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Human Trafficking Awareness

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Kids and Trauma: When Does It Require Treatment?

A child watches her father kill her mother. A tween has a medical emergency and nearly dies. A teen is sexually assaulted.

When children experience a serious trauma, most will show a visible change in behavior and emotions but will recover within a few months. A significant minority, however, go on to develop Post-Traumatic Stress Disorder— a severe and often chronic anxiety disorder whose symptoms include nightmares, intense fearfulness, preoccupation with avoiding memories of the trauma, and decreased interest in formerly enjoyed activities.

Is there any hope for them? It appears so. Psychological interventions – particularly cognitive-behavioral therapies (CBT) – are effective in treating PTSD in children, concludes recent research from Clinical Psychology Review. A round of psychotherapy for PTSD may even alleviate the additional depression that frequently co-occurs with PTSD in children.

One review estimated at 16 percent – about one in six children will develop PTSD from experiencing trauma. Rates appear to be lowest for boys exposed to non-interpersonal traumas such as life-threatening accidents or natural disasters (8 percent) and highest for girls who are exposed to interpersonal traumas such as assault or sexual abuse (33 percent).

This latest study is an important one because it is a well-designed meta-analysis in which the authors carefully selected 39 already-published studies of treatments for childhood PTSD and combined the results using sophisticated mathematical techniques.

CBT was defined by the authors as psychotherapy that focuses on the memory of the trauma and/or its meaning. Examples include TF-CBT (Trauma-Focused CBT) and Prolonged Exposure. CBT for PTSD might also include helping clients to approach the memories and triggers they have been avoiding, such as by telling the story of the trauma, drawing pictures of it, or visiting safe places that remind them of the trauma like the site of their car accident or the hospital at which they were treated.

You might be having a “well, duh” moment, assuming that any therapist who treats PTSD would necessarily have the client speak directly about the original trauma.

You would be incorrect. Other research with adults has shown that therapists are often reluctant to encourage patients to approach memories and other trauma-related triggers for fear that this might be too upsetting, make the PTSD permanently worse, or somehow erode the trusting relationship between therapist and client.

But, as the current study and many others have shown, in the hands of a trained therapist, focusing the treatment on the remembering and processing of the trauma can help a lot, even with children and teens.

My own experience as a clinician providing CBT to traumatized children is in line with the published research: Helping the child gradually to tell me about the trauma in detail helps them, even when a child is reluctant at first. Over a course of therapy, the memories become less scary and the child more willing to talk about them. Parents, too, are helped, and report exhilaration at watching their child emerge from the aching fog of PTSD.

Two major hurdles for parents are finding a trustworthy source of information about what psychotherapies have scientific backing and then locating a therapist who has been trained in these evidence-based interventions. One online resource I highly recommend for both is Effective Child Therapy, a website maintained by the Society of Clinical Child and Adolescent Psychology of the American Psychological Association. The National Center for PTSD has lots more about the disorder in both children and adults. The Philadelphia Department of Behavioral Health and Intellectual disAbility Services website has information on accessing evidence-based treatments for PTSD locally.

EPIC Seminar Series: Making Your EBP Stick for the Long Haul!

The 2016 EPIC Seminar Series is focused on the theme of implementing evidence-based practices (EBPs) in community behavioral health settings. These presentations are geared toward behavioral health administrators and clinicians who are interested in an exploration of the latest topics in the field of evidence-based practice and implementation science. Seminars will cover a range of issues that cut across EBPs, including organizational, cultural and practice change factors related to successful implementation of EBPs.

Torrey Creed, Ph.D. will join us to share concrete ideas about what it takes to keep your EBP or innovative practice going. Dr. Creed will share key insights into what sustainability is, why it doesn’t happen automatically, and how to make it more successful.

About our Presenter:
Torrey A. Creed, PhD. is an Assistant Professor in Psychiatry at the University of Pennsylvania’s Aaron T. Beck Psychopathology Research Center. As the director of The Beck Community Initiative at Penn, she leads a large-scale implementation program to increase community access to evidence-based cognitive behavioral therapy (CBT). This program implements CBT in community services with diverse populations, presenting problems, and levels of care. Dr. Creed has traveled nationally and internationally to deliver tailored training in CBT. Her co-authored book, Cognitive Therapy for Adolescents in School Settings, is used as a guide for mental health services in Philadelphia and other public schools. Dr. Creed’s primary research interests are the adaptation, implementation, and sustainment of CBT for community mental health settings, and the role of recovery and resilience in behavioral health.

Research Grand Rounds

Super-adopters, conscientious objectors or the disconnected? Shining a light on non-participants in DBHIDS evidence-based practice initiatives.

Presented by, Rebecca Stewart PhD, Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania

The Research Grand Rounds is a collaboration of DBHIDS and the University of Pennsylvania to inform DBHIDS staff, policy makers, and stakeholders on the latest research in the field on behavioral health, including advances in evidence based practices.

Frequently Asked Questions

Frequently Asked Questions

How do providers ensure that EBPs are delivered with quality?

