Trauma Treatment Models and Ratings
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When a child or adult is scared or feels threatened by something they have
seen or been involved in, it is called trauma. Reactions to trauma can include
unstable emotions and behavior, nightmares, headaches, nausea and stomach problems.
These reactions are normal, but sometimes can make it hard to move forward.
Mental/behavioral health care providers can help people to find ways manage these
reactive emotions.
There is a wide range or trauma types that children or adults may be
exposed to:
- bullying
- community violence
- complex trauma (multiple events)
- disasters
- early childhood trauma (ages 0-6)
- domestic violence (also referred to as “Intimate Partner Violence or IPV”)
- medical trauma
- physical abuse
- refugee trauma
- sexual abuse
- terrorism and violence
- traumatic grief
The Medical Home Portal has put together this information to help families
of children and youth with special health care needs understand what trauma
treatment is, and how you can access providers and treatment. The Portal’s
Services Directory includes
information on some mental/behavioral health care providers including their
training, certification and approaches used to treat trauma.
Treatment Models for Those Who Have Experienced Trauma
The information below comes from the California Evidence-Based Clearinghouse for Child Welfare (CEBC). It
uses a rating scale to help describe available trauma treatment options.
Scientific Rating Scale: This scale is a 1 to 5 rating of the
strength of the research evidence supporting a treatment practice or program. A
scientific rating of 1 represents a practice with the strongest research evidence,
and a 5 represents a practice that appears to pose substantial risk to children and
families. Our listings contain only those programs rated 1-3:
- 1 – well-supported by research evidence
- 2 – supported by research evidence
- 3 – promising research evidence
Trauma Treatment (Child & Adolescent) is defined by the
CEBC as treatment designed to help a child or adolescent process a trauma or
multiple traumas he or she experienced and learn how to cope with the feelings
associated with the experience (e.g., fear, posttraumatic stress, anxiety,
depression, etc.).
Trauma Treatment (Adult) is defined by the CEBC as treatment
developed to assist adults in coping with the effects that come from experiencing
trauma. The trauma(s) may have occurred at any point in the individual’s life and
may have occurred once or many times. Research finds that more than half of all
adults in the United States will experience a traumatic event at some point in their
lives.
Children and Adolescents - Models
Scientific Rating: 1 – Well-Supported by Research Evidence
Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR)
EMDR therapy is an 8-phase psychotherapy treatment that was
originally designed to alleviate the symptoms of trauma. During the EMDR
trauma processing phases, guided by standardized procedures, the client
attends to emotionally disturbing material in brief sequential doses
that include the client’s beliefs, emotions, and body sensations
associated with the traumatic event while simultaneously focusing on an
external stimulus. Therapist directed bilateral eye movements are the
most commonly used external stimulus, but a variety of other stimuli
including hand-tapping and audio bilateral stimulation are often used.
Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR)
Prolonged Exposure Therapy for Adolescents (PE-A)
PE-A is a therapeutic treatment where clients are encouraged
to repeatedly approach situations or activities they are avoiding
because they remind them of their trauma (in vivo exposure) as well as
to revisit the traumatic memory several times through retelling it
(imaginal exposure). Psychoeducation about common reactions to trauma as
well as breathing retraining exercises are also included in the
treatment. The aim of in vivo and imaginal exposure is to help clients
emotionally process their traumatic memories through imaginal and in
vivo exposure. Through these procedures, they learn that they can safely
remember the trauma and experience trauma reminders, that the distress
that initially results from confrontations with these reminders
decreases over time, and that they are capable of tolerating this
distress. Prolonged Exposure Therapy for Adolescents (PE-A)
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
TF-CBT is a conjoint child and parent psychotherapy model for
children who are experiencing significant emotional and behavioral
difficulties related to traumatic life events. It is a components-based
hybrid treatment model that incorporates trauma-sensitive interventions
with cognitive behavioral, family, and humanistic principles. Trauma-Focused Cognitive-Behavioral Therapy;
TB-CPT Certified Therapists
Scientific Rating: 2 – Supported by Research Evidence
Child-Parent Psychotherapy (CPP)
CPP is a treatment for trauma-exposed children aged 0-5.
