Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A)

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. Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Youth ages 10-18 with Posttraumatic Stress Disorder (PTSD)

For children/adolescents ages: 10 – 18

For parents/caregivers of children ages: 10 – 18

Brief Description

TARGET-A is an educational and therapeutic intervention designed to prevent and treat traumatic stress disorders (including PTSD, severe anxiety disorders, depression, and dissociative disorders), co-occurring addictive, personality, or psychotic disorders, and adjustment disorders related to other types of stressors.

TARGET-A teaches a seven-step sequence of skills, the FREEDOM Steps, designed to enable participants to recognize, understand, and gain control of stress reactions by enhancing their strengths/abilities for mental focusing, mindfulness, emotion regulation, executive function, and interpersonal engagement/interaction. TARGET-A provides a systematic approach to processing traumatic and other critical memories that does not require memory processing.

TARGET-A provides a manualized protocol for brief (4-session), time-limited (10-14 sessions), and extended (26+ sessions) individual, group, or couple/family education and therapy. TARGET-A can be delivered in community, outpatient, inpatient, residential treatment, shelter, workplace, correctional, or healthcare settings.

TARGET-A has been adapted to be gender-specific, culturally responsive, and attuned to the unique needs of adults who have experienced (or are currently experiencing) childhood trauma, sexual trauma, domestic violence, community violence, traumatic losses, disaster trauma, medical trauma, racism-related trauma, sexual identity-related trauma, or military trauma.

TARGET for Adults is highlighted in the Trauma Treatment (Adults) topic area on the CEBC as well.

Program Goals:

The goals of Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) are:

  • Reduction in severe PTSD symptoms and remission from diagnostic PTSD
  • Enhanced capacities for emotion regulation and stress/anxiety management
  • Reduction in biopsychosocially impairing stress reactions
  • Reduction in severe anxiety, depression, guilt, and shame
  • Reduction in persistent complicated bereavement
  • Reduction in severe problems with anger and aggression
  • Reduction in severe problems with psychoform and somatoform dissociation
  • Increased ability to maintain sobriety in recovery from addictive disorders
  • Reduction in non-suicidal self-injury
  • Increased self-efficacy and dispositional hope/optimism

Essential Components

The essential components of Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) include:

  • A unique sequential set of stress management skills—FREEDOM steps:
    • Focus – Pay attention to your body signals, clear your mind, and focus on one thought that reflects what you truly value.
    • Recognize triggers – Know your stress Triggers and teach your brain to distinguish between a real threat and a reminder.
    • Emotion self-check – Identify ALARM/REACTIVE Emotions (fear, anger, sadness) and balance them with MAIN Emotions (calmness and confidence).
    • Evaluate thoughts – Learn to evaluate the ALARM thoughts and find within them the MAIN Thoughts that represent what you believe in.
    • Define goals – Restore hope by tapping into goals that express your true values and dreams rather than quick fixes.
    • Options – Regain personal control by making choices that reflect who you are and what you want most in your life.
    • Make a contribution – Recognize how you make the world a better place when you are in control of your brain’s stress ALARM.
  • Group therapy conducted by Bachelors, Masters or Doctoral-level facilitators (a single facilitator or co-facilitators) that may be time-limited (10-14 sessions), brief (4 sessions), or extended (26+ sessions).
  • Individual therapy conducted by Masters or Doctoral-level clinicians that may be brief (4 sessions), time-limited (10-14 sessions), or extended (26+ sessions).
  • Family therapy conducted by Masters or Doctoral-level clinicians (single therapist or co-therapy team) that may be brief (4 sessions), time-limited (10-14 sessions), or extended (26+ sessions).

