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PRESENTERS Steven Marans , MSW, Ph.D.

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,

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PRESENTERS Steven Marans , MSW, Ph.D.

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  1. The Child and FamilyTraumatic Stress Intervention:Implementing an Evidence-BasedEarly/Acute Interventionin Child Advocacy Centers

  2. 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.

  3. 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

  4. 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

  5. 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.)

  6. CFTSI: Filling a Gapin 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

  7. 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

  8. 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

  9. The CFTSI Model

  10. 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

  11. 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

  12. CFTSI: An Evidence-based ModelListed in: • NCTSN list of evidence-based treatments • California Evidence-based Clearinghouse for Child Welfare • NREPP (National Registry of Evidence-based Programs and Practices (soon)

  13. 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

  14. Sample Demographics(Sample Size = 106) • Intervention • N=53 • 24 Boys • 29 Girls • Mean Age=12; SD=2.8 • Mean # Traumas=6.1; SD=2.7 • Comparison • N=53 • 21Boys • 32 Girls • Mean Age=12; SD=2.7 • Mean # Traumas=6.6; SD=2.4

  15. Nature of Trauma

  16. Children Who Received CFTSI Were 73% Less Likely to Meet Partial or Full Criteria for PTSD * *p<.05

  17. Adapting CFTSIfor 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

  18. 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

  19. Safe Horizon’sChild 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

  20. 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

  21. 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

  22. 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!

  23. 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

  24. Evaluation of CFTSI in CAC Setting

  25. 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 reductionsin symptoms (p<.001) • Symptom severity goes from clinically significant levels to below clinical levels

  26. Change in PTSD Symptoms Following CFTSI (N=134)

  27. Caregiver Satisfaction Survey • Completed with caregivers following final CFTSI session • N=63

  28. If you had a friend dealing with a similar situation, would you suggest that s/he try CFTSI?

  29. Did you learn about trauma and how it may affect your child and family?

  30. 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?

  31. Future Directions

  32. 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

  33. CFTSI:Dissemination and Spread • National trainings • Learning collaboratives • Train-the-Trainer program

  34. Implementation of CFTSIin a CAC Setting:A Brief Case Presentation

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