Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
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. Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Teens (13 to 18 years of age) with emotional and behavior problems

For children/adolescents ages: 13 – 18

Brief Description

The Fairy Tale Model is a model of trauma-informed psychotherapy and is so named because it is taught with the telling of a fairy tale, in which each element of the story corresponds to one of the phases in treatment. Following the treatment manual, Treating Problem Behaviors: A Trauma-Informed Approach, this phase model of trauma-informed treatment calls for a given phase of treatment to be pursued until the client outcome specified for that phase has been achieved. The treatment manual has scripted interventions for working with teens individually.

Program Goals:

The goals of the Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) are:

  • Recognizing the trauma/loss contribution to the presenting problem
  • Improving motivation
  • Improving stability and self-management skills
  • Resolving trauma/loss memories
  • Anticipating future challenges

Essential Components

The essential components of the Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) include:

  • The Fairy Tale Model is so named because the model is taught to therapists via the telling of a fairy tale, in which each element of the story corresponds to one of the phases in treatment. For example, the hero’s love for the princess (which moves him to try to slay the dragon) represents the treatment phase in which the client’s motivation is identified and developed.
  • Treatment is continued within a given phase until that phase’s associated client outcome is achieved -- or at least achieved as far as possible. For example, the therapist works with the client on goals and motivation until the client has identified personal goals and has stated a determination to work to achieve those goals. The phases are as follows:
    • Evaluation including learning about the client's strengths, resources, trauma/loss history, life situation, and presenting problems
    • Identification and enhancement of the client's goals and motivation
    • Trauma-informed case formulation and treatment contracting
    • Stabilization, potentially including case management, parent training, problem-solving, and strategic avoidance of high risk situations
    • Identification and enhancement of coping and affect tolerance skills
    • Resolution of trauma and loss memories
    • Consolidation of gains
    • Anticipation of future challenges
  • The Fairy Tale Model is a system of guiding the client to achieve specified outcomes in a set order. Fidelity to the model entails sequentially working towards each of these outcomes. How this is done is up to the therapist, which can make the model adaptable to culture and other contexts. Thus, for example, trauma resolution might be accomplished with Eye Movement Desensitization and Reprocessing (EMDR), Progressive Counting, or any other effective method. Throughout the manual, selected interventions have been scripted to facilitate mastery and replicability.
  • In the manual, it is stated that the therapist may use any other effective method that the therapist believes is suited to the client. For example, it is suggested that many of the outcomes can be achieved with research-supported interventions in the various areas (e.g., motivation and engagement, parent training, self-management skills training, trauma resolution, relapse prevention). However, the research evidence reviewed for this program only used the scripted interventions as found in the manual.
  • Much of the work is typically done individually, with some being done in group or milieu settings.

Child/Adolescent Services

Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) directly provides services to children/adolescents and addresses the following:

  • Problem behaviors (including aggression, oppositionality, substance abuse/addiction, crime, school/work failure, etc.), anxiety, depression, and posttraumatic stress disorder (PTSD)

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) includes a homework component:

Homework may be assigned on occasion for reasons specific to a given case. There is no standardized homework requirement. However, if/when self-management skills training is involved – if/as needed for the client to achieve the designated outcomes of the associated phase of treatment – then it is fairly common for the therapist to assign practice in whatever skills were being worked on in session. This generally simply means that the client should make an effort to handle some identified challenging situation in the better way that was discussed/practiced in session.

Languages

Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) has materials available in languages other than English:

Canadian French, Dutch

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:

The typical resources required to conduct psychotherapy and – depending on the type of case – related activities (e.g., case management) as appropriate.

Minimum Provider Qualifications

The core of the Fairy Tale Model requires one or more psychotherapists -- in the USA, typically Master’s level or higher -- who are trained in the model.

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:

Presently trainings are offered in various locations in the Northeast, as well as onsite for agencies & institutions nationally and internationally.

Distance learning programs are also available.

Number of days/hours:

The training program is 5 days long (typically 4 straight days, and then two half-day follow-up sessions by web-based videoconference). There is also a 14-day (over 9 months) Certificate Program which is more comprehensive.

Implementation Information

Since Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) 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

There are no pre-implementation materials to measure organizational or provider readiness for Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach).

Formal Support for Implementation

There is formal support available for implementation of Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) as listed below:

Dr. Ricky Greenwald, the program developer, will provide consultation for implementation, upon request.

Fidelity Measures

There are fidelity measures for Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach) as listed below:

A treatment fidelity rating scale is available and has been used in previous research. The scale would be completed by a mental health professional who is trained in the Fairy Tale Model, based on live or video review of sessions. It is available from Dr. Ricky Greenwald, the program developer.

Implementation Guides or Manuals

There are no implementation guides or manuals for Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach).

Research on How to Implement the Program

Research has not been conducted on how to implement Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach).

