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Study Guide: When the Nightmare Is Real: Final Exam

by: Brianda Hickey

Study Guide: When the Nightmare Is Real: Final Exam V05.0203

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Brianda Hickey

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A detailed study guide covering the subjects of: Child maltreatment, Sexual Abuse of Children and Adolescents, War, Terror, and Community Violence, Trauma of Living Through a Life-Threatening or Ch...
When the Nightmare Is Real: Trauma In Childhood and Adolescence
Adam Brown
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This 19 page Study Guide was uploaded by Brianda Hickey on Friday May 6, 2016. The Study Guide belongs to V05.0203 at NYU School of Medicine taught by Adam Brown in Spring 2016. Since its upload, it has received 121 views.


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Date Created: 05/06/16
Study Guide: When the Nightmare Is Real: Final Exam Child Maltreatment Related Links: Know the different types of child maltreatment Physical Abuse: is the use of physical course, such as hitting, kicking, shaking, burning or other show of force against a child Sexual Abuse: involves engaging a child in sexual acts. It includes fondling, rape, and exposing a child to other sexual activities Emotional Abuse refers to behaviors that harm a child's sel-worth or emotional well-bring. Examples include name calling, shaming, reeciton, withholding love, and threatening Neglect is the failure to meet a child's basic needs. These needs include housing, food, clothing, education, and access to medical care Be able to discuss the main findings of the studies on corporal punishment (discussed in class) A meta-analysis of 88 studies found that, almost without exception, there is a negative relationship between "normative" physical punishment and children's mental health Although spanking is usually followed by short term compliance, it does not lead to new learning, it can lead to more aggressive children and the desired behavior is not usually present when the punitive parent is not around About one third of the 1 year olds and about half of the 2 and 3 year olds had been spanked in the last week Spanking at age 1 predicted child aggressive behavior problems at age 2 and lower cognitive development scores at age 3 In a study of more than 3,000 families in Quebec, children who experienced minor physical violence (pinching, shaking, spanking) were seven times more likely to also experience severe violence (punching, kicking, hitting with an object) than those who had not experienced minor physical violence The American Academy of Pediatrics: "Although spanking may immediately reduce or stop an undesired behavior, its effectiveness decreases with subsequent use, The only way to maintain the initial effect of spanking is to systematically increase the intensity with which it is delivered, which can quickly escalate into abuse" In Summary: Physical punishment has been consistently associated with poorer child and adult mental health, including depression, aggression, pro attachment, poor school achievement, unhappiness, anxiety and feelings of hopelessness Rather than teaching children right from wrong, physical punishment predicts weaker internalization of moral values (e.g., empathy, altruism, resistance to temptation) Know the results of the ACE study and the findings on child maltreatment Adverse Childhood Experiences (ACEs) are common. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-responserelationship between ACEs and negative health and well-being outcomes across the life course. Dose-response: the change in an outcome (e.g. alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g. ACEs) As the number of Aces increases so does the risk for: Alcoholism Depression Fetal death Liver disease Financial Stress Smoking Suicide Attempts Effect on children throughout their life: How can parental beliefs about physical punishment be changed in a positive way? (3 factors) Educate: A parents' realization of how their children feel when they are spanked can stop the physical punishment Remember: Parens' acknowledgement of their own childhood memories of being hit (e.g., "My dad hit me and I turned out fine!" ..."Well did it really help you?'... "No, I still behaved the way I wanted. I just got sneakier about it" Resources: The availability of information and instruction through a supportive context to help parents adopt new approaches to disciplining their children Sexual Abuse of Children and Adolescents Related Links: Warning- Some of graphic/touch upon very emotional subjects. woman/53472aa502a760044c0008f1 What are the similarities and differences between males and females in terms of sexual abuse (prevalence, risk factors, consequences, etc). 1 in 4 girls is sexually abused before the age of 18 1 in 6 boys is sexually abused before the age of 18 Girls are sexually abused three times more often than boys Boys are more likely to die or be seriously injured from their abuse Boys experience symptoms very similar to females who have been sexually abused anxiety denial dissociation self-mutilation Holmes et al explored why comparatively few adult males with a history of sexual abuse receive help from professionals for the difficulties relating to the abuse found two recurrent myths across the literature Relatively few males experience abuse Abuse has little effect on the males Males are unlikely to disclose their history of abuse males are more likely to deny the impact that abuse has on their lives Professionals fail to hypothesize that their male clients have been abused Professionals do not crease the conditions that would allow male clients to talk about their abuse 1998 study by U of