Journ Child Adol Trauma (2019) 12:23–29

DOI 10.1007/s40653-017-0162-z

ORIGINAL ARTICLE

Increasing Resource Parents’ Sensitivity towards Child

Posttraumatic Stress Symptoms: a Descriptive Study
on a Trauma-Informed Resource Parent Training
Maj R. Gigengack 1 & Irma M. Hein 1,2 & Robert Lindeboom 3 & Ramón J. L. Lindauer 1,2

Published online: 24 June 2017

# The Author(s) 2017. This article is an open access publication

Abstract Resource parents are often insufficiently prepared Background

for recognizing and managing posttraumatic stress symptoms
(PTSS) in their traumatized foster children, which can put a Internationally, a large amount of children currently grow up
successful foster placement at risk. The Resource Parent in foster care: 402,378 in the United States, and 18,175 in the
Curriculum (RPC) developed by the National Child Netherlands (Child Welfare Information Gateway, 2015;
Traumatic Stress Network is designed to increase resource Pleegzorg Nederland 2015). Many of them have experienced
parents’ sensitivity towards child PTSS. This study explores persistent and multiple child maltreatment. In particular ne-
the effect of the RPC on resource parents’ recognition of child glect, physical abuse and sexual abuse are common reasons
PTSS, resource parents’ perceived upbringing stress in caring for placement in foster care (Oswald et al. 2010). Mental
for their foster child, and child PTSS before entering the RPC health problems that frequently arise in maltreated children
(T0), after completing the RPC (T1) and at six-month follow- include behavioral and emotional disorders (Burns et al.
up (T2). Results (n = 108) show an increase in recognition of 2004), posttraumatic stress disorder (PTSD; Dubner and
child PTSS and a decrease in resource parents’ experienced Motta 1999) and attachment disorder (Zeanah et al. 2004),
upbringing stress and child PTSS over time. Findings suggest which may lead to problems in daily functioning in the foster
that the RPC increases resource parents’ trauma sensitivity. family, at school and in relationships.
However, child PTSS severity remains high. To address foster Parenting foster children can be challenging for foster
children’s PTSS, child trauma-focused treatment appears parents, especially because of the mental health problems
needed in addition to the RPC. many foster children are facing (Chamberlain et al. 2006;
Sullivan et al. 2016). Farmer et al. (2005) showed that
Keywords Posttraumatic stress disorder . Resource parents . multiple conduct problems, hyperactivity and violent be-
Foster care . PTSD recognition . Upbringing stress . Child havior in foster children are significantly related with fos-
PTSD . Resource parent curriculum . Training ter parents’ experienced strain during the placement.
Foster parents may lack the awareness that these foster
children’s mental health problems result from chronic
* Maj R. Gigengack
[email protected] traumatization and are often insufficiently prepared for
providing adequate care for traumatized children
(Sullivan et al. 2016). As a result, this lack of trauma-
1
Department of Child and Adolescent Psychiatry, Academic Medical informed perspective can put a successful foster place-
Center, University of Amsterdam, Meibergdreef 5, 1105
AZ Amsterdam, the Netherlands
ment at risk (Sullivan et al. 2016). Previous studies re-
2
ported that higher levels of behavior problems and depres-
de Bascule, Academic Center for Child and Adolescent Psychiatry,
Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
sion in foster children predict placement disruption (Barth
3
et al. 2007; Chamberlain et al. 2006; Oosterman et al.
Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Master Evidence based practice in Health Care,
2007). In turn, placement disruptions may negatively af-
Academic Medical Center, University of Amsterdam, fect a child’s development and aggravate existing mental
Amsterdam, the Netherlands health problems (Sullivan et al. 2016).
24 Journ Child Adol Trauma (2019) 12:23–29

