Crea eating g a F a Ful ull C Cont ontinuum um of of Traum - - PowerPoint PPT Presentation

Crea eating g a F a Ful ull C Cont

• ntinuum

um

• f
• f Traum

auma-Specif ific ic M Mental l He Health th S Servi vice ces s

Emily Robbins, LCSW Tiffany Brandt, Ph.D.

University of Arkansas for Medical Sciences Arkansas Building Effective Services for Trauma

EVI EVIDENCE CE-BASED ASED TRAUMA- INFO FORMED ED MEN ENTAL AL HEAL HEALTH SERVI SERVICES ES FOR FOR OUT OUTPATIEN ENT CL CLIENTS

What are re th the Evi vidence-Base ased Treatm tments? nts?

Trauma-Focused Cognitive Behavioral Therapy (3 to 18) Child-Parent Psychotherapy (0 to 5) Parent-Child Interaction Therapy (2 to 7)

9 14

Age Continuum

18+

Cognitive Processing Therapy (18+)

CPP PCIT TF-CBT

90 have attended 60 have attended 680 have completed

ARBEST Trai aine ned Clini nicians ans and Clini nicians ans in Trai aini ning ng

Child ld-Pare arent nt Psychotherapy (a (ages ges 0-5) 5)

More Information:

https://www.facebook.com/ChildParentPsychotherapy http://www.cebc4cw.org/program/child-parent-psychotherapy/

What is it?

• CPP is a relationship-based intervention, in which a child

is typically seen with his or her primary caregiver.

• CPP examines how the trauma and the caregivers’

relational history affect the caregiver-child relationship and the child’s developmental trajectory.

• Typical course of treatment lasts between 20 – 32

sessions.

CPP CPP Research

CPP has been tested in a variety of settings, with diverse populations, and has demonstrated results in the following areas (with follow-up data collected up to three years post- treatment):

• Enhancing the quality of parent-child attachment.
• Increasing child cognitive performance.
• Lowering parental posttraumatic and depressive

symptoms.

• Reducing posttraumatic symptoms and behavioral

problems in children.

• Increasing healthy mental representations and

corresponding expectations of children and parents.

• Regulating cortisol patterns in infants.

Pare rent-Chi hild Interac acti tion

• n Therap

apy (a (ages ges 2-7) 7)

What is it?

• PCIT was developed for young children with emotional and

behavioral disorders that places emphasis on improving the quality of the parent-child relationship and changing parent- child interaction patterns.

• Children and their caregivers are seen together in PCIT. Most
• f the session time is spent coaching caregivers in the

application of specific therapy skills.

• Typical course of treatment is 12-16 weeks

More Information: http://www.pcit.org

http://www.cebc4cw.org/program/parent-child-interaction-therapy/

PCIT Resear arch

• Very strong effects on child behavior problems
• By end of treatment & up to 6 years later
• Improves parenting satisfaction and parent-child

relationship strength

• Adapted for multiple problems
• Used in dozens of countries and cultures
• 2004 study: Parents court-ordered for treatment

following physical abuse

• Significantly less recidivism when they received PCIT

(Chaffin et al., 2004)

Tr Trauma-Foc Focuse used Cogni niti tive-Behav havior

• ral

al Therap apy y (a (ages ges 3-18)

What is it?

• TF-CBT is a trauma-informed treatment designed to address

PTSD symptoms in children through pschoeducation, parent management, relaxation, coping with feelings, cognitive processing, trauma narration and processing, and enhancing safety.

• A primary, supportive, caregiver is also involved throughout

the course of treatment

• Length of treatment is 8-16 sessions
• 16-25 for Complex Trauma

More Information: http://www.tfcbt2.musc.edu

http://www.ctg.musc.edu http://www.nctsn.org

TF TF-CB CBT Res esea earch

• TF-CBT is the most rigorously tested treatment for

traumatized children

• 16 RCTs
• Improved PTSD, depression, anxiety, shame and

behavior problems compared to supportive treatments

• Improved parental distress, parental support, and

parental depression compared to supportive treatment

• Successful with diverse ethnic and racial populations

Th Them emes es Acr cross Trauma-Inf nform

• rmed Treatm

atment nt for r Childr ldren

• Relatively short-term.
• Less than one year and often less than six months with

regular weekly attendance.

