Family Assessment of Needs and Strengths
– Trauma Exposure and Adaptation
(FANS-TEA)
Laurel Kiser
Vickie Beck
Kay Connors
Sarah Gardner
Fred Strieder
&
John Lyons
Acknowledgements
•Substance Abuse and Mental Health Services
Administration (NCTSI Category II)
•In developing the FANS-TEA, we build off of several
existing versions of the CANS:
–the CANS-TEA (Kisiel, Lyons, Saxe, Blaustein & Ellis, 2002)
–Several of the trauma items were developed or adapted
based collaborations with Cassandra Kisiel, Ph.D., Glenn Saxe,
M.D., Margaret Blaustein, Ph.D., and Heidi Ellis, Ph.D., with the
SAMHSA-funded National Child Traumatic Stress Network.
–the Family Advocacy and Support Tool (FAST)
–Additionally, we want to acknowledge the work of all those
individuals who made contributions to development of the
CANS family of instruments.
Families with Complex
Adaptations to Trauma
• Too many families are exposed to accumulated traumatic
circumstances.
• Complex adaptations to trauma in families are defined by the
intensity, duration, chronicity, or “toxicity” of the accumulated
trauma, and by the nature of the family’s response.
• Those families whose strengths have been overwhelmed by
their accumulated traumatic stressors exhibit distress and
disrupted family functioning.
Families with Complex
Adaptations to Trauma
• Exposure to multiple traumas within a
traumatic context
• Systemic response
–
–
–
–
–
Multiple family members experiencing trauma-related distress
Multiple family subsystems negatively impacted
Family resources are insufficient to support needs
Family unit trauma-related distress
Family maladaptation with risk of becoming a trauma-organized
system
Child
Response
Sibling
Relations
Traumatic
Context
Family
Unit
Parent-Child
Relations
Adult/
Parental
Response
Intergenerational
Response
Time
Individual
and
Family
Outcomes
Parenting
Practices &
Quality
Adult
Intimate
Relations
Acute and longer-term effects
Individual development
Family life cycle
Adapted from Kiser & Black, 2005
Purposes
1) To document the range of strengths and needs
exhibited by families affected by trauma,
2) To describe the contextual factors and systems
that can support a family’s adaptation to trauma,
and
3) To assist in the management and planning of
services for families with exposure and adaptation
to traumatic experiences.
Administration
• Completed by a trained clinician
• Information is typically gathered during 1-3 sessions
with the family.
• Clinician may use the Family Trauma Treatment
Interview (FTTI) for structuring the conversation with
the family.
• Clinician completes the FANS-TEA using the
information collected.
I. THE FAMILY TRAUMATIC
CONTEXT
In this section, we would like you to think about the experiences that your
family has had regarding trauma and stressors. These traumas and
stressors could have occurred to any member of the family or to the
whole family together.
For Family Traumatic Context, use the following categories/action levels:
0 indicates a dimension where there is no evidence of any trauma/stress of
this type.
1 indicates a dimension where a single incident of trauma occurred or
suspicion exists of trauma experiences; or mild stressor
2 indicates a dimension on which the family has experienced multiple
traumas or a moderate degree of trauma/stressor.
3 indicates a dimension which describes repeated and severe incidents of
trauma with medical and physical consequences; or major stressors.
I. THE FAMILY TRAUMATIC
CONTEXT
• Items 1-10 cover different trauma types.
sexual abuse
physical abuse
emotional abuse
neglect
medical trauma
family violence
community violence natural/manmade disaster
political violence
cultural violence
I. THE FAMILY TRAUMATIC
CONTEXT
11. IMMEDIATE RISK - This item refers to the family’s current risk of
exposure to any of the previously rated traumas.
0 Family has no current risk of exposure as could be reasonably expected.
1 Family has some limited risk of exposure to trauma(s) but no current,
on-going exposures.
2 Family is at high risk of experiencing trauma(s).
3 Family is experiencing on-going trauma(s).
Family at risk of exposure to: (circle all that apply): sexual abuse, physical
abuse, emotional abuse, neglect, medical trauma, family violence,
community violence, natural or manmade disaster, political violence
List family members at immediate risk:
I. THE FAMILY TRAUMATIC
CONTEXT
• Items 12-17 cover potential contextual
stressors/strengths:
family life cycle stressors
neighborhood safety
community resources
financial resources
residential stability
military transitions
Assessing Family Needs &
Strengths
Section
II
14 items assess the Family as a Whole
III
11 items assess Adult family members
IV
11 items assess Child family members
V
3 items assess Intergenerational family matters
VI
4 items assess Adult Intimate Partnerships
VII
9 items assess Caregiving
VIII
2 items assess Caregiver-Child Relations
IX
3 items assess Sibling dynamics
FANS-TEA Scoring
Needs
Strengths
• '0' indicates no need for
action
• '1' indicates a need for
watchful waiting
• '2' indicates a need for
action/moderate degree
• '3' indicates the need for
either immediate or
intensive action
• '0' indicates centerpiece
strength
• '1' indicates a strength that
you can use in planning
• '2' indicates an identified
strength that must be built
• '3' indicates the no strength
identified
II. THE FAMILY as a Whole
22. EFFICACY- This rating should be based on the family’s belief that it is
effective in achieving its goals and able to successfully manage daily family
life and handle stressors.
