Attachment, Regulation, and Competency (ARC) [Trauma Treatment - System-Level Programs (Child & Adolescent)]

Scientific Rating:
NR
Not able to be Rated
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Attachment, Regulation, and Competency (ARC) [Trauma Treatment - System-Level Programs (Child & Adolescent)] has been reviewed by the CEBC in the area of: Trauma Treatment - System-Level Programs (Child & Adolescent), but lacks the necessary research evidence to be given a Scientific Rating.

Target Population: Organizational systems (e.g., residential programs, schools, group homes, hospital settings, etc.) working with and supporting children/adolescents/young adults (0-21 years) who have experienced chronic/complex trauma and their caregivers

For organizations that serve children ages: 0 – 21

Brief Description

ARC is a core components framework designed to support organizational change in agencies that work with youth and families who have experienced complex trauma. The framework is organized around the core domains of attachment (i.e., building safe caregiving systems), regulation (i.e., supporting youth regulation across domains), and developmental competency (i.e., supporting factors associated with resilient outcomes); and is designed to be translatable across service systems. In organizations/systems implementing ARC, (e.g., within a residential program, school, inpatient center, etc.) the system itself is a key target of intervention, with change efforts focused on development of trauma-informed systems structures. ARC can also be used as a client-level trauma treatment intervention on its own or in combination with the system-level program, click here to go to the program’s entry in the Trauma Treatment-Client Level Interventions (Child & Adolescent) topic area.

Program Goals:

The goals for Attachment, Regulation, and Competency (ARC) [Trauma Treatment - System-Level Programs (Child & Adolescent)] are:

  • Integrate routine, rhythms, and structures into intervention approaches and daily functioning to increase felt safety and support skill development
  • Support adult caregivers including milieu staff, administrators, support staff, and educators in understanding and managing their own responses to youth in their care
  • Build adult/provider/caregiver capacity to effectively understand and respond to the needs driving youth behaviors
  • Support effective responses to youth behavior that are trauma-informed and that increase, rather than decrease, safety
  • Build child/adolescent understanding of emotional and physiological experience, including a language for experience and an ability to connect and contextualize emotional cues, through systematic approaches that engage youth in reflecting upon their internal experience
  • Build child/adolescent ability to effectively manage and tolerate emotional and physiological experience through systematic approaches to supported regulation
  • Build organizational structures and supports to engage and support children/adolescents in building and sustaining relational connections with others
  • Support children/adolescents in recognizing choice points, managing impulsive behaviors, and actively making choices through staff/caregiver training and systematic structures that support active problem evaluation, decision-making, and empowerment in youth
  • Engage systems in developing activities and approaches that support youth understanding of self, including unique characteristics and influences, coherence across time and situations, sources of efficacy and esteem, and future template
  • Build organizational structures and systems that support youth in reflecting upon, processing, and developing a narrative of traumatic experience, and integrating this into a coherent and comprehensive understanding of self

Essential Components

The essential components of Attachment, Regulation, and Competency (ARC) [Trauma Treatment - System-Level Programs (Child & Adolescent)] include:

  • Emphasis on developing child, family, and provider engagement and stake in the organizational framework
  • Integration of psychoeducation about traumatic stress at all levels of the work (e.g., system, providers, caregivers, child), including systematic approaches to both foundational and ongoing staff/provider training
  • Integration of and attention to the use of routine and rhythm in organizational approach and structure
  • Attention to staff and, if applicable, primary caregiver emotional experience through attention to staff systemic supports and structures (i.e., supervision)
  • Engaging and building a curious, attuned stance among adult caregivers (e.g., staff, providers, administrators), including an understanding of the trauma-related drivers of behavior and skill in mirroring and responding to youth needs
  • System-level approaches to addressing youth behavior that integrate an understanding of the drivers of that behavior and a trauma-sensitive, individualized behavioral approach
  • Active, proactive attention to supporting youth physiological, emotional, and behavioral regulation through development of systematic regulation supports and routine engagement in modulating strategies
  • Routine integration in treatment plans and milieu processes of attention to and support for development of youth strengths and competencies as a core element of intervention

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Foster/Kinship Care
  • Homeless Shelter
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - System-Level Programs (Child & Adolescent)] has materials available in languages other than English:

Dutch, Spanish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Commitment of administration to the implementation process; personnel willing and able to commit the time/effort into training and consultation, along with identified change processes. The training/implementation process in a service system typically requires a commitment of a minimum of one-year; systems should anticipate a typical 3-year process of building sustainable organizational change. No specific concrete resources are viewed as essential, as the program is adaptable to the real-world setting in which it is implemented.

