The information in this program outline is provided by the program representative and edited by the CEBC staff. The Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) program has been reviewed by the CEBC in the area of: Sexual Behavior Problems in Children, Treatment of, but lacks the necessary research evidence to be given a Scientific Rating.

• Type of Maltreatment: Sexual Abuse
• Target Population: Children ages 4-11 who have a history of child sexual abuse (CSA) and are exhibiting problematic sexual behavior (PSB).

The SMART Model is an innovative, structured, phase-based, abuse-focused treatment approach to address the emotional and behavioral needs of young children with a history of child sexual abuse (CSA) exhibiting problematic sexual behavior (PSB). A major premise of the model is that the PSB stems from emotional responses to the prior CSA causing the child to form cognitive distortions about themselves, others, and the world around them. The family unit is a major target of treatment. Important aspects of family values and beliefs are integrated into the model including examining the family power structure, perceptions regarding sexuality, gender roles and identity, stigmatization of mental health, and spirituality. Unique to the model is the formation of parallel narratives of the child’s experiences as a victim and as one who victimizes others and the development of a family narrative that addresses the impact and difficulties associated with caring for a child with a history of CSA and PSB.

The goals of the Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) model are to:

• Reduce/eliminate the PSB.
• Address the dual-treatment needs of the child as a victim and one who victimizes others.
• Establish stability and a sense of safety for the child and their family.
• Increase the child’s and family’s awareness of personal and familial risk patterns and triggers.
• Develop coping skills and strategies aimed at improving emotional and behavioral regulation across domains (home, school, and community).
• Build a strong resource structure that will support the family across the child’s life trajectory.

The Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) model consists of three clinically essential phases: Safety & Stabilization, Trauma Integration & Recovery, and Re-Socialization & Mastery. Each phase contains content modules that must be mastered in order to move to the next phase of treatment. Each module includes specific activities and interventions. The SMART Model includes a treatment guide that was developed as a mechanism to standardize and promote fidelity of the model and a specialized treatment workbook. The treatment guide offers indicators of mastery to inform and guide clinical practice. Another unique aspect of the model is that key themes are interwoven within each phase including the use of psycho-education, safety contracting and monitoring, and skill building.

Safety & Stabilization - The initial phase of treatment focuses on:

• Trauma Assessment of the child
• Risk Reduction Plan with a focus on safety
• Family and Community Engagement – Family engagement and the formation of a strong therapeutic relationship are critical.

Trauma Integration & Recovery - The second phase of the model focuses on:

• Impulse Regulation – helping the child regulate his/her behavior
• Affect Modulation - Helping the child regulate his/her emotions
• Trauma Triggers - helping the child understand what might bring the unwanted behaviors and emotions back
• Cognitive Processing – helping the child develop coping and problem-solving skills
• Trauma Narratives – helping the child be able to talk about what happened

Re-socialization & Mastery -The final phase of the model focuses primarily on relapse prevention and supports the child and family to integrate all the skills learned into daily practice:

• Stress/Relaxation – learning to recognize stress and use relaxation skills to alleviate the stress
• Healthy Intimacy – learning to be comfortable with his/her own body
• Self-esteem – teaching the child about self-esteem and helping them acquire it
• Relapse Prevention – integrating above learned skills into daily practice

Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) was designed with a child component that addresses the following presenting problems and symptoms:

• Problematic sexual behavior, placement instability, safety contracting, PTSD symptoms, feelings of shame, distorted beliefs about self and others, and symptoms of anxiety and depression.

Age range: 4 – 11

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Has a child with problematic sexual behavior (PSB) and failure to recognize familial patterns and communication that exacerbate the PSB. May also be experiencing trauma-related emotional distress.

Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family involvement is mandatory at least 2x per month. There are family activities included in the treatment workbook. Extensive safety planning and formal and informal resources are identified and hopefully developed to support the child and family at home, at school, and in the community.

Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Recommended Intensity:

Number of contacts per week is tailored to the specific needs of the family and is based on risk and family stability. The average length of sessions is 50 minutes.

Recommended Duration:

12-18 months. This may vary with the number of contacts per week as needed by the family.

This program is typically conducted in a(n):

• Outpatient Clinic

This program does not include a homework component.

Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) does not have materials available in a language other than English.

The typical resources for implementing the program are:

• A trained clinician
• Confidential space to conduct sessions
• Treatment guide and workbook
• Therapeutic books and supplies
  
• Crayons, markers, and colored pencils
  

Master’s Degree in Counseling, Psychology, or Social Work and training in the intervention. At least one year’s experience working with children and families impacted by childhood sexual abuse and other childhood traumas.

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

Training Contact:

• Betsy Offermann, LCSW-C
  offermann@kennedykrieger.org
  phone: (443) 923-5907

Training is obtained:

Training can be provided onsite at an agency, or at The Family Center at the Kennedy Krieger Institute.

Number of days/hours:

Initial 2-day didactic training prior to implementation, follow-up monthly consultation calls, and 1-day advanced training to be delivered approximately 6 months later

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

No reference materials are currently available for Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART).