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 Hows

• 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 parents 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 familys 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

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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

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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.)