THE PATH to Trauma Therapy. A Guide for Getting Traumatized Children the Help They Need

Transcription

1 THE PATH to Trauma Therapy A Guide for Getting Traumatized Children the Help They Need

2 Screen. Assess. Treat. Step Two Trauma Assessment Step One Trauma Screen Specific About If there To verify Diagnosis/Assessment: questions is a that proposed an assessment you therapy, can ask make is a a therapist comprehensive sure it has are: the assessment following About Treatment: Core of complex Components: trauma, you should ensure the Tell me how you arrived at this diagnosis What the best known, most effective approach with this The This Are following 1. screen you Building approved brochure core is a a tool components strong administered by Medicaid/Magellan relationship. are will covered: by a Children front-line describe to who conduct professional have experienced CPP this (which or TF-CBT? can trauma pathway be any have professional had their to trust you compromised Tell me What assessment tool(s) problem? How do you decide which approach to use? about therefore your are training often wary of expertise adults. Building with treatment a relationship of trauma trained a. did to A wide you complete range use? the of screening traumatic events caseworkers, are assessed attorneys, How etc) will to determine not only allows the parent a or child s the family trauma child caregiver to Have be involved in this b. disclose you A help wide treated range discuss you of symptoms helped REFERRAL the follow traumatic other are assessed children events, it in with (including but your models trauma risk a history foundation cases behaviors, or symptoms? for functional healthy boundaries impairments, history If so, What does this diagnosis mean? treatment? relationships. how related many cases symptoms. developmental have derailments) you completed? What How sure are you? Is this a best practice/evidence-based practice ( are 2. c. Psycho-education is Information your level is of gathered licensure about normal using (i.e., a response provisional, variety of to techniques trauma. independent, (clinical etc.) interviews, stardized mea Do 3. you Parent incorporate support, the conjoint following therapy into or your parent trauma training. assessment? The sures, purpose behavioral is to identify observations) children who require an immediate Children stabilization need coaches (i.e., suicidal), to help them to use the skills they Trauma you learn Screen formally in therapy. Trauma Assessment PSYCHOLOGICAL EVALUATION d. Assessment Information of trained is traumatic collected in it)? from events a variety symptoms of perspectives (including (child, risk caregivers, behaviors, teachers, functional other identify Listen 4. impairments, for: Emotional children for Trauma-Focused expression whom developmental a Cognitive complete All regulation trauma derailments) children Behavioral skills. assessment who Therapy Both caregivers by a qualified have (TF-CBT), Child-Parent children provider been need is needed. Psychotherapy to learn The providers, etc) to (CPP), explore Parent emotions trauma e. Use screen Therapist of Child manage a variety should Interaction considers them of be when techniques completed Therapy how they each maltreated are (PCIT), using (clinical traumatic overwhelming. only interviews, Dialectical documentation event Behavior should might stardized have Therapy impacted other be (DBT), screened collateral measures, developmental Eye (which behavioral Movement may tasks Desensitization 5. observations) Anxiety management sources Reprocessing (EMDR); relaxation (child, caregivers, there skills. teachers, other providers, etc) include interview derailed future of caregivers), development may be others but make sure to assess degree of experience fit A Psychological 6. to Trauma collect with processing information Evaluation the child is for integration. sometimes trauma, not through direct Without the third assessed interviews with processing step in the the path trauma by the to a child. trauma through trained therapy. f. Therapist tries to link traumatic events to traumatic reminders that may trigger techniques symptoms like a or trauma As shown Consideration narrative, avoidant above, How the if behavior do a child trauma of how you assess provider each screen the for relationships traumatic co-occurring indicates if event needed, cannot a conditions referral might heal. for have (behavioral, After a trauma impacted some treated substance skill assessment developmental building, use, the should mental child tasks be health, the other)? caregiver made, You can you need find derailed should to the What be trauma able make future is the to screen, talk that development goal about or referral. created goals the of facts However, by treatment? the of National the further trauma, What Child is evaluation as a Traumatic well reasonable as that Stress thoughts outcome is above Network to expect? feelings (NCTSN), beyond related assessment Linkage to the for trauma. of How traumatic through long will may events treatment also be to be necessary. appropriate traumatic reminders needed? A psychological therapy. that may evaluation trigger would symptoms be the or at: next 7. step avoidant Personal beyond behavior If you have any questions about What safety a do trauma you training do assessment when or empowerment. you reach if the an assessment impasse Children in who treatment? therapist have experienced had concerns trauma about need to recalibrate their Trauma Screen Trauma Assessment issues like sense trauma screening, assessment major of Are safety. If Trauma the therapist Therapy is conducting an there mental any health risks to disorders, this treatment? cognitive functioning or intellectual functioning. Still 8. not Resilience sure? Contact treatment, please contact Are there Put closure. Jennie other this list choices Children Cole-Mossman, of components we have? caregivers LIMHP, in need at jcole-mossman@unl.edu. assessment for Child-Parent to end this very difficult work with the therapist in a Psychotherapy (CPP) way Jennie is properly Cole-Mossman at that How models will your we healthy referral know relationship we to are the getting therapist. ending somewhere? allows for the child or caregiver to seek help if they need Once you it select in jcole-mossman@unl.edu. the Who future. a therapist, make sure to ask them what collateral is needed qualified, to that assessment will provides your clinical consultation or supervision? start the trauma assessment. include a trauma assessment. How are you incorporating the trauma narrative? Overview Qualifications Needed to do a Trauma Assessment Step Three Psychological Evaluation Step Four Trauma Therapy What to Ask the Therapist

