Child and Family Traumatic Stress Intervention (CFTSI)

Scientific Rating:
3
Promising Research Evidence
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. Child and Family Traumatic Stress Intervention (CFTSI) has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Children ages 7-18 recently exposed to a potentially traumatic event, or having recently disclosed physical or sexual abuse, and endorsing at least one symptom of posttraumatic stress

For children/adolescents ages: 7 – 18

For parents/caregivers of children ages: 7 – 18

Brief Description

CFTSI is a brief early intervention model for children and adolescents 7-18 that is implemented soon after exposure to a potentially traumatic event, or in the wake of disclosure of physical and sexual abuse. Developed at the Yale Child Study Center, CFTSI 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. The goal of this family-strengthening model is to improve the caregiver’s ability to respond to, and support, a child who has endorsed at least one posttraumatic symptom. By raising awareness of the child’s symptoms, increasing communication and providing skills to help master trauma reactions, CFTSI aims to reduce symptoms and prevent onset of posttraumatic stress distorder (PTSD). In addition, CFTSI offers an opportunity to assess which children and families need longer-term treatment. CFTSI is provided by master’s-level clinicians who have been trained by CFTSI master trainers.


Program Goals:

The goals of Child and Family Traumatic Stress Intervention (CFTSI) are:

  • Improve screening and identification of children impacted by traumatic stress
  • Reduce posttraumatic stress symptoms
  • Enhance emotional support through increased caregiver-child communication
  • Teach/practice coping skills to reduce trauma reactions
  • Identify and address concrete external stressors (such as safety, legal issues, medical care)
  • Assess child’s need for longer-term treatment

Essential Components

The essential components of Child and Family Traumatic Stress Intervention (CFTSI) include:

  • CFTSI grew out of two decades of responding collaboratively with law enforcement and child protective services partners to provide acute, on-scene, and follow-up post-event interventions to children and families who had been exposed to violence and other potentially traumatic events. As a result of this work, developers recognized the need for an evidenced-based early intervention that would fill the gap between the provision of standardized acute interventions and the evidenced-based, longer-term treatments that are required to deal with enduring posttraumatic reactions. CFTSI, a brief early intervention model, is designed to be implemented shortly after a potentially traumatic event or in the wake of later disclosure of traumatic events (typically sexual abuse) that occurred earlier in a child’s life.
  • Social and family support is one of the most important protective factors for children after exposure to potentially traumatic events. CFTSI attempts to increase the ability of caregiver(s) to support their child by helping to:
    • Increase the child and parental understanding of the possible impact of exposure to potentially traumatic events on symptom formation, behavioral changes and daily functioning (psychoeducation).
    • Increase the child’s ability to communicate feelings and symptoms to caregiver(s).
    • Increase the caregiver(s)’ ability to observe and attend to the child’s behavioral symptoms of distress.
    • Increase caregiver(s)’ ability to respond appropriately and supportively to the child’s difficulties by teaching them:
      • Specific strategies and interventions to do with their child.
      • How to remind themselves and their child about the correlation between behavioral changes, internal feeling states, and the potentially traumatic event.
  • By working with the child and family in these four areas, the goal of CFTSI is to help children feel more supported, which will lead to improved post-exposure outcomes.
  • CFTSI Session Outline:
    • Session 1 - Caregiver Meeting
      • Provide psychoeducation about trauma and trauma symptoms.
      • Assess caregiver(s)’ and child’s traumatic stress symptoms.
      • Address case management issues.
    • Session 2A: Meeting the child alone

      • Provide psychoeducation about trauma and trauma symptoms.
      • Assess child’s traumatic stress symptoms.
    • Session 2B: Family Meeting: Caregiver and child together (key session in CFTSI)
      • Begin discussion by comparing child and caregiver’s reports about child’s trauma symptoms.
      • Identify the specific trauma reactions that will be focused on and introduce coping skills.
    • Session 3: Caregiver and child together

      • Review progress and support communication attempts.
      • Re-assess levels of distress and increased awareness.
      • Practice coping skills and support efforts.
    • Session 4: Caregiver and child together: Case disposition
      • Re-assess levels of distress and increased awareness.
      • Review progress made and support communication attempts.
      • Review coping skills and support efforts.
      • Assess and identify any additional treatment needs or case management needs.

