New Treatment for Child Abuse Reduces Post-Traumatic Stress

Posted on: Tuesday, April 3, 2012

Keywords: child abuse, child abuse treatment, Yale University, Safe Horizon, trauma treatment in child abuse, child abuse victim treatments, Child Family Traumatic Stress Intervention

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Yale’s Childhood Violent Trauma Center and Safe Horizon Partnership Creates New Model for Treatment of Child Abuse

(New York, NY) – April 3, 2012 – The Yale Childhood Violent Trauma Center and Safe Horizon today released the results of a four-year pilot program to treat children who have experienced severe sexual or physical abuse.

The results were released as part of a forum, “Hope and Healing for Child Abuse Victims,” organized by Safe Horizon and the Yale Childhood Violent Trauma Center, at The Jerome L. Greene Performance Space.  National experts in childhood trauma, Dr. Steven Marans, Dr. Frank Putnam, and Teresa Huizar participated in the forum, which was attended by city officials, health care providers, social workers and others active in addressing the problem of child abuse.

The program – the Child and Family Traumatic Stress Intervention (CFTSI) – has been implemented in four Safe Horizon Child Advocacy Centers (CACs) since 2008.  This initiative was a key part of Safe Horizon’s response to the surge of child abuse cases in New York City after the tragic death of seven-year old Nixmary Brown in January 2006.  Prior to the implementation of CFTSI at Safe Horizon’s CACs, the mental health response, interventions and assessments varied.  For the past four years, Safe Horizon has implemented standardized assessment measures and a more effective mental health response to treat children who disclose abuse.

The Child and Family Traumatic Stress Intervention is a four-to-six session, family strengthening, evidence-based early intervention for children seven to 18 years old who have either recently experienced or recently disclosed a traumatic event.  The intervention was developed by clinicians at the Yale Childhood Violent Trauma Center (CVTC), a program of the Yale Child Study Center.  Safe Horizon and the CVTC began partnering in 2007 to determine how the CFTSI would work in a large, urban environment.  In a randomized control study conducted by the CVTC, children who received CFTSI were 65% less likely than comparison youth to meet criteria for full Post-Traumatic Stress Disorder (PTSD) at the three month follow-up and were 73% less likely than comparison youth to meet combined criteria for partial and full PTSD at the three month follow-up. 

The partnership has been enormously successful and resulted in overwhelmingly positive outcomes for children and families who have received CFTSI in the CAC setting.  To date, nearly 500 children have participated in CFTSI at Safe Horizon CACs.  The results these children and their caregivers report mirror those found in the previous evaluations of CFTSI.  In a review of data from 124 children who completed CFTSI at Safe Horizon CACs between April 2010 and March 2011, there was a 54% decrease in children’s trauma symptoms at the end of the intervention, alongside an increase in symptom recognition and communication between children and caregivers.  Finally, caregivers have reported almost universally that they learned skills to help their child feel better and decrease the frequency of trauma reactions exhibited by their child.

“When children are alone with and do not have words for their traumatic reactions, symptomatic behavior is their only means of expression,” explained Dr. Steven Marans, Harris professor of child psychiatry, professor of psychiatry at Yale University School of Medicine and Director of the Yale Childhood Violent Trauma Center.  “Children need recognition and understanding from the most important source of support in their lives – their caregivers.”

Dr. Marans, who co-authored a white paper released today on the New York City pilot program with Safe Horizon and Yale colleagues Carrie Epstein and Hilary Hahn, added:  “The Yale/Safe Horizon partnership has created a model that can significantly change how abused children are treated throughout the United States.”

Ariel Zwang, the Chief Executive Officer of Safe Horizon, said, “The Child and Family Traumatic Stress Intervention model is evidence-based, and builds on each family’s strengths. It helps child victims and their parents to communicate better, which eases the trauma for both. Safe Horizon and the Yale Child Study Center have worked together to adapt this treatment to meet the individual needs of the families at our CACs, who may be facing homelessness, court involvement, foster care placement, and the need for medical care, in addition to the trauma of abuse.  We are grateful to the Yale Child Study Center for their strong collaboration with us, and look forward to working with Dr. Marans and the Yale team to make this powerful intervention available to many more child abuse victims in the coming years.”

The partnership has also had benefits for Safe Horizon CAC social work and case management staff who describe an increased sense of efficacy in their ability to help children, and accomplish the following goals immediately following the disclosure of overwhelming, traumatic experiences of abuse:

- Improve screening and identification of children impacted by traumatic stress
- Reduce negative reactions and symptoms related to the traumatic event
- Strengthen communication between caregiver and child
- Teach and practice coping skills
- Identify and address concrete external stressors (e.g. safety, legal issues, medical care)
- Assess each child’s need for longer-term treatment.