Pennsylvania found: 8-16% of the general male population had a history of sexual abuse Boys at highest risk were: younger than 13 Non-white Low SES Not living with their father Abuse most commonly: Occurred outside the home By known, but unrelated males Involved penetration and took place more than once Another study looked at a cross section of a sample of 733 college students who completed a survey about their sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others Results: Females reported greater prevalence and severity Females reported more distress and self blame post the assault Females were more likely to have disclosed the assault and were more likely to receive position reactions Females were also more likely to report PTSD symptoms Child Prostitution: Boys 20,000-30,000 child prostitutes are primarily boys In the DR, young boys, known as Sanky Panky boys, stay with foreign tourists on the beaches of Boca Chica and Sousa. The beach boys become the sex tourists annual partners In Haiti, sex between local boys and adult male tourists from the US has existed in the tourist industry for decades In Africa, boys are recruited into armed forces not only to fight but also to sexually service the soldiers In Summary: 1 in 4 girls is sexually abused before the age of 18 1 in 6 boys is sexually abused before the age of 18 Girls are sexually abused 3X more often than boys Boys are more likely to die or be seriously injured from their abuse Boys experience symptoms very similar to females who have been sexually abused Males are less likely to disclose their history of abuse than women Sexually abused females receive more positive reactions (help) than sexually abused males Males are more likely to deny the impact of the abuse while women are more likely to report PTSD symptoms Know the Oats et al. study on intergenerational factors of sexual abuse as discussed in class Study by Oates et al compared mothers of children who had been sexually abused with mothers of children who had not been sexually abused Results: 34% of mothers of sexually abused children gave a history of sexual abuse int heir own childhoods compared to 12% of controls Sexually abused children had no differences in measures of self- esteem or depression over time whether or not their mothers were sexually abused This study found that sexual abuse in a mother's childhood was related to an increased risk for sexual abuse in the next generation What are the consequences of sexual abuse? Decreased / Increased rate of: STRESS PAS S Self and Self esteem; Decreased T Teen Pregnancy; Increased R Running Away and Truancy; Increased E Episodes of Depression; Increased S Substance use; Increased S Suicidality; Increased P Prostitution; Increased A Abuse of others; Increased* S Sexually Inappropriate behaviors; Increased * 40% of sex offenders report sexual abuse as children What are the signs of sexual abuse? Child has difficulty walking or sitting Suddenly refuses to change for gym or participate in physical activity Reports nightmares or has sudden onset bedwetting Experiences a sudden change in appetite Demonstrates bizzare, sophisticated, or unusual sexual behavior or knowledge Becomes withdrawn or isolated Has frequent somatic complaints Discuss child prostitution risk factors for being exploited and consequences. Understand the controversy and complexity associated with child prostitution The number of prostituted children is thought to be increasing and could be as high as 10 million Locating these children can be difficult because they are often moved and managed by organized crime organizations In some communities. child prostitution is accepted and laws against prostitution are not enforced Male client often believe children are less likely to have HIV and other STD's and thus consider them more desirable than adult prostitutes Risk Factors: Being a child of sex worker Being homeless, runaway, or abandoned Countries wherein international sex tourism or travel solely for the purpose of ex is a significant cause of child prostitution Poverty Abuse HIV and other STD's Mental illness Substance Abuse Violence Malnutrition War, Terror, and Community Violence Related Links: Be able to identify factors that affect a child’s response to disaster. Measures of exposure Direct exposure Personally witness the attack, hut in the attack etc. Family Exposure Having a family member, mother, father, stepparent etc. killed or injured or witness the attack, but escaped unharmed Other exposure: media, signs of heightened security Exposure levels: severe, moderate, middle exposure Previous exposure to trauma Exposure to Multiple traumas everyday violence War-Relaid exposure Caregiver Mental Health For each additional symptom that caregivers reported, increased odds for child psychiatric disorder by 11 percent Be able to discuss child soldiers. Approx. 250,000-300,000 children have fought in armed conflicts Children are especially vulnerable to army recruitment; they are frequently displaced from home and their families and have little means of support and access to education They have a need for security, access to food, and sometimes a surrogate family Once recruited- or abducted- they often serve as porters, cooks, couriers and spies, as well as human shields, sexual entertainment, and war fighters Front line com at puts children at risk for rape,torture, war injuries, substance abuse, depression, anxiety, and suicidal ideation Witness, receive, and perpetuate violence Study Found: Mean age at time of recruitment into armed forces: 12.1 years, range 5-18 Mean months served: 38.3 months, range 0-96 34% met criteria for PTSD 704% had been exposed to threats of being killed or injured 54.4% had killed others 34.9% had forced sexual contact The more PTSD