Transcript Document

The Child and Family
Traumatic Stress Intervention:
Implementing an Evidence-Based
Early/Acute Intervention
in Child Advocacy Centers
PRESENTERS
Steven Marans, MSW, Ph.D.
‒ Harris Professor of Child Psychiatry and Professor of Psychiatry
‒ Director, Childhood Violent Trauma Center,
Yale Child Study Center
‒ Yale University School of Medicine
Carrie Epstein, LCSW-R
‒ Assistant Professor
‒ Director of Clinical Services and Training,
Childhood Violent Trauma Center, Yale Child Study Center
‒ Yale University School of Medicine
‒ Consultant, Safe Horizon, Inc.
Nancy Arnow, LMSW
‒ Vice President
‒ Child Advocacy Centers and Mental Health Treatment Programs
‒ Safe Horizon, Inc.
CFTSI: What Is It?
Brief (4-8 session) evidence-based early
intervention model for children following a range
of potentially traumatic events (PTE)
– After exposure
– After disclosure of earlier sexual or physical
abuse
Children aged 7-18 years old
Goals of CFTSI
CFTSI aims to:
Reduce traumatic stress symptoms and prevent
chronic PTSD
Improve screening and initial assessment of
children impacted by traumatic stress
Assess child’s need for longer-term treatment
Mechanisms of CFTSI
CFTSI works by:
Increasing communication between caregiver and
child about child’s traumatic stress reactions
Providing skills to family to help cope with traumatic
stress reactions
Assessing concrete external stressors (e.g. housing
issues, systems negotiation, safety planning, etc.)
CFTSI: Filling a Gap
in Available Interventions
CFTSI:
Fills a gap between acute responses/crisis
intervention and evidence-based, longer-term
treatments designed to address traumatic stress
symptoms and disorders that have become
established
Capitalizing on Protective Factors
Family and social support are best predictors for good
post-trauma outcomes
– Primary caregiver/s are central to CFTSI
Improves support through improving communication:
– Helps child communicate about reactions and
feelings more effectively
– Increases caregiver’s awareness and
understanding of child’s experience
CFTSI provides skills to help children and families
cope with and master trauma reactions
Recovery through
Regaining a Sense of Control
CFTSI:
Replaces chaotic post-traumatic experience with:
– Structure
– Words
– Opportunity to be heard by caregiver
Uses standardized assessment instruments to:
– Structure discussion about symptoms
– Increase symptom recognition and communication
about them
Provides skills and behavioral interventions
Increases control through symptom reduction
The CFTSI Model
CFTSI: What and How?
Session 1 – Meeting with Caregiver
• Provide psychoeducation about trauma and trauma symptoms
• Assess caregiver’s and child’s trauma symptoms
• Address case management and care coordination issues
Session 2, Part A: Meeting with Child
• Provide psychoeducation about trauma and trauma symptoms
• Assess child’s symptoms
Session 2, Part B: Family Meeting - Key part of intervention
• Begin discussion by comparing caregiver and child’s reports
about trauma symptoms
• Identify the specific trauma reactions to be the focus of
behavioral interventions and introduce coping skills
CFTSI: What and How?
Session 3: Family Meeting
• Praise and support communication attempts
• Re-administer measures to assess levels of distress and
increased awareness
• Practice coping skills(s), support efforts
Session 4: Family Meeting/Case Disposition
• Follow same format as Session 3
• Review progress made and identify any additional case
management or treatment needs
Possible Additional Sessions
• May require 1 or 2 additional individual sessions with
caregiver(s) or child due to a range of issues
CFTSI: An Evidence-based Model
Listed in:
NCTSN list of evidence-based treatments
California Evidence-based Clearinghouse for
Child Welfare
NREPP (National Registry of Evidence-based
Programs and Practices (soon)
Randomized Control Trial: Results
CFTSI versus 4-session
psychoeducation/supportive comparison
intervention
Sample size = 112
Participants recruited from:
– Forensic Sexual Abuse Program
– Pediatric Emergency Department
– New Haven Department of Police Service
Funded by SAMHSA
Sample Demographics
(Sample Size = 106)
Intervention

N=53

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
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24 Boys
29 Girls
Mean Age=12; SD=2.8
Mean # Traumas=6.1;
SD=2.7
Comparison

