Treating sexually abused children: 1 year follow-up of a randomized controlled trial

Size: px
Start display at page:

Download "Treating sexually abused children: 1 year follow-up of a randomized controlled trial"

Transcription

1 Child Abuse & Neglect 29 (2005) Treating sexually abused children: 1 year follow-up of a randomized controlled trial Judith A. Cohen, Anthony P. Mannarino, Kraig Knudsen Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA Received 1 May 2003; received in revised form 24 November 2003; accepted 27 December 2004 Abstract Objective: To measure the durability of improvement in response to two alternative treatments for sexually abused children. Method: Eighty-two sexually abused children ages 8 15 years old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy (NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. Data analysis: Intent-to-treat and treatment completer repeated measures analyses were conducted. Results: Intent-to-treat indicated significant group time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. Conclusion: This study provides additional support for the durability of TF-CBT effectiveness Elsevier Ltd. All rights reserved. Keywords: Child sexual abuse; Posttraumatic stress disorder; Trauma-focused cognitive-behavioral therapy; Treatment outcome This study was funded by the Office of Child Abuse and Neglect (formerly NCCAN), Administration for Children, Youth and Families, Department of Health and Human Services, Grant No. 90-CA Corresponding author /$ see front matter 2005 Elsevier Ltd. All rights reserved. doi: /j.chiabu

2 136 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) Introduction Child sexual abuse is associated with psychiatric difficulties which can potentially be long lasting and cause significant functional impairment. Sexually abused children and adolescents have been found to have increased rates of depression, anxiety, posttraumatic stress disorder (PTSD), externalizing symptoms, and substance use disorders (Saywitz, Mannarino, Berliner, & Cohen, 2000). Although it has been suggested that these deleterious outcomes are attributable to family factors which heighten risk for both sexual abuse and psychiatric dysfunction, recent epidemiologic and twin studies have demonstrated that sexual abuse per se accounts for increased rates of depression, suicide attempts, PTSD, substance use disorders and sexual victimization in adulthood (Kendler et al., 2000; Nelson et al., 2002). Thus, it is critical to identify treatments which optimally reduce these difficulties in children who have been sexually abused, and which produce lasting symptomatic remission. In the past decade, knowledge about efficacious treatments for sexually abused children has grown substantially, due to the publication of several empirically rigorous treatment outcome studies for this population. These studies have incorporated gold standard elements of evidence-based treatment trials, such as random assignment to well defined, manualized treatments, and the comparison of index treatments to alternative treatments or wait list controls. Deblinger, Lippman, and Steer (1996, 1999) followed 100 sexually abused children who were randomly assigned to receive trauma-focused cognitive-behavioral therapy ( TF-CBT ) provided to the child only, the non-offending parent only, or to the child and parent, and compared these three groups to children who received standard community care. This study documented that the children who received TF-CBT (either child only or child + parent treatment conditions) experienced significantly greater improvement in PTSD symptoms, whereas children whose parents received TF-CBT (in the parent only or parent + child treatment conditions) experienced significantly greater improvements in child-reported depression and parent-reported behavioral problems, and that these differences were maintained at a 1-year follow-up. Cohen and Mannarino (1996, 1998) randomly assigned 69 sexually abused preschool children to TF- CBT or non-directive supportive therapy (NST); children receiving TF-CBT experienced significantly greater improvements in PTSD symptoms including sexualized behaviors, and in internalizing and total behavior problems. These differences were maintained over the course of a 1-year follow-up. Cohen and Mannarino (1998) conducted a parallel study for sexually abused children ages 8 15 years, and found significant group time differences among 49 treatment completers, with children who received TF-CBT experiencing significantly greater improvement in depression and social competence compared to children who received NST. King et al. (2000) randomly assigned to 17-year-old sexually abused child to one of three conditions: CBT provided individually, CBT family therapy, or a wait list control condition. This study indicated that the two CBT conditions were both superior to the wait list condition and that at a 3-month follow-up, the children whose families were included in treatment experienced significantly greater improvement in anxiety than those who received only individual CBT. Another randomized controlled trial compared 30 sessions of individual psychoanalytic treatment to18 sessions of group psychoeducation and found that children in the individual psychoanalytic condition experienced significantly greater improvement in PTSD symptoms. However, the design of this study did not make it possible to determine whether these differences were because of the treatment orientation (psychoanalytic vs. psychoeducation), the mode of treatment (individual vs. group), or the length of treatment (30 weeks vs. 18 sessions). Cohen, Deblinger, Mannarino, and Steer (2004) conducted a multisite study in which 229 sexually abused children were randomly assigned to TF-CBT or supportive Child Centered Therapy (CCT). At

3 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) posttreatment, the TF-CBT group demonstrated significantly greater improvement in PTSD, depression, behavior problems, abuse-related attributions, and shame. Parents receiving TF-CBT also showed greater improvement with regard to their own depression, abuse-specific distress, support of the child and effective parenting practices. In developing, testing, and disseminating evidence-based treatments for traumatized children, it is important to address not only the efficacy of treatment (how well it works to achieve specified results), but also the efficiency of treatment (how quickly it achieves these results) and the duration of treatment effects (how long treatment effects are maintained after treatment is completed). These issues may be particularly relevant for sexually abused children because of the documented deleterious long-term effects of child sexual abuse (Kendler et al., 2000; Nelson et al., 2002) and the potentially negative psychobiological impact of this type of child maltreatment. Sexually abused children have been found to have abnormalities in stress hormones related to dysregulation of the hypothalamic pituitary adrenal axis (DeBellis, Baum, et al., 1999; Kaufman et al., 1997), increased adrenergic tone as evidenced by elevated resting and reactive heart rate and blood pressure (Perry, 1994), and alterations in immunological functioning (DeBellis, Burke, Trickett, & Putnam, 1996). Perhaps most concerning is the finding that sexually abused children had smaller intracranial volume and lower scores on intelligence tests than carefully matched controls, with earlier age of onset and longer duration of abuse predicting smaller brain size and lower intellectual functioning (DeBellis, Keshavan, et al., 1999). Although it is not clear that psychosocial treatment can reverse these changes, one case report indicates that successfully treating children s abuserelated psychological symptoms may reverse the associated psychobiological abnormalities (DeBellis, Keshevan, & Karenski, 2001). Thus, it may be critically important to identify treatments that not only reduce psychological symptoms, but also lead to the most prompt and long-lasting symptom remission. For this reason, it is essential to examine treatment response to relatively brief interventions, and to assess outcome not only immediately at the conclusion of therapy, but for a period of time after therapy has ended. By definition more efficient treatments result in faster symptomatic improvement (thus shortening the time that children must suffer from these psychiatric symptoms); the DeBellis, Keshavan, et al. (1999) findings suggest that more efficient treatments are also associated with less psychobiological adversity. Treatments with longer duration of effects (i.e., that maintain superior symptom remission over time) not only provide ongoing relief from psychological symptoms, but may also have the most promise for potentially halting or even reversing the adverse psychobiological effects of child sexual abuse. Such treatments may optimally protect children from the deleterious adult outcomes associated with child sexual abuse discussed above (Nelson et al., 2002). Thus, while minimizing psychological suffering more quickly is in itself an important goal, maintaining this effectiveness over time may be of even greater value in preventing the long-term negative sequelae of child sexual abuse. The current study evaluates the duration of treatment effects of two alternative brief (12 week) treatments for sexually abused children over the course of the year following the end of treatment. TF-CBT was selected as the index treatment because TF-CBT interventions were superior to play therapy in improving these symptoms in sexually abused younger children (Cohen & Mannarino, 1996, 1997), have been effective in treating PTSD in adult sexual assault victims (Foa, Rothbaum, Riggs, & Murdock, 1991), and have a sound theoretical basis for alleviating PTSD, depressive and anxiety and associated symptoms (Cohen, Mannarino, Berliner, & Deblinger, 2000). We selected the comparison treatment, NST, because it typifies the empowering, supportive and non-directive techniques provided to children and adults in many rape crisis and community mental health settings, and because it contains therapeutic elements which