While there are many factors to consider when thinking about the quality delivery of an EBP we have detailed three frequently used terms below.

Fidelity

An important feature of EBPs is that the elements of the practice are clearly articulated so that they can be delivered consistently. This is often done through specific training expectations and the use of a manual or protocol to guide treatment delivery. This is important because it allows a researcher to be sure that the outcomes achieved are due to the specific practice. It also provides a roadmap for how a treatment provider should deliver the practice in order to achieve similar outcomes. In other words, an EBP is delivered with “fidelity” when care is taken to ensure that it is delivered as it was designed in the research studies.

Fit

The success and sustainability of an EBP starts with selecting a practice or program that fits with your organization, population, or community. Fit impacts things like how well the innovation is adopted at an agency, and how effective it is for the intended population. Below are a few examples of the kinds of fit questions you may want to think about.
How does this program fit with:

  • The population that we serve
  • The mission, vision and values of my agency and community
  • Our organizational resources and readiness
  • Staff skills and structure
  • Existing initiatives

To read more about fit you can check out this ASPE Brief on contextual fit, this infographic that highlights fit and offers additional useful resources, or this hexagon tool created by the National Implementation Research Network (NIRN).

Adaptations

Adaptation is the process of making changes to an evidence-based practice or program in order to make it more suitable for a particular population, setting or structure without compromising or removing its core components. Adaptations to EBPs need to be done systematically and thoughtfully to ensure that the treatment isn’t compromised. Fortunately, some minor adaptations can be done without changing core elements.
Examples:

  • Adapting language/examples that are relevant to age or culture when teaching skills (e.g making the words, images, and scenarios inclusive of all participants).
  • Considering cultural norms when presenting coping methods or skills (e.g. faith or spiritual approaches, expressivity when communicating, respect for elders).

You can read more about making thoughtful adaptations by using this guide for adapting evidence-based programs or this tip sheet.

Are EBPs being developed in diverse communities such as ours?

Yes, in fact in recent decades research funders have begun to expect more culturally diverse samples. They have also begun to require that research be conducted in “real world” communities to ensure that the treatment and trainings developed are relevant and feasible. Here in Philadelphia we’ve seen more researchers interested in doing research in our community settings.

You can also learn more by visiting the general registries section on the EPIC Resources page. Many EBP registries provide descriptive information about where and with whom the practice or intervention has been researched. These categories include things like: age, race/ethnicity, geographic location, settings, gender, and many more.

What is implementation science? How does that relate to EBPs?

The definition of implementation is: “a specified set of activities designed to put into practice an activity or program of known dimensions.” Implementation Science is a field of research that aims to identify concrete strategies for how to implement and sustain a practice; these may include supports such as training, coaching, or infrastructure.

Implementation Science is important when talking about EBPs because evidence-based programs aren’t much help unless we can put them into everyday practice and produce the same positive results that they produced during the research process. Implementation Science helps us understand HOW to make use of the interventions and programs that have been identified as effective. Read more about implementation science, or watch this quick implementation overview for more information.

(Definition from the National Implementation Research Network, 2016.)

How does clinician expertise factor into the delivery of EBPs?

Clinician expertise isn’t just a factor in the delivery of EBPs – it’s an imperative. EBPs sometimes get unfairly judged as “cookbooks” because they provide written structures, but within those structures practitioner success depends on their own experience, judgment, and skills.

A clinician using an EBP is analogous to an architect building a house. The architect needs to follow formulas and plans regarding important structures like the foundation and weight bearing walls, but what the house looks like in the end is determined by the creativity and skill set of the architect.

Practitioner experience, knowledge and skill form the basis for: client engagement, assessment of contributing factors to behaviors of concern, delivery of intervention, and so forth. Clinician expertise is the foundation by which the successful delivery of EBPs is built.

I am seeking services for myself / my family, what do I need to know about seeking evidence-based practices?

You can find lots of useful resources under the family section of our resource section, but here are two resources that we find particularly useful.

  • The Parents Guide to Getting Good Care helps walk you through the steps of finding the best professional (or team) and the most appropriate treatment.
  • The Hawaii State Child and Mental Health Division’s Help Your Keiki site offers links to information about: choosing the right treatment, what to expect from a good therapist, and questions to ask your child’s therapist.

You can also find a listing of the available Evidence-based Practices in Philadelphia by visiting the EBPs in Philadelphia section of our website.

I’d like to learn more about EBP research, where can I find research articles?

This blog post from the Canadian Centre for Addiction and Mental Health offers some free resources and search tips for finding research articles.
In addition, the American Psychological Association has a nice resource that highlights the kinds of things to look for when reading research articles.

How does my organization take part in a DBHIDS-EBP training initiative?

All EBP training opportunities go through a formal procurement process. You can monitor the CBH website for new contracting opportunities, or sign up for CBH News to get email updates on things like upcoming procurement opportunities.

To learn more about the current department funded initiatives visit the Department Funded Initiatives section of our website.