Typically, the child is seen with his or her primary caregiver, and the
dyad is the unit of treatment. CPP examines how the trauma and the
caregivers’ relational history affect the caregiver-child relationship
and the child’s developmental trajectory. A central goal is to support
and strengthen the caregiver-child relationship as a vehicle for
restoring and protecting the child’s mental health. Treatment also
focuses on contextual factors that may affect the caregiver-child
relationship (e.g., culture and socioeconomic and immigration related
stressors). Targets of the intervention include caregivers’ and
children’s maladaptive representations of themselves and each other and
interactions and behaviors that interfere with the child’s mental
health. Over the course of treatment, caregiver and child are guided to
create a joint narrative of the psychological traumatic event and
identify and address traumatic triggers that generate dysregulated
behaviors and affect. Child Parent Psychotherapy
Scientific Rating: 3 – Promising Research Evidence
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT)
AF-CBT is an evidence-based treatment (EBT) designed to
improve the relationships between children and caregivers in families
involved in arguments, frequent conflict, physical force/discipline,
child physical abuse, or child behavior problems. Alternatives for Families: A Cognitive Behavioral Therapy
Child and Family Traumatic Stress Intervention (CFTSI)
CFTSI is a brief early intervention model for children and
adolescents 7-18 that is implemented soon after exposure to a
potentially traumatic event, or in the wake of disclosure of physical
and sexual abuse. Developed at the Yale Child Study Center, CFTSI fills
a gap between acute responses/crisis intervention and evidence-based,
longer-term treatments designed to address traumatic stress symptoms and
disorders that have become established. The goal of this
family-strengthening model is to improve the caregiver’s ability to
respond to, and support, a child who has endorsed at least one
posttraumatic symptom. By raising awareness of the child’s symptoms,
increasing communication and providing skills to help master trauma
reactions, CFTSI aims to reduce symptoms and prevent onset of
posttraumatic stress disorder (PTSD). In addition, CFTSI offers an
opportunity to assess which children and families need longer-term
treatment. CFTSI is provided by master’s-level clinicians who have been
trained by CFTSI master trainers. Child and Family Traumatic Stress Intervention
Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
CBITS is a school-based, group and individual intervention
designed to reduce symptoms of posttraumatic stress disorder (PTSD),
depression, and behavioral problems among students exposed to traumatic
life events, such as exposure to community and school violence,
accidents, physical abuse, and domestic violence. It is designed for
students, who have experienced a traumatic event and have current
distress related to that event. The goals of the intervention are to
reduce symptoms and behavior problems and improve functioning, improve
peer and parent support, and enhance coping skills. The program includes
10 student group sessions, 1-3 student individual sessions, 2 parent
sessions, and a teacher educational session. Developed for the school
setting in close collaboration with school personnel, the program is
well suited to the school environment. Cognitive Behavioral Intervention for Trauma in Schools
Combined Parent-Child Cognitive-Behavioral Therapy
CPC-CBT: Empowering Families Who Are at Risk for Physical
Abuse is a short-term (16-20 sessions), strength-based therapy program
for children ages 3-17 and their parents (or caregivers) in families
where parents engage in a continuum of coercive parenting strategies.
These families can include those who have been substantiated for
physical abuse, those who have had multiple unsubstantiated referrals,
and those who fear they may lose control with their child. Children may
present with PTSD symptoms, depression, externalizing behaviors and a
host of difficulties that are targeted within CPC-CBT. The program is
grounded in cognitive behavioral theory and incorporates elements (e.g.,
trauma narrative and processing, positive reinforcement, timeout,
behavioral contracting) from CBT models for families who have
experienced sexual abuse, physical abuse, and/or domestic violence, as
well as elements from motivational, family systems, trauma, and
developmental theories. CPC-CBT helps the child heal from the trauma of
the physical abuse, empowers and motivates parents to modulate their
emotions and use effective non-coercive parenting strategies, and
strengthens parent-child relationships while helping families stop the
cycle of violence. Combined Parent-Child Cognitive-Behavioral Therapy
Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)
The Fairy Tale Model is a model of trauma-informed
psychotherapy and is so named because it is taught with the telling of a
fairy tale, in which each element of the story corresponds to one of the
phases in treatment. Following the treatment manual, Treating Problem
Behaviors: A Trauma-Informed Approach, this phase model of
trauma-informed treatment calls for a given phase of treatment to be
pursued until the client outcome specified for that phase has been
achieved. The treatment manual has scripted interventions for working
with teens individually. Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)
Preschool PTSD Treatment (PPT)
PPT is a manualized, 12-session cognitive behavioral therapy
protocol to treat very young children with posttraumatic stress disorder
(PTSD) and trauma-related symptoms. The sessions are either with the
therapist working individually with the child (with the parent observing
via a video feed) or with the parent and child together. Preschool PTSD Treatment
Seeking Safety for Adolescents
Seeking Safety was originally designed for adults and has been
rated by the CEBC in the area of Substance Abuse Treatment (Adult).