4 138 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) theoretically might reverse some of the traumagenic dynamics (Finkelhor, 1987) associated with child sexual abuse (i.e., powerlessness, stigmatization, traumatic sexualization and betrayal). Although this type of treatment is often provided over a longer period of time (New & Berliner, 2001), the importance of evaluating treatment efficiency led to the decision to limit treatment duration to 12 weeks. It was hypothesized that, although both treatments were theoretically sound and frequently used for treating this population, TF-CBT would be more effective for reducing psychological difficulties, particularly depressive and anxiety symptoms, and that these differential treatment effects would be sustained over the course of a 1-year follow-up. This was based on TF-CBT but not NST containing treatment components specifically targeting conditioned fear responses and cognitive errors which contribute to symptom development and maintenance in these particular disorders (Cohen et al., 2000), as well as a treatment component aimed at helping children optimally integrate the abuse experience into their view of themselves, others and their world. An initial analysis of pre to posttreatment results for 49 treatment completers (30 CBT, 19 NST) in this study indicated that TF-CBT was superior to NST in improving depressive and social competence problems (Cohen & Mannarino, 1998). A subsequently published review of cognitive-behavioral therapies for children and adolescents suggested the importance of following children after completion of treatment, using intent-to-treat analyses to determine the durability of treatment effects (Brent, Gaynor, & Weersing, 2002). The present paper examines the outcomes of these children during the course of 1 year following treatment completion. Methods Subjects Subjects were 82 children and adolescents aged 8 15 years old who were referred to an urban outpatient child psychiatric program specializing in the treatment of traumatic stress in children. This clinic is part of the Department of Psychiatry in an academically affiliated, not-for-profit general hospital. It receives referrals from child protective services (CPS), pediatric clinics and offices, police, forensic investigative agencies, victim advocacy programs, community mental health agencies, rape crisis centers, the courts, and from patient- or family-initiated referrals. It accepts all types of insurance, and approximately half of its patients receive Medicaid or are uninsured. Although located in an urban area, the clinic is geographically within a few miles of suburban and 15 miles of rural areas. Thus, the clinic serves a population believed to be representative of treatment-seeking sexually abused children in many communities. Although agencies, which routinely refer clients to our program were informed of the study, no recruitment ads were utilized to obtain referrals. Children referred to the clinic were screened for appropriateness for inclusion, and those who met criteria were invited to participate. Parents or caregivers were paid $25 for their time and expenses (travel, parking, babysitting, etc.) involved in completing initial and follow-up evaluations. Treatment was provided free of charge. Inclusionary criteria included the following: contact sexual abuse within the past 6 months which had been validated by CPS or an independent forensic evaluation prior to entry into the study, significant symptomatology related to the sexual abuse experience (as documented by a score in the clinical range on any of the self-report instruments or the presence of sexually inappropriate behavior as reported by the parent), and availability of a non-offending parent or primary caregiver who was able to participate in treatment. Exclusionary criteria included active psychotic symptoms or substance abuse, or mental retardation or pervasive developmental delay in the child, or active psychosis in the parent or

5 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) primary caretaker participating in the treatment. Power analysis indicated that inclusion of 40 subjects in each treatment condition would provide adequate power to detect medium or greater effect sizes. Sample composition included 56 females and 26 males. Mean ages were 11.4 years (TF-CBT) and 10.8 years (NST). Self-reported racial identity of participants was as follows: 49 (60%) Caucasian, 30 (37%) African American, 2 (2%) Biracial, and 1 (1%) Hispanic. Most intrusive type of abuse experienced was intercourse for 38 (46%) children, oral-genital contact for 3 (4%) children, fondling for 28 (34%) children, and other or unknown for 13 (16%) children. Twenty-five (31%) children experienced a single sexual abusive act, 11 (14%) experienced 2 5 abusive episodes, 9 (11%) experienced 6 10 episodes, 22 (27%) experienced more than 10 abusive episodes, and 15 (17%) were unable to report the number of abusive episodes. Perpetrators of the abuse were father or stepfather for 12 (14%) children, mother s paramour for 5 (6%), grandmother for 2 (3%), mother for 1 (1%), brother for 12 (15%), cousin for 8 (9%), uncle for 2 (3%), older person for 13 (16%), non-familial adult for 13 (16%), and other for 14 (17%). There were no significant differences between the TF-CBT and NST groups on any of these demographic variables. Measures The following measures were utilized to evaluate symptomatology. The Children s Depression Inventory (CDI) (Kovacs, 1985), a 27-item self-report instrument widely used to evaluate depressive symptoms in children and young adolescents; the Trauma Symptom Checklist for Children (TSC-C) (Briere, 1995), a 54-item self-report instrument which measures trauma-related symptoms with distinct scales based on factor analysis for anxiety, depression, PTSD, sexual problems, dissociation and anger; the State-Trait Anxiety Inventory for Children (STAIC) (Spielberger, 1973), a two-factor self-report instrument which measures both state anxiety and trait anxiety in children; the Child Sexual Behavior Inventory (CSBI) (Friedrich et al., 1992), a 42-item parent report scale which measures both normative and inappropriate sexual behaviors; and the Child Behavior Checklist (CBCL) (Achenbach & Edelbrock, 1983), a parent report instrument which measures a variety of child emotional and behavioral difficulties and includes four broad band factors (Social Competence, Behavior Problems Total, Internalizing, and Externalizing), and nine narrow band scales. Only the broad band factors were included in the present analysis. All of these instruments have documented strong psychometric properties, and have been used in past studies of sexually abused children (Cohen & Mannarino, 1998). Design and procedures Upon referral, initial phone screening was conducted, and for children who appeared to qualify for inclusion in the study, an initial evaluation was conducted at the clinic where treatment was to be provided. The Allegheny General Hospital Institutional Review Board approval was obtained prior to the start of the study and informed parental consent/child assent procedures were utilized. Children were randomly assigned to treatment using a random number series generated by computer. The evaluator conducting the initial and follow-up assessments was blind to treatment condition or assignment. As noted, there was a differential drop out rate, with 30/41 children assigned to TF-CBT completing treatment and 19/41 children assigned to NST completing treatment. Following completion of treatment or drop out, attempts were made to obtain follow-up assessments on all participants at posttreatment (Time 2), and at 6- (Time 3) and 12 (Time 4)-month follow-ups. A total of 46 children (27 CBT, 19 NST) completed the T3 assessment, and 39 children (23 CBT, 16 NST) completed the T4 assessment.

6 140 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) Treatments Both treatments were manualized; adherence monitoring was conducted through intensive supervision and rating of randomly selected audiotapes of treatment sessions. Treatment manuals are available upon request from the first author. All children and their caretakers received 12 sessions of treatment. Each session consisted of 45 minutes for the child and 45 minutes for the caretaker. TF-CBT. The trauma-focused CBT intervention has been described in detail elsewhere (Cohen et al., 2000). Major components for the child included feeling identification, stress inoculation techniques, direct discussion of various aspects of the sexual abuse experience through gradual exposure exercises, cognitive processing of the abuse and integrating this experience into the child s self-and world-views, education about healthy sexuality, and safety skill building. Components of parental treatment generally paralleled those for the child, with the addition of parenting management skills building. NST. The NST intervention was a non-directive child/parent-centered treatment model provided individually to the child and parent. This model focused on the establishment of a trusting therapeutic relationship which was self-affirming, empowering and validating for the parent and child. In the NST model therapists encouraged children and parents to direct the content and structure of each treatment session. Therapists provided active listening, reflection, accurate empathy, encouragement to talk about feelings, and belief in the child s and parent s ability to develop positive coping strategies for abuse-related difficulties. A variety of expressive arts materials (puppets, human figures, drawing and writing materials) were available for the child or parent to use if they so desired. Therapists did not provide direct advice regarding the management of behavioral problems, but instead encouraged the parent and child to generate their own strategies in this regard. Data analysis In order to examine comparative treatment effects of the two alternative treatments over the course of the 1-year follow-up, an intent-to-treat repeated measures analyses (using the SPSS general linear model) was conducted for the 82 children who entered the study. The Bonferroni correction was used to minimize the risk of overestimating effect sizes due to the large number of analyses conducted. A conservative Last Observation Carried Forward (LOCF) method (in which the score at the most recent available data point was used at subsequent incomplete data points) was used to account for missing data. To examine improvement in the 49 treatment completers at the 6- and 12-month follow-ups, simple main effects analyses were conducted to determine change from pretreatment to 6-month (T3) and 12-month (T4) follow-ups, respectively. Effect sizes at the 12-month follow-up were also calculated. Results Intent-to-treat analyses As shown in Table 1, significant intent-to-treat group time differences were found on the CDI, the State and Trait scales of the STAIC, and the anxiety, depression and sexual problems factors of the

