on reducing the risk factors and promoting the protective factors.

Family can look very different. Our goal is to have a youth who has a caregiver for us to work with, but sometimes that caregiver is a staff member at a group home, a foster parent, or not someone we ever get to work with directly, but we work with the youth on family communication skills such that many of these youth, even if they’re from families from whom they’re separated or aren’t able to take care of them, many of them end up deciding at eighteen to go back into those families or have communication with those families, so how do we help build their resiliency and be able to cope with having these relationships with people that have complicating factors.

[00:30:49] Bouchie: And giving them the skills that they need to be able to navigate those spaces.

[00:30:53] Danielson: But again, often we are able to work with some caregiver and in those circumstances, we really work on empowering the caregiver, that they have the capacity to return to whatever treatment goals they have. Oftentimes, it’s about repairing the relationship with the youth, helping them have a healthy future. Many of these caregivers have their own trauma history, many are at the end of their rope because they’ve had a lot of trials and tribulations to get to this point with their teen. Part of our work in RRFT is building their parenting efficacy again, that they have the capacity to do this. It isn’t that they’re part of the problem, it’s that they’re the most critical part of the solution.

In substance use, this is true for adolescents and adults, we unfortunately have high relapse rates. While treatment’s in place, people do well. When treatment’s removed, we tend to see symptoms return and short of treatment being a lifelong process, which is really hard for that to be the case, what our goal in RRFT, which really comes from MST principles, that generalization and long term sustainability of the skills. As dedicated as our RRFT clinicians are, most of them are unlikely to adopt these kids and bring them home with them. So in lieu of that, who will be in their lives forever and who can be in their lives to help sustain the gains they’ve made and help them make good choices when it comes to being at parties and being around marijuana and other substances and pills.

[00:32:52] Bouchie: I was first introduced to you and your work as I was learning more about the CHARM study, which is another great study around understanding how to best to serve children and their families. Tell us about CHARM.

[00:33:14] Danielson: Very excited to talk with you about the CHARM study, which stands for the Charleston Resiliency Monitoring study. That is something that I wanted to say out of the gate has been a great team effort, as most of my research has been, if that’s okay to interject that here, that the study of trauma is very much a team science. It requires a team science, which means everybody from experts from different fields, our staff members, our research assistants and project coordinators, everyone is such a critical part of this team. Everything I am talking about today is truly the result of teamwork and I wish I could give a shoutout to every single person who has been on my team and all of my collaborators, but we would be here all day because that is how many wonderful experts we have here at MUSC and beyond.

We know that when somebody experiences a potentially traumatic event, that not everyone goes on to develop mental health problems, but some do. What we don’t know in fine grain detail is exactly why that is. What are the mechanisms? What are the pathways that promote resiliency after an event has been experienced versus people going on to develop anxiety disorders, depression, substance use. So really, CHARM is about helping us better understand that pathway from child maltreatment in particular, but other forms of trauma as well, onto anxiety disorders and other forms of mental health problems, with a particular mechanism that we have focused on. The fancy word is threat-related negative valence systems, but that is a fancy way of saying “how do we process threat?”

We are trying to understand that if after somebody has experienced a traumatic event or child maltreatment, how does that impact their threat processing, how does that impact their threat processing and in turn, does that altered threat processing potentially lead to these outcomes that we talked about. How we go about studying that is multi-faceted. This is something that our funder for this study, the National Institute of Mental Health, NIMH, has put forward this matrix, this conceptualization of how do we best approach research questions in mental health. It’s called RDOC system, research domain criteria system, so this is an RDOC study. That means when we’re studying this pathway of threat processing, we’re doing it in many different ways. We’re doing it through neuroimaging, through psychophysiology, so EEG. Startle, we’re looking at blinks for example in the face of a stressor and we’re looking at cortisol reactivity. Of course, we’re doing clinical interviewing that has to do with trauma history and mental health symptoms and so on. What that means is, I’m very proud of and grateful for the youth and families that have participated in this study because those lab visits could be up to eight hours at a time. Importantly, for us to understand these questions best, we need to look at these things over time, so this is what we call a longitudinal study.