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

Show relevant research...

Farkas, L., Cyr, M., Lebeau, T., & Lemay, J. (2010). Effectiveness of MASTR/EMDR therapy for traumatized adolescents with conduct problems. Journal of Child & Adolescent Trauma, 3, 125-142.

Type of Study: Randomized controlled trial
Number of Participants: 40

Population:

  • Age — 13-17 years
  • Race/Ethnicity — Not specified, all French speaking
  • Gender — 63% Female
  • Status — Participants were adolescents in the child welfare system who were exhibiting conduct problems and internalizing and externalizing behaviors and who had been exposed to maltreatment.

Location/Institution: Quebec, Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined MASTR/EMDR [now called the Fairy Tale Model (Treating Problem Behavior: A Trauma-Informed Approach)], a trauma-focused treatment for traumatized youth taken in charge by youth protective services. Participants were randomly assigned to MASTR/EMDR treatment or to a routine care condition. Measures included the Diagnostic Interview Schedule for Children (DISC), Trauma Symptom Checklist for Children (TSCC), the Child Behavior Checklist (CBCL), and the Lifetime Incidence of Traumatic Events (LITE) and were administered to participants and one of their parents/caregivers at three points in time: pretreatment, posttreatment, and follow-up. Analysis showed that participants in the MASTR/EMDR group had significant improvements in their trauma symptoms and behavioral problems compared with the control group at the posttreatment evaluation. These effects were maintained at a 3-month follow-up. Limitations include the same sample size, high attrition rate (only 40 of the original 65 participants completed the postintervention assessments), and lack of information regarding what the control group received.

Length of postintervention follow-up: 3 months.

Becker, J., Greenwald, R., & Mitchell, C. (2011). Trauma-informed treatment for disenfranchised urban children and youth: An open trial. Child & Adolescent Social Work Journal, 28, 257-272.

Type of Study: One group pretest-posttest study
Number of Participants: 59

Population:

  • Age — 4-19 years (Mean=11.2 years)
  • Race/Ethnicity — 57% Latino, 19% African-American, 17% Caucasian, and 7% No Ethnicity
  • Gender — 37 Male
  • Status — Participants were recruited impoverished youth and families from a multicultural urban neighborhood.

Location/Institution: San Diego

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the use of the Fairy Tale Model [now called Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)] with impoverished, disenfranchised youth and their families. Measures utilized include the Lifetime Incidence of Traumatic Events, Student and Parent Forms (LITE-S, LITE-P), the Impact of Events Scale (IES), the Child Report of Post-Traumatic Symptoms (CROPS), and the Family Empowerment Scale (FES). Results indicate that treatment completers showed clinically and statistically significant gains on all three of the posttraumatic stress outcome measures, in each case moving from the clinical to the normal range. The FES showed no change from pretreatment to posttreatment. Limitations include lack of a control group, absence of data on number of sessions delivered, and nonblind administration of outcome measures.

Length of postintervention follow-up: None.

Greenwald, R., Siradas, L., Schmitt, T. A., Reslan, S., Sande, B., & Fierle, J. (2012). Implementing trauma-informed treatment for youth in a residential facility: First-year outcomes. Residential Treatment for Children & Youth, 29(2), 141-153.

Type of Study: One group pretest-posttest study
Number of Participants: 48

Population:

  • Age — 10-21 years
  • Race/Ethnicity — 48% African-American, 33% Caucasian, 13% Hispanic, and 6% Biracial
  • Gender — 37 Male
  • Status — Participants were youth in a residential facility.

Location/Institution: San Diego

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes archival data from January 1, 2008, to December 31, 2009, to report on the effects of the Fairy Tale Model [now called Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)]. Training in the Fairy Tale Model of trauma-informed treatment was provided starting in January 2009 to clinical and direct care staff working with youth in a residential treatment facility. The measure used was the Problem Rating Scale (PRS). Results indicate that compared to the year prior to receiving training, the average improvement in presenting problems was increased by 34%, time to discharge was reduced by 39%, and rate of discharge to lower level of care was doubled. Limitations include lack of comparison group and the uneven delivery of therapy, making it difficult to determine if the Fairy Tale Model training was what led to the changes.

Length of postintervention follow-up: None.

References

Greenwald, R. (2003, Spring). The power of a trauma-informed treatment approach. Children’s Group Therapy Association Newsletter, 24(1), 1, 8-9.

Greenwald, R. (2009). Treating problem behaviors: A trauma-informed approach. New York: Routledge.

Contact Information

Name: Ricky Greenwald, PsyD
Agency/Affiliation: Trauma Institute & Child Trauma Institute
Website: www.childtrauma.com/treatment/phase-model
Email:
Phone: (413) 774-2340

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: May 2017

Date Program Originally Loaded onto CEBC: December 2013