The Child and Family

Traumatic Stress
Intervention
A family based model for early
intervention and secondary prevention
Steven Berkowitz, M.D.
Steven Marans Ph.D.

Primary Goals
1. To decrease post traumatic symptoms and
disorders in children exposed to potentially
traumatic events
2. To increase the likelihood of children and
family members engagement and acceptance
of on-going treatment when necessary
3. To identify individuals in need of treatment due
to prior psychiatric disorders with linkage

Current Status
In pilot stage
On-going modifications
Current attempts to shorten, by further
adapting incorporated measures
Presenting at ANM for feedback

CFTSI: Hows
Simultaneous evaluation of and
intervention with child and parent/s
Enhance communication regarding
emotions, symptoms
Provide Care coordination and case
management to decrease external
stressors
Delivered in home or clinic
4

Family and Social Support

Primary Objective:
Increase parent/s ability to provide
support to children
Multiple studies have demonstrated that
social and family support are key
protective factors for individuals exposed
to a PTE
5

Family and Social Support

CFTSI is designed to enhance parents inherent
desire to care for child and mediate their
experience.
Targets children who experience accidental
injury and exposure to community violence and
sexual abuse
Not presently used with other forms of
intrafamilial violence
6

Nuts and Bolts

CFTSI is composed of two people:
Lead clinician: Masters level or above with
trauma specialization
Support clinician: Para professional or above
with trauma specialization
3 to 4 protocolized meetings (2 hours each)
Individual sessions for parents and child
Follow up family meeting
7

Nuts and Bolts: Roles

Lead Clinician: conducts interviews separately
with parent/s and child
Interviews are centered around modified versions of

TESI
PTSD-RI
MFQ
PBI
Perceived Social Support-family (child only)
May decrease number of items from TESI?
May change to checklist from PTSD-RI

Nuts and Bolts: Measure

Modifications
On PTSD-RI and MFQ: parents asked if
child told them about symptom or they
observed
Child asked if they told anyone and, if so,
who
All interview questions are reported Since
Event
9

Support Clinician: Role

Parent meeting
Trauma psychoeducation
Clinician reviews PCL-Civilian Version with parent and
discusses parent symptomatology and mental health
history
Reviews child developmental, medical and psychiatric
history
Reviews concrete case management needs
(e.g. medical appointments, transportation, housing
issues,
Court issues etc.)

10

Support Clinician: Role

Child Meeting
Trauma psychoeducation

Depending on age either/or

Observational play session to assess
spontaneous issues around traumatic issues
Discussion of other potential issues and
stressors such as medical/physical issues,
school, family and friends
11

Nuts and Bolts: Procedure

First Session
Brief orientation with child and parent/s
Parents and child meet separately
Lead clinician meets with either child or parent
while support clinician meets with other
Based on familys interest and developmental issues
(e.g.. lead clinician likely to meet with adolescent first)

12

Nuts and Bolts: Procedure

Everyone meets together
Clinicians facilitate discussion about
comparison of responses to interview
questions
(not PBI)
Attempts to help improve communication and
decrease barriers to authentic discussion
Asks family to decide on two most concerning
symptoms
13

Nuts and Bolts: Procedure

Modules are selected that help family with
specific interventions to address identified
symptoms (each with information for
parents and child):

14

CFTSI: Modules
1. All get general overview with psychoeducation
2. Sleep Disturbance
3. Depressive Withdrawal
4. Intrusive Thoughts and Traumatic Reminders
5. Anxiety-- avoidance, clinginess, phobic
reactions, etc
6. Tantrums and Oppositional Behavior

15

CFTSI: Modules
Family and child and given brief instruction
on identified modules
Receive log of frequency of symptoms,
module use and effectiveness
Research and clinical questions:
Will use of module correlate to outcomes or is
increased communication and support sufficient?

16

Session I Wrap out

Next session is schedule for one week
later
Family is encouraged to call with any
questions and told that team is available
for earlier session if necessary to assess
symptoms and help practice family
intervention modules

17

Next Sessions
Sessions follow same format as first, but
Questionnaires are administered briefly
Family meeting focuses on review of past week
looking at log and checking on effectiveness
New or different symptoms to address
Communication issues
Practice interventions modules

18

Third Session

At end of third session team discusses

with family next steps:
1. If asymptomatic or close: follow up contact
and 3 month post assessment (always told
may return whenever interested)
2. Improvement, but still symptomatic: continue
CFTSI for one or two more sessions or
individual trauma focused treatment
19

Third Session
3. No PTS Sxs, but preexisting MH issues:
refer to treatment (this may occur in any
session
4. Little or no improvement Trauma SXs:
refer for Trauma focused treatment (TFCBT etc.)

20