• Child-based treatment requires consistent and on-

going parental involvement.

• Equips parent with the ability to be the agent of

change for the child.

• Focus on skills building that addresses specific

symptoms of trauma.

How To Know Which Tre reatment is s Appropriate for r th the F Family

The following should be considered when determining a treatment plan for each individual family.

• Appropriate evaluation for presence of trauma symptoms

as well as other possible symptoms.

• Determine what symptoms are “driving the train.”
• Age of the child.
• Caregiver that will be involved.
• Skill set of the clinician and the training the clinician has

received.

Cogn gnitiv ive Proces cessing g Th Ther erapy (a (ages ges 18+) 8+)

What is it?

• CPT is a trauma-informed cognitive-behavioral treatment

developed for adults to address symptoms of PTSD.

• Through psychoeducation and trauma processing, CPT helps

adults learn how to challenge and modify unhelpful beliefs related to the trauma and create a new understanding and conceptualization of the traumatic event .

• Treatment is completed in approximately 12 sessions lasting

60 to 90 minutes each.

More Information: https://www.ptsd.va.gov/public/treatment/therapy- med/cognitive_processing_therapy.asp http://www.cpt.musc.edu

CPT T Res esea earch

• CPT is a Well-Supported treatment for PTSD in adults

according to the California Evidence Based Clearinghouse.

• Shown effective for both men and women as well as

civilians and veterans. Also shown effective for various ethnic and racial groups.

• Can be conducted as either individual or group

treatment.

• Shown to reduce symptoms of PTSD as well as

depression and anxiety.

EVID IDENC NCE-BASED TRA RAUMA MA- INF INFORMED M D MENT NTAL HE L HEALTH H SERVICES F FOR INP INPATI TIENT NT C CLIE LIENT NTS

Tr Trauma-Inf nfor

• rmed Care

re on an Inpati atient nt Unit UAMS Child ild Dia Diagn gnostic c Unit it

What is it?

• The UAMS Child Diagnostic Unit utilizes a multidisciplinary

approach to help provide a comprehensive diagnostic impression and individualized treatment plan for early intervention.

• This approach includes longer lengths of stay (approximately
• ne month); medication washout as appropriate; individual

and family therapy; comprehensive psychological, speech and language, and occupational therapy evaluations; and extensive family and/or caregiver involvement whenever possible.

• Continued involvement of caregivers. Caregivers are allowed

to stay with the child for their entire stay or for any amount

• f time possible.

Tr Trauma-Inf nfor

• rmed Care

re on an Inpati atient nt Unit UAMS Child ild Dia Diagn gnostic c Unit it

What is it?

• As part of the multidisciplinary approach, youth receive

a comprehensive trauma assessment that includes:

• Interview with the primary caregiver regarding trauma

experiences.

• Behavioral observations on a daily basis with peers, staff, and

caregivers (when caregivers are available) as well as discussions with the youth.

• Formal assessment of trauma symptoms through parent- and

self-report rating scales (e.g., UCLA, TESI, CATS, TSCYC).

More Information: http://psychiatry.uams.edu/child/patient-services/child- diagnostic-unit/

Tr Trauma-Inf nfor

• rmed Care

re on an Inpati atient nt Unit UAMS Child ild Dia Diagn gnostic c Unit it

What is it not?

• A place where full trauma-informed mental health

treatment is completed.

• Given that the CDU provides inpatient services for

approximately one month, it is not a place where psychotherapy can be conducted to treat symptoms of PTSD.

• The CDU therapist will work with families to discuss how

trauma impacts their child and their family to help set up the most appropriate services possible once the child is discharge.

• Families are provided with recommendations regarding which

treatments would be most effective for their child’s diagnostic presentation.

When referring a client for mental health

• r behavioral services,

rely on the trained clinician to make the best clinical recommendation for treatment. This includes the best decision on who should be involved in treatment.

Emily Robbins, LCSW robbinsemilyn@uams.edu Tiffany Brandt, Ph.D. tdbrandt@uams.edu