Minimum Provider Qualifications

Integration of ARC into a system requires the appropriate education/licensure/certification of each staff member as required by their position/profession.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training may be provided on-site to a contracting agency; consultation is typically remote. The two-day foundational training is also available several times/year as an open-registration workshop.

Number of days/hours:

The standard foundational training is 2 days; minimum suggested follow-up consultation is at least one year (1-3 hours/month) for systems change initiatives. In an organizational system offering clinical services, systems change efforts typically incorporate both clinical and systems-focused consultation.

Relevant Published, Peer-Reviewed Research

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Child Welfare Outcomes: Not Specified

Show relevant research...

Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., … Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34-51.

Type of Study: One group pretest-posttest study
Number of Participants: 93

Population:

  • Age — Children: 3-12 years; Parents: Not specified
  • Race/Ethnicity — Children: 65.6% American Indian/Alaska Native, 39.8% Caucasian, 20.4% African American, 4.3% Native Hawaiian/Pacific Islander, 2.2% Asian; Parents: Not specified
  • Gender — Not specified
  • Status — Participants were caregivers and children in the child welfare system who have were exposed to multiple traumatic experiences.

Location/Institution: Alaska Child Trauma Center at Anchorage Community Mental Health Services

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article introduces the Attachment, Self-Regulation, and Competency (ARC) model [now called Attachment, Regulation, and Competency (ARC)] and describes its application with young children of diverse ethnocultural backgrounds involved in the child protection system due to maltreatment. Measures included the Trauma Symptom Checklist-Alternate Version (TSCC-A), the UCLA PTSD Index for DSM IV, and the Child Behavior Checklist (CBCL). Results indicate that comparing clients who completed ARC and those who ended treatment early, those completing treatment demonstrated a far greater level of improvement in CBCL scores. Children completing treatment also achieved a high rate of permanent placement. Limitations include reliance on self-report measures, high drop-out rate, and lack of follow-up.

Length of postintervention follow-up: None.

Hodgdon, H., Kinniburgh, K., Gabowitz, D., Blaustein, M. & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in residential schools using the ARC framework. Journal of Family Violence, 28, 679-692.

Type of Study: One group pretest-posttest study
Number of Participants: 126

Population:

  • Age — Children: Mean=16.1 years, Parents: Not specified
  • Race/Ethnicity — Children: 87% White, 19% Black, 6.4% 1% Asian, 1% Indian, and 18% Other; Parents: Not specified
  • Gender — Children: 100% Female, Parents: Not specified
  • Status — Participants were youth in residential centers in the child welfare system who have were exposed to multiple traumatic experiences

Location/Institution: Two residential treatment programs in Massachusetts

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article describes the feasibility, utility and efficacy of Attachment, Self-Regulation and Competency (ARC) [now called Attachment Regulation, and Competency (ARC)] in 2 residential treatment settings serving female youth with histories of complex childhood trauma. ARC was provided at a system level for both sites, but not at a group or individual level for all residents at both sites. Measures included the Child Behavior Checklist (CBCL) and the UCLA PTSD Reaction Index (PTSD-RI). Results indicated that youth at the two targeted programs demonstrated a significant decrease in trauma-related symptoms over the course of the project period. Notably, youth receiving the ARC client-level intervention evinced a significant decrease in their overall level of PTSD symptoms, driven by decreases in their Criterion B (re-experiencing) and D (hyperarousal) symptoms. Youth also displayed decreases in aggressive behaviors, attention problems, rule breaking behaviors, anxiety, depression, thought problems, and somatic complaints over the course of the project period, as measured by the CBCL. Limitations include nonrandomization of participants, lack of control group, and reliance on self-report measures.

Length of postintervention follow-up: None.

References

Blaustein, M., & Kinniburgh, K. (2016, in preparation). The Attachment, Regulation, and Competency (ARC) treatment model. In M. Landolt, U. Schnyder, and M. Cloitre (Eds.). Evidence-based treatments for trauma-related disorders in children and adolescents, Springer International Publishing.

Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford Press.

Ford, J., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental trauma therapy models. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models (pp. 261-276). New York: Guilford Press.

Contact Information

Name: Margaret Blaustein, PhD
Agency/Affiliation: Trauma Center at Justice Resource Institute
Website: www.traumacenter.org
Email:
Phone: (617) 232-1303 or (617) 232-1280

Date Research Evidence Last Reviewed by CEBC: April 2016

Date Program Content Last Reviewed by Program Staff: June 2016

Date Program Originally Loaded onto CEBC: August 2016