Only the adult caregivers and the provider are present for the first session. At its opening, the clinician explains each step in the process and its rationale. A psychoeducational approach is applied with explanations of typical reactions to PTEs and the protective role of family support. Consistent with the focus on the essential role of caregivers, the Posttraumatic Checklist-Civilian version (Weathers, Litz, Huska, & Keane, 1994
) is administered. This allows the clinician to integrate an understanding of the caregiver’s psychological status throughout the Intervention. External stressors related to the recent PTE are identified and a plan for managing them is developed. We have found that addressing event related stressors both serves as an engagement tool and permits caregiver’s to more readily focus on the child’s emotional needs. Lastly, the caregivers are administered parent versions of the Trauma History Questionnaire (THQ)(Berkowitz & Stover, 2005
), and modified versions of the UCLA Posttraumatic Reaction Index (PTSD-RI) (R. Pynoos, N. Rodriguez, A. M. Steinberg, M. Stuber, & C. Frederick, 1998
) and the Mood and Feelings Questionnaire (MFQ) (Angold & Costello, 1987
), which will be the central focus of the joint session to follow next. Session one and all subsequent session average an one to one and one half hours in length.
Session Two occurs as close to Session One as possible and the provider meets first with the child alone and then with caregivers and child. The second half of this session is the core component of the CFTSI and lays the groundwork for all subsequent aspects of the Intervention. First, the child is administered the THQ, PTSD-RI and Short MFQ. The clinician, with the child and caregiver/s) facilitates a comparison of the responses as means of improving communication, which is the presumed pre-requisite to enhancing caregiver emotional support. If there is an agreement about symptom severity the parent and child are praised. Discordance is seen as an opportunity to increase communication. The clinician takes a dual approach to improving communication; both helping the child to better inform the parent about symptoms, and the parent to be more aware, receptive, and supportive. Session Two ends with the clinician proposing two areas of concern based on symptom clusters the child and caregivers have identified as most problematic. Together the clinician and family choose two behavioral skill modules as “homework” before the next session. These modules cover 6 topic areas (1) sleep disturbance, (2) depressive withdrawal, (3) oppositionality/tantrums, (4) intrusive thoughts, (5) anxiety, avoidance and phobic reactions and (6) a general overview of traumatic stress symptoms and techniques to manage them. Each module reviews psychoeducation and specific techniques, with separate instructions for the caregiver and child to discuss and practice. The maintenance of routines is emphasized throughout. Specific techniques involve both behavioral and cognitive procedures such as thought replacement methods for intrusive thoughts, breathing retraining for anxiety, behavioral activation for depression and avoidance. The specific elements for addressing each problem area have been borrowed and adapted from well accepted methods from the Traumatic Stress treatment literature.
The caregivers, child, and clinician meet together for Session Three; demonstrating the solution to the child’s difficulties is a family matter. The same symptom surveys are administered with the child responding first and the caregivers offering their perspective on the items. It permits symptom monitoring as well as an examination of which methods of communication and supportive efforts were most successful. Efforts center on adjustments to improve communication efforts and review the effectiveness of the skill modules and other supportive measures. While the skill modules were reviewed during Session Two, they are practiced in Session Three and Four.
Session Four essentially duplicates Session Three with one key difference. The end of the session is used to discuss next steps. Depending on the status of the child, the clinician may suggest a future check-in, evaluation and treatment for an apparent pre-existing psychiatric disorder or a more extensive treatment for PTSD.