Seeking Safety for Adolescents is a present-focused, coping skills
therapy to help people attain safety from trauma and/or substance abuse.
The treatment is available as a book, providing both client handouts and
clinician guidelines. The treatment may be conducted in group or
individual format for adolescents (both females, and males) in various
settings (e.g., outpatient, inpatient, residential, home care, and
schools). Seeking Safety for Adolescents consists of 25 topics that can
be conducted in any order and number. Examples of topics are Safety,
Asking for Help, Setting Boundaries in Relationships, Healthy
Relationships, Community Resources, Compassion, Creating Meaning,
Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment,
Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life
Choices. Seeking Safety for Adolescents
SITCAP-ART
The SITCAP-ART program is a comprehensive trauma intervention
program, modified from the original Structured Sensory Intervention for
Traumatized Children, Adolescents and Parents (SITCAP) program initially
researched in 2001. SITCAP-ART is designed specifically for at-risk and
adjudicated youth. SITCAP-ART integrates cognitive strategies with
sensory/implicit strategies. When memory cannot be linked linguistically
in a contextual framework, it remains at the symbolic level for which
there are no words to describe. To retrieve that memory so it can be
encoded, given a language, and then integrated into consciousness, it
must be retrieved and externalized in its symbolic perceptual (iconic)
form. SITCAP-ART, which is followed by cognitive or explicit strategies,
supports moving from victim to survivor thinking allowing changes in
negative behaviors (aggressive and rule-breaking behavior) and making
adolescents more resilient to future traumas. SITCAP-ART
Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET)
TARGET is an educational and therapeutic approach for the
prevention and treatment of complex Post-Traumatic Stress Disorder
(PTSD). TARGET provides a practical skill-set that can be used by trauma
survivors and family members to de-escalate and regulate extreme
emotional states, to manage intrusive trauma memories in daily life, and
to restore the capacity for information processing and autobiographical
memory. TARGET teaches a sequence of seven skills described as the
FREEDOM steps. Trauma Affect Regulation: Guide for Education and Therapy for Adolescents
Trauma-Focused Coping (TFC)
TFC targets the internalizing effects of exposure to trauma in
children and adolescents, with an emphasis on treating posttraumatic
stress disorder (PTSD) and the collateral symptoms of depression,
anxiety, anger, and an external locus of control [i.e., tendency to
attribute one’s experiences to fate, chance, or luck]. The intervention
utilizes social learning theory and a skills-oriented
cognitive-behavioral approach that is carried out in 14-week sessions of
gradual exposure, moving from psycho-education, anxiety management skill
building, and cognitive coping training, to finally, trauma narrative
and cognitive restructuring activities. Trauma-Focused Coping
Adults - Models
Scientific Rating: 1 – Well-Supported by Research Evidence
Cognitive Processing Therapy (CPT)
Developed originally for use with rape and crime victims, CPT
begins with the trauma memory and focuses on feelings, beliefs, and
thoughts which directly emanated from the traumatic event. The therapist
then helps the clients examine whether the trauma appeared to disrupt or
confirm beliefs prior to this experience, and how much the clients have
over-generalized (over-accommodated) from the event to their beliefs
about themselves and the world. Clients are then taught to challenge
their own self-statements using a Socratic style of therapy (leading
clients to understand their reasoning processes and beliefs through
questions), and to modify their extreme beliefs to bring them into
balance. CPT can be conducted individually or in groups where the
written trauma account is completed in an individual session. Cognitive Processing Therapy
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR therapy is an 8-phase psychotherapy treatment that was
originally designed to alleviate the symptoms of trauma. During the EMDR
trauma processing phases, guided by standardized procedures, the client
attends to emotionally disturbing material in brief sequential doses
that include the client’s beliefs, emotions, and body sensations
associated with the traumatic event while simultaneously focusing on an
external stimulus. Therapist directed bilateral eye movements are the
most commonly used external stimulus, but a variety of other stimuli
including hand-tapping and audio bilateral stimulation are often used.
Eye Movement Desensitization and Processing
Prolonged Exposure Therapy (PE)
PE consists of 8 -15 weekly or semi-weekly treatment sessions
that are 60-90 minutes each. Clients are encouraged to repeatedly
approach situations or activities they are avoiding because they remind
them of their trauma (in vivo exposure) as well as to revisit the
traumatic memory several times through retelling it (imaginal exposure).
