Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Brown, Adam D.; McCauley, Kelly; Navalta, Carryl P.; Saxe, Glenn

doi:10.1007/s10896-013-9542-9

Cited by 62 publications

(56 citation statements)

References 17 publications

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“…There has been an increase in knowledge about the treatment of externalizing disorders in recent years. Some of these treatment programs include trauma-informed modules and could be considered in this setting (Brown, McCauley, Navalta, & Saxe, 2013;Greenwald, 2002;Hodgon, Kinniburgh, Gabowitz, Blaustein, & Spinazzola, 2013). As specific trauma therapeutic interventions are available, they should play a more important role in a holistic treatment approach for residents with high emotional/behavioral comorbidity.…”

Section: Comorbiditymentioning

confidence: 99%

“…Although there is still a need for further research regarding treatment options for patients with psychiatric disorders and histories of childhood maltreatment, there are several evidence-based trauma treatment methods available from which the patient can benefit, for instance Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR). There are also some programs that take into account the special setting when the patient lives in a residential care unit (Brown et al, 2013;Hodgon et al, 2013). While primary and secondary prevention of childhood abuse is the primary goal, it is also essential to provide tertiary prevention through delivering the best possible assessment, care, and treatment for those who have already been exposed.…”

Section: Implication For Clinical Practicementioning

confidence: 99%

See 1 more Smart Citation

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

Greger

Myhre

Klöckner

et al. 2017

Child Abuse & Neglect

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Printed by NTNU Grafisk senter 1 NORSK SAMMENDRAG Ungdom i risiko: Overgrepserfaringer, psykopatologi og livskvalitet blant ungdom i barnevernsinstitusjonerOvergrep og omsorgssvikt i barndommen er assosiert med en rekke fysiske og psykiske helseplager senere i livet. Å kunne identifisere risikoutsatte befolkningsgrupper er svaert verdifullt med tanke på å kunne forebygge helseplager. Barn og unge i fosterhjem og på barnevernsinstitusjoner har opplevd mer overgrep og omsorgssvikt enn barn og unge i normalbefolkningen, og kan derfor vaere i en høy-risikogruppe for helseproblemer.Hovedmålet med denne studien var å studere om overgrepserfaringer var assosiert med psykiske lidelser og redusert livskvalitet også i en høy-risikogruppe av ungdom bosatt i barnevernsinstitusjoner. Et sekundaert mål var å forsøke å identifisere medierende faktorer som kunne øke kunnskapen om disse assosiasjonene ytterligere.Prosjektet er en del av studien «Psykisk helse hos barn og unge i barnevernsinstitusjoner» som ble gjennomført mellom 2010 og 2015. 400 ungdommer mellom 12 og 20 år bosatt i barnevernsinstitusjoner i Norge ble inkludert, og av disse gjennomførte 335 et semi-strukturert diagnostisk intervju som i tillegg til informasjon om psykiske lidelser også ga informasjon om overgrepserfaringer.En stor andel av ungdommene (71 %) oppga å ha overgrepserfaringer (å ha vaert vitne til vold, å ha vaert utsatt for fysiske eller seksuelle overgrep). I denne gruppa var det høyere forekomst av en rekke psykiske sykdommer sammenlignet med de andre ungdommene i barnevernsinstitusjonene. Det var statistisk signifikant forskjell i forekomst av alvorlig depresjon, dystymi, generalisert angstlidelse, alvorlig atferdsforstyrrelse og autismespekterforstyrrelse mellom de to ungdomsgruppene. I tillegg var det signifikant økt forekomst av tidligere selvmordsforsøk blant ungdommene med overgrepserfaringer. Denne gruppen ungdommer hadde også dårligere livskvalitet enn ungdom i normalbefolkningen i forhold til fysisk og emosjonelt velvaere, selvtillit og i forholdet til venner. Økende antall ulike typer overgrepserfaringer inkludert dysfunksjonelle familieforhold, var assosiert med økt odds for flere av de psykiatriske diagnosene, og for dårligere livskvalitet på alle undersøkte livsområder. Tre potensielle medierende faktorer ble undersøkt: globalt selvbilde, tilknytningsproblemer og bruk av tobakk/rusmidler. Av disse ble det funnet at kun globalt selvbilde hadde medierende effekt både på assosiasjonen mellom overgrepserfaringer og psykopatologi, og overgrepserfaringer og livskvalitet.Unge i barnevernsinstitusjoner hadde opplevd en rekke overgrepserfaringer. Resultatene fra denne studien indikerer at overgrepserfaringer spiller en nøkkelrolle i utviklingen av psykiske lidelser og utviklingen av dårlig livskvalitet blant ungdom i barnevernsinstitusjoner. Global selvfølelse ble identifisert som en mediator, og kan derfor vaere et velegnet angrepspunkt for intervensjon innenfor denne ungdomsgruppa. Studien åpner for muligheten av at tiltak som øker selvbild...

