The Intergenerational Trauma Treatment Model (ITTM)
The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been reviewed by the CEBC in the following Topic Areas:
About This Program
Target Population: Children ages 3-18 and their parents/caregivers burdened by the impact, symptoms and behaviors of traumatic events or unacceptable living conditions
For children/adolescents ages: 3 – 18
For parents/caregivers of children ages: 3 – 18
ITTM targets and treats not only the child's complex trauma, but the caregiver's unresolved childhood trauma history. When a family is impacted by trauma, the child-adult relationship is also threatened. Caregivers parenting a traumatized child frequently have unresolved trauma themselves and are frequently clinically depressed which makes it difficult for them to be emotionally available to their hurting child. Their distress is often unintentionally acted out on the child whose misbehavior is "triggering" the caregiver's own history of victimization.
The majority of families referred to ITTM are “at risk,” financially vulnerable, or receiving social assistance. The intrinsic motivation levels, productivity and employability are frequently compromised. Many of the children’s caregivers are struggling in core domains such as school, social arenas, and within their own families. Others are early year’s families, families with very young parents, or children no longer living with their family of origin.
ITTM is designed to treat the unresolved trauma impact from childhood in parents & other caregivers prior to engaging the child in treatment (aged 3-18 years). The caregiver can include any adult with long-term involvement with the child. In effect, ITTM treats two generations at once, increasing the functioning of both child and parent.
The model is consistent with recommendations of the Complex Trauma Working Committee and provides clinicians with a manual- phase-based method of reaching treatment goals. The model includes activities to address:
- Attachment and emotional attunement issues between child and caregiver
- Regulation of caregiver and child affect
- Safe expression and processing of trauma experiences
- The development of parent competency and self-efficacy
Psycho-educational, cognitive-behavioral and attachment-informed strategies of intervention are employed. ITTM also focuses on the primacy of parents to children’s change and on directly addressing the intergenerational nature of trauma.
The goals of The Intergenerational Trauma Treatment Model (ITTM) are:
- Eliminate waitlists
- Directly address caregivers’ traumatic experiences and the resulting impact on the parent-child relationship and the strength of that relationship
- Resolve caregivers’ unresolved traumatic impact from childhood which is critical to achieving sustained changes in children’s emotional and behavior symptoms
- Significantly reduce emotional and behavioral symptoms so that stronger bonds to caregiver will occur in children
- Interrupt the intergenerational transmission of trauma which is a key mechanism of change
- Engage and treat the caregiver which should result in greater changes in emotional dysregulation, efficacy, empathy, and effectiveness
- Ensure a good cross section of professionals who provide treatment services to families are trained in the ITTM program, so that it can be delivered frequently and in centers that are most accessible to the parents/caregivers who make referrals
- Ensure referrals are facilitated as simply as possible for referring families
The essential components of the Intergenerational Trauma Treatment Model (ITTM) include:
- Three Treatment Phases:
- Phase A -
- ITTM Practitioners deliver six, 90-minute Trauma Information Sessions (TISs) within a course-like setting. The sessions have a recommended size of 15-30 parents per group.
- The six sessions are psycho-educational in nature and provide current information on the effects of trauma on children, adults, and families.
- Advanced Cognitive-Behavioral Therapy (CBT) diagrams are utilized as the primary clinical skills method.
- The diagrammatic structures integrate principles of trauma, attachment, and CBT.
- The TIS material achieves four goals to:
- Sensitize caregivers to the child's experience of trauma
- Strengthen caregiver's ability to respond effectively to the traumatized child
- Challenge caregivers' interpretations of the child's behavior as oppositional
- Disengage the caregiver from conflict with the child
- Phase B -
- Caregivers participate in seven individualized sessions.
- Clinicians are trained in advanced CBT, formal logic-based methods to rapidly and sustainably reconstruct negative self-deductions rooted in the caregiver’s own history of unresolved trauma in childhood.
- Phase C -
- Caregiver and child participate in four assessment and treatment sessions.
- Directed sand tray methods are utilized to gather information about the child experience of trauma, relationship with their caregiver, and belief system.
- The caregiver, having resolved their own issues of trauma is able to act as co-therapist in the child's treatment.
