Running head: CAMERON COMPLEX TRAUMA INTERVIEW 1

Trauma Assessment Review: Cameron Complex Trauma Interview

Sarah Furtado

Bridgewater State University

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Trauma Assessment Review: Cameron Complex Trauma Interview

Childhoods shaped by traumatic events are defined as those that experience extraordinary

and unfortunate events. The impact of these experiences results in loss of control over memories

and thoughts that were once perceived as safe (Cordon, Pipe, Sayfan, Melinder, & Goodman,

2004). For example, a trauma victim’s understanding of personal safety is dismantled to the

extent that uncontrollable flooded thoughts overwhelm the ability for a young person to

experience and learn a healthy lifestyle (Herman, 1992).

This essay seeks to explain the psychometric breakdown of the Cameron Complex

Trauma Interview (CCTI) based off data from the initial analysis. Dr. Jennifer King, who is

responsible for the development of the CCTI, conducted the first study in 2015 and designed an

evidence-based manual titled Getting the Picture: A Cartoon-Based Assessment Tool for

Complex Trauma in Children, which is affiliated with the University of Pennsylvania (UPENN)

Scholarly Commons Doctorate in Social Work Dissertation program (King, 2015). The program

describes insightful outcomes with use of the assessment. Let’s continue the review for a sense of

those outcomes.

How can a therapeutic assessment assist with pain relief from enduring traumatic

incidents? Mental health counselors help guide children to a self-fulfilling life. Administration

of early interventions like the CCTI assists with the diagnosis and prognosis of complex trauma

symptoms or multiple severe trauma symptoms. The paper format CCTI develops a therapeutic

process for children to unload behavioral and psychological symptoms in a safe harbor with the

mental health counselor.

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Cameron Complex Trauma Interview

CCTI is a 3-part structured interview, pictorial-based tool used in face-to-face therapy

sessions. Criteria to participate is to be members of the pediatric population impacted by one or

more traumatic experiences. The pictorial approach has been used for multiple purposes: to

assess the psychological developmental stages of children, to diagnose Diagnostic and Statistical

Manual of Mental Disorders (DSM–5) disorders, as a projective tool, and to measure cognitive,

emotional, and behavioral constructs (King, 2015).

In addition to administration of other standardized measures, the CCTI results with

clinical judgement of trauma history and symptoms (King, 2015). Combined measures, ensure

the counselor stays on task to help the family move away from severe symptoms and behaviors.

This process helps the counselor gain full emission of diagnosis exemplified by the National

Child Traumatic Stress Network (NCTSN, 2003). CCTI serves to therapeutically transition

children into their adolescence developmental stage by enabling them to make connections with

their recognition memory bank rather than their recall memory bank (Dubi & Schneider, 2009).

Hypothetical Construct

The hypothetical construct of this trauma assessment shares insightful data to

epidemiological and clinical studies of children exposed to trauma as well as recognition that

symptomatology intensifies linearly with the severity one’s traumatic stress (Ford & Rogcrs,

1997). The idea behind the CCTI is to evaluate data the 7 psychological domains: attachment,

biology, affect regulation, dissociation, behavioral regulation, cognition, and self-concept

(NCTSN, 2013).

CCTI measures how the child views their world at the present moment. Expression

through symbolism becomes the key player in traumatic stress reduction and planning treatment
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goals. Guided exercises using images represent evidence of trauma, which is significant because

abstract thought process does not develop till adolescence (King, 2015).

Reliability

The study of CCTI was broken down into 3 sections, trauma history, symptomology, and

voluntary narrative feedback survey. History and symptom components were measured to reflect

its reliability. The CCTI adopted its methodology from the UCLA Child/Adolescent PTSD

Reaction Index for DSM-5 (UCLA PTSD-RI). The CCTI met criteria for a measurable reliability

paralleled to that of the UCLA PTSD-RI reliability and validity ranging from good to excellent

(Steinberg, 2004).

 Part 1, Trauma History, was found to be insignificantly reliable (=.632). Part 1 of the

CCTI and Part 1 of the UCLA PTSD-RI, positively and significantly correlated, r=.677, p

(King, 2015).

 Part 2, Symptomatology, found to be significantly reliable (=.931) (King, 2015).

Test-retest reliability ranged from good to excellent, and one study reported an intra-class

correlation coefficient of 0.93 for adolescents tested initially and again after 7 days (Steinberg,

2004).

Validity

CCTI data was examined with convincing parallel data to versions of the UCLA PTSD-

RI tested for validity constructs (Steinberg, 2004). For example, UCLA PTSD-RI achieved good

convergent validity: .70 in comparison with the PTSD Module of the Schedule for Affective

Disorders and Schizophrenia for School-Age Children (King, 2015).

The CCTI contains comparable data to the Traumatic Events Screening Inventory-Child

Version (TESI-C) (Ford, 2012), Structured Interview for Disorders of Extreme Stress-Adolescent
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Version (SIDES-A) (Pelcovitz, 2004). Developmental Trauma Disorder Structured Interview for

Children (DTDSI-C) (Ford, 2012).

