Assessment and Treatment in Barnahus

1. Assessment and Treatment in Barnahus Guðríður Haraldsdóttir Specialist in child clinical psychology

2. Treatment Services • Victim therapy can start soon after the interview • For children who disclose abuse treatment is always suggested • Children are assigned to a therapist (different from the interviewer) who provides treatment and follow-up • Therapy is practiced in the child´s hometown • Psychotherapist at Barnahus are all mental health professionals, trained in evidence-based treatment approaches • Beside the treatment/interviewing we collaborate with different agencies, writing final report to CPS, give opinion of expertise to police/legal system and often important witness in court proceedings

3. Assessment • Provides a understanding and a overall picture of the child • Assessment helps to determine • Presenting symptoms and the history of the traumatic exposure • Strenght and weeknesess • Parenting skills and support • Need of a treatment • Helps in development of treatment plan

4. Methods • Formal, standardized measuresment with different scales and semistructured interviews • Clinical Interview with the child and the family (timeline and family-map) • Clinical observation and information gathered from other sourses

5. Assessment tools • Depression and anxiety scales • BDI-II – Becks Depression Inventory • BYI – Becks Youth Inventories • CDI – Kovack´s Children´s Depression Inventory • DASS – Depression Anxiety Stress Scales • MASC – Multidimensional Anxiety Scale for children • ADIS(Anxiety Disorders Interview Schedule for DSM-IV) • K-SADS- PL (Semi-structured diagnostic interview to assess psychopataholgy in children and adolescents)

6. Assessment tools • PTSD scales • UCLA-PTSD index for DSM-IV • PSS-SR – PTSD Symtom Scale – Self Report • CAPS – Clinician Administered PTSD Scale • Semistructured interview

7. Treatment • PTSD - often requires a full treatment of TF-CBT or CPT • Children with few/light symtoms would benefit from a light version of tf-cbt • Young children – psychoeducation and parent involvment • Children that have a long history of abuse/domestic violance/Developmental trauma

8. Type of therapy • The treatment are evidence based and best practice approaches • TF-CBT is most researched and most supported of all vurrent treatments for childhood PTSD and child trauma • Psychoeducation • Family support/therapy • Play / sand therapy • Group therapy/self esteem

9. Type of therapy • According to WHO (world health organisation) for children with PTSD (post traumatic stress disorder) • TF-CBT (Trauma-focused cognitive-behavioural therapy) • https://tfcbt.musc.edu/ • CPT (cognitive-processing therapy) • https://cpt.musc.edu/ • EMDR (eye movement desensitization and reprocessing)

10. What is TF-CBT? • An evidence-based treatment for children experiencing trauma related difficulties • Adresses wide range of traumas • Developed for youth ages 3-18 years • Components-based treatment protocol • Time limited, structured (12-20 sessions) • Parents are an integral part of treatment

11. TF-CBT Components • Assessment • Psychoeducation and Parenting skills • Relaxation • Affective Modulation • Cognitive Processing • Trauma Narrative • Conjoint parent-child sessions • Enhanching safety and social skills

12. What is CPT • A short term evidence based treatment for PTSD • A specific protocol • With or without written account • Can be conducted in groups and individually • 12 sessions

13. CPT components • Education regarding PTSD, thoughts and emotions • Processing the trauma • Learning to challenge thoughts • Trauma themes • Facing the future

14. What is EMDR • An evidence-based treatment for children experiencing trauma related difficulties • Re-processing of traumatic memories • Standardized protocol • For all ages of people • One to four sessions • Complicated trauma needs more sessions

15. Family therapy • Three family therapists in Barnahus • Always two therapists • When the abuser is a family member • Young „offender“ • When severe conflicts in the family interrupts child´s recovery • When the non-abusive parent is not supportive

16. Group therapy • For adolesents that have finished therapy • Two therapists • Same sex – similar age • Meeting others who have been through similar experiance • 6-8 sessions • Focus on self esteem, self respect, self regulation

17. Play/sand therapy • For young children • TF-CBT through playful interventions • Sand, art, games, puppets, stories • Has proven to be effective for children • Play is the language of children • Motivate children to participate in treatment

18. DSM-5 criteria A • Exposure to actual or threatned death, serious injury or sexual violation • The individual... • Directly experiences the traumatic event • Witnesses the traumatic event in person • Learns that the traumatic event occurred to a close family member or close friend • Experiences first-hand repeated or extreme exposure to aversive details of the traumatic event

19. DSM-5 symtoms • These symtoms have to have lasted at least a month, seriously affect one´s ability to function and can´t be due to substance use, medical illness or anything except the event itself

20. DSM-5 symtoms • Criterion B - Re-experiencing (1) • Spontaneous memories of the traumatic event • Recurrent dreams related to it • Flashbacks, feeling like the event is happening again • Psychological and physical reactions to reminders of the traumatic event

21. DSM-5 symtoms • Criterion D – Negative alertions in mood and cognitions (2) • Memory problems that are exclusive to the event (inability to remember key aspects of the event) • Negative beliefs about one´s self or the world • Distorted sense of blame for one´s self or others, related to the event • Being stuck in severe emotions related to the trauma (e.g. horror, shame, sadness) • Severely reduced interest in pre-trauma activities • Feeling detached, isolated or disconnected from other people

22. DSM-5 symtoms • Criterion C – Avoidance (1) • Avoiding thoughts or feelings connected to the traumatic event (distressing memories) • Avoiding people or situations connected to the traumatic event (external reminders)