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Section: Comorbiditymentioning

confidence: 99%

Section: Implication For Clinical Practicementioning

confidence: 99%

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

Greger

Myhre

Klöckner

et al. 2017

Child Abuse & Neglect

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“…Indeed, for some maltreated children their experiences of maltreatment, combined with adverse care experiences, may mean they cannot be managed in substitute home-based care settings, such as adoption and fostering. A variety of specific interventions are used in the therapeutic residential care studies included in this review, among which are therapeutic parenting, life story work, 553 trauma-focused psychological therapy, 551 addressing cognitive distortions, improving impulse control, social skills training, risk management, sex education and behaviour modification, 557 as well as preparation for independence for older adolescents. 562 Therapeutic day programmes aim to meet the developmental needs of children in terms of fine motor, language, and social and emotional skills.…”

Section: Therapeutic Residential/day Carementioning

confidence: 99%

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…The clinician will benefit from descriptions of specific techniques for use with traumatized youth (see Brown et al 2013;D'Andrea et al 2013;Habib et al 2013;Hodgdon et al 2013;Kagan and Spinazzola 2013;Warner et al 2013). Those of us who operate private agencies can learn to be responsive to the need to allow for connection to occur, creating a space for staff to feel confident and supported in their efforts to assist (see Hodgdon et al 2013;Knoverek et al 2013).…”

mentioning

confidence: 99%

“…Three of these papers describe more systemic, components-based approaches to complex trauma intervention in residential settings, using the Attachment, Regulation and Competency (ARC; Hodgdon et al 2013), Real Life Heroes (RLH; Kagan and Spinazzola 2013); and Trauma Systems Therapy (TST; Brown et al 2013) intervention models. A fourth paper features application in residential settings of a more focused, session-protocol based intervention for adolescents with complex trauma: Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS; Habib et al 2013).…”

mentioning

confidence: 99%

Editorial Introduction: Residential Services for Children and Adolescents Impacted by Family Violence and Trauma

Pond

Spinazzola

2013

J Fam Viol

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There are times when our experiences as clinicians, practitioners, and managers align in a moment of enlightenment. This happened for one of us (Pond) several months ago at a meeting of foster parents who have been trained to provide intensive support to particularly vulnerable youth. In my welcoming remarks, I reflected upon some of the challenges associated with working with children whose lives have been impacted by multiple and chronic or recurrent interpersonal trauma, violence and neglect, experiences often referred to collectively as "complex trauma" (see Cook et al. 2005;Spinazzola et al. 2005;Spinazzola et al. 2013). I noted that residential programs see the same population of traumatized youth-often sharing cases and transition plans. We know from consistent federal data that in excess of 100,000 U.S. children and adolescents newly enter out-of-home placements each year (U.S. Department of Health and Human Services 2012).In some instances the determination of whether to place a maltreated child with a foster family versus within a congregate is based upon the acuity or severity of emotional and behavioral difficulties exhibited by these highly vulnerable youth. For example, through analysis of one of the world's largest child trauma databases, our colleagues at National Center for Child Traumatic Stress (NCCTS) have demonstrated that youth in residential treatment settings constitute the most vulnerable subgroup of children and adolescents victimized by trauma, exhibiting the highest rates of trauma exposure, associated impairment, and need for extensive intervention (Briggs et al. 2012). Just as often, however, out-of-home placement decisions are seemingly "the luck of the draw," predicated upon local resources and capacity, and in many instances ultimately decided by whoever happens to be next in line for an available bed.Later during this meeting we had a guest speaker, Hector, a man now in his mid-thirties, who spoke about his life as one of these children who spent years in out-of-home placements. His story is all too common, although his level of insight about the impact of his experiences was exceptional. Hector approached me after the event, and told me that when I spoke about the impact of repeated, familial trauma-physical abuse, witnessing domestic violence, and chronic disruption of placements-"You are talking about me. That's my story." Sadly, this disclosure was hardly surprising considering recent research by our NCCTS colleagues establishing that over 70 % of children in foster care have been exposed to complex trauma (see Greeson et al. 2011).Through his entire childhood, Hector witnessed severe domestic violence and suffered frequent physical abuse. The violence escalated; his mother began to beat him to the point that he feared for his life. Even though he had barely turned 13, Hector had the bravery to walk into a social services office and ask that he be put into a safe place. Hector thought this act would be his salvation-what he knew of foster families was from television, and he...

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Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Cited by 62 publications

References 17 publications

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Editorial Introduction: Residential Services for Children and Adolescents Impacted by Family Violence and Trauma

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