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.

Primary Goals
1. To decrease post traumatic symptoms and disorders in children exposed to potentially traumatic events 2. To increase the likelihood of children and family members engagement and acceptance of on-going treatment when necessary 3. To identify individuals in need of treatment due to prior psychiatric disorders with linkage

Current Status
In pilot stage On-going modifications
Current attempts to shorten, by further adapting incorporated measures Presenting at ANM for feedback

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
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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

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

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
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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

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

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.)
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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
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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)

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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
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Nuts and Bolts: Procedure

Modules are selected that help family with specific interventions to address identified symptoms (each with information for parents and child):

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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?

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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
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Third Session
At end of third session team discusses with family next steps:
1. If asymptomatic or close: follow up contact and 3 month post assessment (always told may return whenever interested) 2. Improvement, but still symptomatic: continue CFTSI for one or two more sessions or individual trauma focused treatment

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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 (TFCBT etc.)

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