0 Family believes in itself and has confidence in its ability to successfully
deal with family life. The family takes on problems and stressors with
the attitude that they will be able to handle whatever happens.
1 Family members believe that they are able to handle most situations
although they can be tentative about their ability to manage stressors at
times.
2 Family has limited expectations about its ability to handle situations
successfully. Family members are often surprised when they are
successful at dealing with problems.
3 Family feels that it fails/is unable to handle most situations. Family
members act based on the premise that “we are not able to cope with
the things that happen to us”.
VI. Adult Intimate Partners
61. PARTNERSHIP AFFECT MANAGEMENT - This item refers to the
extent to which adult partners modulate or express emotions and manage
their reactions in the context of their relationship.
0 This rating is given to adult partners with no difficulties co-regulating
emotional responses; adult partners manage strong emotions in a
healthy, adaptive way. They recognize and respond appropriately to the
affect expressed...
1 This rating is given to adult partners with some minor difficulties with
affect regulation. They generally recognize and respond appropriately to
the affect expressed, but there are some miscues and
miscommunications…
2 This rating is given to adult partners with moderate problems with affect
regulation. They may exhibit marked shifts in emotional responses…
3 This rating is given to adult partners with highly dysregulated affect…
I. Caregiving
65. SATISFACTION/MEANING OF CAREGIVING- This item refers to the
importance placed on the role of caregiving and to the sense of
accomplishment or pride that the caregiver feels related to carrying out
her/his caregiving role and responsibilities.
0 Caregiver gives high priority to her/his caregiving role and
responsibilities and gains significant satisfaction from carrying them out.
1 Caregiver places some importance on her/his caregiving role and
responsibilities and gains some satisfaction from carrying them out.
2 Caregiver feels that her/his caregiving responsibilities must get done but
only occasionally feels a sense of pride in accomplishing them.
3 Caregiver does not value her/his caregiving role and feels little or no
sense of satisfaction for accomplishing any of her/his caregiving
responsibilities. Caregiving is seen as a burden.
FANS-TEA Triggers and Links
• Triggers - indicate actions that should be
considered based on the section or item rating:
• Additional assessments recommended
• Plans to be developed/implemented
• Reports that need to be made
• Referrals that need to be facilitated
• Links - indicate additional materials or resources
that may be valuable in assisting the clinician in
treatment planning or service delivery.
FANS-TEA Triggers and Links
Links for items 8 & 9 - Disaster/Political Violence
•Psychological First Aid was developed by the
NCTSN and National Center for PTSD.
•It is an evidence-informed approach for
assisting children, adolescents, adults, and
families in the aftermath of disaster and
terrorism:
www.nctsnet.org/nccts/nav.do?pid=typ_terr_
resources_pfa
FANS-TEA Triggers and Links
Section VII: CAREGIVING
Needs [items = 5; range = 0-15]; Strengths [items = 4; range = 0-12]
High Needs & Low Strengths Triggers - The following table identifies programs
that effectively impact on parenting:
Program
Developer
Parent Child
Eyberg
Interaction
(2003)
Therapy (PCIT)
STAR (Stop,
Think, Ask,
Respond)
Parenting
Program
Nicholson,
Anderson,
Fox &
Brenner
(2002)
Essential Elements
Evidence/ Outcomes
Therapists coach parents on
two major components:
relationship enhancement
and strategies for
compliance.
Utilizes cognitive behavioral
& anger management
techniques to help parents
develop a “thoughtful”
parenting style.
Shown to be effective in reducing
maternal stress and increasing
the number of positive parentchild interactions.
Research indicates decreased
levels of verbal and corporal
punishment, anger, stress, and
child behavior problems
following this intervention.
Looking forward to your input:
For more information on the FANS TEA or to review
it, provide feedback, participate in beta testing
e-mail Dr. Kiser at
lkiser@psych.umaryland.edu
Please visit the FITT Website to learn more
about the FITT Center and FITT Model
http://fittcenter.umaryland.edu