Program

Mar 11, 2015

OVERVIEW

The Child and Family Traumatic Stress Intervention (CFTSI) is a clinical intervention that aims to prevent the development of post-traumatic stress disorder (PTSD) in children and adolescents who were recently exposed to a potentially traumatic event. It is comprised of four sessions focused on communication and building coping skills, with all but the first (which is for the caregiver only) involving both caregiver and child. In an experimental study, the CFTSI was found to have positive impacts on diagnosis of PTSD, severity of PTSD symptoms, and symptoms of anxiety, post-traumatic stress, re-experiencing, and avoidance. No impacts were found on hyperarousal or dissociation symptoms.

DESCRIPTION OF PROGRAM

Target population: Children and adolescents ages seven to 17 who have been exposed to a potentially traumatic event, and their caregivers

Each year, millions of children are exposed to potentially traumatic events, which can lead to the development of post-traumatic stress disorder (PTSD). The Child and Family Traumatic Stress Intervention (CFTSI) is an intervention, delivered by a trained clinician, with the goal of PTSD prevention in at-risk children and adolescents through addressing the risk factors of poor social or familiar support and poor coping skills. It aims to do this by increasing caregiver support of the child by improving communication about feelings, symptoms, and behaviors, and by providing both caregiver and child with specific behavioral skills to help in coping with symptoms.

The CFTSI is administered over four sessions, beginning within 30 days of the potentially traumatic event. The first session, with clinician and caregiver only, serves to assess the caregiver’s psychological status and identify the child’s external stressors related to the recent potentially traumatic event. In the second session, the clinician meets first with the child, administers baseline assessments measuring trauma history, post-traumatic reactions, and recent moods and feelings, and then incorporates the caregiver into a group session focused on communication. At the end of the session, caregivers and clinicians choose one or two behavioral skill modules, related to areas of concern, to work on as “homework.” Sessions three and four, with caregiver and child together, review and practice skill modules and work to build communication. The fourth and final session also includes a discussion of next steps.

EVALUATION(S) OF PROGRAM

Berkowitz, S. J., 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 and Psychiatry, 52(6), 676-685.

Evaluated population: The study sample consisted of 106 children and adolescents and a primary caregiver. Child participants were seven to 17 years old, with a mean age of 12 years, 48 percent male, 37 percent African-American, 32 percent Caucasian, and 22 percent Hispanic. Seven percent were multiethnic and two percent reported being of other ethnicities. All children had recently been exposed to a potentially traumatic event, spoke English, were not receiving other counseling or mental health treatment, and did not have a developmental delay or diagnosed psychotic or bipolar disorder. All caregivers spoke English, were non-offenders, and were mostly (90 percent) female, while 10 percent were male fathers or stepfathers.

Approach: Families were recruited by referral from police or forensic sexual assault programs, or contacted following a record review in a pediatric emergency department. Children were randomized using block randomization to a group assigned to the CFTSI or to a four-session comparison group receiving a psychoeducational and supportive intervention that consisted of an initial meeting with the child’s adult caregiver, two sessions with the child only, and a fourth caregiver-and-child feedback session. The outcomes of interest were full or partial PTSD diagnosis, index measures of post-traumatic stress, anxiety, and dissociation, severity of PTSD symptoms, and incidence of the PTSD symptoms of re-experiencing, avoidance, and hyperarousal. Data were collected at baseline, post-test, and at a three-month follow-up. Initially, 112 families were randomized into the treatment and comparison groups, but six were excluded after randomization because it was found they could not complete research measures, follow the CFTSI protocol, or that the child was already receiving treatment. Of the 106 families participating in the study, 83 completed measures at all three time points (although all 106 were included in the data analysis using mixed-effects models). Fifteen families only completed the baseline session and an additional five did not attend the final session. There were no differences between groups at baseline.

Results: At post-test and at the three-month follow-up, children in the CFTSI group were significantly less likely than those in the comparison group to have a full or partial PTSD diagnosis (at follow-up, odds ratio of 0.345 for full diagnosis and 0.268 for full or partial diagnosis), and had significantly lower scores in indices of post-traumatic stress and anxiety symptoms. At the follow-up, children in the CFTSI group had a significantly lower incidence of symptoms of re-experiencing (57 percent of CFTSI group members versus 85 percent of comparison group members) and of avoidance (17 percent versus 37 percent), and had significantly lower severity of PTSD symptoms overall. There were no impacts found on scores in an index of dissociation symptoms or in incidence of hyperarousal.

SOURCES FOR MORE INFORMATION

References

Berkowitz, S. J., 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 and Psychiatry, 52(6), 676-685.

Contact Information for Program Director

Steven Marans

Yale Child Study Center

P.O. Box 207900, 230 South Frontage Road

New Haven 06520–7900

Phone: (203)-785-3377

Fax: (203)-785-4608

KEYWORDS: Children (3-11), Adolescents (12-17), Males and Females (Co-ed), High-Risk, Clinic/Provider-based, Counseling/Therapy, Parent or Family Component, Family Therapy, Anxiety Disorders/Symptoms, Other Mental Health

Program information last updated 3/11/15.

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