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The Child and Family Traumatic Stress Intervention: Implementing an Evidence-Based Early/Acute Intervention in Child Advocacy Centers

Dec 25, 2015

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  • Slide 1
  • The Child and Family Traumatic Stress Intervention: Implementing an Evidence-Based Early/Acute Intervention in Child Advocacy Centers
  • Slide 2
  • PRESENTERS Steven Marans, MSW, Ph.D. Harris Professor of Child Psychiatry and Professor of Psychiatry Director, Childhood Violent Trauma Center, Yale Child Study Center Yale University School of Medicine Carrie Epstein, LCSW-R Assistant Professor Director of Clinical Services and Training, Childhood Violent Trauma Center, Yale Child Study Center Yale University School of Medicine Consultant, Safe Horizon, Inc. Nancy Arnow, LMSW Vice President Child Advocacy Centers and Mental Health Treatment Programs Safe Horizon, Inc.
  • Slide 3
  • CFTSI: What Is It? Brief (4-8 session) evidence-based early intervention model for children following a range of potentially traumatic events (PTE) After exposure After disclosure of earlier sexual or physical abuse Children aged 7-18 years old
  • Slide 4
  • Goals of CFTSI CFTSI aims to: Reduce traumatic stress symptoms and prevent chronic PTSD Improve screening and initial assessment of children impacted by traumatic stress Assess childs need for longer-term treatment
  • Slide 5
  • Mechanisms of CFTSI CFTSI works by: Increasing communication between caregiver and child about childs traumatic stress reactions Providing skills to family to help cope with traumatic stress reactions Assessing concrete external stressors (e.g. housing issues, systems negotiation, safety planning, etc.)
  • Slide 6
  • CFTSI: Filling a Gap in Available Interventions CFTSI: Fills a gap between acute responses/crisis intervention and evidence-based, longer-term treatments designed to address traumatic stress symptoms and disorders that have become established
  • Slide 7
  • Capitalizing on Protective Factors Family and social support are best predictors for good post-trauma outcomes Primary caregiver/s are central to CFTSI Improves support through improving communication: Helps child communicate about reactions and feelings more effectively Increases caregivers awareness and understanding of childs experience CFTSI provides skills to help children and families cope with and master trauma reactions
  • Slide 8
  • Recovery through Regaining a Sense of Control CFTSI: Replaces chaotic post-traumatic experience with: Structure Words Opportunity to be heard by caregiver Uses standardized assessment instruments to: Structure discussion about symptoms Increase symptom recognition and communication about them Provides skills and behavioral interventions Increases control through symptom reduction
  • Slide 9
  • The CFTSI Model
  • Slide 10
  • CFTSI: What and How? Session 1 Meeting with Caregiver Provide psychoeducation about trauma and trauma symptoms Assess caregivers and childs trauma symptoms Address case management and care coordination issues Session 2, Part A: Meeting with Child Provide psychoeducation about trauma and trauma symptoms Assess childs symptoms Session 2, Part B: Family Meeting - Key part of intervention Begin discussion by comparing caregiver and childs reports about trauma symptoms Identify the specific trauma reactions to be the focus of behavioral interventions and introduce coping skills
  • Slide 11
  • CFTSI: What and How? Session 3: Family Meeting Praise and support communication attempts Re-administer measures to assess levels of distress and increased awareness Practice coping skills(s), support efforts Session 4: Family Meeting/Case Disposition Follow same format as Session 3 Review progress made and identify any additional case management or treatment needs Possible Additional Sessions May require 1 or 2 additional individual sessions with caregiver(s) or child due to a range of issues
  • Slide 12
  • CFTSI: An Evidence-based Model Listed in: NCTSN list of evidence-based treatments California Evidence-based Clearinghouse for Child Welfare NREPP (National Registry of Evidence-based Programs and Practices (soon)
  • Slide 13
  • Randomized Control Trial: Results CFTSI versus 4-session psychoeducation/supportive comparison intervention Sample size = 112 Participants recruited from: Forensic Sexual Abuse Program Pediatric Emergency Department New Haven Department of Police Service Funded by SAMHSA
  • Slide 14
  • Sample Demographics (Sample Size = 106) Intervention N=53 24 Boys 24 Boys 29 Girls 29 Girls Mean Age=12; SD=2.8 Mean Age=12; SD=2.8 Mean # Traumas=6.1; SD=2.7 Mean # Traumas=6.1; SD=2.7 Comparison N=53 21Boys 32 Girls Mean Age=12; SD=2.7 Mean # Traumas=6.6; SD=2.4
  • Slide 15
  • Nature of Trauma
  • Slide 16
  • Slide 17
  • Children Who Received CFTSI Were 73% Less Likely to Meet Partial or Full Criteria for PTSD * *p