In order to reduce disruption of foster placement, it is vital resource parents understand and are able to manage the child’s
to supply foster, therapeutic, adoptive, and kinship parents mental health symptoms, this is hypothesized to lead to a
(hereby referred to as resource parents) with necessary knowl- decrease of resource parents’ perceived upbringing stress.
edge and skills for providing adequate care for chronically Third, we explore the potential secondary effect of the RPC
traumatized children. For this goal BCaring for Children on the child’s PTSS. We hypothesize a possible decrease in
Who Have Experienced Trauma: A Workshop for Resource child PTSS as a result of an improved interaction between
Parents^, often referred to as the Resource Parent Curriculum resource parents and their foster child after the RPC. Finally,
(RPC), was developed by over 30 experts at the National we evaluate resource parents’ satisfaction with the RPC. In
Child Traumatic Stress Network (NCTSN; Grillo et al. accordance with previous studies (Coppens and Van Kregten
2010a). This curriculum is uniquely designed to help resource 2015; Lindauer et al. 2013; Sullivan et al. 2016), we hypoth-
parents provide a trauma-informed response to their foster or esize that resource parents will report high satisfaction rates
adopted child’s behaviors. Through an increased understand- with the content of the RPC and the usefulness of the RPC in
ing of how traumatic events can affect a child’s development, daily life.
resource parents can help their foster or adopted children heal
from the effects of trauma and form healthy attachments. The
curriculum was translated into Dutch by Coppens and Van Method
Kregten (2012) and implemented in multiple institutions for
child mental health in the Netherlands. Participants and Procedure
An initial evaluation of the RPC in the United States by
Sullivan et al. (2016) showed indications that the RPC is ef- From January 1st, 2013 until February 1st, 2015 resource
fective in increasing resource parents’ knowledge about parents participating in the RPC were prospectively enrolled.
trauma-informed parenting and improving their skills for pro- All resource parents and their foster or adopted children (here-
viding care for traumatized children. Recent file studies in the by referred to as foster children) were referred to a specialized
Netherlands demonstrated that resource parents who partici- outpatient clinic for child and adolescent psychiatry, de
pate in the RPC report a high satisfaction and an increase in Bascule, in Amsterdam, the Netherlands. All foster children
scores on training goals (Coppens and Van Kregten 2015; were referred to the Center of Trauma and Family of de
Lindauer et al. 2013). The Dutch studies conducted so far used Bascule, a subdivision that provides treatment for foster fam-
the evaluation tool that was provided by the curriculum, which ilies and (chronically) traumatized children. All participating
assesses the goals of the program on a 10-point scale. foster children were under the age of 18 and experienced one
However, according a literature review, research in this area or more traumatic events. The RPC is part of the standard
with standardized instruments is lacking in the Netherlands. treatment program offered to all resource parents who are
Furthermore, to our knowledge the current study in the referred to de Bascule.
Netherlands is one of the first to evaluate the RPC outside A total of 112 resource parents participated in the RPC
the USA where the RPC was developed. during the study period and were eligible for study participa-
The aim of the present study is to evaluate the effect of the tion, of whom 108 were included, four resource parents
RPC on resource parents’ sensitivity towards child posttrau- elected not to participate. In 34 cases, two resource parents
matic stress symptoms and on their perceived upbringing of one foster/adopted child participated, resulting in data on 91
stress. First, since the RPC aims at increasing resource par- foster children and 93 resource families (two foster children
ents’ knowledge of PTSS, we hypothesize that resource par- lived in two different resource families). Data from these 34
ents recognize more child posttraumatic stress symptoms after resource parents were included in the analyses, because we
completion of the RPC than before. Second, because the RPC aimed to explore the effect of the RPC on the sensitivity and
focuses on increasing resource parents’ awareness that the skills of resource parents individually (not on families).
child’s mental health problems result from chronic traumati- Baseline characteristics are shown in Table 1.
zation and on improving trauma-informed parenting skills, we As part of the standard protocol, resource parents filled
expect a reduction in resource parents’ perceived upbringing out questionnaires at three different times. First, these were
stress. With perceived upbringing stress we refer to the up- filled out before entering the RPC (T0), and second, after
bringing stress resource parents experience in caring for their completing the eight-session RPC. Resource parents filled
foster child. Besides stress that comes with upbringing in gen- out questionnaires immediately after completing the last ses-
eral, resource parents’ perceived upbringing stress could be sion of the RPC (T1). Third, and finally, the questionnaires
influenced by factors unique to foster care, like difficulties in were filled out at six-month follow-up (T2). Not all resource
contact with the foster children’s biological family or foster parents completed all measurements. Of the 108 participat-
children’s mental health problems (i.e. conduct problems, ing resource parents, 102 resource parents filled out the
hyperactivity or violent behavior; Farmer et al. 2005). If questionnaires at T0 (5 parents were not present at T0 and
Journ Child Adol Trauma (2019) 12:23–29 25