N=53

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21Boys
32 Girls
Mean Age=12; SD=2.7
Mean # Traumas=6.6;
SD=2.4
Nature of Trauma
Animal Bite
5%
Injury
8%
Sexual
Abuse
21%
WV/Threats
22%
Assault
20%
MVA
24%
Children Who Received CFTSI
Were 73% Less Likely
to Meet Partial or Full Criteria for PTSD
100
Percent of youth
80
*
60
40
88
93
Comparison
CFTSI
72
44
20
0
Baseline
*p<.05
3 Mos FU
Adapting CFTSI
for Child Advocacy Centers (CACs)
Implementation of CFTSI with sexually and physically
abused children seen in CACs
Initial collaboration with Safe Horizon in New York City
Further dissemination to additional CACs nationally
Overview of Safe Horizon
Safe Horizon is the nation’s leading victim
assistance organization, moving thousands of
victims of violence and abuse from crisis to
confidence each year
Our mission is to provide support, prevent
violence, and promote justice for victims of crime
and abuse, their families and communities
We have 35 years of experience in expert
service delivery
Safe Horizon’s
Child Advocacy Centers
Safe Horizon is the only organization in the
country to operate four and soon to be five fully
co-located, nationally accredited CACs in an
urban setting
Each year, our CACs investigate and respond to
over 4,000 cases of sexual abuse and/or severe
physical abuse
Where We Were: 2006-2007
Environmental Factors:
– 148% increase in CAC volume following a tragic, highly
publicized child fatality
– Flat and diminishing CAC funding
Organizational Factors:
– Strategic Plan: Move to standardize service delivery and
implement evidence-based practices whenever possible
– CAC Vision: To provide immediate, expert victim
advocacy & therapeutic services to every child victim and
impacted family walking through the doors of our CACs
CAC Practice:
– Eclectic CAC services in response to complex and
multiple needs of clients
Safe Horizon-Yale Partnership:
National search for a trauma-focused, brief,
evidence-based treatment
Development of a flow chart illustrating how a
potential CFTSI case progresses through a CAC
Development of inclusion/exclusion criteria
Development of scripts for introducing CFTSI to
families
Translation of CFTSI into Spanish
Creation of audio versions of informational
handouts
Where We Are Now:
Have successfully adapted and sustained CFTSI
at our four CACs for over 5 years
Have completed over 730 CFTSI cases
– Children feel better; Caregivers have learned
skills to help their children feel better
– Staff feel more effective & reduced burnout
– MDT partners feel more hopeful
– Funders are very interested in reduction of
trauma symptoms- importance of data!
Sustaining CFTSI Over Time:
Importance of data-evaluation results
Strong organizational leadership & agency-wide
support
Recruitment changes & Ongoing training
Expert Monthly Consultation Calls
– Rotating case presentations with all CFTSI
providers & leadership
– With Clinical Directors
Monthly tracking of key CFTSI metrics
Evaluation of CFTSI in CAC
Setting
Evaluation Results
Results from 12-month evaluation conducted
in Safe Horizon’s Child Advocacy Centers
Sample Size = 134
Trauma type: sexual and physical abuse
Statistically significant reductions
in symptoms (p<.001)
Symptom severity goes from
clinically significant levels to below clinical levels
Change in PTSD Symptoms
Following CFTSI (N=134)
25
PTSD Symptom Severity
21.68
20
17.57
15
10.87
9.58
10
5
0
Pre-Tx Parent
Post-Tx Parent
Pre-Tx Child
Post-Tx Child
Caregiver Satisfaction Survey
Completed with caregivers following final
CFTSI session
N=63
If you had a friend dealing with a
similar situation, would you suggest
that s/he try CFTSI?
Did you learn about trauma and
how it may affect your child and
family?
Did you and your child learn about
ways/skills to help your child feel better and
make the problems and/or reactions your
child was having happen less often?
Future Directions
CFTSI Treatment Applications
Current:
– CAC setting
– Children in foster care
In development:
– Domestic violence shelter setting
– Young children (aged 3-6 years)
– Physically injured children
– Military families
CFTSI:
Dissemination and Spread
National trainings
Learning collaboratives
Train-the-Trainer program
Implementation of CFTSI
in a CAC Setting:
A Brief Case Presentation