* C Lindsay Shepard, CSW, PhD Candidate & Ryan Grant, LCSW, RPT-S Primary Children’s Center for Safe and Healthy Families * 1. Review Evidence-Based Practice (EBP) * 2. Highlight effective treatment modalities for children & trauma * 3. Provide brief synopses and resources for: * EMDR * TF-CBT * PCIT * CFTSI * * *“Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual [clients]” (Sackett, Richardson, Rosenberg, & Haynes, 1997, p. 2) * * Evidence-based professionals: 1. Pose specific, answerable questions regarding decisions in their practice 2. 3. 4. 5. Acquire best available evidence Critically appraise the evidence for validity and applicability Facilitate an informed decision Monitor and evaluate the results * Effectiveness Question Example: * Population Problem Intervention Comparison Among children seeking outpatient treatment for trauma, what is the most effective intervention Outcome for reducing symptoms of traumatic stress? * Create a search string * Add “AND systematic review OR meta*” to string * Example: * Rock Rock AND Roll Roll * Search databases * EBSCOhost Databases (e.g., PsycInfo) * Scholar (https://scholar.google.com/) * Cochrane Library * Campbell Library * Trip Database * PubMed * Information for Practice * NCTSN (http://www.cochranelibrary.com/) (http://www.campbellcollaboration.org/lib/) (https://www.tripdatabase.com/) (http://www.ncbi.nlm.nih.gov/pubmed) (http://ifp.nyu.edu/) (http://www.nctsn.org/) * * *Three treatment protocols emerged as having the greatest level of theoretical, clinical, and empirical support, and the most agreement among the participants in the consensus-building process. * Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) * Abuse Focused-Cognitive Behavioral Therapy (AF-CBT) * Parent Child Interaction Therapy (PCIT) * (http://www.cebc4cw.org/topic/trauma-treatment-for-children/) * * Developed by Dr. Francine Shapiro (1987) * Based on the Adaptive Information Processing model, a physiological system that helps to transform disturbing information into adaptive resolution by psychologically integrating the information * Trauma = Disruption in our information processing system * Leaving images, sounds, thoughts, feelings or body sensations unprocessed and “stuck” in “state specific form” in the central nervous system * Present environmental stimuli can trigger and activate this unprocessed material * EMDR allows the brain to naturally process traumatic memories into an adaptive state allowing the person to think about and experience the disturbing material in a new and less distressing way * * * Phase 1: Client History and Treatment Plan Phase 2: Preparation * * Phase 3: Assessment * * Original target is held with positive cognition while the client searches his/her body for any residual memory material Phase 7: Closure * * Integrate the positive cognition with the targeted memory Phase 6: Body Scan * * Use of bilateral stimulation (eye movements, taps, tones) in short periods with “free association” of images, thoughts, feelings or body sensations that emerge naturally with “dual awareness” of the targeted memory and the present. Phase 5: Installation * * Disturbing image, negative cognition, positive cognition, emotions, body sensation(s) Phase 4: Desensitization and Reprocessing * * Explanation, skill development and affect regulation Review what has been accomplished and return to a regulated state Phase 8: Reevaluation * Successful reprocessing of all targeted and emerging trauma material * * Three pronged approach: * Past (trauma memories) * Present (current triggers and trauma reminders) * Future (anticipated challenging situations) * * http://www.emdria.org/ * http://www.emdrhap.org/ * http://www.emdr.com/ * Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Edition. The Guilford