At baseline, meaning the first time that we assess these kids, they were in third, sixth, and ninth grade. We were very fortunate to recruit 364 youth and their caregivers to participate, and then we followed up with them two different times after that in person, as well as intermediate phone calls to check in regarding trauma history and new onset of mental health symptoms. In those in person visits, we would bring them into the scanner and subject them to tasks that had to do with attention to different types of pictures, some that might elicit positive emotions and some that might elicit negative emotions, some more neutral. Same thing true with our psychophysiology tasks, we were looking at things like how does the brain respond when you make a mistake which has been argued that that’s a form of a threat, as well as how does somebody respond, that’s the startle piece, when you are presented with things that you may not expect as well as startling pieces that you may expect and so on. It’s a lot of data, as I mentioned, so this is three in person visits over a two-year period as well as those two intermediate phone calls, which I’m thrilled to say we are done with data collection, but as you can imagine during the pandemic this was going on and so there were some challenges there. With our challenges come silver linings and one of the unique things we’re going to be able to talk about is impact of pandemic as a potential significant stressor as well for these families so we did assess how pandemic affected their lives over the past two years as well so we’ll have an opportunity to also see how that may or may not have impacted in this relation between trauma, child maltreatment, and mental health problems.

[00:38:59] Bouchie: That’s really great, because I do think we’re on the front end of what is the research going to yield around the pandemic and the impact that it had in lots of different ways. We can make a list of all the different ways humans were impacted by the pandemic, but I think particularly children is really an important question to answer to kind of understand how did all kinds of things, whether it was the perceived health threat of that scary thing, or losing loved ones, or being separated from their peers for such a long period. That’s really great because that’s research that’s yet to be really out there.

[00:39:43] Danielson: One thing that we do know well in the child trauma research arena is that impact of trauma is cumulative. As you experience more trauma, more adversities, you’re more likely to develop mental health problems following, so I think the pandemic stressor is something we hypothesize that added accumulation potentially to impact. Anecdotally, we heard that when we were interviewing families during the height of the pandemic, a lot of folks would mention things like, you know I never though about or it’s been a long time since I thought about this trauma, it didn’t really impact me, but now that we’re going through the stressors of the pandemic, I’m thinking about it all the time and I don’t understand why, why is it bothering me now, it didn’t bother me before and that’s very normal. It heightened their sensitivity to stressors that had happened previously, and I think we do have an opportunity to learn a lot of that.

We do know that a national state of emergency has been declared for child mental health across the country. That was jointly declared by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Hospital Association. It’s clear enough that there’s been an impact. That was declared in October 2021. We definitely see reports of increased opioid overdoses. We see, again this is anecdotally, clinicians and even our own clinic on waitlists we’ve never seen, at least in the twenty years I’ve been here I’ve never seen our waitlist at the level it is right now, just to keep up with the number of referrals that come in and I know all our community clinicians are in similar positions. All of us are incredibly dedicated to ensuring that those who need service get service. We work a lot with our community partners – the schools, child advocacy centers, to make sure that if we can’t get to a kid immediately, we’ll figure out where we can connect them with services.

[00:42:11] Bouchie: We do focus on research on Science Never Sleeps, but you just talked about service, and I think that’s important because particularly in the space you’re in, it really is about translational research, where it’s moving towards “how do we provide this service?” that ultimately improves the lives of children, their families, and we can also talk about the downstream – generational positive impacts that this kind of thing can have. I want to ask about EMPOWER which really is an extension of the research, it’s services that have been derived from what we’ve learned through research. Can you talk about EMPOWERR?

[00:42:50] Danielson: Yes, I really enjoy talking about EMPOWERR because as I mentioned earlier, I’m a preventionist at heart. I think at the end of the day, of course our goal is to ultimately prevent mental health problems after folks experience traumatic events as well as general life stressors, if we can. Unfortunately, many youth do not line up for prevention services so we have to be creative about how we bring prevention to the community.

