Partnering to Serve Children and - PowerPoint Presentation

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Partnering to Serve Children and Families Following Potentially Traumatic Events

Yale Child Study Center Trauma Section and Yale New Haven Hospital

Steven Marans, PhD, MSW Kirsten Bechtel, MD

Hilary Hahn,

EdM

, MPH

Kristen

Hammel

, LCSW

Psychological trauma as injury

Overwhelming, unanticipated danger that leads to:

Subjective experience of helplessness, loss of control and terror

Immobilization of usual methods for decreasing danger and anxiety (fight or flight)

Neuro-physiological dysregulation that compromises affective, cognitive and behavioral responses to stimuli

YCSC Trauma Section

A specialty clinic of the Child Study Center

Section Chief: Steven Marans, MSW, PhD

Acute response and assessment

– the Child Development Community Policing Program

Early intervention and treatment-

the Child and Family Traumatic Stress Intervention

Longer-term trauma treatment

- including Trauma-Focused Cognitive Behavioral Therapy

Complex evaluation, differential diagnosis and consultation

Phases of Traumatic Reactions: A Clinical Roadmap

Immediate/acute reactions

from within moments to first 24-48 hours

Peritraumatic phase symptoms

up to 3 months after index event

Chronic PTSD and related disorders

3 months after index event

Delayed Onset

6 months after index event

Children’s Peritraumatic Responses to Trauma

Sleep disturbances/nightmaresSeparation anxietyHyper-vigilanceSomatic complaintsIrritability and aggressionRe-experiencing of eventImpulsivity and distractibilityRegressive behaviors

Blunted emotions

Changes in social functioning

Social difficulties

Dissociation

Withdrawal

School difficulties/failure

Drug and alcohol abuse

Long-term Consequences

Without recognition, support and treatment early peri-traumatic reactions can persist and result in long-term outcomesCan result in a variety of emotional, behavioral, social and psychiatric consequences

Examples of long-term

sequelae

:

Attachment and relationship problems

PTSD

School failure

Suicidal behavior

Anxiety disorders

Mood disorders

Substance abuse

Violent/ abusive behaviors

Somatic complaints and chronic illness

Personality disorders

CFTSI: What Is It?

Model developed at the Yale Child Study Center by:

Steven

Marans

, MSW PhD

Carrie Epstein, LCSW-R

Steve Berkowitz, MD

Brief (5-8 session) evidence-based early intervention model for children that is implemented:

After recent exposure to a potentially traumatic event

After recent disclosure of earlier sexual or physical abuse

Serves children ages 3-18 years old, together with their caregivers

Based on a family strengthening approach

Goals of CFTSI

CFTSI aims to:

Reduce traumatic stress symptoms and prevent chronic PTSD

Improve screening and initial assessment of children impacted by traumatic stress

Assess child’s need for longer-term treatment

CFTSI RCT Findings

112 study participants recruited from:Forensic Sexual Abuse ProgramPediatric Emergency DepartmentNew Haven Department of Police ServiceParticipants had experienced, on average, >6 trauma types prior to event that precipitated referral for CFTSI and the control treatment in the study

Major Findings

Children who received CFTSI were 65% less likely to meet full criteria for PTSD

Children who received CFTSI were 73% less likely to meet partial or full criteria for PTSD

Similar results in multiple chart review studies

CFTSI Outcomes

Children Ages 7-17

Receiving CFTSI in Child Advocacy Centers

in North and South Carolina

Change in Child Trauma Symptoms

p < .01

Change in Parent-Child Communication

Change in Parental Trauma Symptoms

Caregiver Survey Results

Caregiver Survey Results

Caregiver Survey Results

Caregiver Survey Results

YCSC and YNNH Collaboration

Partnering to identify, educate and refer children and families in the

peritraumatic

period

Children and families seen in the Sexual Abuse Clinic and Emergency Department

In the context of both emergency room treatment and forensic evaluations, YNNH colleagues are well-placed to introduce:

information about traumatic impact of events

referrals for clinical intervention addressing post-traumatic reactions

CSC colleagues engage, screen and treat referred children and families and “close loop” with YNNH colleagues

Roles in Identifying Cases for Trauma-informed Mental Health Treatment

Role of Medical Providers

:

Identify children who have recently been exposed—as victims or witnesses—to potentially traumatic events

Identify children whose presenting problem may not be trauma (e.g. somatic complaints or psychiatric illness) but an underlying traumatic event is discovered

Introduce health and behavioral phenomena associated with traumatic experience and availability of clinical intervention

Role of Yale Child Study Center Trauma Section

:

Screen for trauma symptoms

Engage children and families in trauma treatment or connect to other services as appropriate