7 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) Table 1 Pretreatment to 1-year follow-up group by time interactions on outcome measures Measure Pretreatment mean Posttreatment mean 6-month follow-up 12-month follow-up Group F Time F Group vs. time F CSBI TF-CBT (N = 41) (10.70) 8.59 (9.52) 8.32 (8.52) 6.93 (7.87) *** NST (N = 41) (8.91) (8.77) 9.20 (7.72) 9.28 (7.92) CDI TF-CBT (8.84) 7.61 (7.04) 9.20 (7.88) 8.85 (7.37) *** 3.86 **.17 NST (7.46) (7.97) (8.22) (7.51) STAIC-STATE TF-CBT (9.69) (8.16) (7.51) (6.32) *** 2.57 *.21 NST (9.87) (8.96) (9.02) (8.87) STAIC-TRAIT TF-CBT (8.66) (7.44) (6.39) (7.87) *** 3.07 *.12 NST (9.22) (8.98) (9.23) (8.83) TSCC-PTSD TF-CBT (5.17) 8.78 (4.88) 7.66 (3.94) 7.17 (4.17) *** NST (5.84) 9.92 (5.28) 9.60 (5.79) 9.58 (5.81) TSCC-ANX TF-CBT 8.07 (4.67) 5.90 (3.82) 5.34 (3.15) 5.76 (3.92) *** 2.87 *.11 NST 7.65 (4.68) 6.88 (3.75) 7.02 (3.81) 6.23 (4.06) TSCC-DEP TF-CBT 7.44 (4.66) 5.56 (4.35) 5.10 (3.45) 5.90 (4.49) ** 3.11 *.09 NST 6.40 (4.49) 6.30 (3.95) 6.15 (3.87) 5.50 (3.79) TSCC-SEX TF-CBT 5.29 (4.02) 4.10 (3.39) 3.68 (2.84) 4.17 (3.66) *.10 NST 5.28 (3.78) 4.85 (3.81) 5.67 (4.64) 4.55 (3.75) TSCC-DIS TF-CBT 9.02 (5.29) 7.80 (5.72) 6.88 (4.49) 6.68 (4.97) * NST 8.43 (4.32) 8.20 (4.74) 8.73 (5.03) 7.78 (4.53) TSCC-ANG TF-CBT 8.51 (5.07) 6.49 (4.87) 6.80 (4.17) 6.85 (4.92) * NST 8.85 (5.86) 8.40 (5.48) 8.68 (6.70) 7.70 (5.43) CBCL-SOCIAL TF-CBT (13.11) (12.01) (11.42) (10.76) *** NST (13.45) (11.55) (11.12) (11.42) CBCL-INTERNAL TF-CBT (15.40) (13.38) (14.11) (13.67) *** NST (17.38) (16.54) (16.22) (16.28) CBCL-EXTERNAL TF-CBT (14.74) (13.83) (14.63) (15.96) NST (16.41) (16.91) (16.01) (16.39) CBCL-TOTAL (15.54) (14.35) (15.22) (15.87) ** TF-CBT (17.08) (16.74) (15.96) (16.40) Effect size (d) 12-month Note. CSBI: Child Sexual Behavior Inventory; CDI: Child Depression Inventory; STAIC: State-Trait Anxiety Inventory for Children; TSCC: Trauma Symptom Checklist for Children; CBCL: Child Behavior Checklist. p <.05. p <.01. p <.001. p =.06. p =.07.

8 142 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) TSCC, with the TF-CBT group experiencing significantly greater improvement over time than the NST group on all of these measures. Group time differences also approached significance (p =.07) on the TSCC dissociation factor. It should also be noted that most instruments demonstrated significant time effects, suggesting that children significantly improved over time in both treatment groups. At the 12- month follow-up, medium effect sizes (.30) were found for sexual behaviors (CSBI), PTSD, and social competence (CBCL) (Cohen, 1988). Treatment completer analysis Among the 49 treatment completers analysis of change from pretreatment to 6-month follow-up demonstrated significantly greater improvement in the TF-CBT group on the state (F = 5.92, p <.01) and trait (F = 5.43, p =.02) scales of the STAIC, and the anxiety (F = 5.73, p <.01), depression (F = 5.49, p =.02), sexual problems (F = 4.64, p =.03) and dissociation (F = 7.42, p <.01) factors of the TSCC. From pretreatment (T1) to 12-month (T4) follow-up, the TF-CBT group demonstrated significantly greater improvement on the PTSD (F = 3.70, p <.05) and dissociation (F = 4.09, p <.05) factors of the TSCC. At both the 6-month and 12-month follow-ups, the TF-CBT group had greater improvement on the CSBI, which approached but did not reach statistical significance (p =.06). Discussion The results of this study indicate that TF-CBT was superior to a prototypical supportive, empowerment therapy (NST) in producing durable improvement in depressive, anxiety, and sexual concern symptoms over the course of a year following treatment. Additionally, treatment completers receiving TF-CBT demonstrated significantly greater improvement than those receiving NST in PTSD and dissociative symptoms at the 1-year follow-up. These findings are consistent with previous studies (Cohen & Mannarino, 1997; Deblinger et al., 1999) which similarly demonstrated the maintenance of TF-CBT effects during posttreatment follow-ups. The present study adds to the growing evidence indicating the efficacy and durability of TF-CBT interventions for sexually abused children and adolescents. One of the limitations of this study is that the measure used for PTSD was less than optimal. The TSCC does not inquire about PTSD symptoms in specific relation to the identified traumatic experience (in this case, sexual abuse). Such inquiry increases the sensitivity with which PTSD symptoms are identified, and it is likely that use of a PTSD-specific instrument would have had higher sensitivity in detecting such symptoms (American Academy of Child and Adolescent Psychiatry, 1998). Use of such an instrument would most likely have increased the significance of the differences noted between the two treatment groups with regard to PTSD, which in the present analyses were only significant among treatment completers at the 12-month follow-up. Thus, one possible explanation for the fact that significant differences in PTSD only appeared at the 12-month follow-up is insufficient sensitivity of the instrument used to measure PTSD. An alternative explanation which is supported by the data is that while both treatment groups experienced improvement in PTSD immediately after treatment, the TF-CBT group continued to substantially improve with regard to PTSD during the follow-up year (mean T1 to T2 improvement = 1.85; mean T2 to T4 improvement = 1.61) while the NST group did not experience this degree of ongoing improvement (mean T1 to T2 improvement =.91; T2 to T4 improvement =.32). This suggests that the positive impact of TF-CBT on PTSD symptoms continues beyond the duration of