symptoms, the less likely the willingness to reconcile and the more they harbored feelings of revenge toward those who harmed them Another study found that those with PTSD symptoms were more likely to see violence as the means to achieve peace In contrast, nonviolence as a means to achieve peace was less likely to be reported by those with depression and more likely to be reported by those with at least a primary education Some youth combatants describe sense of belonging and support system within armed groups, similar to surrogate family Histories of violence and perpetration of violence Disrupted education Psychiatric symptoms including persistent fears of death, violent memories, and nightmares Separation from biological families, community of origin Be able to discuss assessment and the phases of treatment related to disasters Assessment Interview the family together first and then individual members separately NEVER use children as interpreters The child can distort what others are saying Always look to identify healthy, adaptive coping strategies used in past and other personal strengths Additional considerations: language, culture (including any stigma associated with mental illness and treatment, cultural expressions of MH needs), hierarchy of needs, access to resources Treatment Sometimes children need to talk more about practical and current difficulties than about their traumatic past Once the basics are covered, one can start focusing more on the trauma history Consider setting of intervention and possibility of co-location of MH treatment and interventions in clinics, community settings, and schools Treatment Phases Initial Phase Children and families need to develop sense of stability, safety, and trust Regain a sense of control over one's life Initial session may need to focus on solving housing and financial problems, as well as facilitating access to reputable solicitors, family tracing services, educational, health, religious, cultural, and leisure facilities Psycho-education, normalizing reactions to trauma, as well as the provisions of symptom management and coping strategies. Middle Phase Only after individuals feel that they have some sense of safety and predictability, as well as some level of trust, are they ready to begin the next phase of treatment Working through traumatic events to create a coherent and detailed narrative of past experienced Consider cultural expectations about perceived value of thinking about painful events Encourage alternative means of expression in addition to "talk therapy" including dance, testimonials, music and art Painful memories can be processed and more fully integrated into an individual's life story Exploration of feelings of guilt and shame and other cognitive distortions Reintegration Beginning to integrate into a new community Imagining and creating a future Trauma of Living Through a Life-Threatening or Chronic Medical Illness Related Links: Effects of hospitalization at different stages of development Infancy - 18 Months The infant's primary developmental goal is to establish trust Infants are unable to understand why they are in the hospital Infants younger than 7 months rarely protest separation but are often very upset upon return home Infants older than 7 months protest separation, are often uncooperative in the hospital, and require readjustment upon their return home They find themselves in an unfamiliar, fearful environment which can provoke confusion and anxiety They are able to perceive pain and if the parents are unable to be there to soothe the child, apathy and withdrawal can develop Possible After-Effects of Hospitalization: Anxiety and confusion with any separation Disruption of attachment to caregivers 18 Months - 3 Years The toddler's primary goal is to establish early autonomy and separation individuation from the parents Toddlers fear abandonment by the caregiver upon hospitalization They have little capacity for reasoning or understanding the experience of hospitalization Possible Effects of Hospitalization Regression to younger stages of development due to the infantalizing effects of medical care Restricted activities of non-hospitalizated toddlers Preschool 3-5 Years Preschool age children seem to be more upset by hospitalization than older children or younger infants Concrete thinking leads to fears and misconceptions and ultimately to guilt and distress They have a rudimentary understanding of body parts and often fear mutilation; blood draws are terrifying Preschool are is the period of "Magical Thinking" and they often attribute illness to punishment for bad behavior Possible Reaction to Hospitalization They may continue to fear abandonment even outside the hospital They may also continue to fear multination School Age 6-12 Years Children in this age group are attempting to become secure in their abilities and accomplishments They begin to internalize societal values and norms Illness as punishment for bad behavior Given their strong respect for authority and rules, they consider illness to be the result of not rolling the rules They understand simple bodily function, but adult attempts to explain illness might be overwhelming and confusing Possible Effects of Hospitalization Fear repeated pain or hospitalization Feel less competent than their peers Adolescents 13 - 18 years old As children enter adolescence, their ability to understand their illness, their body and its function, and the causes, nature, and treatment of their illness increases They are able to hypothesize cause and effect, understand hypothetical situations, and participate in decision making They have the capacity for abstract thinking and are aware of the implications that hospitalization has on their lives Possible Effects of Hospitalization They