Post on 25-Dec-2015
The Child and FamilyTraumatic Stress Intervention:
Implementing an Evidence-BasedEarly/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 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
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
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 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)
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
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
Children Who Received CFTSI Were 73% Less Likely
to Meet Partial or Full Criteria for PTSD
8872
93
44
0
20
40
60
80
100
Baseline 3 Mos FU
Perc
ent o
f you
th
ComparisonCFTSI
*
*p<.05
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
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’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
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 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
Change in PTSD Symptoms Following CFTSI (N=134)
Pre-Tx Parent Post-Tx Parent Pre-Tx Child Post-Tx Child0
5
10
15
20
25
17.57
9.58
21.68
10.87
PT
SD
Sym
pto
m S
ever
ity
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?
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