9 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) treatment to a greater extent than that of NST. Another limitation of this study is the relatively high dropout rate, particularly in the NST group. This differential drop-out rate was in part due to a larger number of children in the NST group (N = 7) than in the CBT group (N =2,χ 2 = 3.44, df =1,p <.06) needing to be removed from the study due to ongoing sexual behaviors with other children (Cohen & Mannarino, 1998). However, even aside from the removed subjects, drop-out was higher in the NST group (N = 15) than in the TF-CBT group (N = 9). Although intent-to-treat analyses were used to address the differential dropout rate, a larger cohort of treatment completers would have enhanced the generalizability of the present findings. Given the significant findings of this study despite limited power, it is likely that increasing the number of treatment completers would have also increased the statistical significance of these results. On the other hand, the higher drop-out rate among NST subjects indicates that field objections to the use of CBT on the grounds that it is experienced as less individualized and supportive may be unwarranted. As reported earlier, child and parent satisfaction did not differ between the two treatment groups (Cohen & Mannarino, 1998). Despite these limitations, the present findings add to the growing number of studies supporting the durability of TF-CBT effects for treating a variety of psychological difficulties following child sexual abuse. Acknowledgment The authors thank the study therapists, project coordinators, the children and families who participated in this project, and Ann Marie Kotlik for assistance in manuscript preparation. References Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist and revised child behavior profile. Burlington, VT: Department of Psychiatry, University of VT. American Academy of Child and Adolescent Psychiatry. (1998). Practice parameters for the assessment and treatment of posttraumatic stress disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10, Suppl.), Brent, D. A., Gaynor, S. T., & Weersing, V. R. (2002). Cognitive-behavioral approaches to the treatment of depression and anxiety. In M. Rutter & E. Taylor (Eds.), Child and adolescent psychiatry: Modern approaches (4th ed., pp ). London: Blackwell Scientific Publications. Briere, J. N. (1995). Professional manual for the Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates Publishers. Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for sexually abused children with PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35, Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: Outcome during a one year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, Cohen, J. A., & Mannarino, A. P. (1998). Interventions for sexually abused children: Initial treatment findings. Child Maltreatment, 3, Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive-behavioral therapy: An empirical update. Journal of Interpersonal Violence, 15,

10 144 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) DeBellis, M. D., Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A. M., Jenkins, F. J., & Ryan, N. D. (1999). Developmental traumatology Part I: Biological stress symptoms. Biological Psychiatry, 45, DeBellis, M. D., Burke, L., Trickett, P. K., & Putnam, F. W. (1996). Antinuclear antibodies and thyroid function in sexually abused girls. Journal of Traumatic Stress Studies, 9, DeBellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., Frustaci, K., & Ryan, N. D. (1999). Developmental traumatology Part II: Brain development. Biological Psychiatry, 45, DeBellis, M. D., Keshavan, M. S., & Karenski, K. A. (2001). Case study: Anterior cingulate N-acetylaspartate concentrations during treatment of a maltreated child with PTSD. Journal of Child and Adolescent Psychopharmacology, 11, Deblinger, E., Lippman, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, Deblinger, E., Steer, R., & Lippman, J. (1999). Two-year follow-up study of cognitive-behavioral therapy for sexually abused children suffering posttraumatic stress symptoms. Child Abuse & Neglect, 23, Finkelhor, D. (1987). The trauma of child sexual abuse: Two models. Journal of Interpersonal Violence, 2, Foa, E. B., Rothbaum, B. O., Riggs, D., & Murdoch, T. (1991). Treatment of PTSD in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, Friedrich, W. N., Grambsch, P., Damon, L., Hewitt, S. K., Koverola, C., Lang, R., Wolf, V., & Broughton, D. (1992). The Child Sexual Behavior Inventory: Normative and clinical comparisons. Psychological Assessment, 4, Kaufman, J., Birmaher, B., Perel, J. M., Dahl, R. E., Moreci, P., Nelson, B., Wells, W., & Ryan, N. D. (1997). The CRH challenge in depressed abused, depressed non-abused and normal control children. Biological Psychiatry, 42, Kendler, K. S., Bulik, C. M., Silberg, J., Hetterma, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance abuse disorders in women: An epidemiological and co-twin control analysis. Archives of General Psychiatry, 57, King, N. J., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., Martin, R., & Ollendick, T. H. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39, Kovacs, M. (1985). The Children s Depression Inventory (CDI). Psychopharmacology Bulletin, 21, Nelson, E. C., Heath, A. C., Madden, P. A. F., Cooper, M. L., Dinwiddie, S. H., Buckolz, K. K., Glowinski, A., McLaughlin, T., Dunne, M. P., Statham, D. J., & Martin, N. G. (2002). Association between self-reported childhood sexual abuse and adverse psychosocial outcomes. Archives of General Psychiatry, 59, New, M., & Berliner, L. (2001). Mental health service utilization by victims of crime. Journal of Traumatic Stress, 13, Perry, B. D. (1994). Neurobiological sequelae of childhood trauma: PTSD in children. In M. M. Murburg (Ed.), Catecholamine function in PTSD: Emerging concepts (pp ). Washington, DC: American Psychiatric Press. Saywitz, K., Mannarino, A. P., Berliner, L., & Cohen, J. A. (2000). Treatment for children who have been sexually abused. American Psychologist, 55, Spielberger, C. D. (1973). Manual for the State-Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press. Résumé Objectif: Mesurer la durabilité des progrès thérapeutiques suite à deux types de traitements pour enfants agressés sexuellement. Méthode: Deux types de thérapies (une thérapie béhaviorale axée sur le traumatisme vécu et une thérapie d appui à caractère non directif) ont été prodiguées de façon aléatoire à quatre-vingt deux enfants victimes d agressions sexuelles, âgés de 8 à 15 ans, ainsi qu aux personnes qui en avaient la charge. Les traitements comprenaient douze sessions. L étude a examiné les symptômes durant les douze mois suivant le traitement. Analyse des données: On a mené des analyses portant sur l intention d entreprendre un traitement et sur les traitements achevés.

11 J.A. Cohen et al. / Child Abuse & Neglect 29 (2005) Résultats: Les analyses sur l intention d entreprendre un traitement indiquent des effets importants favorisant la thérapie béhaviorale par rapport à la dépression, l angoisse et les difficultés sexuelles. Parmi ceux qui ont achevé le traitement, cette même thérapie apporte des améliorations plus notables au niveau de l angoisse, de la dépression, des difficultés sexuelles et de la dissociation dans les six mois suivant le traitement; et du désordre de stress posttraumatique et de la dissociation au bout de douze mois suivant le traitement. Conclusion: Cette étude appuie davantage les constats à savoir la durabilité du traitement béhavioral. Resumen Objetivo: Medir la durabilidad de la mejoría como respuesta a dos tratamientos alternativos utilizados en niños sexualmente abusados. Método: Ochenta y dos niños abusados de 8 15 años de edad y sus cuidadores primarios fueron asignados al azar a terapia conductual cognitiva enfocada en el trauma (TF-CBT) o a terapia no directiva de apoyo (NST) realizada durante 12 sesiones; este estudio examina la sintomatología durante los 12 meses después del tratamiento. Análisis de los Datos: Se realizaron análisis de mediciones repetidas de intentos de tratamiento y tratamientos completos. Resultados: Los intentos de tratamiento indicaron un grupo significativo veces con efectos a favor de TF-CBT en medidas de depresión, ansiedad, y problemas sexuales. Entre los tratamientos completos, el grupo de TF-CBT evidenció significativamente mayor mejoría en ansiedad, depresión, problemas sexuales y disociación en el seguimiento a los 6 meses y en PTSD y disociación a los 12 meses de seguimiento. Conclusión: Este estudio ofrece apoyo adicional sobre la efectividad de la durabilidad de TF-CBT.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Treatment Description Target Population Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Acronym (abbreviation) for intervention: TF-CBT Average length/number of sessions: Over 80% of traumatized children

More information

TF-CBT: Trauma-Focused Cognitive NAME:

TF-CBT: Trauma-Focused Cognitive NAME: Treatment Description Acronym (abbreviation) for intervention: TF-CBT Average length/number of sessions: 12-25 sessions (60-90 minute sessions, divided approximately equally between youth and parent/caregiver)

