Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model (TAP)

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Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model (TAP). Presented by: Alicia Gilbert, PhD Robyn Igelman, PhD. Chadwick Center for Children and Families . Chadwick Center Programs Trauma Counseling Forensic and Medical Services Family Support
Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model (TAP)

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Slide 1

Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model (TAP)

Presented by:

Alicia Gilbert, PhD

Robyn Igelman, PhD

Slide 2

Chadwick Center for Children and Families

Chadwick Center Programs

Trauma Counseling

Forensic and Medical Services

Family Support

Professional Education

Research Linkage

Child & Adolescent Services Research Center

(funded by the NIMH)

Slide 3

Trauma Counseling Program

  • Assessment-based individual, group and family therapy for children who have experienced

    traumatic events.

  • Therapy and advocacy to domestic violence victims and their children at the Family Justice Center.

  • School-based counseling services.

  • Parent-child interaction therapy.

  • Medication & psychological assessments.

  • Crisis intervention, advocacy, information and referrals.

Slide 4

TAP Model Overview

  • A treatment manual for traumatized children ages 2 to 18 years

  • Incorporates assessment data, clinical interview, and observation to create a Unique Client Picture

  • Includes specific components of trauma-specific treatment described by the Trauma Wheel

  • Draft completed and undergoing revisions

Slide 5

What Is Assessment Based Treatment (ABT)?

Development of clinical assessment-based treatment refers to the “development of an integrated plan of prioritized interventions, that is based on the diagnosis and psychosocial assessment of the client, to address mental, emotional, behavioral, developmental and addictive disorders, impairments and disabilities, reactions to illnesses, injuries, and social problems.” (Social work, consolidated laws, effective Sept. 1, 2004)

Slide 6

Clinical Pathways

  • A sequence or path that clinicians follow in making assessment, triage, and clinical decisions.

  • Found increasingly useful within the medical field.

  • Evaluation of UCLA’s Asthma Pathway showed substantial cost effectiveness and adherence to medical standards (Chest, 1998)

  • Rady Children’s Hospital developed over 40 pathways, starting with Asthma in 1994, domestic violence in 2001, and TAP in 2005.

  • TAP includes a pathway that directs triage, assessment, referrals, and clinical interventions.

Slide 7

Chadwick’s Philosophy ofTrauma Treatment

  • The therapeutic goal is to resolve the impact of a single or series of traumatic experiences to the child and their family.

  • Therapeutic decisions emerge from clinical and standardized assessment.

Slide 8

3 Components of TAP

  • Assessment

    Creating a Unique Client Picture

  • Triage

  • Treatment

Slide 9


Is the client appropriate for your Center and for the TAP Model?

Slide 11

To get the full rich unique client picture, gather information via:

  • Clinical Interviews

  • Behavioral Observation

  • Standardized Measures

Slide 13

Standardize your Assessment ChoicesWhat measures exist to help you know your client?

Slide 14

Psychometric Properties

Reliability and Validity

Clinical Cutoffs

Sensitivity to Change

Feasibility Issues

Time to administer

Staff training

Costs of using measures


Multiple vs. Single Informants

Real World Validity

Clinical Utility

Measurement Considerations

Slide 15

Assessment Pathway Process

Core measures administered

Problem areas identified

Other measures are administered to probe more deeply

Slide 16

Guiding Therapists via Assessment

Pathways integrated into assessment measures

Slide 17

Therapists’ Use of Assessment Measures:

Guiding the assessment and providing feedback.

Slide 18

How to make sense ofassessment results:

  • Know what each measure assesses and applicable populations

  • Have a general understanding of each subscale

  • Examine the validity scales (if any)

  • Use assessment results as an adjunct to your clinical interview

  • Clarify inconsistencies between assessment results and clinical impressions

Slide 19

How to make sense of assessment results (cont.):

  • Involve the parents and children in your interpretive process

  • Integrate results with clinical impressions & think about how the results can be used to plan treatment

  • Don’t discount your clinical judgment!!

Slide 20

Problem Solving: What Happens When the Measures & Clinician Don’t Agree?

Slide 21

Critical Items

Slide 22

How do you discuss feedback with your clients?

Slide 23

Parent and client feedback:Dos & Don’ts


  • Allow one therapy session to discuss results and give feedback

  • Elicit client feedback and impressions regarding assessment results

  • Discuss results with parent and child to confirm clinical impressions

  • Address areas of concern not initially revealed through clinical interview

  • Most important: Engage them in the process!

Slide 24

Parent and client feedback:Dos & Don’ts (cont.)


  • Avoid discussing results with your clients

  • Act like the assessments are a waste of time (because your clients will too!)

  • Be afraid to share written feedback and printouts with parents and children

  • Underestimate the ability of your clients to understand and appreciate your feedback

Slide 25

How to form your clinical hypothesis

  • Consider all assessment feedback

  • Which family members need to be included in treatment? What are the dynamics in the family?

  • Family and client buy in

  • Consider the cause of distress

Slide 26

Heuristics of Using theClinical Pathway

  • One skill builds upon another.

  • All spokes of the Trauma Wheel will be addressed at some point during treatment.

  • The length of time and intervention type depend upon the unique client picture.

  • The wheel is fluid – you move back and forth between spokes of the wheel.

Slide 27

The Trauma Wheel

Relationship Building

Addressing Maladaptive Cognitions



Child Development

Systemic Dynamics

Skill Building



Trauma Integration


Slide 28

Case Example:

Referral Information

Interview with Child & Family

Standardized Assessment Results

Consider family buy-in & needs before making treatment decisions


Slide 29

On-going Re-assessment

  • Weekly interviews/updated goals

  • Progress notes

  • Supervision

  • Follow-up standardized measures

    • Must use the same measures for each time period (to measure change over time)

    • Can add measures over time (once added must continue to administer added measure to assess change over time).

Slide 30

Symptom Change

Over Time

Slide 31

Trauma Assessment Pathway Model (TAP): At a Glance

Initial Screening Process


Refer out


Clinical Interview and Standardized Measures

Integrate Assessment Information

Form Unique Client Picture

Narrow the Clinical Focus Select Symptom Domains Hypotheses/Prioritize

Refer to a specialized program if needed

Establish Treatment Goals

Treatment Pathway

Guides treatment decisions and the use of the Trauma Wheel

Trauma Wheel


Weekly interviews, update goals


Follow-up standardized measures

Continue Treatment

Following the Treatment Pathway


Slide 32

You’re the Experts

  • What are some basic assumptions you may have about traumatized clients?

  • How have you validated those assumptions?

  • What is your experience with using assessment measures?

Slide 33


  • (Chadwick)

  • (National Child Traumatic Stress Network)

  • (TF-CBT on-line and OVC guidelines)


Slide 34

Contact Information

Alicia Gilbert, PhD


Robyn Igelman, PhD

858-576-1700, ext. 3211

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