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The Child and Family Traumatic Stress Intervention: Implementing an Evidence-Based Early/Acute Intervention in Child Advocacy Centers . PRESENTERS Steven Marans , MSW, Ph.D. Harris Professor of Child Psychiatry and Professor of Psychiatry Director, Childhood Violent Trauma Center,

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The Child and FamilyTraumatic Stress Intervention:Implementing an Evidence-BasedEarly/Acute Interventionin Child Advocacy Centers
  • Steven Marans, MSW, Ph.D.
    • Harris Professor of Child Psychiatry and Professor of Psychiatry
    • Director, Childhood Violent Trauma Center,
    • Yale Child Study Center
    • Yale University School of Medicine
  • Carrie Epstein, LCSW-R
    • Assistant Professor
    • Director of Clinical Services and Training,
      • Childhood Violent Trauma Center, Yale Child Study Center
    • Yale University School of Medicine
    • Consultant, Safe Horizon, Inc.
  • Nancy Arnow, LMSW
    • Vice President
    • Child Advocacy Centers and Mental Health Treatment Programs
    • Safe Horizon, Inc.
cftsi what is it
CFTSI: What Is It?
  • Brief (4-8 session) evidence-based early intervention model for children following a range of potentially traumatic events (PTE)
    • After exposure
    • After disclosure of earlier sexual or physical abuse
  • Children aged 7-18 years old
goals of cftsi
Goals of CFTSI

CFTSI aims to:

  • Reduce traumatic stress symptoms and prevent chronic PTSD
  • Improve screening and initial assessment of children impacted by traumatic stress
  • Assess child’s need for longer-term treatment
mechanisms of cftsi
Mechanisms of CFTSI

CFTSI works by:

  • Increasing communication between caregiver and child about child’s traumatic stress reactions
  • Providing skills to family to help cope with traumatic stress reactions
  • Assessing concrete external stressors (e.g. housing issues, systems negotiation, safety planning, etc.)
cftsi filling a gap in available interventions
CFTSI: Filling a Gapin Available Interventions


  • 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
capitalizing on protective factors
Capitalizing on Protective Factors
  • Family and social support are best predictors for good post-trauma outcomes
    • Primary caregiver/s are central to CFTSI
  • Improves support through improving communication:
    • Helps child communicate about reactions and feelings more effectively
    • Increases caregiver’s awareness and understanding of child’s experience
  • CFTSI provides skills to help children and families cope with and master trauma reactions
recovery through regaining a sense of control
Recovery through Regaining a Sense of Control


Replaces chaotic post-traumatic experience with:



Opportunity to be heard by caregiver

Uses standardized assessment instruments to:

Structure discussion about symptoms

Increase symptom recognition and communication about them

Provides skills and behavioral interventions

Increases control through symptom reduction

cftsi what and how
CFTSI: What and How?
  • Session 1 – Meeting with Caregiver
  • Provide psychoeducation about trauma and trauma symptoms
  • Assess caregiver’s and child’s trauma symptoms
  • Address case management and care coordination issues
  • Session 2, Part A: Meeting with Child
  • Provide psychoeducation about trauma and trauma symptoms
  • Assess child’s symptoms
  • Session 2, Part B: Family Meeting - Key part of intervention
  • Begin discussion by comparing caregiver and child’s reports about trauma symptoms
  • Identify the specific trauma reactions to be the focus of behavioral interventions and introduce coping skills
cftsi what and how1
CFTSI: What and How?
  • Session 3: Family Meeting
  • Praise and support communication attempts
  • Re-administer measures to assess levels of distress and
  • increased awareness
    • Practice coping skills(s), support efforts
  • Session 4: Family Meeting/Case Disposition
  • Follow same format as Session 3
  • Review progress made and identify any additional case
  • management or treatment needs
  • Possible Additional Sessions
  • May require 1 or 2 additional individual sessions with
  • caregiver(s) or child due to a range of issues
cftsi an evidence based model listed in
CFTSI: An Evidence-based ModelListed in:
  • NCTSN list of evidence-based treatments
  • California Evidence-based Clearinghouse for Child Welfare
  • NREPP (National Registry of Evidence-based Programs and Practices (soon)
randomized control trial results
Randomized Control Trial: Results
  • CFTSI versus 4-session psychoeducation/supportive comparison intervention
  • Sample size = 112
  • Participants recruited from:
    • Forensic Sexual Abuse Program
    • Pediatric Emergency Department
    • New Haven Department of Police Service
      • Funded by SAMHSA
sample demographics sample size 106
Sample Demographics(Sample Size = 106)
  • Intervention
  • N=53
    • 24 Boys
    • 29 Girls
    • Mean Age=12; SD=2.8
    • Mean # Traumas=6.1; SD=2.7
  • Comparison
  • N=53
    • 21Boys
    • 32 Girls
    • Mean Age=12; SD=2.7
    • Mean # Traumas=6.6; SD=2.4
children who received cftsi were 73 less likely to meet partial or full criteria for ptsd
Children Who Received CFTSI Were 73% Less Likely to Meet Partial or Full Criteria for PTSD