More information

CHILDREN AND TRAUMATIC EVENTS: THERAPEUTIC TECHNIQUES FOR PSYCHOLOGISTS WORKING IN THE SCHOOLS

CHILDREN AND TRAUMATIC EVENTS: THERAPEUTIC TECHNIQUES FOR PSYCHOLOGISTS WORKING IN THE SCHOOLS , Vol. 46(3), 2009 Published online in Wiley InterScience (www.interscience.wiley.com) C 2009 Wiley Periodicals, Inc..20364 CHILDREN AND TRAUMATIC EVENTS: THERAPEUTIC TECHNIQUES FOR PSYCHOLOGISTS WORKING

More information

Trauma-Focused Cognitive Behavioural Therapy for Children and Parents

Trauma-Focused Cognitive Behavioural Therapy for Children and Parents Child and Adolescent Mental Health Volume 13, No. 4, 2008, pp. 158 162 doi: 10.1111/j.1475-3588.2008.00502.x Trauma-Focused Cognitive Behavioural Therapy for Children and Parents Judith A. Cohen & Anthony

More information

Questions and Answers about Child Sexual Abuse Treatment

Questions and Answers about Child Sexual Abuse Treatment Questions and Answers about Child Sexual Abuse Treatment An Interview with Judith Cohen, MD Dr. Judith Cohen is a member of the and Medical Director of the Center for Traumatic Stress in Children, Department

More information

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH

Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis, MD, MPH CBT for Youth with Co-Occurring Post Traumatic Stress Disorder and Substance Disorders Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis,

More information

Trauma Focused Coping (Multimodality Trauma Treatment)

Trauma Focused Coping (Multimodality Trauma Treatment) Trauma Focused Coping (Multimodality Trauma Treatment) Trauma Focused Coping (TFC), sometimes called Multimodality Trauma Treatment, is a school-based group intervention for children and adolescents in

More information

Community Outreach Program-Esperanza (COPE)

Community Outreach Program-Esperanza (COPE) Community Outreach Program-Esperanza (COPE) Treatment Description Target Population Essential Components Acronym (abbreviation) for intervention: COPE Average length/number of sessions: Generally there

More information

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD

WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD WHAT IS PTSD? A HANDOUT FROM THE NATIONAL CENTER FOR PTSD BY JESSICA HAMBLEN, PHD Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a

More information

Child Depression and Child Sexual Abuse: What is the Role of Parental Efficacy Factors in Predicting Children s Symptoms? Introduction Method

Child Depression and Child Sexual Abuse: What is the Role of Parental Efficacy Factors in Predicting Children s Symptoms? Introduction Method Child Depression and Child Sexual Abuse: What is the Role of Parental Efficacy Factors in Predicting Children s Symptoms? Candace T. Yancey, Cindy L. Nash, Stephanie L. Bruhn, Katie A. Gill, Mary Fran

More information

Guy S. Diamond, Ph.D.

Guy S. Diamond, Ph.D. Guy S. Diamond, Ph.D. Director, Center for Family Intervention Science at The Children s Hospital of Philadelphia Associate Professor, University of Pennsylvania, School of Medicine Center for Family Intervention

More information

Child Therapy for the Impacts of Sexual Abuse A Literature Review from a New Zealand Perspective

Child Therapy for the Impacts of Sexual Abuse A Literature Review from a New Zealand Perspective Child Therapy for the Impacts of Sexual Abuse A Literature Review from a New Zealand Perspective Anna T. O Sullivan 4/12/2012 Anna O Sullivan is a student at the University of Auckland, New Zealand, and

More information

CPP: Child-Parent Psychotherapy

CPP: Child-Parent Psychotherapy Treatment Description Acronym (abbreviation) for intervention: CPP Average length/number of sessions: 50 Aspects of culture or group experiences that are addressed (e.g., faith/spiritual component, transportation

More information

Treatment of Rape-related PTSD in the Netherlands: Short intensive cognitivebehavioral

Treatment of Rape-related PTSD in the Netherlands: Short intensive cognitivebehavioral Treatment of Rape-related PTSD in the Netherlands: Short intensive cognitivebehavioral programs Agnes van Minnen October 2009 University of Nijmegen Clinic of Anxiety Disorders Acknowledgements: We kindly

More information

Eaton County Youth Facility Intensive Substance Abuse Treatment Program

Eaton County Youth Facility Intensive Substance Abuse Treatment Program Eaton County Youth Facility Intensive Substance Abuse Treatment Program FOCUS ON TREATMENT The Eaton County Youth Facility (ECYF) Intensive Substance Abuse Residential Treatment Program will help your

More information

Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness

Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness Multisystemic Therapy With Juvenile Sexual Offenders: Clinical and Cost Effectiveness Charles M. Borduin Missouri Delinquency Project Department of Psychological Sciences University of Missouri-Columbia

More information

Substance Abuse and Mental Health Services Administration Reauthorization

Substance Abuse and Mental Health Services Administration Reauthorization Substance Abuse and Mental Health Services Administration Reauthorization 111 th Congress Introduction The American Psychological Association (APA) is the largest scientific and professional organization

More information

Institution Dates Attended Major Subject Degree

Institution Dates Attended Major Subject Degree Mary Ann Donaldson EDUCATION Institution Dates Attended Major Subject Degree Morningside College 9/69-6/71 Psychology ------ University of Minnesota 9/71-6/73 Psychology & Social Work B.A. University of

More information

Arkansas Strategic Plan for Early Childhood Mental Health

Arkansas Strategic Plan for Early Childhood Mental Health Summary of Arkansas Strategic Plan for Early Childhood Mental Health Arkansas Early Childhood Comprehensive Systems Social-Emotional Workgroup 2014-2015 Early Childhood Mental Health Early childhood professionals

More information

DOMESTIC VIOLENCE AND CHILDREN. A Children s Health Fund Report. January, 2001

DOMESTIC VIOLENCE AND CHILDREN. A Children s Health Fund Report. January, 2001 DOMESTIC VIOLENCE AND CHILDREN A Children s Health Fund Report January, 2001 Peter A. Sherman, MD Division of Community Pediatrics The Children s Hospital at Montefiore -1- Introduction Domestic violence

More information

Psychotropic Medications: Their Role in Trauma Treatment

Psychotropic Medications: Their Role in Trauma Treatment Psychotropic Medications: Their Role in Trauma Treatment Robert Foltz, Psy.D. Associate Professor Child & Adolescent Track Chicago School of Professional Psychology Overview Scope of the Problem Trauma

More information

AF-CBT: Alternatives for Families A Cognitive Behavioral Therapy

AF-CBT: Alternatives for Families A Cognitive Behavioral Therapy Treatment Description Acronym (abbreviation) for intervention: AF-CBT Average length/number of sessions: The delivery of treatment is organized into three phases: Phase 1: Psychoeducation and Engagement

More information

Assessing families and treating trauma in substance abusing families

Assessing families and treating trauma in substance abusing families Children, Trauma and the impact of Substance abuse Day One Outpatient (874-1045) Amy Stevenson LCPC CCS (amys@day-one.org) Don Burke LCPC CCS (donb@day-one.org) Assessing families and treating trauma in

More information

Applied Psychology. Course Descriptions

Applied Psychology. Course Descriptions Applied Psychology s AP 6001 PRACTICUM SEMINAR I 1 CREDIT AP 6002 PRACTICUM SEMINAR II 3 CREDITS Prerequisites: AP 6001: Successful completion of core courses. Approval of practicum site by program coordinator.

More information

Gregory C. Wells, Ph.D. LA License 1111 CA PSY23440

Gregory C. Wells, Ph.D. LA License 1111 CA PSY23440 , Ph.D. LA License 1111 CA PSY23440 4257 18 th Street San Francisco, CA 94114 415.874.9226 off 415.874.9448 fax www.drgregorywells.com Educational History Postdoctoral Master of Science in Clinical Psychopharmacology

More information

Division of Child and Family Services Treatment Plan Goal Status Review Aggregate Report

Division of Child and Family Services Treatment Plan Goal Status Review Aggregate Report I. Introduction Division of Child and Family Services Treatment Plan Goal Status Review Aggregate Report The more efficient and effective the delivery of our services, the greater our opportunity for realizing

More information

Understanding PTSD and the PDS Assessment

Understanding PTSD and the PDS Assessment ProFiles PUTTING ASSESSMENTS TO WORK PDS TEST Understanding PTSD and the PDS Assessment Recurring nightmares. Angry outbursts. Easily startled. These are among the many symptoms associated with Post Traumatic

More information

Recognizing and Treating Depression in Children and Adolescents.

