1. Understanding and Treating Children with Complex Traumatic Stress: A Brief Overview of CCTC’s Treatment Approach
Kristen A. Caprara, Psy.D.
Director of Trauma Services, Montgomery County
and
Sean Halloran, Ph.D.
Division Director, Montgomery County Services

2. Trauma Assistance Program/Sexual Trauma Treatment Program
General Information About the Children We Treat:
Ages 18 months through 18 years, and their caregivers
Experienced a recent traumatic event
Currently reside in a safe environment
Resident of Montgomery or Philadelphia County
Most of the Children We Serve:
Are covered by Magellan or Community Behavioral Health (CBH)
Are from low-income, multi-problem families with multiple system involvement
Have a history of multiple traumas

3. Types of Traumas that Bring Clients into Treatment
Physical Abuse
Sexual Abuse
Domestic Violence
Suicide
School/Community Violence (e.g., drive-by shootings)
Medical Trauma
Homicide
House Fires
Accidents (e.g., car accidents, being hit by a motor vehicle)
Home invasions
Kidnapping

4. Trauma Screening
Starts with the initial phone call to ensure that the child is appropriate for TSP
Referral resource completes an Application for Services that asks about the current trauma and history of past traumas
The child is assigned to a trauma clinician that will complete a comprehensive intake evaluation and also provide the subsequent treatment

5. Trauma-Focused Intake Assessment
Comprehensive Clinical Interview
Detailed review of attachment and history of moves/placements
Comprehensive assessment of multiple traumas faced by families
Systems involvement
Familial medical and mental health history
Assessment Measures
Child Behavior Checklist for Children (CBCL) Ages or 6-18
Teacher Report Form
Trauma Symptoms Checklist for Young Children (TSCYC) (ages 3 – 7)
Trauma Symptoms Checklist for Children (TSCC) (ages 8 – 16)
Child and Adolescent Needs and Strengths (CANS) Assessment
CCTC Medical Developmental History Form
Behavioral Observations of the child and family
Collateral contacts with other service providers
A review of prior medical records/evaluations

6. Trauma Focused Intake Assessment
Treatment Diagnosis
Comprehensive and Individually Tailored Treatment Plan
Overview of current and past trauma
Set of 3 overarching goals that encompass
Attachment and relationship building
Symptom Reduction and Stabilization
Active Parent Involvement and Consistent Participation
Goals are individually tailored and based on the needs of the child
Goals are reviewed every 15 sessions or 120 days
The parent and child are an important part of the treatment team, their feedback and voices are important and should be implemented
Detailed and thorough Trauma-Focused Intake Evaluation

7. Trauma-Focused Treatment
Child Parent Psychotherapy (CPP)
Core Components/Common Factors Approach

8. Why look at common factors and core components?
Complex trauma histories for both children and their families
Experience ongoing traumas/stressors that occur over the course of treatment that make it challenging to follow a linear course of treatment, or provide the treatment with fidelity
Multiple systems involvement
A longer term treatment approach is needed
Trust issues impact the course of treatment
The effects of multi-generational trauma
Age/developmental issues should be considered

9. Commonalities between CPP and the Core Components/Common Factors Approach:
Respect and focus on attachment and the therapeutic relationship
Incorporates trauma-focused “Best Practices”/evidence based interventions
Developmentally aware and adaptable
Sensitive to culture and gender
Systems-oriented
Goals are attained through multiple modalities (e.g., direct discussion, play, therapeutic games and activities, art, etc.)
Flexible/room for clinical judgment (e.g., the number of sessions for each phase, flow, techniques employed)
Adjunctive services available if needed (e.g., psychiatry/psychotropic medication, preschool partial hospitalization program, wraparound services, summer therapeutic enrichment program)

10. Differences CPP is a specialized treatment used with clients 0 – age 5
Relationship-based intervention focused on attachment and re-building the parent-child relationship post-trauma
The child and caregiver are considered the client, all sessions are completed with the dyad
Emphasis on teaching skills to both parents and young children
Play is the main modality of treatment
Core Components/Common Factors Approach is used with clients ages 6 – 18
Focus on some individual work with clients, as well as with family
Multiple modalities are used (e.g., direct discussion, relaxation and mindfulness, therapeutic games and activities, art, and play)
Emphasis on teaching skills to the child, with the support of their family and in collaboration with other services (e.g., school)

11. Child Parent Psychotherapy Core Components
Self-Reflection
Integrate a sociocultural lens
Observe Behavior and enter through multiple ports of entry
Act as a conduit
Familiarity with Relevant Bodies of Knowledge (developmental psychopathology and diagnostic frameworks; infant an early child development; and adult development)
Coordinate Care & Collaborate with Other Service Providers
Co-Construct a Trauma Framework and Narrative

12. Core Components/Common Factors Approach
Attachment and Therapeutic Relationship Building
Psychoeducation
Feelings Identification and Expression
Affect Regulation
Coping Skills/Safety/Self-Protection Skills
Relaxation Skills
Trauma Processing (e.g., play, trauma workbooks, trauma narratives, etc.)
Integration of Trauma and Moving Forward (e.g., meaning making of a traumatic experience, helping families integrate the trauma they have experienced in their lives and move forward in a positive way, and helping families create a new “normal”)

15. Resources
Leiberman, A.F., Ghosh Ippen, C., & Van Horn, P. (2015) Don’t Hit My Mommy: A Manual for Child-Parent Psychotherapy with Young Children Exposed to Violence and Other Trauma. Washington, DC: Zero to Three.
The National Child Traumatic Stress Network,
The Sanctuary Model by Dr. Sandra Bloom,
Adverse Childhood Experiences Study,