Table 1 Baseline characteristics

of resource parents (n = 108), n (%) Mean (SD, min-max)
foster/adopted children (n = 91)
and resource families (n = 93) Gender resource parents
Male 32 (29.6) -
Female 76 (70.4) -
Gender foster/adopted children
Male 53 (58.2) -
Female 38 (41.8) -
Age foster/adopted children - 9.8 (3.4, 4–17)
Type family
Adoptive family 5 (5.4) -
Foster family 65 (69.9) -
Professional foster family 23 (24.7) -
Intended duration of placement
Short-term (≤ 1 year) 20 (21.5) -
Long-term (placement until adulthood) 55 (59.1) -
N/A (adoption) 5 (5.4) -
Not reported 13 (14.0) -
Kinship carea
No 74 (79.6) -
Yes 9 (9.7) -
Not reported 10 (10.8) -
Actual duration of placement (months) - 31.2 (32.4, 0–151)
Number of children in resource family - 4.0 (1.7, 2–8)
Biological children - 2.0 (1.0, 1–4)
Foster/adopted children - 2.0 (1.5, 1–7)
Experience as a resource parent
0–3 years 42 (45.2) -
3–6 years 23 (24.7) -
6–10 years 11 (11.8) -
> 10 years 12 (12.9) -
Not reported 5 (5.4) -
a
Kinship care: Care for foster/adopted children by a member of the child’s social network (e.g. a relative, neighbor
or family friend)

started the RPC after the first session, 1 parent did not com- accordance with the 1964 Helsinki declaration and its later
plete the measures). At T1, 91 resource parents completed amendments or comparable ethical standards.
all measures (12 parents were lost to follow up, 1 parent
stopped the RPC, 3 parents filled out questionnaires about
another child, 1 parent stopped the foster placement). At T2, Intervention
56 resource parents filled out the questionnaires (41 parents
were lost to follow up, 2 parents stopped the RPC, 1 parent The RPC consists of the following eight modules: 1)
filled out questionnaires about another child, 7 parents BIntroductions^, 2) BTrauma 101^ (types of trauma), 3)
stopped the foster placement and 1 parent could not be BUnderstanding the effect of trauma^, 4) BBuilding a safe
traced). place^, 5) BDealing with feelings and behaviors^, 6)
At T0 resource parents were informed about the study by BConnections and healing^, 7) BBecoming an advocate^ and
the RPC trainers and were asked permission to use the ques- 8) BTaking care of yourself^ (Grillo et al. 2010b). Each mod-
tionnaire data for the study. Informed consent was obtained ule covers one or more topics aimed at improving resource
from the participating resource parents. The medical ethics parents’ knowledge and skills for providing adequate care for
committee of the Academic Medical Center approved the traumatized children. The topics are shown in Table 2 (also
study. All procedures performed in this study were in available on the website: http://nctsn.org/products/caring-for-
26 Journ Child Adol Trauma (2019) 12:23–29

Table 2 Modules and topics of

the Resource Parent Curriculum Module Topics
(Grillo et al. 2010b)
1: Introductions Introducing the RPC
Introducing the concept of trauma-informed parenting
2: Trauma 101 Define child trauma / types of child trauma
Children’s response to trauma
PTSD
Resilience
3: Understanding trauma’s effect Effect of trauma on children’s development
Responses to trauma in children of different ages
4: Building a safe place Promote safety for traumatized children
Trauma reminders (intrusion)
5: Dealing with feelings and Feelings and emotions of traumatized children (understanding and
behaviors managing)
Acting out behavior of traumatized children (understanding and
modification)
6: Connections and healing Influence of trauma on children’s perspective on themselves and the
future
Traumatized children’s connections and relationships
7: Becoming an advocate Help others to understand child traumatic stress and its impact
Promote and support trauma-focused treatment for the child
8: Taking care of yourself Awareness of own health
Recognition of warning signs