fear alienation from peers They have ongoing concerns about their appearance and the effect that the illness/hospitalization may have on their identity, sexuality, relationships and vocational possibilities Be able to discuss the traumas and challenges associated with medical illness (both for the child and the family) Potential traumas of medical illness Recurrent separations Surgery Medication side effect Painful or time consuming procedures Disrupted Sleep Pain Chronic Stress for the child and family Anxiety and financial stress in the family Infancy to 18 months Possible Effects of Chronic Illness: Decreased access to the typical environment of an infant Parental guilt, fear and anxiety may interfere with attachment The child may later have difficulties establishing trust Greater sense of helplessness in the developing infant 18 months to 3 years Possible Effects of Chronic Illness Delayed motor and language development Parental reluctance to set limits can lead to increased oppositional behaviors Problems with bowel and bladder function due to regression Preschool 3-5 years Possible reaction to chronic illness Parental over protection regression limited initiative compromised Social Skills School Age children 6-12 Possible Effects of chronic illness Alienation from peers Fewer social interactions Limited activities Parental Overprotection Adolescents 13-18 Possible Effects of Chronic Illness Concerns about appearing different from peers Noncompliance with treatment Immaturity and increased dependence on parents Identity formation is affected Describe supports that exist in hospitals to help reduce trauma (eg. child life) Child life programs - purpose is to help minimize disruption in a child's development Child life specialists provide recreational activities and therapeutic play rooms where children can engage in therapeutic hospital play They aim to reduce anxiety, increase coping skills, and help children to understand their feelings about hospitalization Pain Management there is regular assessment of pain in children using age appropriate measures The use of relaxation techniques and pharmacological measures to minimize painful procedures has become more commonplace Education in the hospital collaboration with the child's school takes place hospital schools and teachers are present in most pediatric settings Helps to retain the routine and structure of everyday life and to continue the child's educational trajectory Family Centered Care Helping children and adolescents to adapt to hospitalization involves the child, parent, family, and hospital staff Child care is planned around the whole family, with parents considered an integral part of the treatment process Support is provided for parents by the staff and through facilitation of support from other parents Parents of children with life-threatening illnesses often feel guilty and need support to maintain usual parenting practices Be able to discuss a child’s conceptualization of death by developmental stage Birth - age 3: Sensorimotor They cannot distinguish between death and separation Preschool: Pre-Operational Do not believe that death is universal They attribute life to the dead and may think that the dead come hungry or cold underground Death is to "go away" or "go to sleep" They may fear that their misbehavior may cause their illness or death They do not understand the permanence of death Age 5-11: Concrete Operational May believe that death may be avoided if one is clever enough Death is personified and given a personality i.e. the "boogie man" May believe if their behavior is exemplary, they will be spared Adolescents: Formal Operations Begin to have more abstract understanding of death They understand the universality of death, however they may not completely grasp that death is irreversible They begin to incorporate spiritual and ethical beliefs about notions such as an afterlife and heaven and hell Resilience and Treatment Related Links: How is resilience defined? Definition: "Good outcomes" in spite of threats to adaptation Good outcomes is variably defined: Psychiatric standpoint: resilience is often defined as the absence of psychopathology Ex. did the child develop PTSD after years of abuse? Developmental Psychologists: resilience is based on meeting developmental milestones Did the child develop speech, language, and cognitive skills, on normal trajectory? Meeting cultural/social expectations Did the child graduate high school, go to college, hold down a job? There must have been exposure to risk factors Do all children exposed to difficult events develop trauma? The majority of children and adolescents manifest resilience in the aftermath of traumatic experiences. This is especially true of single-incident exposure. Youths who have been exposed to multiple traumas, have a past history of anxiety problems, or have experienced family adversity are likely to be at higher risk of showing symptoms of posttraumatic stress. Despite exposure to traumatic events and experiencing short-term distress, most children and adolescents return to their previous levels of functioning after several weeks or months and resume a normal developmental course. This resilience typically results in a reduction in both psychological distress and physiological arousal. Research has provided evidence about predictors of trauma recovery, although there are no perfect predictors. Recovery can be impeded by individual and family factors, the severity of ongoing life stressors, community stress, prior trauma exposure, psychiatric comorbidities, and ongoing safety concerns. Also, poverty and racism can make this recovery much more difficult. Caretakers are affected by children’s exposure to trauma, and their responses affect children’s reactions to