The Professional Counselor | Volume 11, Issue 3 295 trauma symptoms, suggesting that higher rates of PM experiences may increase trauma-related symptoms. For example, previous researchers have found adverse childhood experiences and signs of trauma-related symptoms lead to serious mental health diagnoses, early mortality, and/or significant biological health risks in children (Tyrka et al., 2013; Vachon et al., 2015; Zimmerman & Mercy, 2010). Further exploration to determine if and how PM influences other trauma-related symptoms in children throughout their life span would expand upon the results of this study. Suicidal Ideation Finally, our data revealed a significant effect between respondent endorsement of suicidal ideation and PMI total scores. PM experiences accounted for 23% of the variance for children who reported thoughts of suicide (41%, n = 68) compared to those who did not report thoughts of suicide (59%, n = 98). This finding is consistent with prior research exploring children’s experiences with maltreatment and suicidal thoughts (Thompson et al., 2005; Wherry et al., 2013). Limitations This study has several limitations. First, by developing the PMI using national definitions, some regional and localized nuances were not considered. Second, data collected for this study were from a single Midwest CAC; thus, the data are limited in geographic generalizability. Third, the majority of respondents were White, and a more diverse sample would have been more representative of the region in which data were collected. Fourth, 99% of respondents identified as either male or female and may reflect an underrepresentation of non-binary or gender fluid youth in the results of this study. Fifth, this study relied heavily on quantitative data, which limited the ability to analyze each individual’s experiences with PM as they might describe from their unique perspectives. Implications for Research and Practice The results of this study provide several areas for future research. While the PMI demonstrated good internal consistency across all items (α =.91), more research with diverse populations across the United States is needed. Research from other geographical locations may demonstrate how reporting patterns for PM interact with ethnicity, culture, and elements of social expectations (Spinazzola et al., 2014). The initial results of this study indicate the PMI may be a useful tool for children to report PM experiences in CAC settings; however, future research at other CACs and similar treatment facilities is needed to determine the PMI’s true utility and scalability. Future analysis (i.e., exploratory factor analysis and confirmatory factor analysis) of the PMI may also identify factors and help refine the instrument. More research with the PMI can expand researchers’ knowledge of PM and services needed to help children. Working with other CACs, child protection professionals, and the NCA may help bridge current gaps in interdisciplinary assessment and care and establish a stable and comprehensive understanding of PM (López et al., 2015). Furthermore, understanding how CACs are equipped to identify and handle PM cases may provide useful insights to help improve services for children in need. Although some CACs may have a variety of professionals working in specific roles, some CACs may be understaffed, causing staff to take on multiple and overlapping roles. It is important to understand if and how different combinations of trained professionals influence children reporting PM (Hart & Glaser, 2011; NCA, 2016). More research with the PMI is needed for refinement and to ensure the instrument is not misused. Releasing the PMI at this stage to clinicians and researchers without a fully developed assessment manual may lead to inappropriate or ineffective administration of the PMI and potentially unethical
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