Prior to the first CFTSI session, a formal trauma symptom screening is conducted, using the CPSS (Child PTSD Symptom Scale) to assess the level of trauma the child is experiencing.  If the child is seven years of age or older, has made a disclosure of sexual and/or physical abuse and is symptomatic, he/she is encouraged, along with the caregiver, to begin CFTSI at the CAC.

The first session involves a meeting with the caregiver, providing education about trauma and trauma symptoms, assessing the child’s trauma symptoms and beginning to address external stressors the family is facing, often requiring case management and care coordination. 

The second session is divided into two parts – the first part involves meeting with the child alone, providing education about trauma and their symptoms in addition to assessing the child’s symptoms; the second part involves a family meeting, with both the child and the caregiver, and is a key part of the intervention.  The child and caregiver begin to discuss and compare the caregiver and child’s report about trauma symptoms.  Together, they identify the specific trauma reactions that will be the focus of behavioral interventions.  Coping skills are introduced to provide some immediate relief from the reactions, and the child and caregiver are encouraged to practice these skills at home. 

The third session involves another family meeting between the child and caregiver.  Communication attempts between them are praised and supported.  Trauma measures are re-administered to assess levels of distress and increased awareness.  Coping skills are practiced and efforts are supported.

The fourth session again involves the child and caregiver and follows the same format as session three.  Progress is reviewed and any additional case management or treatment needs are identified.  One to two additional sessions may be provided as needed.  After CFTSI is completed, the CPSS (Child PTSD Symptom Scale) is administered again to assess the level of trauma the child is experiencing.  Pre- and post-CPSS scores are shared and discussed with both the child and caregiver.
The New York City results were similar to a randomized study of CFTSI effectiveness completed in 2009.  In that study conducted in New Haven, victimized children who were treated with CFTSI were 65% less likely than comparison youth to meet criteria for full PTSD at three-month follow-up.

Officials from both Yale and Safe Horizon stressed the need to expand intervention nationally given the child abuse crisis in the United States.

“Child abuse, neglect and violent trauma are a national epidemic in the United States,” Dr. Marans and Ms. Zwang said jointly.  “Far too many children are trapped in abusive situations, suffering at the hands of caregivers upon whom they rely.”

In 2010, an estimated 3.3 million allegations of child maltreatment were reported to child protective service agencies nationwide.  In New York City, there were more than 60,000 allegations.  Safe Horizon’s CACs are designed to investigate and respond to the most serious of these allegations-those involving sexual abuse and/or severe physical abuse.

“Hope and Healing for Child Abuse Victims,” the report released by Safe Horizon and the Yale Child Study Center today, notes as well that “children who are victims of, and witness to, violence – and whose trauma goes unaddressed – are at higher risk of developing behavioral problems, school failure, substance abuse, repeat victimization, and violent criminal behavior.”

“We must work as a society to stop this violence against children,” Zwang said.  “But until it ends, we have an obligation to assist children who have suffered abuse – and those who lovingly care for them – by providing the tools to help them deal with this life-altering experience.  We need to do this for the child, for the caregiver and for society.”

Impacts of child abuse on society include:

- Children who experience abuse and neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult and 30% more likely to commit violent crime
- Substantiated cases of adolescent maltreatment increase the odds of arrest, general and violent offending and illicit drug use in young adulthood
- Abused children are 25% more likely to experience teen pregnancy
- As many as two-thirds of people in treatment for drug abuse report being abused or neglected as children
- About 30% of abused and neglected children will later abuse their own children

Based on shared clinical experience and input from Safe Horizon colleagues, the Yale team recently developed CFTSI Adaptation for Children in Foster Care. Training and implementation of this program has begun in Safe Horizon’s four nationally accredited CACs, as approximately 50% of the children seen who disclose abuse are in out of home placements, in addition to several trauma-informed clinical agencies around the country.

About Safe Horizon

Safe Horizon is the largest victims’ services agency in the United States, with more than 50 locations touching the lives of 250,000 children, adults, and families affected by crime and abuse throughout New York City each year. Since 1978, Safe Horizon has provided victims of domestic violence, child abuse, human trafficking, rape and sexual assault, as well as homeless youth and families of homicide victims, with a wide range of comprehensive support.  Our programs also partner with governmental and other community agencies so we can offer additional assistance, including finding resources for those living outside New York City.

About the Yale Child Study Center

The Yale Child Study Center is a department of the Yale University School of Medicine.  The mission of the Center is to understand children's mental health problems, and prevent or alleviate the symptoms of patients who suffer from them.  The faculty includes internationally recognized experts from multiple disciplines, including child psychiatry, pediatrics, psychology, genetics, neurobiology, epidemiology, nursing, education, social work, and social policy.  The Center plays a key national and international role in psychiatric research, training, and professional activity. The mission of the Center is carried out through six interrelated areas.


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