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Assessment and Treatment of Trauma in Children and Young People

Assessment and Treatment of Trauma in Children and Young People. Robyn Lamb March 09. Domains of Impairment in Children exposed to Complex Trauma. Attachment Biology Affect Regulation Dissociation Behavioural control Cognition Self concept.

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Assessment and Treatment of Trauma in Children and Young People

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  1. Assessment and Treatment of Trauma in Children and Young People Robyn Lamb March 09

  2. Domains of Impairment in Children exposed to Complex Trauma • Attachment • Biology • Affect Regulation • Dissociation • Behavioural control • Cognition • Self concept

  3. Initial contact Child Sexual Assault Service • Psychosocial Assessment • Medical Assessment general / forensic • What does the child/family need? • Safety? • Stabilization? • Concrete services [referrals, legal information/assistance with reporting, liaison with CPS and other systems] • What helps for those needs? • Crisis response • Advocacy • Case management • Psychoeducation

  4. Safety and basic physical and wellbeing MASLOW’S HIERARCHY Diagram of Maslow's hierarchy of needs.1. Physiological (Biological needs)2. Safety3. Love/Belonging4. Status (Esteem)5. Actualization Hierarchy of needs

  5. Assess before treating so that intervention can be matched to need Multidimensional approach • Areas of competence and vulnerability are assessed in overlapping biological, emotional, social and cognitive domains • Individual functioning is considered in the context of the child’s relationships and the family’s ecological niche

  6. Assessment-Based Treatment for Traumatized Children: Using the Trauma Assessment Pathway Model (TAP) Al Killen Harvey Rady Childrens Hospital Chadwick Center Programs San Diego Trauma Counseling Forensic and Medical Services Family Support Professional Education Research Linkage Child & Adolescent Services Research Center (funded by the NIMH) It is with the generous permission of Al Killen Harvey, Chadwick Centre that *Slides have been reproduced in this presentation

  7. *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 trauma-specific treatment described by the Trauma Wheel • Draft completed and undergoing revisions

  8. *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)

  9. *Clinical Pathways • 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.

  10. *Chadwick’s Philosophy ofTrauma 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.

  11. *3 Components of TAP • Assessment Creating a Unique Client Picture • Triage • Treatment

  12. *Unique Client Picture • Clinical Interviews • Behavioral Observation • Standardized Measures

  13. *Standardize your Assessment ChoicesWhat measures exist to help you know your client?

  14. *Assessment Pathway Process Core measures administered Problem areas identified Other measures are administered to probe more deeply

  15. *Guiding Therapists via Assessment Pathways integrated into assessment measures

  16. *Treatment Triage • What are the treatments that you have available at your site? • What treatments are you as a therapist able to provide? • Funding? • Client Issues? …Reality!!!!!

  17. *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!!

  18. *Problem Solving: What Happens When the Measures & Clinician Don’t Agree?

  19. *How do you discuss feedback with your clients?

  20. Critical Items

  21. *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

  22. *Treatment Triage • Select the treatment modality that is best for your client based upon the unique client picture and the evidence-based practices available: • Trauma-Focused CBT • TAP Model • PCIT • Abuse-Focused CBT • Lieberman et al.’s Models for young children • UCLA Trauma/Grief Focused Group Model

  23. *Treatment through the TAP Model Using the Trauma Wheel & the Clinical Pathway

  24. Characteristics of Treatments with good evidentiary support • Tend to be behavioral or cognitive-behavioral (eg TFCBT); or use tailored responses (Ref Eliana Gil) • Use specific procedures, not much “free-styling” • Goal directed • Skill-building oriented • Use of practice and feedback methods • Role play • Homework

  25. *The Trauma Wheel Relationship Building Addressing Maladaptive Cognitions Affect Regulation Child Development Systemic Dynamics Skill Building & Psychoeducation Trauma Integration Culture

  26. Multiple modalities for treatment • Play, Art, Craft, Sand tray • Psychotherapy • Expressive therapy

  27. *Affect Regulation: Assumptions • Expressing feelings and emotions is important. • Symptoms are associated with underlying feelings and impacts behavior and social relationships. • There is a need to validate, understand, and experience feelings before resolution of those feelings can occur.

  28. *Affect Regulation: Tasks • Feeling identification and labeling • Express feelings congruent with feelings you are identifying • Experience and communicate feelings • Appropriately manage range of emotions • Develop positive self-feelings • Resolution of troubling emotions

  29. Feelings

  30. Feelings

  31. *Skill Building and Psychoeducation: Assumptions • The child and family lack the skills to effectively cope with trauma reactions of the child • An increase in information and skills will increase knowledge and adaptive functioning. • Increase in knowledge will decrease uncertainty and increase normalization.

  32. *Skill Building and Psychoeducation: Tasks • Behavior management techniques • Enhancement of positive behaviors/social skills • Relaxation techniques • Psychoeducation • Dynamics of abuse • Healthy relationships • Age-appropriate development • Communication and problem-solving • Development of safety plans

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