trauma. On a positive note, individual, family, cultural, and community strengths can facilitate recovery and promote resilience. Social, community, and governmental support networks are critical for recovery, particularly when an entire community is affected, as when natural disasters occur. What are thought to be factors that lead to resilience? Connections to competent and caring adults in the family and community Close relationships with family and friends Attachment School or community attachment Cognitive Skills Good Problem-solving and communication skills Self-regulation skills The ability to manage strong feelings and impulses coping with stress in healthy ways and avoiding harmful coping Positive views of the self Feeling in control Finding positive meaning in your life despite difficult or traumatic events Confidence in you strengths and abilities Motivation to be effective in the environment Academic achievement/Drive Aspirations/Goals What are elements common to various approaches to treatment childhood trauma? Safety Emotion/Behavior regulation Trauma (History) Looking towards the future What is meant by evidence based treatment? Treatment has been proven to be trustworthy through clinical and studies the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. treatments that have been researched academically or scientifically, been proven effective. What do you know about the National Child Traumatic Stress Network? The mission of the National Child Traumatic Stress Network (NCTSN) is to raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States The NCTSN Vision To implement community-based treatments for traumatized children and adolescents on a national scale Treatments must: Have measurable positive clinical outcomes Be well-defined and teachable Be acceptable to clients, providers, and payers Be fiscally and administratively manageable, cost-effective and affordable What do you know about the role of psychopharmacology in treating Trauma? Very little evidence to guide psychopharmacological treatment of PTSD in children and adolescents There is no medicine for PTSD Psychopharmacology can be helpful for treating specific symptoms of post traumatic stress, such as hyper arousal, irritability, anxiety, depression, aggression and sleep problems Psycho-therapy should be considered first, and medicine can be added for treatment resistant situation as an adjunct to therapy What do you know about creative arts therapy? Can help children and families cope with stress and a variety of emotional and behavioral issues Music Therapy, Yoga, Dance Movement Therapy Many people think that traumas are encoded in a body sensory way: use these creative therapy The creative process involved in expressing one’s self artistically can help people to resolve issues as well as develop and manage their behaviors and feelings, reduce stress, and improve self-esteem and awareness Art Drama Play Trauma-Focused Cognitive Behavioral Therapy What are the various components and the acronym that contains them? PRACTICE P Psychoeducation and parenting skills R Relaxation A Affective modulation C Cognitive coping and processing T Trauma narrative I In vivo mastery of trauma reminders C Conjoint child-parent sessions E Enhancing future safety and development How do the different components of TF-CBT work together? They allow for applicability to a wide variety of psychological difficulties, which is critical, due to the diversity of symptoms shown by children with PTSD and complex ptsd and their families. work together to provide a flexible and developmentally appropriate manner to address the unique needs of each child and family How are sessions structured? Step 1 - Psychoeducation General information about abuse and trauma, and the effects of traumatic events Specific information about types of traumatic events (sexual abuse, physical abuse, witnessing domestic violence, others) Sex education Risk reduction The different types of trauma Why does this type of trauma occur Effects of trauma Why children may not like to talk about trauma Serves as an introduction tot he treatment process can normalize confusing symptoms, and establish expectations about treatment and the collaborative approach. It can clarify misconceptions or myths Talking in general terms about the type of trauma a child experienced can help de-sensitize them to become less anxious about talking about it, and can help prepare them for the narrative. Step 2: Stress Management 3 elements controlled breathing (belly breathing) relaxation training progressive muscle relaxation tin soldier -> wet noodle thought stopping this is a tool that is taught to help children recognize the difference between positive and negative thoughts and to learn to have control by replacing a negative thought with a positive one During the trauma narrative -> the therapist will end to remind the child to implement these strategies Step 3: Affect Expression and Modulation Feeling Identification Games, feeling faces, etc. Rationale for feeling identification Generating feelings Rating the intensity of feelings Appropriate expression of feelings Children who have been traumatized often have trouble accurately identifying their own or others emotions Therapist will Help children identify differing levels of intensity of emotion and strategies for expressing emotions appropriately. Assign homework so that children practice feelings identification and appropriate feelings expression in real-world situations Step 4: Cognitive Coping Teaching difference between accurate and innacurate and helpful and unhelpful thoughts and beliefs The Cognitive Triangle A triangle containing Thoughts, Feelings or Behavior at each corner This teaches the connection between thoughts, feelings, and