Child and Family Traumatic Stress Intervention (CFTSI) is an early intervention and secondary prevention model that aims to reduce traumatic stress reactions and posttraumatic stress disorder (PTSD). It is delivered to children aged 7–18 years, together with their parent or caregiver, after the child has experienced a potentially traumatic event (PTE). Examples of PTEs are events such as sexual and physical abuse, domestic violence, community violence, rape, assault, and motor vehicle accidents. Children are referred by law enforcement, child protective services, pediatric emergency rooms, mental health providers, forensic settings, and schools.
Given in four brief, manualized sessions, the goals of CFTSI are to:
- Improve screening and identification of children impacted by traumatic stress
- Reduce traumatic stress symptoms
- Increase communication between the caregiver and the child about the child’s traumatic stress reactions
- Provide skills to help master trauma reactions
- Assess the child’s need for longer-term treatment
- Reduce concrete external stressors (e.g. housing issues, systems negotiation, safety planning, etc.)
In the first session, treatment providers meet with the parent or caregiver alone. The process is explained step-by-step and its intervention, rationalized. Providers use a psycho–educational approach when explaining typical reactions to PTEs and the importance of familial support. A series of questionnaires are completed in order to assess the parent or caregiver’s psychological status throughout the intervention. During this session, providers discuss external stressors related to the PTE, and a case management plan is set up.
The second session occurs as close to the first session as possible and includes the provider, child, and parent or caregiver. The first half of this session starts with just the provider working with the child. This is followed by the provider, child, and parent or caregiver together. The second half of this session lays the groundwork for future aspects of the intervention. A series of questionnaires, similar to those given to the parent or caregiver during session 1, are also completed by the child. Then answers from both participants are compared. Areas of agreement are praised and areas of disagreement are seen as opportunities to improve communication by helping the child learn how to better inform the parent or caregiver about their symptoms and helping the parent or caregiver be more aware, receptive, and supportive of the child. Providers end the session by providing the child and parent or caregiver with behavioral skill modules to work on as homework before the next session. These areas include sleep disturbance, depressive withdrawal, tantrums, intrusive thoughts, anxiety, and techniques to manage traumatic stress symptoms.
The third session includes all three participants, where the child completes questionnaires, with the parent or caregiver providing perspective on the items mentioned. The main emphasis is adjustment of communication efforts to improve the effectiveness of behavioral skill modules as well as other supportive measures.
The final session is delivered almost identically as the third, with the end of this session focused on future check-ins and possible plans for more extensive treatments.
7 to 17
Posttraumatic Stress Disorder (PTSD)
At the 3 month follow-up, Berkowitz, Stover, and Marans (2010) found that youth in the Child and Family Traumatic Stress Intervention (CFTSI) group had significantly lower posttraumatic and anxiety scores than comparison youth. The CFTSI group was significantly less likely to have PTSD at follow-up, reducing the odds of PTSD by 65 percent. CFTSI reduced the overall odds of partial or full PTSD by 73 percent. There were significant differences between groups in reexperiencing (85 percent comparison versus 57 percent CFTSI) and avoidance (37 percent comparison versus 17 percent CFTSI) but not in hyperarousal. There were also significant differences at follow up in severity of PTSD symptoms (14.74 comparison versus 8.70 CFTSI).
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