EMPOWERR actually came from a call from SAMHSA in 2007. I remember that because I remember my daughter being about nine months old when I was pulling all-nighters to write this grant, to be able to bring prevention, HIV and substance use prevention services to our community, so it wasn’t specific to trauma per say, but given those base rates I talked about trauma, there’s certainly a lot of overlap there. I have learned, and I didn’t know this, and I think many people don’t know this, that our HIV acquisition rates in South Carolina, including in Charleston and surrounding area, are quite high with regard to national rates. South Carolina has been in the top ten for many years with regard to new HIV acquisition rates. It was very important to think about how might we parlay this into our opportunity that we have in working in our community, working in schools, working with the Department of Juvenile Justice, for example. That was that first grant that we were fortunate to get funded to implement these prevention services in the community. Since then, we’ve been fortunate to receive a range of grants building on that program and form even more community partnerships – Palmetto Community Care, our Infectious Diseases department here at MUSC, Roper, many partners in the community.

We have worked to expand to local colleges, Dr. Alyssa Rheingold who is one of my colleagues has helped lead that work with young adults. For example, we do community HIV testing events for that and most recently – SAMHSA has multiple branches, prevention branch but also offer a treatment branch, and I mentioned earlier the Family Tree grant – at MUSC, we were fortunate to be one of only eighteen places across the country to be awarded this grant. Family tree, as it implies, is that we’re focusing not just on adolescents with substance use problems, but also the branches of that tree which includes caregivers and other community aspects. We were fortunate to receive that, it actually provides funding for RRFT clinicians and clinicians who are implementing evidence-based treatments for substance use disorders, but do not have the co-occurring traumatic stress piece. That’s housed in our Center for Drug and Alcohol Program, our CDAP program, who are very much a partner on this. We’re very fortunate to have those resources in place now to be able to implement those services. We have just launched within the past, about six months maybe? And we are already close to waitlist/on waitlist for those clinicians, so as we suspected there’s a huge demand for this. We’re very grateful for any opportunity to have these resources to be able to fund us to do this. As I mentioned before, the Glenn Family Foundation also has been an opportunity to be able to provide some of these services in the community that would otherwise not be possible without those funds.

Along those lines, we have a long road ahead of us. We’re so excited about the gains we’ve been able to make in the science and in the services. We’re grateful for the generous contributions, whether that be from the NIH, from other Foundation funding, SAMHSA, on through private donors. If anyone is listening and wondering, what is it I can do to make a difference with my resources? We are always open and looking for resources that could further what we’re able to do with these research questions that we have and with the services that we provide, and you can contact me.

[00:47:54] Bouchie: At the end of the day, it’s about improving the lives of children, which ultimately help us all as adults live happier, healthier lives.

[00:48:05] Danielson: One hundred percent. I can’t emphasize that point enough. These youth grow up to be adults. They grow up to be contributing members of our society or would like to be contributing members of our society. What PTSD and substance use disorder and other forms of mental health look like in adults is that much more impairing. It’s that much more difficult to do those daily functioning tasks I was talking about earlier. It’s not attending school; it’s getting to work and paying your bills. It’s being able to become parents and sometimes stop intergenerational transmission of trauma. It’s such a great opportunity when we have the ability to intervene earlier in life, rather than waiting for these things to come up as adults. We could get into the numbers; it is in the billions and billions of dollars the degree to which it is estimated the United States is impacted by substance use disorder and mental health problems. Any prevention that we engage in, any financial contributions that we receive certainly play out tenfold in the long run for society.

[00:49:25] Bouchie: Thank you so much for being with us on Science Never Sleeps, Dr. Danielson.

[00:49:29] Danielson: Thank you so much, Gwen. I can’t tell you how much I appreciate the opportunity to talk about the science, to talk about the work that we’ve done. My team and I are very grateful for you to be able to bring the message out to the public because it doesn’t do anybody any good sitting in journals or sitting in our conference rooms where we talk about these things. We are working hard to really think about how to get this to the very people who we’re hoping to serve, so thank you so much for being a vehicle for that.

[00:50:09] Bouchie: We’ve been talking to Dr. Carla Kmett Danielson about her research on supporting children and adolescents who’ve experienced trauma. Have an idea for a future episode of Science Never Sleeps? Click on the link in our show notes to share with us.

Science Never Sleeps is produced by the Office of the Vice President for Research at the Medical University of South Carolina. Special thanks to the Office of Instructional Technology for support on this episode.