As an attorney, you may come in contact with cases where a child has been traumatized. Effective treatment is important otherwise the trauma can impede normal development. Understanding TF-CBT can help you make appropriate referrals when you learn a child has experienced trauma. People can experience many types of trauma including sexual abuse, domestic violence, natural disasters, terrorism, community violence, and traumatic loss throughout their lifetime, to name a few.

Symptoms related to trauma include:
An inability or unwillingness to recall details of the trauma
Intrusive thoughts about the trauma
Emotional and physical numbing
Recalling physical sensations that occurred during the trauma
Difficulty staying still or fidgeting
Disturbed sleep routines
Rapid changes in mood
Difficulty concentrating
Irritability or depression
Anxiety
Low self-esteem
Inability to trust others
Drug use
A desire to hurt oneself or others

In children, symptoms can lead to problems at school, isolation, and conflicts with parents and peers. If symptoms are not addressed, they can impede a child’s normal development. Thus it is vital a child get treatment for their trauma.

Trauma focused cognitive behavioral therapy has been widely researched and there are proven results! Studies have shown TF-CBT to be more effective than other therapeutic interventions in addressing trauma symptoms. Over 80% of children show significant improvement within 12-16 weeks of weekly treatment. Improvements are seen in PTSD symptoms along with depression, anxiety, behavior problems, trauma related shame, interpersonal trust, and social competence.

TF-CBT is a treatment model targeting children ages 3-18 who have developed significant emotional or behavioral difficulties following exposure to trauma. Treatment includes individual sessions with the child, individual sessions with a non-offending parent/caregiver, and joint parent-child sessions to maximize progress. It integrates cognitive and behavioral interventions with traditional child abuse therapies to teach children how to examine their thoughts, feelings, and behaviors and how to change these in order to feel better. Treatment is guided by assessment measures that are completed by both the child and caregiver to provide the most individualized care. Therapy incorporates gradual exposure to trauma details to build the child’s confidence and competence. The best part of this treatment for children is that sessions are designed to be fun!

The child will learn others have survived similar experiences and the trauma was not their fault. They will have the opportunity to discuss details about their trauma in a supportive and nurturing environment.

Children will learn to:
Use adaptive skills to handle stress
Identify feelings and learn how to manage them
Relax and tolerate trauma reminders
Identify negative thoughts and replace them with more helpful ones
Resolve problems
Implement safety skills

Parents/caregivers will have the opportunity to explore their own thoughts and feelings about their child’s experience and resolve their own distress. Parents will learn many of the same skills being introduced to their child in addition to learning effective parenting skills and ways to provide optimal support to their child.

Forensic considerations when recommending TF-CBT:
1) TF-CBT is NOT a form of evaluation. Referrals should be made only following an identifiable trauma and when the child is displaying symptoms. For a child to be a candidate for TF-CBT they need to be in a safe living situation, having no contact with the alleged perpetrator. There also needs to be a stable, supportive caregiver able to engage in treatment with the child regularly.

2) It should also be noted the trauma narrative is not a forensic tool. The narrative should not be used or viewed by others outside of the therapy setting. The purpose of the trauma narrative is for the child to be able to address maladaptive thoughts contributing to ongoing symptoms. The goal is for the child to make meaning out of their experiences, identify times where they took action to keep themself safe, and be able to talk about their trauma without becoming overwhelmed with anxiety or other intrusive symptoms.

For more information about TF-CBT and whether it could be right for a child, you can:

– Call Dr. Tina Lepage for more general information/case consult, 919-572-0000.
– Contact Dr. Colleen Hamilton at Diverse Family Services (serving children with Medicaid), 919-572-8833.
– Contact Jordan Motta, Mental Health Clinician and Intake Coordinator at Duke Center for Child and Family Health, 919-385-0710.