3 Overview In most cases, this is the path to trauma therapy: Overview Most children in the child welfare system have experienced trauma. Some children have protective factors that buffer the effects of trauma. However, many are exposed to such severe or prolonged trauma that they have short long-term serious physical mental health consequences that need to be addressed. All professionals working with at-risk children should be aware of trauma should identify those cases that may benefit from further assessment. This brochure describes the process of screening, assessing, properly treating trauma. Trauma Screen Trauma Assessment Trauma Therapy. This brochure will describe this pathway to you help you follow it in your cases.

4 Trauma Screen Do we need to look at this further? Trauma Screen A trauma screen is the first step in the path to trauma therapy. The screen is a tool administered by a front-line professional (which can be any professional trained to complete the screening caseworkers, attorneys, etc.) to determine a child s trauma history related symptoms. The purpose is to identify children who require an immediate stabilization (e.g., suicidal), to identify children for whom a complete trauma assessment by a qualified provider is needed. The trauma screen should be completed using only documentation other collateral (which may include interview of caregivers), not through direct interviews with the child. Step One Trauma Screen You can find the trauma screen, created by the National Child Traumatic Stress Network (NCTSN), at:

5 Trauma Assessment What is the impact of trauma what should happen? A trauma assessment is the second step in the path to trauma therapy. The assessment is an in-depth evaluation of trauma symptoms psychological functioning administered by a clinically trained provider (such as a therapist) who understs child development complex trauma. Being trauma informed does not necessarily mean the therapist is conducting a trauma assessment. Trauma Assessment Put this list of components in your referral to the therapist. To verify that an assessment is a comprehensive assessment of complex trauma, you should ensure the following core components are covered: 1. A wide range of traumatic events are assessed. 2. A wide range of symptoms are assessed (including risk behaviors, functional impairments, developmental derailments). 3. Information is gathered using a variety of techniques (clinical interviews, stardized measures, behavioral observations). 4. Information is collected from a variety of perspectives (child, caregivers, teachers, other providers, etc.) 5. Therapist considers how each traumatic event might have impacted developmental tasks derailed future development. 6. Therapist tries to link traumatic events to traumatic reminders that may trigger symptoms or avoidant behavior. If the therapist is conducting an assessment for Child-Parent Psychotherapy (CPP) is properly qualified, that assessment will include a trauma assessment. Step Two Trauma Assessment

6 How do I know if someone is qualified to do a trauma assessment? If a therapist is approved by Medicaid to provide an evidence-based practice like Child-Parent Psychotherapy (CPP) or Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), that is a good indication they are qualified to conduct a trauma assessment. Specific questions you can ask a therapist are: Are you approved by Medicaid/Magellan to conduct CPP or TF-CBT? Tell me about your training expertise with treatment of trauma. Have you treated helped other children with trauma history or symptoms? If so, how many cases have you completed? What is your level of licensure (e.g., provisional, independent, etc.)? Do you incorporate the following into your trauma assessment? Assessment of traumatic events symptoms (including risk behaviors, functional impairments, developmental derailments) Use of a variety of techniques (clinical interviews, stardized measures, behavioral observations) sources (child, caregivers, teachers, other providers, etc) to collect information Consideration of how each traumatic event might have impacted developmental tasks derailed future development Linkage of traumatic events to traumatic reminders that may trigger symptoms or avoidant behavior Still not sure? Contact Jennie Cole-Mossman, LIMHP, at jcole-mossman@unl.edu. Once you select a therapist, make sure to ask them what collateral is needed to start the trauma assessment. Qualifications Needed to do a Trauma Assessment

