Crea eating g a F a Ful ull C Cont ontinuum um of of 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? Cognitive Processing Therapy (18+) Trauma-Focused Cognitive Behavioral Therapy (3 to 18) Parent-Child Interaction Therapy (2 to 7) Child-Parent Psychotherapy (0 to 5) 0 14 18+ 9 Age Continuum
ARBEST Trai aine ned Clini nicians ans and Clini nicians ans in Trai aini ning ng TF-CBT CPP PCIT 90 have attended 60 have attended 680 have completed
Child ld-Pare arent nt Psychotherapy (a (ages ges 0-5) 5) 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. More Information: https://www.facebook.com/ChildParentPsychotherapy http://www.cebc4cw.org/program/child-parent-psychotherapy/
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 on 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 of 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 oral 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 More Information: • 16-25 for Complex Trauma 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 ormed 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 ormed 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 one 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 of time possible.
Tr Trauma-Inf nfor ormed 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 ormed 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 or 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
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