Transcript Slide 1

Silver Springs-Martin Luther
School
Shelley Spear, LCSW
Marcelle Ancrum, MA, LPC
Trauma Focused
Cognitive Behavioral Therapy
(TF-CBT)
Silver Springs-Martin Luther School
(SS/MLS)
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Located in Plymouth Meeting, Pennsylvania
Silver Springs provides assessment,
treatment and education to children and
families within the context of innovative
residential, specialized foster family care,
BHRS and educational
programs.
www.silver-springs.org
SS/MLS– Implementation of Trauma Informed Care
and Evidence Based Models
• 2003 All staff, treatment parents and board members are trained on
the principles of Trauma Recovery and Resiliency based on the
works of John Brier, Jan Hindman, Sandra Bloom, Lyndra Bills and
others.
• 2004 Incorporation of trauma informed analysis and trauma
informed interventions in the residential, school and community
based programs.
• 2006 Agency spring full day training consisted of staff from each
treatment program presenting examples of their work as they
reflected our trauma informed principles.
• 2007 Residential Treatment Program joins statewide initiative and
formally implements the “Sanctuary Model”
• 2008 Community Based Program participates in the National Child
Traumatic Stress Network (NCTSN) TF-CBT Learning Collaborative
and implements this evidence based model.
TF-CBT
TF-CBT is a structured, time-limited model
appropriate for most children and youth
who have had one or more traumas and
who are having symptoms of posttraumatic stress.
TF-CBT Components
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Education about trauma and common reactions
Help with parenting and behavior problems
Relaxation/Stress Management training
Learning about feelings and ways to express them
Learning about thoughts, feelings, and actions
Developing creative ways for children and youth to
gradually tell their stories about what happened
Changing any unhelpful thoughts about the trauma
Family sessions to help the family talk together
about the trauma
Learning and practicing safety skills
SS/MLS-TF-CBT
Assessment tools are used to obtain a full
history and assess treatment outcomes:
– Structured checklist to obtain details of
trauma history
– UCLA- Post Traumatic Stress DisorderReaction Index (PTSD-RI) to assess changes
in the presence of trauma-related symptoms
Assessing Trauma History: General
Trauma Information Form
• 20 items that assess different types of
trauma experienced and at what age
• Assists in gathering a thorough trauma
history from referral sources, family and
child interviews.
• Deciding which trauma(s) to focus on in
treatment
Standardized Assessment-UCLA
Post Traumatic Stress DisorderReactive Index (PTSD-RI)
for DSM IV
• 22 items
• Screen for meeting diagnostic criteria for
PTSD in DSM---re-experiencing,
avoidance, increased arousal symptoms
• Use as a continuous measure to assess
changes in symptoms
TF-CBT Components
• Culture is Considered
• Age Matters
• Homework is Assigned
–Reinforces skills
–Increases ownership
• Clinical Innovations are Integrated
PSYCHOEDUCATION
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TF-CBT model of treatment
Different types of trauma
Why a specific type of trauma may occur
Prevalence of a specific type of trauma
Effects of trauma
Why traumatic events are hard to talk
about
• Risk reduction
PARENTING SKILLS
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Praise
Limit Setting
Alter/Create Antecedents
Selective Attention
Time-Out
Contingency Reinforcement Programs
Open Communication
• Controlled Breathing
• Relaxation Training
– Relaxing word
– Use of imagery
– Progressive muscle relaxation
• Managing Troubling Thoughts
– Thought stopping
– Distraction
– Replacement
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Feeling identification/labeling
Intensity rating
Modes of expression
Processing emotions
Positive imagery and self talk
Enhancing sense of personal safety
Enhancing Problem Solving and Social
Skills
Cognitive Triangle– distinction and relation among thoughts,
feelings and behaviors
• Difference between accurate vs.
inaccurate thoughts
• Difference between helpful vs. unhelpful
thoughts
• Change feelings and behaviors by thinking
differently
• Vehicle for the child to tell their story or
their trauma
• Explore how child thinks and feels about
the trauma
• Reduce avoidance of cues, situations and
feeling associated with the trauma
• Correct factual and thinking errors
• Reduce anxiety and foster healthier
emotions in association with the trauma
FUTURE SAFETY
• Help child recognize, anticipate and
prepare for reminders of the trauma
• Personal safety skills training
• Enhance feelings of control and
confidence
SS/MLS-TF-CBT: Ensuring Fidelity to
the Model
Utilizing a standard monitoring tool (Monthly
Metrics), therapists report monthly on:
• Number of TF-CBT sessions delivered
• Number with caregiver involvement
• Number where assessments were completed
• Use of each TF-CBT component with self-assessment of
level of skill in delivering the component
SS/MLS-TF-CBT: We Assess Staff
Competence
Fundamental:
• Completion of 10 hour web-based course
• Completion of required text book
• Participation in bi-weekly supervision specific to TF-CBT
• In-vivo supervision
• Ongoing completion of Monthly Metrics
Competent:
• Minimum of 4 completed cases
• Minimum of 30 supervised hours
• Ongoing completion of Monthly
Metrics
http://tfcbt.musc.edu/
http://tfcbt.mu
sc
Treating Trauma And Traumatic Grief in Children And Adolescents: A
Clinician's Guide,
Judith A. Cohen, Anthony P. Mannarino, and Esther Deblinger
The Guilford Press, 2006
TF-CBT
DISCUSSION