children-who-have-experienced-trauma, National Center for subscales and from .89 to .91 for the total score,
Child Traumatic Stress 2010). McDonald’s omega ranged from .87 to .98 for the subscales
The RPC was provided in eight bi-weekly sessions of 2.5 h and from .96 to .97 for the total score (Vermulst et al. 2015).
by two trained health care professionals and attended by 10 to Child PTSS was measured by the Children’s Revised
15 resource parents each training. One follow-up session of Impact of Event Scale (CRIES) parental version (Verlinden
2.5 h was given six months after the last session. et al. 2005). The CRIES is based on PTSD symptoms accord-
ing to the Diagnostic and Statistical Manual of Mental
Measures Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The
CRIES offers a total score (0–65) and three subscale scores on
Baseline characteristics of the foster children (e.g. age and the symptom clusters intrusion (0–20), avoidance (0–20) and
gender), the resource parents (e.g. gender and years of expe- hyperarousal (0–25). Initial psychometric properties of the
rience as a resource parent) and the resource families (e.g. type CRIES parental version showed good reliability and validity
of family and number of children living in the resource family) (Verlinden et al. 2014a). The internal consistency was
were measured by a questionnaire on demographic informa- α = 0.87 for the total score, 0.78 for the intrusion cluster,
tion filled out by the resource parents. 0.78 for the avoidance cluster and 0.71 for the hyperarousal
Parental stress was measured by the Burden of Upbringing cluster. Calculation of the convergent validity showed a strong
Questionnaire (Opvoedingsbelastingvragenlijst (OBVL); correlation between the CRIES total score and the total score
Vermulst et al. 2011) filled out by the resource parents. This of another PTSD questionnaire, the Trauma Symptom
questionnaire consists of 34 items divided over five subscales: Checklist for Young Children (TSCYC) (r = .73, p < .001).
(1) BProblems in the educator-child relationship^, (2) Furthermore, calculation of the divergent validity showed
BUpbringing problems^, (3) BDepressive moods^, (4) moderate correlations between the CRIES total score and
BRestricted role^ and (5) BPhysical health^. The total score three subscales and the total behavioral problem scale of the
is categorized into five groups, ranging from BNo problems^ Strengths and Difficulties Questionnaire (SDQ; total score
to BVery serious problems^. Overall reliability and validity of r = .38, p = .005; intrusion r = .37, p = .008; avoidance
the Burden of Upbringing Questionnaire are good (Vermulst r = .15, p = .300 and hyperarousal r = .46, p = .001;
et al. 2015). The overall internal consistency, which was esti- Verlinden et al. 2014a). If resource parents did not know the
mated with Cronbach’s alpha and McDonald’s omega, was answer to a CRIES item they were asked to fill out a question
good: Cronbach’s alpha ranged from .74 to .87 for the mark. The number of question marks was used as an indicator
Journ Child Adol Trauma (2019) 12:23–29 27

