Quasi-Qualitative Evaluation of Progressive Counting in Secure Accommodation in Scotland: an Exploratory Cluster Case Study

Abstract

This was the first study to introduce a brief exposure therapy, within a trauma-informed phase approach, into a secure facility in Scotland. An exploratory cluster case study was used to identify the perceptions of the first three youth who completed Progressive Counting (PC), a novel approach to brief exposure, within the Fairy Tale Model. The youth and their newly trained therapist received a semi-structured interview at 3 months following the completion of therapy. In-depth interviews involving rating scales and open-ended questions were conducted by telephone and digitally recorded. A quasi-qualitative approach was used to analyze data. Independent ratings by two researchers checked for inter-rater reliability. A retrospective expert rating was provided for treatment fidelity. Youth reported a range of gains in relation to program objectives including reduced distress and putting trauma into the past. Challenges of implementation are discussed. More rigorous evaluation of PC, including randomized control trials, is needed before PC can be recommended as a treatment of choice.

Intergenerational Trauma in the Occupied Palestinian Territories: Effect on Children and Promotion of Healing

“…As with residential studies, therapists' in secure facilities perceived a range of gains for youth who experienced FTM (Farkas et al 2010). Similar to youth reports in Barron and Tracey's (2017) cluster case study in a secure facility, youth were perceived by therapists in the current study to made gains in motivation, stabilization, problemsolving, anticipating risks, and imagining more hopeful futures . These perceived gains reflected program components, suggesting each phase of FTM may make a valuable contribution towards positive outcomes (Greenwald 2013).…”

“…Adding to the gains of satisfaction and reduced reactivity found in previous residential qualitative studies (Greenwald et al , 2008, the current study found perceived increases in therapist traumainformed knowledge, skills, and confidence, as well as the ability to talk about trauma with staff, parents, and agencies. In contrast to behavior risk and criminogenic models, FTM was perceived to support the growth of a trauma-sensitive environment (Barron and Tracey 2017). For some therapists, traumatization and resultant symptomology was increasingly discussed in placement transition meetings.…”

“…Building on previous studies of FTM in residential settings, and the experiences of youth reported in a cluster case study in a secure facility (Barron and Tracey 2017), the current study explored novice therapist perception of the process and outcomes of FTM in order to inform future secure facility delivery and evaluation. Qualitative semi-structured interviews explored therapist perceptions of the benefits, challenges, and facilitating factors of implementing a traumainformed phase model into a context that had traditionally used a behavior risk paradigm (Barron and Mitchell 2017a, b).…”

“…Numerous studies have affirmed the efficacy of cognitive-behavioral skills training for a wide range of mental health problems (Nathan 2007), and there is extensive literature affirming the centrality of working with attachment in therapy (Orlans and Levy 2014). Progressive Counting, typically used in the trauma resolution phase of FTM, has a growing empirical base (PC: Greenwald et al 2013Greenwald et al , 2015Barron and Tracey 2017). Finally, early studies into alcohol and substance misuse, and more recently studies related to other mental health concerns, highlight the importance of planning for relapse prevention (Marlatt and Donovan 2005).…”

“…Therapist and youth reported gains for youth in all treatment objectives including increased motivation, capacity to assess risk, and the ability to consider positive alternatives. Youth also reported reduced stress levels (Barron and Tracey 2017). There have only been two other qualitative FTM studies, both conducted in the US.…”