7 Psychological Evaluation Does the child need a Psychological Evaluation, too? PSYCHOLOGICAL EVALUATION REFERRAL Trauma Screen Trauma Assessment PSYCHOLOGICAL EVALUATION A Psychological Evaluation is sometimes the third step in the path to trauma therapy. As shown above, if a trauma screen indicates a referral for a trauma assessment should be made, you should make that referral. However, further evaluation that is above beyond assessment for trauma may also be necessary. A psychological evaluation would be the next step beyond a trauma assessment if the assessment therapist had concerns about issues like major mental health disorders, cognitive functioning or intellectual functioning. Step Three Psychological Evaluation

8 The Core Components of Trauma Therapy While trauma-focused therapy may vary depending on the age of the child, there are some core components that are proven to work with children. These elements should be included in the work done by the therapist, the caregiver the child. TRAUMA THERAPY If there is a proposed therapy, make sure it has the following Core Components: 1. Building a strong relationship. Children who have experienced trauma have had their trust compromised therefore are often wary of adults. Building a relationship not only allows the child caregiver to disclose discuss the traumatic events, but models a foundation for healthy boundaries relationships. 2. Psycho-education about normal response to trauma. 3. Parent support, conjoint therapy or parent training. Children need coaches to help them use the skills they learn in therapy. 4. Emotional expression regulation skills. Both caregivers children need to learn to explore emotions manage them when they are overwhelming. 5. Anxiety management relaxation skills. 6. Trauma processing integration. Without processing the trauma through techniques like a trauma narrative, the child the relationships cannot heal. After some skill building, the child the caregiver need to be able to talk about the facts of the trauma, as well as the thoughts feelings related to the trauma. 7. Personal safety training or empowerment. Children who have experienced trauma need to recalibrate their sense of safety. 8. Resilience closure. Children caregivers need to end this very difficult work with the therapist in a way that models healthy relationship ending allows for the child or caregiver to seek help if they need it in the future. Step Four Trauma Therapy

9 Questions to Ask Therapists Questions for front-line professionals to ask therapists about their Trauma Therapy. Trauma narratives are important in treatment. Whether they are done through play or in written form, they allow for integration of the trauma. You don t need the details of the narrative but asking if the child is working on a trauma narrative is an important question. Gauge your reaction to the person: A good listener? Understing? Welcoming? Open to questions? Does this person seem like a good fit for the family child? About Diagnosis/Assessment: Tell me how you arrived at this diagnosis. What assessment tool(s) did you use? What does this diagnosis mean? How sure are you? About Treatment: What is the best known, most effective approach with this problem? How do you decide which approach to use? How will the parent or family be involved in this treatment? Is this a best practice/evidence-based practice ( are you formally trained in it)? Listen for: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Child-Parent Psychotherapy (CPP), Parent Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), Eye Movement Desensitization Reprocessing (EMDR); there may be others but make sure to assess degree of experience fit with the child. How do you assess for co-occurring conditions (behavioral, substance use, mental health, other)? What is the goal or goals of treatment? What is a reasonable outcome to expect? How long will treatment be needed? What do you do when you reach an impasse in treatment? Are there any risks to this treatment? Are there other choices we have? How will we know we are getting somewhere? Who provides your clinical consultation or supervision? How are you incorporating the trauma narrative? If you have any questions about trauma screening, assessment treatment, please contact Jennie Cole-Mossman at jcole-mossman@unl.edu. What to Ask the Therapist

10 nebraskababies.com

11 The Nebraska Resource Project for Vulnerable Young Children (NRPVYC) at UNL-Center on Children, Families the Law (UNL-CCFL) focuses on improving outcomes for maltreated young children in Nebraska. The NRPVYC works both at a systems level in partnership with other Nebraska organizations on a local case level with court teams, state agencies, local organizations local providers to address the needs of young children in their courts on their caseloads. Systems issues include exping stabilizing evidence-based practices for young children like Child-Parent Psychotherapy (CPP), increasing access to early intervention (EDN) services increasing access to high quality child care. Case level issues focus on developmental needs, the parent-child relationship, child care medical care. The NRPVYC also provides training to caseworkers, attorneys, judges others on evidence-based practices, identifying trauma in young children, representing young children other issues. For more information, go to Nurture. Heal. Thrive. The information contained in this brochure is based on the Child Welfare Trauma Referral Took Kit created by the National Child Traumatic Stress Network. More information is available at