Child/Adolescent Services

Child and Family Traumatic Stress Intervention (CFTSI) directly provides services to children/adolescents and addresses the following:

  • Early posttraumatic distress
  • Posttraumatic adaptive difficulties
  • Pre-existing psychiatric problems

Parent/Caregiver Services

Child and Family Traumatic Stress Intervention (CFTSI) directly provides services to parents/caregivers and addresses the following:

  • Caregiver of child who has potentially been exposed to trauma
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Caregivers, including Foster Parents, participate together with the identified child in each CFTSI session (except for Session 1 when the provider meets only with the caregiver and Session 2a when the provider meets with the child alone prior to the first family session)

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic

Homework

Child and Family Traumatic Stress Intervention (CFTSI) includes a homework component:

Child and parent/caregiver are asked to practice the coping skill taught in the session and are provided a Family Log to record efforts.

Languages

Child and Family Traumatic Stress Intervention (CFTSI) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, 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:

Private meeting space; copies of standardized instruments

Minimum Provider Qualifications

Master’s level trained therapists

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 is offered at a site of the trainee agency’s choosing

Number of days/hours:

2 days for 12 hours total

Implementation Information

Since Child and Family Traumatic Stress Intervention (CFTSI) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Child and Family Traumatic Stress Intervention (CFTSI).

Fidelity Measures

The program representative did not provide information about fidelity measures of Child and Family Traumatic Stress Intervention (CFTSI).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Child and Family Traumatic Stress Intervention (CFTSI).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Child and Family Traumatic Stress Intervention (CFTSI).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Berkowitz, S., Stover, C. S., & Marans, S. (2010). The Child and Family Traumatic Stress Intervention: Secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry, 52(6), 676-685.

Type of Study: Randomized controlled trial
Number of Participants: 106

Population:

  • Age — 7-17 years
  • Race/Ethnicity — 37% African American, 32% Caucasian, 22% Hispanic, 7% Multiethnic, and 2% other ethnicities
  • Gender — 52% Female and 48% Male
  • Status — Participants were children exposed to events that can lead to posttraumatic stress disorder (PTSD) .

Location/Institution: Yale Child Study Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Child and Family Traumatic Stress Intervention (CFTSI) to prevent the development of chronic PTSD when provided within 30 days of exposure to a potentially traumatic event. Youth were randomly assigned to CFTSI or a 4-session control group. Measures utilized were the Trauma History Questionnaire (THQ), the Parent Behavior Inventory (PBI), the Perceived Social Support-Family (PSS-Fa), the UCLA Posttraumatic Stress Disorder Index (PTSD-RI), the Behavior Assessment System for Children, Second Edition-Self Report (BASC-2), the Child Behavior Checklist (CBCL), the PTSD Checklist-Civilian Version (PCL-C), and the Trauma System Checklist for Children (TSCC). Results show that at follow-up, the CFTSI group demonstrated significantly fewer full and partial PTSD diagnoses than the control group; in addition, the CFTSI group had significantly lower posttraumatic and anxiety score than the comparison group. This study is limited due to high sample attrition.

Length of postintervention follow-up: 3 months.

References

Marans, S., Epstein, C., & Berkowitz, S. (2011). The CFTSI provider manual: Adaptation for children in foster care. Yale Childhood Violent Trauma Center: New Haven, CT.

Marans, S., Hahn, H., Epstein, C., Arnow, N., & Roberts, L. (2012). The Safe Horizon-Yale Child Study Center Partnership: Offering hope for abused children. (White Paper). Yale Childhood Violent Trauma Center: New Haven, CT.

Contact Information

Name: Hilary Hahn, MPH, EdM
Agency/Affiliation: Yale Childhood Violent Trauma Center
Email:
Phone: (203) 737-6304
Name: Carrie Epstien
Title: Director of Training
Agency/Affiliation: Yale Childhood Violent Trauma Center
Email:

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: October 2012

Date Program Originally Loaded onto CEBC: October 2012