Evaluation of Real Life Heroes treatment for children with complex PTSD.

Abstract

The efficacy of Real Life Heroes (RLH) treatment was tested with 119 children in 7 child and family service programs, ranging from home-based family counseling to residential treatment. RLH is a sequential, attachment-centered treatment intervention for children with Complex PTSD that focuses on 3 primary components: affect regulation, emotionally supportive relationships, and life story integration to build resources and skills for resilience. Results included statistically significant decreases from baseline to 6 months in child behavior problems on the CBCL (Internalizing and Total Behavior), the Anger subscale of the TSCC, the UCLA PTSD Index-Parent Version (Reexperiencing, Avoidance, Hyperarousal, and Total Symptoms), and the UCLA PTSD Index-Child Version (Avoidance and Total Symptoms). Significant reductions were also found with repeated measures at 3-month assessments from baseline to 9 months on the CBCL, the UCLA Parent and Child Versions, and the PTSD subscale of the TSCC. Children receiving RLH did not have placements or psychiatric hospitalizations, a positive, but not significant trend, compared with trauma-informed "treatment as usual" provided by RLH-trained practitioners in the same programs. The study supported the efficacy of implementing trauma and resiliency-focused treatment in a wide range of child welfare programs and the importance of providing sequential attachment-centered treatment for children with symptoms of Complex PTSD.

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

“…Since the prior review, three studies—one RCT (Ford, Steinberg, Hawke, Levine, & Zhang, 2012), one quasi-experimental study (Kagan, Henry, Trinkle, & LaFrenier, 2014), and one naturalistic study (Lanktree et al, 2012)—have tested individual integrated therapy for complex trauma. The therapies in this family incorporate various theories, including attachment, developmental, family systems, and CBT within a “complex trauma” framework (see Cook et al, 2005, for more information).…”

“…All were individually delivered, but there was variation in parent involvement and inclusion of exposure. Parent involvement was recommended but not always possible (Kagan et al, 2014; Lanktree et al, 2012) or was not part of the intervention (Ford et al, 2012). Explicit exposure (imaginal and/or in vivo) was included in both Kagan et al (2014) and Lanktree et al (2012) but specifically was not included in Ford et al (2012).…”

“…TARGET moderately outperformed the enhanced TAU (ETAU) condition for reexperiencing and total PTSS and was similarly effective to ETAU for some outcomes (e.g., depression, hypervigilance), whereas ETAU outperformed TARGET for others (anger, mood regulation expectancies). The quasi-experimental study of Real Life Heroes by Kagan et al (2014) found reductions in varying outcomes assessed at either 6 or 9 months; however, the study had a number of weaknesses. The comparison condition was an inadequately defined TAU (and included only for some, not all, outcomes), treatment was of highly variable duration (1–9 months), and only about one third of youth participated in data collection at 6 months, with only about 10% participating at 9 months.…”

Effective therapies for the treatment of complex posttraumatic stress disorder: A qualitative systematic review

“…Lastly, Kagan, Henry, Richardson, Trinkle, and LaFrenier (2014), developed a group program for children and adolescents focused on emotional regulation, affective social support, and life history integration to build resources and resilience skills. The content of the sessions was based on sharing the feelings and emotions experienced, with therapy focusing on improving self-control, together with mindfulness exercises for stress reduction.…”

“…Eye movement desensitization and reprocessing, together with the integrative group treatment protocol (EMDR-IGTP) designed by Jarero et al (2013), produced an increase in mastery and confidence regarding traumatic memories in the children in whom it was implemented. The Real Life Heroes Treatment program (Kagan et al, 2014) was also effective in improving the symptoms of internalization, externalization, and overall behavior of the children who took part in this program. In the study by Lanktree et al (2012), reductions in levels of anxiety, depression, dissociation, and sexual concerns were achieved through the use of integral treatment for complex trauma.…”