Press. * Gomez, A. (2012). EMDR Therapy and Adjunct Approaches with Children: Complex Trauma, Attachment, and Dissociation. Springer Publishing Company. * See references * * * “An empirically supported treatment model designed to assist children, adolescents, and their parents in the aftermath of traumatic experiences. TF-CBT is a components-based hybrid approach that integrates traumasensitive interventions, cognitive-behavioral principles, as well as aspects of attachment, developmental neurobiology, family, empowerment, and humanistic theoretical models in order to optimally address the needs of traumatized children and families. TF-CBT components particularly address symptoms of PTSD, depression, and anxiety, as well as features associated with these conditions. Although TF-CBT components can address and successfully resolve certain behavioral problems, it may not be ideally suited for children whose primary difficulties reflect severe preexisting behavioral difficulties” (Cohen, Mannarino, & Deblinger, 2006, p. 32) * *P *R *A *C *T *I *C *E Psychoeducation/Parenting Relaxation Affect Expression/Modulation Cognitive Coping/Processing Trauma Narrative In Vivo Mastery Conjoint parent-child Enhancing Safety * * Who did a stop touch? * What were the stop touches? * What did you think? * What did you feel? * What was the worst part? * Who’s fault was it? * What would you tell other kids to do? * * * Cohen, J. A., Mannarino, A. P. & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press. * TF-CBT Web: A Web-Based Learning Course for Trauma-Focused Cognitive Behavioral Therapy (http://tfcbt.musc.edu/) * NCTSN (http://www.nctsn.org/) * https://tfcbt.org * Trainings: * * https://tfcbt.org/training/ Contact your local Children’s Justice Center (CJC) and/or email Laura Seklemian (lseklemian@utah.gov) in the AG’s office * See References * * * Parent-Child Interaction Therapy (PCIT) * Treatment model developed by Dr. Sheila Eyberg in the 1970s for families with children (2-8 years) with disruptive behavior problems (e.g., oppositional, defiant, aggressive and/or temper tantrums) * Foundational theories: attachment and learning theory, systems theory, and behavior modification * Highly specific model * Live parent coaching * 14-20 outpatient sessions * Mom School * Child Directed Interaction (CDI) Phase * Special Play Time 5 minutes/day (avoid toys and games with rules or rough play) * * No commands, questions, or critical statements PRIDE Skills: * * raise eflection * mitation * Behavioral * * Labeled escription njoy/Enthusiasm Selective Attention: At negative behavior, remove attention (e.g., no eye contact, neutral face, no discussion with or response to child, remain silent or distract by describing own behavior). At appropriate behavior, return attention and give a labeled praise * * Parent Directed Interaction (PDI) Phase * Simple commands: * * * * * * * * * Direct Positively stated One at a time Specific Age-Appropriate Polite/respectful Only when necessary Follow compliance with labeled praise Contingencies (e.g., “If you don’t (repeat command), you’ll have to…”) * Time out sequence * * * http://www.pcit.org/ * Web-Based Learning Courses for PCIT: * http://pcit.extensiondlc.net/login/index.php * http://pcit.ucdavis.edu/pcit-web-course/ * Trainings: * http://www.pcit.org/certified-trainers/ * See references * * * 4-6 sessions brief intervention/prevention for trauma exposed youth (7-18 years) with a consistent caregiver * Recent trauma or disclosure (e.g., within 3 months) * Engaged in therapy ASAP * Components: * Assessment of both child and caregiver(s) * Targeted case management * Symptom identification, improved communication within the family, and enhancement of coping strategies * No Trauma Narrative! * Session 1 – parent(s) only * Parents symptoms and case management * Child’s history and symptoms * Session 2a – child only * Child’s history and symptoms * Session 2b – parent and child together * Compare symptoms * Decide on treatment focus * Limit to 1 or 2 symptoms and 1 or 2 skills * Session 3, 4 – parent and child together * Evaluate symptoms and skills * * Berkowitz, S., & Marans, S. (2011). The Child and Family Traumatic Stress Intervention: Implementation Guide for Providers. * Training: * http://medicine.yale.edu/childstudycenter/cvtc/p rograms/cftsi/training.aspx * Contact Carrie Epstein (Carrie.epstein@yale.edu; epstein.carrie@gmail.com), CFTSI Training Director at the Yale Childhood Violent Trauma Center. * See reference * Treatment Reviews that include EMDR * Bisson, J.I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for Chronic Post-traumatic Stress Disorder: Systematic review and meta-analysis. The British Journal of Psychiatry, 190, 97-104. doi: 10.1192/bjp.bp.106.021402 * Diehle, J., Schmitt, K., Daams, J.G., Boer, F., & Lindauer, R.J.L. (2014). Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: A meta-analysis. Journal of Traumatic Stress, 27(3), 257-264. doi: 10.1002/jts.21924 * Dowd, H., & McGuire, B.E. (2011). Psychological treatment of PTSD in children: An evidence-based review. The Irish Journal of Psychology, 32(1-2), 25-39. doi: 10.1080/03033910.2011.611612 * Field, A. & Cottrel, D. (2011). Eye movement desensitization and reprocessing as a therapeutic intervention for traumatized children and adolescents: A systematic review of the evidence for family therapists. Journal of Family Therapy, 33(4), 374-388. doi: 10.1111/j.1467-6427.2011.00548.x * Forman-Hoffman, V., Knauer, S., McKeeman, J., et al. (2013). Child and adolescent exposure to trauma: Comparative effectiveness of interventions addressing trauma other than maltreatment or family violence. Comparative effectiveness review no 107. AHRQ pub no 13-EHC054-EF. Rockville, MD, Agency for Healthcare Research and Quality. * Forman-Hoffman, V.L., Zolotor, A., McKeeman, J.L., Blanco, R., Knauer, S.R., Lloyd, S.W.,…Viswanathan, M. (2013). Comparative effectiveness of interventions for children exposed to nonrelational traumatic events. Pediatrics, 131(3), 526-539. doi: 10.1542/peds.2012-3846 * Fraser, J.G., Lloyd, S.W., Murphy, R.A., et al. (2013). Child exposure to trauma: Comparative effectiveness of interventions addressing maltreatment. Comparative effectiveness review no 89. AHRQ pub no 13-EHC002-EF. Rockville, MD, Agency for Healthcare Research and Quality. * Gillies, D., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2012). Psychological therapies for the treatment of Post-traumatic Stress Disorder in children and adolescents. Cochrane Database of Systematic Reviews, 12(CD006726), 1-110. doi: 10.1002/14651858.CD006726.pub2 * * Leenarts, L.E.W., Diehle, J., Doreleijers, T.A.H., Jansma, E.P., & Lindauer, R.J.L. (2013). Evidencebased treatments for children with trauma-related psychopathology as a results of child maltreatment: A systematic review. European Child & Adolescent Psychiatry, 22, 269-283. doi: 10.1007/s00787-012-03675 * Rodenburg, R., Benjamin, A., de Roos, C., Meijer, A.M., & Stams, G.J. (2009). Efficacy of EMDR in children: A meta-analysis. Clinical Psychology Review, 29(7), 599-606. doi: 10.1016/j.cpr.2009.06.008 * Rolfsnes, E.S., & Thormod, I. (2011). School-based intervention programs for PTSD symptoms: A review and meta-analysis. Journal of Traumatic Stress, 24(2), 155-165. doi: 10.1002/jts.20622 * Seidler, G.H., & Wagner, F.E. (2006). Comparing the efficacy of EMDR and Trauma-Focused Cognitive Behavioral Therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine, 36(11), 1515-1522. doi: 10.1017/S0033291706007963 * Zantvoord, J.B., Diehle, J., & Lindauer, R.J.L. (2013). Using