Recognizing and Treating Depression in Children and Adolescents. Recognizing and Treating Depression in Children and Adolescents. KAREN KANDO, MD Division of Child and Adolescent Psychiatry Center for Neuroscience and Behavioral Medicine Phoenix Children s Hospital

More information

Japanese Psychological Research Jewish Social Studies Journal for Social Action in Counseling & Psychology Journal for Specialists in Pediatric

Japanese Psychological Research Jewish Social Studies Journal for Social Action in Counseling & Psychology Journal for Specialists in Pediatric Japanese Psychological Research Jewish Social Studies Journal for Social Action in Counseling & Psychology Journal for Specialists in Pediatric Nursing Journal for the Scientific Study of Religion Journal

More information

THE ALLENDALE ASSOCIATION. Pre-Doctoral Psychology Diagnostic Externship Information Packet 2015-2016

THE ALLENDALE ASSOCIATION. Pre-Doctoral Psychology Diagnostic Externship Information Packet 2015-2016 THE ALLENDALE ASSOCIATION Pre-Doctoral Psychology Diagnostic Externship Information Packet 2015-2016 INTRODUCTION TO ALLENDALE The Allendale Association is a private, not-for-profit organization located

More information

Eye Movement Desensitization and Reprocessing (EMDR) Theodore Morrison, PhD, MPH Naval Center for Combat & Operational Stress Control. What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) Theodore Morrison, PhD, MPH Naval Center for Combat & Operational Stress Control. What is EMDR? Eye Movement Desensitization and Reprocessing (EMDR) Theodore Morrison, PhD, MPH Naval Center for Combat & Operational Stress Control What is EMDR? Eye movement desensitization and reprocessing was developed

More information

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment

CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment This chapter offers mental health professionals: information on diagnosing and identifying the need for trauma treatment guidance in determining

More information

A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability

A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability A Parent Management Training Program for Parents of Very Young Children with a Developmental Disability Marcia Huipe April 25 th, 2008 Description of Project The purpose of this project was to determine

More information

Interventions to reduce psychological distress and their effectiveness

Interventions to reduce psychological distress and their effectiveness and non prescribed medication. These behaviours are independently associated with poor mental and physical health (Resnick et al., 1997). Patterns of utilisation of different forms of health care reveal

More information

A One Year Study Of Adolescent Males With Aggression and Problems Of Conduct and Personality: A comparison of MDT and DBT

A One Year Study Of Adolescent Males With Aggression and Problems Of Conduct and Personality: A comparison of MDT and DBT A One Year Study Of Adolescent Males With Aggression and Problems Of Conduct and Personality: A comparison of MDT and DBT Jack A. Apsche, Christopher K. Bass and Marsha-Ann Houston Abstract This study

More information

The Effects and Treatment of Childhood Sexual Abuse in Adult Survivors

The Effects and Treatment of Childhood Sexual Abuse in Adult Survivors 103 The Effects and Treatment of Childhood Sexual Abuse in Adult Survivors Carrie J. Hale Mentor: Richard Beck Abilene Christian University 104 Abstract Sexual abuse has become a national emergency in

More information

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder AACAP Official Action: OUTLINE OF PRACTICE PARAMETERS FOR THE ASSESSMENT AND TREATMENT OF CHILDREN, ADOLESCENTS, AND ADULTS WITH ADHD

More information

UMASS Department of Psychiatry Central Massachusetts Communities of Care Jessica L. Griffin, Psy.D. Eugene Thompson, MSW, MSP

UMASS Department of Psychiatry Central Massachusetts Communities of Care Jessica L. Griffin, Psy.D. Eugene Thompson, MSW, MSP Sustaining Evidence-Informed Practice in System of Care Using Trauma-Focused Cognitive Behavioral Therapy: Training, Coaching, and Evaluation Workshop Session #3 UMASS Central Massachusetts Communities

More information

Project BEST. A Social-Economic, Community-Based Approach to Implementing Evidence-Based Trauma Treatment for Abused Children

Project BEST. A Social-Economic, Community-Based Approach to Implementing Evidence-Based Trauma Treatment for Abused Children Project BEST A Social-Economic, Community-Based Approach to Implementing Evidence-Based Trauma Treatment for Abused Children Prof. Benjamin E. Saunders, Ph.D. National Crime Victims Research and Treatment

More information

Child Abuse & Neglect

Child Abuse & Neglect Child Abuse & Neglect 34 (2010) 215 224 Contents lists available at ScienceDirect Child Abuse & Neglect Practical strategies Trauma focused CBT for children with co-occurring trauma and behavior problems

More information

BRIAN ALLEN, PSY.D. Charvat, M., & Allen, B. (2007). The business of building a career in trauma research. Traumatic Stresspoints, 21(4), 14-16.

BRIAN ALLEN, PSY.D. Charvat, M., & Allen, B. (2007). The business of building a career in trauma research. Traumatic Stresspoints, 21(4), 14-16. Brian Allen Curriculum Vitae 1 Address: Department of Psychology Sam Houston State University Box 2447 Huntsville, TX 77341 BRIAN ALLEN, PSY.D. Phone: (936) 294-1177 (office) (530) 219-5670 (cell) E-mail:

More information

State of Washington Sexual Abuse/Assault Services Standards

State of Washington Sexual Abuse/Assault Services Standards Washington State Department of Commerce Office of Crime Victims Advocacy State of Washington Sexual Abuse/Assault Services Standards FOR Core Services for Community Sexual Assault Programs Only Information,

More information

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment

More information

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa

Cognitive Behavioral Therapy for PTSD. Dr. Edna B. Foa Cognitive Behavioral Therapy for PTSD Presented by Dr. Edna B. Foa Center for the Treatment and Study of Anxiety University of Pennsylvania Ref # 3 Diagnosis of PTSD Definition of a Trauma The person has

More information

William Gardner, Psy.D.

William Gardner, Psy.D. William Gardner, Psy.D. 388 Market St, Suite 1010 San Francisco, California 94111 (415) 323-5750 wgardner@earthlink.net Education 2009 2010 Post-Doctoral Psychology Resident Kaiser Permanente Medical Center

More information

Rachel A. Klein, Psy.D Licensed Clinical Psychologist (610) 368-4041 rachel.klein81@gmail.com

Rachel A. Klein, Psy.D Licensed Clinical Psychologist (610) 368-4041 rachel.klein81@gmail.com Rachel A. Klein, Psy.D Licensed Clinical Psychologist (610) 368-4041 rachel.klein81@gmail.com EDUCATION Widener University, Institute of Graduate Clinical Psychology, Doctor of Psychology, 5/2012 Widener

More information

Treatment of PTSD and Comorbid Disorders

Treatment of PTSD and Comorbid Disorders TREATMENT GUIDELINES Treatment of PTSD and Comorbid Disorders Guideline 18 Treatment of PTSD and Comorbid Disorders Description Approximately 80% of people with posttraumatic stress disorder (PTSD) have

More information

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member Co Occurring Disorders and the on Children: Effectively Working with Families Affected by Substance Abuse and Mental Illness Definition (Co-Occurring also called Dual Dx) A professional diagnosis of addictive/substance

More information

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking

More information

Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT)

Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) Treatment Description Target Population Acronym (abbreviation) for intervention: AF-CBT Average length/number of sessions: The

More information

USF Psychiatry Grand Rounds Morsani Center

USF Psychiatry Grand Rounds Morsani Center USF Psychiatry Grand Rounds Morsani Center Define target population with best evidence for Parent-Child Interaction Therapy (PCIT) implementation Describe assessment/progress monitoring tools, and phases

