Transcript The Child and Family Traumatic Stress Intervention

The Child and Family
Traumatic Stress
Intervention
A family based model for early
intervention and secondary prevention
Steven Berkowitz, M.D.
Steven Marans Ph.D.
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Primary Goals
1. To decrease post traumatic symptoms and
disorders in children exposed to potentially
traumatic events
2. To increase the likelihood of children and
family members engagement and acceptance
of on-going treatment when necessary
3. To identify individuals in need of treatment due
to prior psychiatric disorders with linkage
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Current Status
• In pilot stage
• On-going modifications
– Current attempts to shorten, by further
adapting incorporated measures
– Presenting at ANM for feedback
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CFTSI: How’s
• Simultaneous evaluation of and
intervention with child and parent/s
• Enhance communication regarding
emotions, symptoms
• Provide Care coordination and case
management to decrease external
stressors
• Delivered in home or clinic
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Family and Social Support
• Primary Objective:
Increase parent/s ability to provide
support to children
• Multiple studies have demonstrated that
social and family support are key
protective factors for individuals exposed
to a PTE
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Family and Social Support
• CFTSI is designed to enhance parent’s inherent
desire to care for child and mediate their
experience.
• Targets children who experience accidental
injury and exposure to community violence and
sexual abuse
• Not presently used with other forms of
intrafamilial violence
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Nuts and Bolts
• CFTSI is composed of two people:
– Lead clinician: Masters level or above with
trauma specialization
– Support clinician: Para professional or above
with trauma specialization
– 3 to 4 protocolized meetings (2 hours each)
– Individual sessions for parents and child
– Follow up family meeting
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Nuts and Bolts: Roles
• Lead Clinician: conducts interviews separately
with parent/s and child
– Interviews are centered around modified versions of
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TESI
PTSD-RI
MFQ
PBI
Perceived Social Support-family (child only)
– May decrease number of items from TESI?
– May change to checklist from PTSD-RI
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Nuts and Bolts: Measure
Modifications
• On PTSD-RI and MFQ: parents asked if
child told them about symptom or they
observed
• Child asked if they told anyone and, if so,
who
• All interview questions are reported “Since
Event”
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Support Clinician: Role
• Parent meeting
– Trauma psychoeducation
– Clinician reviews PCL-Civilian Version with parent
and discusses parent symptomatology and mental
health history
– Reviews child developmental, medical and psychiatric
history
– Reviews concrete case management needs
(e.g. medical appointments, transportation, housing
issues,
Court issues etc.)
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Support Clinician: Role
• Child Meeting
– Trauma psychoeducation
Depending on age either/or
– Observational play session to assess
spontaneous issues around traumatic issues
– Discussion of other potential issues and
stressors such as medical/physical issues,
school, family and friends
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Nuts and Bolts: Procedure
• First Session
– Brief orientation with child and parent/s
– Parents and child meet separately
• Lead clinician meets with either child or parent
while support clinician meets with other
– Based on family’s interest and developmental issues
(e.g.. lead clinician likely to meet with adolescent first)
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Nuts and Bolts: Procedure
• Everyone meets together
– Clinicians facilitate discussion about
comparison of responses to interview
questions
(not PBI)
– Attempts to help improve communication and
decrease barriers to authentic discussion
– Asks family to decide on two most concerning
symptoms
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Nuts and Bolts: Procedure
• Modules are selected that help family with
specific interventions to address identified
symptoms (each with information for
parents and child):
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CFTSI: Modules
1. All get general overview with psychoeducation
2. Sleep Disturbance
3. Depressive Withdrawal
4. Intrusive Thoughts and Traumatic Reminders
5. Anxiety-- avoidance, clinginess, phobic
reactions, etc
6. Tantrums and Oppositional Behavior
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CFTSI: Modules
• Family and child and given brief instruction
on identified modules
• Receive log of frequency of symptoms,
module use and effectiveness
– Research and clinical questions:
• Will use of module correlate to outcomes or is
increased communication and support sufficient?
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Session I Wrap out
• Next session is schedule for one week
later
• Family is encouraged to call with any
questions and told that team is available
for earlier session if necessary to assess
symptoms and help practice family
intervention modules
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Next Sessions
• Sessions follow same format as first, but
Questionnaires are administered briefly
Family meeting focuses on review of past week
looking at log and checking on effectiveness
New or different symptoms to address
Communication issues
Practice interventions modules
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Third Session
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At end of third session team discusses
with family next steps:
1. If asymptomatic or close: follow up contact
and 3 month post assessment (always told
may return whenever interested)
2. Improvement, but still symptomatic: continue
CFTSI for one or two more sessions or
individual trauma focused treatment
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Third Session
3. No PTS Sxs, but preexisting MH issues:
refer to treatment (this may occur in any
session
4. Little or no improvement Trauma SXs:
refer for Trauma focused treatment (TFCBT etc.)
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