- Therapy with the child resolves impact related to:
- Attachment relationship to the caregiver
- Loss of significant relationship in the child's life
- Shame or guilt for the history of problematic behaviors
- The traumatic event itself
- Unique Components of ITTM
- Works directly with the caregiver first and then the child to improve a child’s ability to travel beyond the impact of the trauma
- Its efficiency (a 21-session program)
- The ability to be used as a method to eliminate waitlists approach for facilitating referrals easily from multiple access points
- The role of caregivers in treatment as the primary agent of change for the child
- Improved self-efficacy and empowerment in parent’s capacity for and confidence in, addressing their children’s trauma and related behaviors and symptoms
- The caregiver established and positioned (rather than the practitioner) as the secure foundation for the child
- The importance of parents to children directly affirmed by having parents attend therapy first without their children and then involving the parents as participants and co-directors of their child’s therapy
- Children seen alone only for the purpose of assessment, and in possible cases of emergency or crisis intervention (e.g., child or caregiver reports child suicidal intent or maltreatment)
- Program that is intended to strengthen the emotional attunement level with their child and to promote co-regulation of children’s trauma-related affect where parent participates in delivery
- Its recognition of the intergenerational nature of trauma
- Its applicability across diverse cultures and varying geographical regions
- Its support of the caregiver’s dysregulation as related to the child’s trauma which increases parents’ capacity for self-regulation
- Its ability to construct and strengthen intrinsic motivation platforms of parents as a method to increase engagement and child trauma treatment completion
- Increased levels and intensity of homework assigned to the caregiver over time to increase engagement, integration and screen caregivers who need to be seen individually
- In effect, treats two generations at once, increasing the functioning of both child and parent
The Intergenerational Trauma Treatment Model (ITTM) directly provides services to children/adolescents and addresses the following:
- Experienced traumatic event(s)
The Intergenerational Trauma Treatment Model (ITTM) directly provides services to parents/caregivers and addresses the following:
- Clinical depression, lack of motivation, affect dysregulation, experienced trauma in own life before child’s traumatic event
60-90 minutes per week
This program is typically conducted in a(n):
- Community Agency
- Outpatient Clinic
- Residential Care Facility
The Intergenerational Trauma Treatment Model (ITTM) includes a homework component:
For the parents/caregivers, it is weekly and grows in intensity.
The Intergenerational Trauma Treatment Model (ITTM) does not have materials available in a language other than English.
Resources Needed to Run Program
The typical resources for implementing the program are:
Meeting room, large white board, extensive sand tray set
Minimum Provider Qualifications
Master’s level degree in social work or similar field preferred
Education and Training Resources
There is a manual that describes how to implement this program, and there is training available for this program.
Training is obtained:
On-site at agency/treatment center
Number of days/hours:
Varies depending on training
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.
Copping, V. E., Warling, D. L., Benner, D. G., & Woodside, D. W. (2001). A child trauma treatment pilot study. Journal of Child and Family Studies, 10(4), 467-475.
Type of Study: One group pretest-posttest
Number of Participants: 27
- Age — 3-17 years
- Race/Ethnicity — Not specified
- Gender — 14 Boys and 13 Girls
- Status — Participants were children in foster care that have been exposed to complex childhood trauma.
Location/Institution: Southwestern Ontario, Canada
Summary: (To include comparison groups, outcomes, measures, notable limitations)
This paper examined outcomes of the Intergenerational Trauma Treatment Model, a trauma treatment model for children and their caregivers. All children in treatment had experienced at least one traumatic event. Measures utilized include the Standardized Client Information System (SCIS). Results reflect significant reductions in conduct disorder, problems in social relations, and caregiver depression. Limitations include nonrandomization, the lack of a control group, and small sample size.
Length of postintervention follow-up: None.
Scott, K., & Copping, V. E. (2008). Promising direction for the treatment of complex childhood trauma: The Intergenerational Trauma Treatment Model. Journal of Behavior Analysis of Offender and Victim - Treatment and Prevention, 1(3), 273-283.
Date Research Evidence Last Reviewed by CEBC: June 2015
Date Program Content Last Reviewed by Program Staff: June 2013
Date Program Originally Loaded onto CEBC: December 2012