Psychoeducation about common reactions to trauma as well as breathing
retraining exercises are also included in the treatment. The aim of in
vivo and imaginal exposure is to help clients emotionally process their
traumatic memories through imaginal and in vivo exposure. Through these
procedures, they learn that they can safely remember the trauma and
experience trauma reminders, that the distress that initially results
from confrontations with these reminders decreases over time, and that
they are capable of tolerating this distress. Prolonged Exposure Therapy for PTSD for Adults (PE)
Target Population: Adults with a variety of traumas such as
combat, sexual assault, car accidents, violent crimes, and acts of
terrorism.
Scientific Rating: 2 – Supported by Research Evidence
Cognitive Behavioral Therapy for Acute Stress Disorder
Cognitive Behavioral Therapy for Acute Stress Disorder is a
form of therapy used in the early stages of traumatic response.
Cognitive-behavioral therapy helps people with acute stress disorder
change their way of thinking about the traumatic event and alter their
behaviors in anxiety-provoking situations. Like posttraumatic stress
disorder (PTSD), acute stress disorder may develop in an individual who
has experienced or witnessed a traumatic event. Unlike PTSD, however,
the anxiety which accompanies acute stress disorder lasts for a minimum
of 2 days and a maximum of 4 weeks. If symptoms persist for longer than
4 weeks, or begin more than a month after the trauma was initially
experienced or witnessed, a diagnosis of PTSD may be appropriate.
Cognitive Behavioral Therapy for Acute Stress Disorder
Seeking Safety
Seeking Safety is a present-focused, coping skills therapy to
help people attain safety from trauma and/or substance abuse. The
treatment is available as a book, providing both client handouts and
clinician guidelines. The treatment may be conducted in group or
individual format; with females and males; and in various settings
(e.g., outpatient, inpatient, residential, home care, schools). Seeking
Safety consists of 25 topics that can be conducted in as many sessions
as time allows, and in any order. Examples of topics are Safety, Asking
for Help, Setting Boundaries in Relationships, Healthy Relationships,
Community Resources, Compassion, Creating Meaning, Discovery, Recovery
Thinking, Taking Good Care of Yourself, Commitment, Coping with
Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking
Safety for Adolescents is also highlighted on the CEBC in the Trauma
Treatment (Child and Adolescent) topic area. Seeking Safety
Scientific Rating: 3 – Promising Research Evidence
Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder
The 16-session Brief Eclectic Psychotherapy for PTSD (BEPP)
protocol starts with psychoeducation on posttraumatic stress disorder
(PTSD). The patient and his/her partner learn to understand the symptoms
of PTSD as dysfunctional, and caused by the traumatic event. The patient
will then receive 4-6 sessions of relaxation and imaginary exposure,
focused on the suppressed intense emotions of sorrow.
Memorabilia are used to stimulate remembrances of the
traumatic event and the patient is tasked to write a letter to a person
or an institution blamed for the traumatic incident. The letter is
specifically used to express aggressive feelings. Symptoms will then
typically disappear and the patient will be able to concentrate on the
impact of the trauma on his/her view of self and the world. The
treatment is ended with a farewell ritual. Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder
Trauma Affect Regulation: Guide for Education and Therapy for Adults (TARGET)
TARGET is an educational and therapeutic approach for the
prevention and treatment of complex Post-Traumatic Stress Disorder
(PTSD). TARGET provides a practical skill-set that can be used by trauma
survivors and family members to de-escalate and regulate extreme
emotional states, to manage intrusive trauma memories in daily life, and
to restore the capacity for information processing and autobiographical
memory. TARGET teaches a sequence of seven skills described as the
FREEDOM steps. Trauma Affect Regulation: Guide for Education and Therapy for Adults (TARGET)
Other
Somatic Experiencing
Not listed on California Clearinghouse
3-year training program with 3 levels: beginning, intermediate,
advanced. Each level has more than one training module. Supervision sessions
are required for each level. A certificate is given upon completion.
Somatic Experiencing Program
Resources
Information & Support
For Parents and Patients
The National Child Traumatic Stress Network (NCTSN)
In-depth information about trauma-informed clinical interventions, screening and assessment practices, disaster behavioral
health response and recovery, culture and trauma, and more.
Services for Patients & Families in Idaho (ID)
| Service Categories | # of providers* in: | ID | NW | Other states (5) (show) | | NM | NV | OH | RI | UT |
|---|---|---|---|---|---|---|---|---|---|---|
| Crisis Mental Health Care | 2 | 5 | 34 | 3 | 5 | 26 | ||||
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Authors & Reviewers
Initial publication: February 2016; last update/revision: February 2021
Current Authors and Reviewers:
| Author: | Mindy Tueller, MS, MCHES |
| Reviewer: | Tina Persels |