of the resource parents’ recognition of posttraumatic stress family (biological, foster/adoptive, total), or number of years
symptoms in their foster child. Although this measurement as a foster/adoptive parent. Moreover, no significant differ-
merely represents an indication of parents’ PTSS recognition, ences were found at baseline between responders and non-
it was used, as no validated test is currently available. In ac- responders on number of question marks filled out on the
cordance with previous studies, the missing items were scored CRIES (t(98) = 0.56, p = .58), OBVL scores (t(94) = 0.98,
0 for calculation of the total score. If two or more items of a p = .33) and CRIES scores (t(63) = 0.88, p = .38).
subscale were not filled out, a total score could not be calcu- Magnitude of the changes on the PTSS recognition, CRIES
lated (Verlinden et al. 2014b). Cut-off score of the CRIES scores and OBVL scores between time points are shown in
parental version is 31 (Verlinden et al. 2014a). Table 3. The number of question marks filled out on the
Participants’ satisfaction with the RPC was measured by an CRIES significantly decreased between T0 and T1 and be-
evaluation questionnaire. Parents rated the 8 modules and the tween T0 and T2. Moderately large effect sizes were seen for
overall usefulness of the RPC in daily life on a 0 to 5 response these two time points (respectively 0.74 and 0.72). OBVL
scale (0 = not satisfied, 3 = neutral, and 5 = very satisfied). scores significantly decreased between T0 and T2, the effect
size was small (0.07). Furthermore, total CRIES scores signif-
Data Analysis icantly decreased between T0 and T1 and between T0 and T2,
with small to medium effect sizes (respectively 0.38 and 0.40).
Baseline characteristics and participants’ satisfaction with the The reliability of the measures at the different time points
RPC were summarized with mean ± SD and range for contin- ranged from α = 0.79 to α = 0.86 for the CRIES total score
uous variables and numbers and percentages for categorical and from α = 0.93 to α = 0.94 for the OBVL total score.
variables. Attrition analysis was conducted in order to deter- Participants’ satisfaction with the RPC was generally high.
mine differences between responders and non-responders on All modules had mean satisfaction scores exceeding 4, except
demographic characteristics, number of question marks filled for module 1 (Introductions) which showed a mean satisfac-
out on the CRIES at baseline, baseline OBVL scores and tion score of 3.71. The mean satisfaction score for the overall
baseline CRIES scores. For the analysis and significance test- usefulness of the RPC in daily life was 3.92.
ing of the repeated measures over time, we used linear mixed
models (LMM; West et al. 2015). To test the changes over
time on the different outcome measures, time was entered as Discussion
a fixed effect. Using LMM we could enter all available mea-
surements; even if a participant did not complete a specific The RPC appears to have a positive effect on resource parents’
measurement, the data of the other measurements could still recognition of child PTSS, which was represented by a de-
be included in the analysis (PTSS recognition n = 108, OBVL creased number of question marks resource parents filled out
n = 105, CRIES n = 101). Magnitude of the differences be- on the CRIES. This recognition is achieved after completing
tween mean scores on the time points were examined by cal- the curriculum and is still present at the six-month follow-up,
culating effect sizes using Cohen’s d ((Mean1 - Mean2) divid- suggesting that the positive effect on resource parents’ recog-
ed by the pooled SD, where pooled SD = √[(SD12+ SD22)] / 2). nition of child PTSS remains stable over time. Targeting the
Effect sizes were interpreted according to Cohen’s classifica- lack of recognition in resource parents, the RPC appears to
tion: < 0.20 small, around 0.50 medium and >0.80 large achieve the goal of improving sensitivity. This finding con-
(Cohen 1992). The internal consistency of the CRIES and firms our hypothesis and is in line with a previous study of
the OBVL at the three different time points was estimated with Sullivan et al. (2016), who also found that resource parents
Cronbach’s alpha. We used IBM Statistical Product and were more knowledgeable about child PTSS after the RPC.
Service Solutions (SPSS) 19 for all analyses. Furthermore, in line with our second hypothesis, the upbring-
ing stress experienced by resource parents decreased although
the effect size is small. This decrease did not occur during the
Results training, but in the follow-up period. Resource parents might
need some time to digest their newly acquired knowledge and
Attrition analysis showed that responders and non-responders to implement their skills in the resource family.
only differed on placement type: adoptive families were more In addition, resource parents reported significantly less
likely to complete all three measurements than (professional) PTSS in their child after the RPC and at follow-up than at
foster families (χ2 = 8.3, p = .02). No significant differences the start of the training program. Resource parents’ in-
were found between responders and non-responders in terms creased trauma sensitivity might hypothetically have a
of resource parents gender, foster child gender, foster child positive effect on the parent-child interaction, which in
age, actual and intended duration of placement, kinship foster turn might indirectly lead to a reduction in child PTSS.
care/adoption, number of children living in the foster/adoptive However, the effect size was moderate and child PTSS
28 Journ Child Adol Trauma (2019) 12:23–29

Table 3 Differences between Measurements at Three Time Points

Baseline (T0) Post test (T1) Follow-up (T2) Effect size d

Measures n M SD n M SD p (T0-T1) n M SD p (T0-T2) p (T1-T2) T0-T1 T0-T2 T1-T2

PTSS recognition 100 1.57 2.38 89 0.25 0.88 < .001** 53 0.30 0.77 < .001** 1.00 0.74 0.72 −0.06
(# of question marks)
OBVL 96 62.89 9.92 91 62.35 10.49 1.00 55 62.20 10.33 .03* .09 0.05 0.07 0.01
CRIES 65 34.08 12.34 82 29.12 13.54 .04* 49 28.67 14.33 .008** .66 0.38 0.40 0.03

