Transcript Trauma Assessment Pathway: Assessment

Assessment-Based
Treatment for Traumatized
Children: A Trauma
Assessment Pathway
Model (TAP)
Presented by:
Alicia Gilbert, PhD
Robyn Igelman, PhD
Chadwick Center for
Children and Families
Chadwick Center Programs
Trauma Counseling
Forensic and Medical Services
Family Support
Professional Education
Research Linkage
Child & Adolescent Services Research Center
(funded by the NIMH)
Trauma Counseling Program

Assessment-based individual, group and family
therapy for children who have experienced
traumatic events.
 Therapy and advocacy to domestic violence
victims and their children at the Family Justice
Center.
 School-based counseling services.
 Parent-child interaction therapy.
 Medication & psychological assessments.
 Crisis intervention, advocacy, information and
referrals.
TAP Model Overview
 A treatment
manual for traumatized
children ages 2 to 18 years
 Incorporates assessment data, clinical
interview, and observation to create a
Unique Client Picture
 Includes specific components of traumaspecific treatment described by the
Trauma Wheel
 Draft completed and undergoing
revisions
What Is Assessment Based Treatment
(ABT)?
Development of clinical assessment-based
treatment refers to the “development of an
integrated plan of prioritized interventions,
that is based on the diagnosis and
psychosocial assessment of the client, to
address mental, emotional, behavioral,
developmental and addictive disorders,
impairments and disabilities, reactions to
illnesses, injuries, and social problems.”
(Social work, consolidated laws, effective Sept.
1, 2004)
Clinical Pathways
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A sequence or path that clinicians follow in making
assessment, triage, and clinical decisions.
Found increasingly useful within the medical field.
Evaluation of UCLA’s Asthma Pathway showed
substantial cost effectiveness and adherence to
medical standards (Chest, 1998)
Rady Children’s Hospital developed over 40
pathways, starting with Asthma in 1994, domestic
violence in 2001, and TAP in 2005.
TAP includes a pathway that directs triage,
assessment, referrals, and clinical interventions.
Chadwick’s Philosophy of
Trauma Treatment
 The
therapeutic goal is to resolve the
impact of a single or series of traumatic
experiences to the child and their family.
 Therapeutic
decisions emerge from clinical
and standardized assessment.
3 Components of TAP
1.
Assessment
Creating a Unique Client Picture
Triage
3. Treatment
2.
Assessment:
Is the client appropriate for your
Center and for the TAP Model?
To get the full rich unique client
picture, gather information via:
 Clinical
Interviews
 Behavioral Observation
 Standardized Measures
Standardize your Assessment Choices
What measures exist to help you know your client?
Domain
Informants
Child
Caretaker
Clinician
Trauma History
UCLA PTSD Index
Caretaker TraumaTSI
Clinical Interview
Symptom Presentation
Trauma Symptoms
TSCC, UCLA PTSD
Index
Trauma Symptoms
CSBI, CDC,
UCLA PTSD Index
Other Symptoms:
CBCL
Clinical Interview/Observation
Other Symptoms:
YSR, CDI, BAIC
* Teacher can complete TRF
Relevant Contextual
History
Family Dynamics
FAM-III, FRI,
FACES
Peers
YSR
Family Dynamics
FAM-III, FRI
Parenting:
PSI
Peers
CBCL
Clinical Interview/Observation
Developmental History
Clinical Interview
IQ:
WISC,KBIT, Stanford
Binet
Clinical Interview
ITSEA, BITSEA,
ASQ
Clinical Interview/
Observation
Denver, Bayleys
Measurement Considerations

Psychometric
Properties



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Reliability and Validity
Clinical Cutoffs

Language

Multiple vs. Single
Informants

Real World Validity

Clinical Utility
Sensitivity to Change
Feasibility Issues
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Time to administer
Staff training
Costs of using measures
Assessment Pathway Process
1.
2.
3.
Core measures administered
Problem areas identified
Other measures are
administered to probe more
deeply
Guiding Therapists via Assessment
Pathways integrated into assessment measures
Therapists’ Use of
Assessment
Measures:
Guiding the assessment
and providing feedback.
How to make sense of
assessment results:
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Know what each measure assesses and
applicable populations
Have a general understanding of each
subscale
Examine the validity scales (if any)
Use assessment results as an adjunct to your
clinical interview
Clarify inconsistencies between assessment
results and clinical impressions
How to make sense of
assessment results (cont.):
 Involve
the parents and children in your
interpretive process
 Integrate results with clinical
impressions & think about how the
results can be used to plan treatment
 Don’t discount your clinical judgment!!
Problem Solving: What Happens When the
Measures & Clinician Don’t Agree?
Critical Items
How do you discuss
feedback with your
clients?
Parent and client feedback:
Dos & Don’ts
DO:
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
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Allow one therapy session to discuss results
and give feedback
Elicit client feedback and impressions
regarding assessment results
Discuss results with parent and child to
confirm clinical impressions
Address areas of concern not initially
revealed through clinical interview
Most important: Engage them in the process!
Parent and client feedback:
Dos & Don’ts (cont.)
DON’T:
 Avoid discussing results with your
clients
 Act like the assessments are a waste of
time (because your clients will too!)
 Be afraid to share written feedback and
printouts with parents and children
 Underestimate the ability of your clients
to understand and appreciate your
feedback
How to form your clinical
hypothesis
 Consider
all assessment feedback
 Which family members need to be
included in treatment? What are the
dynamics in the family?
 Family and client buy in
 Consider the cause of distress
Heuristics of Using the
Clinical Pathway
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One skill builds upon another.
All spokes of the Trauma Wheel will be
addressed at some point during
treatment.
The length of time and intervention type
depend upon the unique client picture.
The wheel is fluid – you move back and
forth between spokes of the wheel.
The Trauma Wheel
Relationship Building
Addressing
Maladaptive
Cognitions
Skill Building
&
Psychoeducation
Affect
Regulation
Child
Development
Trauma
Integration
Culture
Systemic
Dynamics
Case Example:
•Referral
Information
•Interview with Child & Family
•Standardized Assessment Results
•Consider family buy-in & needs before
making treatment decisions
•Re-Assess
On-going Re-assessment
 Weekly
interviews/updated goals
 Progress notes
 Supervision
 Follow-up standardized measures


Must use the same measures for each time period
(to measure change over time)
Can add measures over time (once added must
continue to administer added measure to assess
change over time).
Symptom
Change
Over Time
Initial Screening Process
Trauma Assessment
Pathway Model (TAP):
At a Glance
Triage
Refer out
Assessment:
Clinical Interview and Standardized Measures
Integrate Assessment Information
Form Unique Client Picture
Narrow the Clinical Focus
Select Symptom Domains
Hypotheses/Prioritize
Establish Treatment
Goals
Treatment Pathway
Guides treatment decisions and the use
of the Trauma Wheel
Refer to a specialized
program if needed
Trauma Wheel
Reassess:
Weekly interviews, update goals
Supervision
Follow-up standardized measures
Continue Treatment
Following the Treatment
Pathway
Termination
You’re the Experts
 What
are some basic assumptions you
may have about traumatized clients?
 How have you validated those
assumptions?
 What is your experience with using
assessment measures?
Resources
 www.ChadwickCenter.org
(Chadwick)
 www.nctsn.net (National Child Traumatic
Stress Network)
 www.musc.edu/cvc/ (TF-CBT on-line and
OVC guidelines)
 www.cachildwelfareclearinghouse.org
Contact Information
Alicia Gilbert, PhD
858-966-8682
[email protected]
Robyn Igelman, PhD
858-576-1700, ext. 3211
[email protected]