behaviors. This is aimed at helping children and parents realize they can choose and change their own thoughts, and that this can lead to changing their feelings and behaviors. Examples of how thoughts affect behavior Generate scenarios and have child identify thoughts, feelings, and likely behaviors Help child generate more accurate or helpful thoughts Discuss how to apply this skill to real life Developmental Considerations Restructuring Coping thoughts Step 5: Creating Trauma Narrative Over the course of several sessions, the child is encouraged to describe more and more details of what happened before, during, and after the trauma, as well as the child's thoughts and feelings during these times. therapists are often concerned that developing the narrative will be overly distressing for the child. For these reasons, this technique is usually taught later in the treatment process, after children have mastered emotion regulation and coping strategies to help deal with the distress of talking about their trauma-related feelings. Format: book, picture, computer , song, poem Step 6: Work through Trauma Narrative Re-read the trauma narrative with particular attention to thoughts Challenge unhelpful or inaccurate cognitions Employ role playing or experiential exercises Best friend role play talk show host role play Examine contradictory evidence/facts Test the accuracy of thoughts Use the Socratic method Trauma Systems Therapy Related Links: What is meant by a trauma system? A traumatized child who experiences Survival-in-the-Momentstates in specific definable moments, A social environment and/or services system that is not able to help the child to regulate these Survival-in-the-Momentstates What are the 4 service elements? Psychiatry/psychopharmacology Skill-based Psychotherapy Legal advocacy Community-Based/Milieu Based What is meant by “cat hair?” Once a child undergoes a trauma, they are left with a “cat hair.” This cat hair is a stimulus that caused a emotional/behavioral dysregulation. Ex. If a child was molested by a man with glasses - overtime they see a man with glasses (The cat hair) they will begin to cry What are the 3 possible assessment categories of survival state behavior? Regulated Maintain Affect, awareness, action (3As) over a usual range of stressors Emotional Dysregulation Shift in Affect, Awareness, Action (3As) over usual range of stressors. Shift in Action does not involve risky/dangerous behavior Behavioral Dysregulation Shift in Affect, Awareness, Action (3As) over usual range of stressors. Shift in Action does not involve risky/dangerous behavior, and may also include emotional dysregulation What are the 3 possible assessment categories for the social environment? Stable Child’s caregiver can adequately help him/her regulate emotion and protect him/her from environmental triggers Distressed Child’s caregivers cannot adequately help him/her regulate emotion and protect him/her from environmental triggers Threatening There is a clear and present danger in the social environment What are the 3 treatment phases, how are they determined, and why is it important to determine the treatment phase? Safety- Focused Treatment, Regulation-Focused Treatment, Beyond Trauma Defining the phase allows you to define the types of modules that are chosen, the modules chosen target the Priority Problem How would you assess and treat someone using TST? Assess Emotional / Behavioral Regulation and social environment stability to find what phase of treatment the child is at. Prioritize Problem…Good treatment depends on accurate pattern recognition. Locations the Cat hair and the cat Moment-by-Moment Assessment (MxM) the ratio of moments when a child became dysregulates vs. all the moments of a child’s life Understanding the moments that lead to dysregulation is very important- it is where we target interventions Understanding the 3 As across the 4 Rs 3As : Affect, Awareness Action (Emotional Regulation) 4 Rs: Regulating, Revving, Re-experiencing, Reconstituting (Regulation Phases) Priority Problems: patterns of links between stimuli and emotional/behavioral dysregulation (stimulus-response) You prioritize among those problems based on how they interfere with child’s functioning address the problems Offer an array of interventions/services, all designed to address, the tightly defined problems in specific and integrated ways Skill based psychotherapy Home and community-based intervention Pscyhopharmacology Legal advocacy By offering this array of interventions/services in a phase based manner, depending on the needs of the child within their social environment: Safety-focused treatment regulation-focused treatment Beyond trauma treatment All TST interventions/services are dedicated to three main goals: 1. Protect the child from environmental signals experienced as threat (cat hair), until child is able to manage them. Protect child from actual threats (cats): safety focused treatment 2. Build the child’s ability to manage environmental signals experienced as threat (cat hair), when the environment is safe and stable enough: Regulation-focused Treatment 3. Prepare the child to grow into the future in a way that is not consumed by the past-Beyond Trauma Treatment TST begins by assessing each child and his/her environment. Based on this assessment, the child is placed into one of the treatment phases, priority problems are established, and a TST treatment team is assembled. Different interventions and therapies are indicated within each phase and may include, among others, environmental stabilization via services such as advocacy or school programs and psycho-education, psychopharmacology, and psychotherapy to facilitate emotion regulation skill building.


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