More information

Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists

Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists Psychotherapeutic Interventions for Children Suffering from PTSD: Recommendations for School Psychologists Julie Davis, Laura Lux, Ellie Martinez, & Annie Riffey California Sate University Sacramento Presentation

More information

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Co-Occurring Substance Use and Mental Health Disorders Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Introduction Overview of the evolving field of Co-Occurring Disorders Addiction and

More information

Paul R. McCrone, Tara Weeramanthri, Martin R. J. Knapp, Alan Rushton, Judith Trowell, Gillian Miles, and Israel Kolvin

Paul R. McCrone, Tara Weeramanthri, Martin R. J. Knapp, Alan Rushton, Judith Trowell, Gillian Miles, and Israel Kolvin LSE Research Online Article (refereed) Paul R. McCrone, Tara Weeramanthri, Martin R. J. Knapp, Alan Rushton, Judith Trowell, Gillian Miles, and Israel Kolvin Costeffectiveness of individual versus group

More information

Using Evidence for Public Health Decision Making: Violence Prevention Focused on Children and Youth

Using Evidence for Public Health Decision Making: Violence Prevention Focused on Children and Youth Using Evidence for Public Health Decision Making: Violence Prevention Focused on Children and Youth Community Guide Slide Modules These slides are designed to be used with overview slides also available

More information

Psychology Externship Program

Psychology Externship Program Psychology Externship Program The Washington VA Medical Center (VAMC) is a state-of-the-art facility located in Washington, D.C., N.W., and is accredited by the Joint Commission on the Accreditation of

More information

Interdisciplinary Care in Pediatric Chronic Pain

Interdisciplinary Care in Pediatric Chronic Pain + Interdisciplinary Care in Pediatric Chronic Pain Emily Law, PhD Assistant Professor Department of Anesthesiology & Pain Medicine University of Washington & Seattle Children s Hospital + Efficacy: Psychological

More information

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City

A Review of Conduct Disorder. William U Borst. Troy State University at Phenix City A Review of 1 Running head: A REVIEW OF CONDUCT DISORDER A Review of Conduct Disorder William U Borst Troy State University at Phenix City A Review of 2 Abstract Conduct disorders are a complicated set

More information

Lone Star College-Tomball Community Library 30555 Tomball Parkway Tomball, TX 77375 http://www.lonestar.edu/library.

Lone Star College-Tomball Community Library 30555 Tomball Parkway Tomball, TX 77375 http://www.lonestar.edu/library. Lone Star College-Tomball Community Library 30555 Tomball Parkway Tomball, TX 77375 http://www.lonestar.edu/library.htm 832-559-4211 PSYCHOLOGY Scholarly ELECTRONIC Electronic JOURNAL Journals LIST The

More information

Claudia A. Zsigmond, Psy.D. FL. License # PY7297

Claudia A. Zsigmond, Psy.D. FL. License # PY7297 Claudia A. Zsigmond, Psy.D. FL. License # PY7297 EDUCATION 9/1989- State University of New York at Buffalo, Buffalo, NY 6/1993 Bachelor of Arts, Psychology, cum laude 9/1995- Illinois School of Professional

More information

[KQ 804] FEBRUARY 2007 Sub. Code: 9105

[KQ 804] FEBRUARY 2007 Sub. Code: 9105 [KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A

More information

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 By April 1, 2006, the Department, in conjunction with the Department of Corrections, shall report the following

More information

AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year

AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year Non-profit mental health agency established in 1945 Recipient of the CAMFT School and Agency Award for 2009 Clients from diverse

More information

Adversity, Toxic Stress & Resiliency. Baystate Medical Center:Family Advocacy Center Jessica Wozniak, Psy.D., Clinical Grants Coordinator

Adversity, Toxic Stress & Resiliency. Baystate Medical Center:Family Advocacy Center Jessica Wozniak, Psy.D., Clinical Grants Coordinator Adversity, Toxic Stress & Resiliency Baystate Medical Center:Family Advocacy Center Jessica Wozniak, Psy.D., Clinical Grants Coordinator Adverse Childhood Experiences ACE Study (www.acestudy.org) 18,000

More information

Krystel Edmonds-Biglow, Psy.D. Licensed Clinical Psychologist PSY19260 dr_kedmondsbiglow@hotmail.com (323) 369-1292 phone (323)756-5130 fax

Krystel Edmonds-Biglow, Psy.D. Licensed Clinical Psychologist PSY19260 dr_kedmondsbiglow@hotmail.com (323) 369-1292 phone (323)756-5130 fax Return to www.endabuselb.org Krystel, Psy.D. Licensed Clinical Psychologist PSY19260 dr_kedmondsbiglow@hotmail.com (323) 369-1292 phone (323)756-5130 fax Education Doctorate of Clinical Psychology, Emphasis:

More information

Effective Treatment for Complex Trauma and Disorders of Attachment

Effective Treatment for Complex Trauma and Disorders of Attachment Effective Treatment for Complex Trauma and Disorders of Attachment By Meds Reactive Attachment Disorder is a severe developmental disorder caused by a chronic history of maltreatment during the first couple

More information

THE EFFECTS OF FAMILY VIOLENCE ON CHILDREN. Where Does It Hurt?

THE EFFECTS OF FAMILY VIOLENCE ON CHILDREN. Where Does It Hurt? THE EFFECTS OF FAMILY VIOLENCE ON CHILDREN Where Does It Hurt? Child Abuse Hurts Us All Every child has the right to be nurtured and to be safe. According to: Family Violence in Canada: A Statistical Profile

More information

Dr. Elizabeth Gruber Dr. Dawn Moeller. California University of PA. ACCA Conference 2012

Dr. Elizabeth Gruber Dr. Dawn Moeller. California University of PA. ACCA Conference 2012 Dr. Elizabeth Gruber Dr. Dawn Moeller California University of PA ACCA Conference 2012 http://www.youtube.com/watch?v=9rpisdwsotu Dissociative Identity Disorder- case presentation Diagnostic criteria Recognize

More information

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study Amanda Dudley, Bruce Tonge, Sarah Ford, Glenn Melvin, & Michael Gordon Centre for Developmental Psychiatry & Psychology

More information

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES Psychological therapies are increasingly viewed as an important part of both mental and physical healthcare, and there is a growing demand for

More information

SCREENING FOR INTIMATE PARTNER VIOLENCE IN THE PRIMARY CARE SETTING

SCREENING FOR INTIMATE PARTNER VIOLENCE IN THE PRIMARY CARE SETTING SCREENING FOR INTIMATE PARTNER VIOLENCE IN THE PRIMARY CARE SETTING Partner violence can affect one third of the patients cared for in the primary care setting. The primary care setting offers an opportunity

More information

QUALIFICATIONS: BSc (Hons) Psychology 1995 Doctorate in Clinical Psychology 2001 MSc Forensic Psychology 2012

QUALIFICATIONS: BSc (Hons) Psychology 1995 Doctorate in Clinical Psychology 2001 MSc Forensic Psychology 2012 Dr Dawn Bailham Consultant Clinical Psychologist BSc, MSc, Doctorate in Clinical Psychologist, Affiliated Member of the British Psychological Society, AFBPS Contact: Expert Witness Department Expert in

More information

Substance Abuse and Sexual Violence:

Substance Abuse and Sexual Violence: Substance Abuse and Sexual Violence: The Need for Integration When Treating Survivors Kelli Hood, M.A. Objective To understand the necessity for therapeutic strategies in clients with cooccurring Substance

More information

SYLLABUS FOR POST-GRADUATE DIPLOMA IN GUIDANCE AND. Personality and Adjustment M. Marks: 100

SYLLABUS FOR POST-GRADUATE DIPLOMA IN GUIDANCE AND. Personality and Adjustment M. Marks: 100 SYLLABUS FOR POST-GRADUATE DIPLOMA IN GUIDANCE AND COUNSELING Duration of the programme: : I: Two semesters July to December January to June (Vocation and holidays shall be as per university calendar)

More information

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents

Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

More information

Master of Arts, Counseling Psychology Course Descriptions

Master of Arts, Counseling Psychology Course Descriptions Master of Arts, Counseling Psychology Course Descriptions Advanced Theories of Counseling & Intervention (3 credits) This course addresses the theoretical approaches used in counseling, therapy and intervention.