adapting cftsi for child advocacy centers cacs
Adapting CFTSIfor Child Advocacy Centers (CACs)
  • Implementation of CFTSI with sexually and physically abused children seen in CACs
  • Initial collaboration with Safe Horizon in New York City
  • Further dissemination to additional CACs nationally
overview of safe horizon
Overview of Safe Horizon
  • Safe Horizon is the nation’s leading victim assistance organization, moving thousands of victims of violence and abuse from crisis to confidence each year
  • Our mission is to provide support, prevent violence, and promote justice for victims of crime and abuse, their families and communities
  • We have 35 years of experience in expert service delivery
safe horizon s child advocacy centers
Safe Horizon’sChild Advocacy Centers
  • Safe Horizon is the only organization in the country to operate four and soon to be five fully co-located, nationally accredited CACs in an urban setting
  • Each year, our CACs investigate and respond to over 4,000 cases of sexual abuse and/or severe physical abuse
where we were 2006 2007
Where We Were: 2006-2007
  • Environmental Factors:
    • 148% increase in CAC volume following a tragic, highly publicized child fatality
    • Flat and diminishing CAC funding
  • Organizational Factors:
    • Strategic Plan: Move to standardize service delivery and implement evidence-based practices whenever possible
    • CAC Vision: To provide immediate, expert victim advocacy & therapeutic services to every child victim and impacted family walking through the doors of our CACs
  • CAC Practice:
    • Eclectic CAC services in response to complex and multiple needs of clients
safe horizon yale partnership
Safe Horizon-Yale Partnership:
  • National search for a trauma-focused, brief, evidence-based treatment
  • Development of a flow chart illustrating how a potential CFTSI case progresses through a CAC
  • Development of inclusion/exclusion criteria
  • Development of scripts for introducing CFTSI to families
  • Translation of CFTSI into Spanish
  • Creation of audio versions of informational handouts
where we are now
Where We Are Now:
  • Have successfully adapted and sustained CFTSI at our four CACs for over 5 years
  • Have completed over 730 CFTSI cases
    • Children feel better; Caregivers have learned skills to help their children feel better
    • Staff feel more effective & reduced burnout
    • MDT partners feel more hopeful
    • Funders are very interested in reduction of trauma symptoms- importance of data!
sustaining cftsi over time
Sustaining CFTSI Over Time:
  • Importance of data-evaluation results
  • Strong organizational leadership & agency-wide support
  • Recruitment changes & Ongoing training
  • Expert Monthly Consultation Calls
    • Rotating case presentations with all CFTSI providers & leadership
    • With Clinical Directors
  • Monthly tracking of key CFTSI metrics
evaluation results
Evaluation Results

Results from 12-month evaluation conducted in Safe Horizon’s Child Advocacy Centers

  • Sample Size = 134
  • Trauma type: sexual and physical abuse
  • Statistically significant reductionsin symptoms (p<.001)
  • Symptom severity goes from

clinically significant levels to below clinical levels

caregiver satisfaction survey
Caregiver Satisfaction Survey
  • Completed with caregivers following final CFTSI session
  • N=63
Did you and your child learn about ways/skills to help your child feel better and make the problems and/or reactions your child was having happen less often?
cftsi treatment applications
CFTSI Treatment Applications
  • Current:
    • CAC setting
    • Children in foster care
  • In development:
    • Domestic violence shelter setting
    • Young children (aged 3-6 years)
    • Physically injured children
    • Military families
cftsi dissemination and spread
CFTSI:Dissemination and Spread
  • National trainings
  • Learning collaboratives
  • Train-the-Trainer program