The Child and Family Traumatic Stress Intervention

1. 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.

2. Primary Goals • To decrease post traumatic symptoms and disorders in children exposed to potentially traumatic events • To increase the likelihood of children and family members engagement and acceptance of on-going treatment when necessary • To identify individuals in need of treatment due to prior psychiatric disorders with linkage

3. Current Status • In pilot stage • On-going modifications • Current attempts to shorten, by further adapting incorporated measures • Presenting at ANM for feedback

4. 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

5. 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

6. 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

7. 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

8. Nuts and Bolts: Roles • Lead Clinician: conducts interviews separately with parent/s and child • Interviews are centered around modified versions of • 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

9. 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”

10. 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.)

11. 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

12. 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)

13. 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

14. Nuts and Bolts: Procedure • Modules are selected that help family with specific interventions to address identified symptoms (each with information for parents and child):

15. 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

16. 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?

17. 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

18. 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

19. Third Session • At end of third session team discusses with family next steps: • If asymptomatic or close: follow up contact and 3 month post assessment (always told may return whenever interested) • Improvement, but still symptomatic: continue CFTSI for one or two more sessions or individual trauma focused treatment

20. 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 (TF-CBT etc.)