Effect size expressed in Cohen’s d

*p < 0.05, **p < 0.01 by linear mixed models

was still severe after the training. Therefore, the need for Conclusion
evidence based child trauma-focused treatment, like Eye
Movement Desensitization and Reprocessing (EMDR) or The RPC developed by the NCTSN appears to provide for
Trauma-Focused Cognitive Behavioral Therapy (TF- increasing resource parents’ recognition of child PTSS, and
CBT), remains unaltered. Finally, as hypothesized, partic- by that for some reduction in resource parents’ perceived up-
ipants’ satisfaction with RPC was generally high. bringing stress and child PTSS reported by resource parents.
This descriptive study has some limitations that should This might have a positive effect on foster children’s place-
be noted. First, although the design fits our aim to evalu- ment, as previous studies show that resource parents’ per-
ate the effects of the RPC training in the Netherlands it ceived upbringing stress and foster children’s mental health
has certain drawbacks. Despite the fact that the RPC ap- problems increase the risk of placement disruption (Barth
pears to have a positive effect on resource parents’ recog- et al. 2007; Chamberlain et al. 2006; Farmer et al. 2005;
nition of child PTSS, on their perceived upbringing stress Oosterman et al. 2007). Further research is needed to confirm
and on the children’s CRIES scores, the pre-post design this effect. We recommend long-term follow up studies on the
offers no certainty on causality between the RPC and the effect of the RPC and foster children’s placement stability.
outcome measures, only a randomized controlled design Also, we suggest the use of more targeted measures to assess
could accomplish this. Second, the number of resource the effect of the RPC on resource parents’ trauma sensitivity.
parents who completed the measurements decreased over The RPC appears to be a useful method to supply resource
time, which lead to a smaller sample size at T2. However, parents with the necessary knowledge and skills for providing
attrition analysis demonstrated that completers and non- adequate care for traumatized foster children. Besides, resource
completers did not differ on all baseline measurements. parents’ high satisfaction rates with the RPC implies that the
Third, only resource parents referred to a specialized content of the curriculum is suitable for resource parents’ and
treatment center were included. The referral criteria of the provided knowledge and skills are applicable to resource
the treatment center include children with severe symp- parents’ daily life. Therefore, we recommend the implementation
toms or comorbidity or children who did not respond to of the RPC in institutions of child mental health and foster care.
previous professional treatment. Although the treatment While foster children’s PTSS appears to decrease as an
center serves a wide region (metropolitan and surround- indirect consequence of resource parents’ increased trauma
ings), the referral criteria might limit the generalizability sensitivity, the severity of child PTSS remained high directly
of this study. Finally, we used number of question marks after the RPC and at six-month follow-up. In order to address
filled out by resource parents on the CRIES as an indica- foster children’s PTSS, we recommend trauma-focused treat-
tor of their PTSS recognition, because there are currently ment for foster children in addition to the RPC.
no validated measures available. Clearly the CRIES is not
designed for this purpose, however this measure might be
Acknowledgements We would like to thank the RPC trainers of de
a valid proxy for PTSS recognition.
Bascule, Amsterdam, the Netherlands for their help with administering
Future studies should include possible confounding fac- the measures. We also thank Bo van der Poel, Merel Barendregt, Claire
tors, like number of foster placement breakdowns. We recom- Nemchik, Joanne Vuijk, and Jane Kirpal for their help with the data
mend future studies to include more targeted measures to as- collection and data entry.
sess changes in resource parents’ sensitivity towards child
PTSS. Specifically, we suggest observational measures utiliz-
Compliance with Ethical Standards All procedures followed were in
ing structured and free play situations in order to evaluate the accordance with the ethical standards of the responsible committee on
interaction between the resource parent and foster child. human experimentation (institutional and national) and with the Helsinki
Journ Child Adol Trauma (2019) 12:23–29 29

Declaration of 1975, as revised in 2000. Informed consent was obtained Caring for children who have experienced trauma: A workshop for
from all patients for being included in the study. resource parents - Facilitator’s guide. Los Angeles, CA & Durham,
NC: National Center for Child Traumatic Stress.
Conflict of Interest The authors declare no potential conflicts of Grillo, C. A., Lott, D. A., & Foster Care Subcommittee of the Child
interest. Welfare Committee, National Traumatic Stress Network. (2010b).
Caring for children who have experienced trauma: A workshop for
Funding This study was supported by a grant of Stichting resource parents - Participant Handbook. Los Angeles, CA &
Kinderpostzegels Nederland (grant number 7788085). Durham, NC: National Center for Child Traumatic Stress.
Lindauer, R. J. L., Bolle, E., & Kampschuur, M. (2013). Traumasensitief
pleegouderschap. Verbeteren van de zorg voor getraumatiseerde
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http:// pleegkinderen. [Traumasensitive foster care. Improving the care
creativecommons.org/licenses/by/4.0/), which permits unrestricted use, for traumatized foster children]. Kinder- en Jeugdpsychotherapie,
distribution, and reproduction in any medium, provided you give appro- 2, 57–67.
priate credit to the original author(s) and the source, provide a link to the National Center for Child Traumatic Stress. (2010). Caring for Children
Creative Commons license, and indicate if changes were made. who have experienced trauma: A workshop for Resource Parents
(2010). Retrieved from http://nctsn.org/products/caring-for-
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