Despite the small sample size, the CCTI shows preliminary signs of convergent validity

and internal consistency. Psychometric analysis presented issues in Part 2 that are in the process

of revision. Directions for future research include employing a larger sample size and additional

testing for evidenced-based measures (King, 2015).

In an effort to be an effective assessment tool, the overall use significantly and positively

impacted clinicians’ ability to implement a therapeutic approach to families that experienced

trauma (King, 2015). At the conclusion of the study, clinicians were encouraged to provide

narrative feedback. Counselors posed the CCTI as useful, comprehensive, developmentally and

culturally appropriate language, easy to use, and engaging (NCTSN, 2003).

Test Structure and Scoring

 Part 1 assesses the trauma history of children, ages 5 to 11.

 Part 1 is structured as a 5-point Likert Scale and then determine agreeableness or

disagreeableness. This part consists of 15 statements to be evaluated (King, 2015).

 Part 2 assesses symptomology of children.

 Part 2 is formatted with a 3-point Likert Scale that evaluates the NCTSN’s 7

domains of impairment (King, 2015).

 Part 2 uses the cartoon picture of Cameron, a dog, to represent interpretation of

child’s response to traumatic incidents. The visuals can best be described to create

Coinciding Images, Visual Likert Scale, Submit Images and Matching Items to

Reviewers Revise and Retest (King, 2015).

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 Part 3 is a survey structured as a 5-point Likert Scale that enables clinicians to

implement varying degrees of agreeableness and disagreeableness.

 Part 3 departs the assessment with the Clinical Utility and Feasibility Survey

online at the SurveyMonkey site. Clinical Utility and Feasibility Survey to

provide narrative feedback (King, 2015).

Consideration of the Population

Information is gathered and processed in 45-minutes of playful therapeutic intervention

with child and caregivers. Time spent with such traumatic emotional dysregulation must be

delivered at a child’s pace in order for them to shift their flooded thoughts to more recognizable,

calmer thoughts that turn into precious moments in a child’s life. More recent studies indicate

this tool suits children educated younger than 5 years old by use of more pictures connected to

words (Cordon, Pipe, Sayfan, Melinder, & Goodman, 2004).

The CCTI sets the therapeutic tone with fun pictures. CCTI is an art therapy form. The

friendly dog illustration, Cameron, was a therapeutic character because of the relational

significance children have with animals (Melson & Melson, 2009). Research suggests children

therapeutically gravitate toward animals. In the presence of animals, children’s blood pressure

lowers which reduces anxiety. (King, 2015). Images of objects and cartoons can therapeutically

bond faultless children with unskilled clinicians.

Lastly, statistical analyses from the Chicago Child Trauma Center found that children

who experienced ongoing trauma in combination with inadequate caregiving systems were 1.5

times more likely than other trauma-exposed children to meet criteria for non-trauma related

diagnoses (Herman, 1992). Certain symptoms may be significant enough to hold a different
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diagnosis. Exposure to various forms of misdiagnosed treatment (i.e. Major depressive disorder,

attachment disorders, communication disorders, etc.) and then prescribed psychotropic

medications could potentially harm a child if symptoms worsen in severity or new symptoms

occur (Herman, 1992). In return, the CCTI does evaluate for diagnostic criteria (King, 2015).

Other Information to Close

For the greatest return in therapeutic investment, Participating clinicians were

asked to administer both the UCLA Child/Adolescent PTSD Reaction Index for DSM-5 (PTSD-

RI) and CCTI, in that order, with children (King, 2015.) The CCTI creates a bridge for therapy to

intervene into a child’s life that experienced trauma.

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References

Cordon, I. M., Pipe, M., Sayfan, L., Melinder, A., & Goodman, G. (2004). Memory for traumatic

experiences in early childhood. Developmental Review, 24.(2). 44-56.

Dubi, K. & Schneider, S. (2009). The Picture Anxiety Test (PAT): A new pictorial assessment of

anxiety symptoms in young children. Journal of Anxiety Disorders, 23, (9). 1148-1157.

Ford, J. D. (2012). Can standardized diagnostic assessment be a useful adjunct to clinical

assessment in child mental health services? A randomized controlled trial of disclosure of

the development and well-being assessment to practitioners. Social Psychiatry and

Psychiatric Epidemiology, 48(5). 583-593. 

Ford, J. D. & Rogcrs, K. (1997), Empirically-based assessment of trauma and PTSD with

children and adolescents. Journal of Consulting and Clinical Psychology, 21(6). 185-192.

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated

trauma. Journal of Traumatic Stress, 5(3). 77-92.

King, J. A. (2015) "Getting the Picture: A Cartoon-Based Assessment Tool for Complex Trauma

in Children". Doctorate in Social Work (DSW) Dissertations. 68. Retrieved from

https://repository.upenn.edu/edissertations_sp2/68

Melson, G.F., & Melson, L.G. (2009). Why the wild things are: Animals in the lives of children.

Boston: Harvard University Press.

National Child Traumatic Stress Network. (2003). NCTSN Complex Trauma Task Force white

paper on complex trauma in children and adolescents. Retrieved from

http://www.nctsn.org/sites/default/files/assets/pdfs/ComplexTrauma_All.pdf