Trauma-Focused Cognitive Behavioral Therapy with Young ... · Trauma-Focused Cognitive Behavioral Therapy with Young Children and Their Families Alison Hendricks, LCSW ... • Use

Trauma-Focused Cognitive Behavioral Therapy with Young Children and Their

Families

Alison Hendricks, LCSW Hendricks Consulting

Learning Objectives Participants will:

�  Identify key developmental considerations when working with young children who have experienced trauma

�  Improve skills in assessing trauma among young children

�  Describe PRACTICE interventions for young children

�  Identify resources for implementing TF-CBT with young children and their families

Hendricks Consulting

Developmental Considerations in TF-CBT

�  Young children �  Developmental impact of trauma �  Egocentric and magical thinking �  Attachment issues �  Symptom presentation �  Ability to engage in CBT �  Creative interventions

�  Use of play for engagement and sensory processing of preverbal trauma

�  Parent involvement


Signs of Trauma in Young Children

�  Feeling helpless and uncertain

�  Fear of being separated from parent/caregiver

�  Crying or screaming a lot

�  Eating poorly and losing weight

�  Regressive behaviors

�  Developing new fears

�  Nightmares

�  Traumatic play

�  Developmental delays

�  Changes in behavior

�  Asking questions about death

�  www.nctsn.org

Trauma Assessment with Young Children

•  Assessment – developmental level, primary symptoms, caregiver issues

•  UCLA PTSD Index – Parent Version

•  Child Stress Disorders Checklist

•  Ages 2-18, observer report measure of trauma symptoms completed by caregiver or professional

•  Sample item: Child startles easily. For example, s/he jumps when hears sudden or loud noises.

•  Available at: http://www.nctsnet.org/nctsn_assets/acp/hospital/CSDC.pdf


Trauma Assessment with Young Children (continued)

•  Post-Traumatic Symptom Inventory for Children

•  Self-report PTSD symptom measure for children ages 4-8; contact [email protected] to obtain measure

•  Sample item: Some children think about really bad things that happened to them. Do you think about really bad things that happened to you? Do you think about these bad things a whole lot like everyday or just sometimes?

•  Diagnostic Infant and Preschool Assessment

•  Caregiver interview for children 9 months-6 years; self-contained modules for 13 diagnostic categories

•  Sample item: Does s/he try to avoid any things or places that might remind him/her of the trauma? I mean, can you tell that s/he is trying to avoid a reminder before s/he becomes upset?

•  Available at: http://www.infantinstitute.com/


Psychoeducation and Parenting Skills with Young

Children and Their Families

•  Brave Bart, Red Flag Green Flag, When Mommy Got Hurt, A Safe Place, Good Touch/Bad Touch, What Do You Know? Game, Radio/Talk Show

•  Educating parents about impact of trauma on young children and their development is key

•  http://www.nctsn.org/resources/audiences/parents-caregivers

•  Help caregiver identify and deal with trauma triggers

•  Behavioral interventions to address trauma reactions


Relaxation for Young Children

•  Bubbles, pinwheel, belly breathing games

•  Robot/rag doll, Hokey Pokey

•  Yoga Pretzels

•  Belly breathing with Elmo

•  Parents to model and help soothe


Affective Expression and Regulation

•  Feelings Charts, Feelings Charades, Feelings Balloons, Color My World/Color Your Heart, books, Candy Land, Sad Mad Glad Game, “If You’re Happy and You Know It,” Weather Report,

•  Feelings Basket, Feelings Abacus

•  Coping Box, Scavenger Hunt List

•  Educate parents on social emotional development, being an emotional container, and teaching/modeling coping skills

•  Emotional support and self-care for caregivers


Cognitive Coping and Processing

•  Use brain or heart image to teach about happy, sad, scared, and mad thoughts

•  Cognitive triangle

•  Worry Brain

•  Thoughts and feelings balloons

•  Puppets (3 headed dragon)

•  Happy song

•  “Who made it happen?” game

•  Teach parents about common distortions among young children and explore parents’ attributions


Trauma Narrative Development and Processing

•  Baseline narrative

•  Use play to demonstrate cleaning out the wound, role of parent

•  Bibliotherapy: Brave Bart, Please Tell, No No the Little Seal, When Mommy Got Hurt

•  Puppet show, dollhouse, sand tray, dollhouse, picture book

•  Feelings abacus, chips, or cones for SUDS ratings

•  Eliciting sensory details – Mr. Potato Head

•  Use of symbolism

•  Fantasy vs. reality

•  Trauma processing: responsibility pie, best friend role play, affirmations

•  Parent perspective and processing (parent’s and child’s distortions)


No No The Little Seal: The Gentle Story of a Little Seal who Learns to Stay

Safe, Say No, and Tell


In Vivo Mastery of Trauma Reminders

•  Common avoidance problems in young children: separation anxiety, sleeping, generalized fears

•  Identify sensory triggers and develop desensitization plans

•  Work with parent to create and implement the plan

•  Develop hierarchy with orange cones representing units of distress

•  Use of play for desensitization in session


Conjoint Child Parent Sessions

•  Parent preparation

•  Incorporate activities and breaks to keep child engaged

•  Therapist may need to be more active to assist child in sharing the narrative

•  Special rewards


Enhancing Future Safety and Development

•  Role plays, puppet shows

•  Red flag green flag people, Let’s Talk about Taking Care of You/A Workbook for Taking Care of Me (CARES Institute)

•  Hula hoop boundaries

•  My Safe Neighborhood, helpers puzzles

•  Caregiver must be engaged in safety planning

Safe Touch vs. Unsafe Touch


Developmental Considerations for Termination

•  Educate and prepare parents and child for potential setbacks related to developmental transitions

•  Assist child in saying good-bye in developmentally appropriate manner (may use a transitional object)


Contact Information

Alison Hendricks, LCSW

Hendricks Consulting [email protected]

www.ahendricksconsulting.com

(619)549-7958


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Trauma-Focused Cognitive Behavioral Therapy with Young ... · Trauma-Focused Cognitive Behavioral Therapy with Young Children and Their Families Alison Hendricks, LCSW ... • Use