neurobiological measures to predict and assess treatment outcome of psychotherapy in Posttraumatic Stress Disorder: Systematic review. Psychotherapy and Psychosomatics, 82, 142-151. doi: 10.1159/000343258 Treatment Reviews that include TF-CBT * Bisson, J.I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for Chronic Post-traumatic Stress Disorder: Systematic review and meta-analysis. The British Journal of Psychiatry, 190, 97-104. doi: 10.1192/bjp.bp.106.021402 * Cary, C.E., & McMillen, J.C. (2012). The data behind the dissemination: A systematic review of TraumaFocused Cognitive Behavioral Therapy for use with children and youth. Children and Youth Services Review, 34(4), 748-757. doi:10.1016/j.childyouth.2012.01.003 * Chadwick Center for Children and Families. (2004). Closing the quality chasm in child abuse treatment: Identifying and disseminating best practices. San Diego, CA: Author. (http://www.musc.edu/ncvc) * Cohen, J., & Mannarino, A.P. (2008). Disseminating and implementing Trauma-Focused CBT in community settings. Trauma Violence Abuse, 9(4), 214-226. doi: 10.1177/1524838008324336 * Diehle, J., Schmitt, K., Daams, J.G., Boer, F., & Lindauer, R.J.L. (2014). Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: A meta-analysis. Journal of Traumatic Stress, 27(3), 257-264. doi: 10.1002/jts.21924 * Dowd, H., & McGuire, B.E. (2011). Psychological treatment of PTSD in children: An evidence-based review. The Irish Journal of Psychology, 32(1-2), 25-39. doi: 10.1080/03033910.2011.611612 * Forman-Hoffman, V., Knauer, S., McKeeman, J., et al. (2013). Child and adolescent exposure to trauma: Comparative effectiveness of interventions addressing trauma other than maltreatment or family violence. Comparative effectiveness review no 107. AHRQ pub no 13-EHC054-EF. Rockville, MD, Agency for Healthcare Research and Quality. * Forneris, C.A., Gartlehner, G., Brownley, K.A., Gaynes, B.N., Sonis, J., Coker-Schwimmer, E.,…Lohr, K.N. (2013). Interventions to prevent Post-Traumatic Stress Disorder: A systematic review. American Journal of Preventative Medicine, 44(6), 635-650. doi: 10.1016/j.amepre.2013.02.013 * Fraser, J.G., Lloyd, S.W., Murphy, R.A., et al. (2013). Child exposure to trauma: Comparative effectiveness of interventions addressing maltreatment. Comparative effectiveness review no 89. AHRQ pub no 13-EHC002-EF. Rockville, MD, Agency for Healthcare Research and Quality. * Gillies, D., Taylor, F., Gray, C., O’Brien, L., & D’Abrew, N. (2012). Psychological therapies for the treatment of Post-traumatic Stress Disorder in children and adolescents. Cochrane Database of Systematic Reviews, 12(CD006726), 1-110. doi: 10.1002/14651858.CD006726.pub2 * Kornor, H., Winje, D., Ekeberg, O., Weisaeth, L., Kirkehei, I., Johansen, K., & Steiro, A. (2008). Early Trauma-Focused Cognitive-Behavioral Therapy to prevent Chronic Post-Traumatic Stress Disorder and related symptoms: A systematic review and meta-analysis. BMC Psychiatry, 8, 1-8. doi:10.1186/1471244X-8-81 * Leenarts, L.E.W., Diehle, J., Doreleijers, T.A.H., Jansma, E.P., & Lindauer, R.J.L. (2013). Evidencebased treatments for children with trauma-related psychopathology as a results of child maltreatment: A systematic review. European Child & Adolescent Psychiatry, 22, 269-283. doi: 10.1007/s00787-012-0367-5 * Macdonald, G., Higgins, J.P., Ramchandani, P., Valentine, J.C., Bronger, L.P., Klein, P.,…Taylor, M. (2012). Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Database of Systematic Reviews, 5(CD001930), 1-70. doi: 10.1002/14651858.CD001930.pub3 * Puttre, J.J. (2011). A meta-analytic review of the treatment outcome literature for traumatized children and adolescents. Dissertation Abstracts International: Section B: The Sciences and Engineering, 72(4-B), 1-2445. * Ramirez de Arellano, M.A., Lyman, D.R., Jobe-Shields, L., George, P., Dougherty, R.H., Daniels, A.S.,…Delphin-Rittmon, M.E. (2014). Trauma-Focused Cognitive Behavioral Therapy for children and adolescents: Assessing the evidence. Psychiatric Services, 65(5), 591-602. * Roberts, N.P., Kitchiner, N.J., Kenardy, J., & Bisson, J.I. (2009). Systematic review and meta-analysis of multiple-session early interventions following traumatic events. The American Journal of Psychiatry, 166(3), 293-301. * Sanchez-Meca, J., Rosa-Alcazar, A.I., & Lopez-Soler, C. (2011). The psychological treatment of sexual abuse in children and adolescents: A meta-analysis. International Journal of Clinical and Health Psychology, 11(2). * Sanchez-Meca, J., Rosa-Alcazar, A.I., & Lopez-Soler, C. (2011). ‘The psychological treatment of sexual abuse in children and adolescents: A meta-analysis’: Erratum. International Journal of Clinical and Health Psychology, 11(1), 67-93. * Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2004, April 26). Child physical and sexual abuse: Guidelines for treatment. Charleston, SC: National Crime Victims Research and Treatment Center. Retrieved from http://www.musc.edu/ncvc * Seidler, G.H., & Wagner, F.E. (2006). Comparing the efficacy of EMDR and Trauma-Focused Cognitive Behavioral Therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine, 36(11), 1515-1522. doi: 10.1017/S0033291706007963 * Silverman, W.K., Ortiz, C.D., Viswesvaran, C., Burns, B.J., Kolko, D.J., Putnam, F.W., & Amaya-Jackson, L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37(1), 156-183. doi: 10.1080/15374410701818293 * Zantvoord, J.B., Diehle, J., & Lindauer, R.J.L. (2013). Using neurobiological measures to predict and assess treatment outcome of psychotherapy in Posttraumatic Stress Disorder: Systematic review. Psychotherapy and Psychosomatics, 82, 142-151. doi: 10.1159/000343258 Treatment Reviews that include PCIT * Baumann, A.A., Powell, B.J., Kohl, P.L., Tabak, R.G., Penalba, V., Proctor, E.,…Cabassa, L.J. (2015). Cultural adaptation and implementation of evidence-based parent training: A systematic review and critique of guiding evidence. Children & Youth Services Review, 53, 113-120. doi: 10.1016/j.childyouth.2015.03.025 * Chadwick Center for Children and Families. (2004). Closing the quality chasm in child abuse treatment: Identifying and disseminating best practices. San Diego, CA: Author. (http://www.musc.edu/ncvc) * Cooley, M.E., Veldorale-Griffin, A., Petren, R.E., & Mullis, A.K. (2014). Parent-Child Interaction Therapy: A meta-analysis of child behavior outcomes and parent stress. Journal of Family Social Work, 17, 191208. doi: 10.1080/10522158.2014.888696 * Foley, K.P. (2011). A comparison of parent-child interaction therapy and treatment as usual with families with a history of child abuse and neglect and intimate partner violence. Dissertation Abstracts International: Section B: the Sciences and Engineering, 71(12-B), 7722. * Fraser, J.G., Lloyd, S.W., Murphy, R.A., et al. (2013). Child exposure to trauma: Comparative effectiveness of interventions addressing maltreatment. Comparative effectiveness review no 89. AHRQ pub no 13-EHC002-EF. Rockville, MD, Agency for Healthcare Research and Quality. * Thomas, R., & Zimmer-Gembeck, M.J. (2007). Behavioral outcomes of Parent-Child Interaction Therapy and Triple P-Positive Parenting Program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35, 475-495. doi: 10.1007/s10802-007-9104-9 Primary Study Evaluating CFTSI * Berkowitz, S., Stover, C.S., & Marans, S.R. (2011). The child and family traumatic stress intervention: Secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology & Psychiatry, 52(6), 676-685. doi: 10.1111/j.1469-7610.2010.02321.x * Lindsay.Shepard@imail.org Ryan.Grant2@imail.org