Transcript 2015 Children and Trauma Treatments that Work with Kids

*
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
*
*
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Phase 1: Client History and Treatment Plan
Phase 2: Preparation
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*
Phase 3: Assessment
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Original target is held with positive cognition while the client searches his/her body for any
residual memory material
Phase 7: Closure
*
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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 ([email protected]) 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 ([email protected];
[email protected]), 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
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and adolescents. Dissertation Abstracts International: Section B: The Sciences and Engineering, 72(4-B),
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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.
*
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multiple-session early interventions following traumatic events. The American Journal of Psychiatry,
166(3), 293-301.
*
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abuse in children and adolescents: A meta-analysis. International Journal of Clinical and Health
Psychology, 11(2).
*
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abuse in children and adolescents: A meta-analysis’: Erratum. International Journal of Clinical and
Health Psychology, 11(1), 67-93.
*
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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
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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
*
[email protected]
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