More information

Pathological Gambling and Age: Differences in personality, psychopathology, and response to treatment variables

Pathological Gambling and Age: Differences in personality, psychopathology, and response to treatment variables Addictive Behaviors 30 (2005) 383 388 Short communication Pathological Gambling and Age: Differences in personality, psychopathology, and response to treatment variables A. González-Ibáñez a, *, M. Mora

More information

Executive summary. Request for advice

Executive summary. Request for advice Executive summary Request for advice Child abuse has always been with us and it takes many different forms. It is estimated that more than 100,000 children are abused in the Netherlands each year. In recent

More information

Post-traumatic stress disorder overview

Post-traumatic stress disorder overview Post-traumatic stress disorder overview A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

Open Residential Firesetting and Sexual Behavior Treatment Program

Open Residential Firesetting and Sexual Behavior Treatment Program Open Residential Firesetting and Sexual Behavior Treatment Program ABRAXAS Open Residential Firesetting and Sexual Behavior Treatment Program Since 2006, the Abraxas Open Residential Firesetting and Sexual

More information

Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls

Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Satellite Conference and Live Webcast Thursday, August 25, 2011 5:30 7:00 p.m. Central Time Faculty David J. Schonfeld,

More information

Trauma and the Family: Listening and learning from families impacted by psychological trauma. Focus Group Report

Trauma and the Family: Listening and learning from families impacted by psychological trauma. Focus Group Report Trauma and the Family: Listening and learning from families impacted by psychological trauma Focus Group Report A summary of reflections and remarks made by Baltimore City families impacted by trauma and

More information

Essential Trauma Informed Practices in Schools. Shannon Cronn, N.C.S.P. Barb Iversen, M.C.

Essential Trauma Informed Practices in Schools. Shannon Cronn, N.C.S.P. Barb Iversen, M.C. Essential Trauma Informed Practices in Schools Shannon Cronn, N.C.S.P. Barb Iversen, M.C. Objectives: Participants attending this session will be able to: Define trauma Explain how trauma may impact child/teen

More information

CBT for PANS/PANDAS. Eric A. Storch, Ph.D. All Children s Hospital Guild Endowed Chair and Professor. University of South Florida

CBT for PANS/PANDAS. Eric A. Storch, Ph.D. All Children s Hospital Guild Endowed Chair and Professor. University of South Florida CBT for PANS/PANDAS Eric A. Storch, Ph.D. All Children s Hospital Guild Endowed Chair and Professor University of South Florida Treatment options remain unclear Pharmacological treatments for PANDAS/PANS

More information

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders.

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders. Page 1 of 6 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Eating disorders are illnesses having to do with disturbances in eating behaviors, especially the consuming of food in inappropriate

More information

Behavioral Health and Wellness

Behavioral Health and Wellness INSPIRA HEALTH NETWORK Behavioral Health and Wellness Providing Quality Care Across the Region Comprehensive Programs Tailored for Your Needs Inspira offers a range of behavioral health and wellness services

More information

An Examination of the Association Between Parental Abuse History and Subsequent Parent-Child Relationships

An Examination of the Association Between Parental Abuse History and Subsequent Parent-Child Relationships An Examination of the Association Between Parental Abuse History and Subsequent Parent-Child Relationships Genelle K. Sawyer, Andrea R. Di Loreto, Mary Fran Flood, David DiLillo, and David J. Hansen, University

More information

Trauma-Informed Care for Children

Trauma-Informed Care for Children Quotes of Inspiration Success is the good fortune that comes from aspiration, desperation, perspiration and inspiration. - Evan Esar Home Statewide Initiatives Guiding Principles Resources Links This is

More information

GOING BEYOND FOSTER CARE

GOING BEYOND FOSTER CARE GOING BEYOND FOSTER CARE Sharon W. Cooper, MD Developmental & Forensic Pediatrics, P.A. University of North Carolina Chapel Hill School of Medicine Sharon_Cooper@med.unc.edu OBJECTIVES Adverse childhood

More information

CHILDHOOD SEXUAL ABUSE FACT SHEET

CHILDHOOD SEXUAL ABUSE FACT SHEET CHILDHOOD SEXUAL ABUSE FACT SHEET Emily M. Douglas and David Finkelhor PART 1: HOW MANY CHILDREN ARE THE VICTIMS OF CHILD SEXUAL ABUSE? There are many estimates of the number of children who are the victims

More information

School Psychologist PK 12 Section 36

School Psychologist PK 12 Section 36 School Psychologist PK 12 Section 36 1 Knowledge of measurement theory, test construction, research, and statistics 1. Identify theories of measurement and test construction. 2. Demonstrate knowledge of

More information

Basic Standards for Residency Training in Child and Adolescent Psychiatry

Basic Standards for Residency Training in Child and Adolescent Psychiatry Basic Standards for Residency Training in Child and Adolescent Psychiatry American Osteopathic Association and American College of Osteopathic Neurologists and Psychiatrists Adopted 1980 Revised, 1984

More information

KATHLEEN BRUNVAND KENNEDY, Ph.D. (Formerly Kathleen Kennedy Brunvand) Kathleen.Kennedy@uvm.edu. Curriculum Vitae EDUCATION LICENSE

KATHLEEN BRUNVAND KENNEDY, Ph.D. (Formerly Kathleen Kennedy Brunvand) Kathleen.Kennedy@uvm.edu. Curriculum Vitae EDUCATION LICENSE KATHLEEN BRUNVAND KENNEDY, Ph.D. (Formerly Kathleen Kennedy Brunvand) Kathleen.Kennedy@uvm.edu Curriculum Vitae Behavior Therapy & Psychotherapy Center Department of Psychology University of Vermont Burlington,

More information

Texas Foster Care Outpatient Treatment Requests (OTRs)

Texas Foster Care Outpatient Treatment Requests (OTRs) Texas Foster Care Outpatient Treatment Requests (OTRs) Recovery Are the interventions built on client strengths and intended to reduce or eliminate the impact of the mental health condition so the client

More information

CORE PROGRAMS ADDITIONAL SERVICES

CORE PROGRAMS ADDITIONAL SERVICES Southern Peaks Regional Treatment Center is a Joint Commission accredited residential treatment center offering an array of specialized behavioral health programs for both male and female adolescents,

More information

Trauma and Treatment SW Spring/Summer 2016 Room: SW 2752 July 8th and 15 th. 9-5pm

Trauma and Treatment SW Spring/Summer 2016 Room: SW 2752 July 8th and 15 th. 9-5pm Trauma and Treatment SW 790-008 Spring/Summer 2016 Room: SW 2752 July 8th and 15 th. 9-5pm Colleen E. Crane MSW, LMSW, LCSW Email: kennac@umich.edu (248) 330-3585 TRIGGER WARNING: This class contains material

More information

Psychopharmacotherapy for Children and Adolescents

Psychopharmacotherapy for Children and Adolescents TREATMENT GUIDELINES Psychopharmacotherapy for Children and Adolescents Guideline 7 Psychopharmacotherapy for Children and Adolescents Description There are few controlled trials to guide practitioners

More information

Royal Commission Into Institutional Responses to Child Sexual Abuse Submission on Advocacy and Support and Therapeutic Treatment Services

Royal Commission Into Institutional Responses to Child Sexual Abuse Submission on Advocacy and Support and Therapeutic Treatment Services Royal Commission Into Institutional Responses to Child Sexual Abuse Submission on Advocacy and Support and Therapeutic Treatment Services Dr Michael Salter School of Social Sciences and Psychology Western

More information