Child/Adolescent Services

Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) directly provides services to children/adolescents and addresses the following:

  • Posttraumatic stress disorder (PTSD) and dissociative symptoms; problems with anxiety, depression, guilt, shame, and complicated grief; disruptive behavior disorders, problems with school/learning, problems with peer and family relationships, addictions, delinquency

Parent/Caregiver Services

Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) directly provides services to parents/caregivers and addresses the following:

  • TARGET-A family therapy involves parents/caregivers as direct recipients of services, in order to assist them in managing (a) parenting stress, (b) stress and emotional problems related to other past or current life events that affect their parenting, (c) emotional or behavioral health disorders that affect their parenting, (d) their children’s problems with PTSD, anxiety, depression, disruptive behavior disorders, school/learning, family relationships, peer relationships, addictions, and delinquency
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: TARGET-A individual or group therapy with children provides education for family and support system members, and conjoint family therapy sessions with family/support persons when clinically indicated.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Homeless Shelter
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School
  • Juvenile detention/justice facility

Homework

Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) includes a homework component:

"Personal Practice Exercises" have been designed in a manualized form for participants to use at home. Using these exercises, participants practice and record the use of the FREEDOM steps.

Languages

Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

A project coordinator and dedicated training space within the host agency to work with Advanced Trauma Solutions on the implementation process, and clinical staff to lead groups or conduct individual treatment.

Minimum Provider Qualifications

Bachelor's level mentors, case managers, or advocates with supervision by Master's of Arts, Master's of Social Work, or PhD level professionals

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:

Advanced Trauma Solutions, Inc., is the only licensed provider for the TARGET-A model. Training is conducted on-site for agencies in the United States and Canada, and either on-site or at the ATS Training Center in Connecticut for agencies internationally.

Number of days/hours:

Introductory: 3 days. Advanced: 3 days Train-the-Trainer: 5 days On-going consultation: 75 hours

Implementation Information

Since Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) 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 pre-implementation materials to measure organizational or provider readiness for Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) as listed below:

There are written documents describing the scope of services and an organizational assessment of readiness for trauma-informed care. These form the basis for pre-implementation project planning. Descriptions of these materials may be obtained by request to www.advancedtrauma.com

Formal Support for Implementation

There is formal support available for implementation of Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) as listed below:

Advanced Trauma Solutions, Inc., provides a comprehensive approach to implementing the TARGET-A curriculum. A two-hour web-based video introductory course describing TARGET-A is available for agencies and clinicians/facilitators who are preparing for the in-person TARGET-A training curriculum.

An intensive training and rigorous quality assurance program includes fidelity monitoring, direct feedback, and group consultation that leads to therapist certification. Training includes a series of components designed to guide clinical staff through an intensive learning process that prepares them to implement TARGET-A concepts and skills in group, individual, and family settings.

Fidelity Measures

There are fidelity measures for Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) as listed below:

The TARGET-A fidelity measure is a behaviorally specific rating scale that identifies each key component of TARGET-A (session by session) with specific descriptive anchors to facilitate accurate ratings by independent observers. The checklist has 56 discrete items keyed to engagement, session structure, and each of the concepts/skills in each session; comment sections address therapeutic and working alliance. It is recommended that each TARGET-A session is videotaped, submitted for fidelity review, and rated on competence and adherence to the model using the above checklist. Independent fidelity monitors review session recordings, rate each one based on this tool, and provide a written report to the therapist. Supportive direct feedback is provided through individual coaching and group consultation.

When taping is not feasible, fidelity is monitored by completion of skills worksheets with clients and review of the worksheets by TARGET-A staff.

A train-the-trainer program provides sites with the capacity to develop and sustain internal TARGET-A trainers (with ongoing fidelity monitoring of training and consultation and certification/re-certification of trainers).

Implementation Guides or Manuals

There are implementation guides or manuals for Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A) as listed below:

TARGET-A has a curriculum that includes detailed group manuals, client handouts, visual aids, posters, and other educational tools to support the rollout of the program.

Research on How to Implement the Program

Research has not been conducted on how to implement Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A).

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...

Ford J. D., Steinberg, K. L., Hawke, J., Levine, J., & Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child & Adolescent Psychology, 41(4), 27-37.

Type of Study: Randomized controlled trial
Number of Participants: 59

Population:

  • Age — 13-17 years
  • Race/Ethnicity — 59% Latina or Mixed Race, 25% White, and 16% Black
  • Gender — 100% Female
  • Status — Participants were delinquent females ages 13-17 years who have experienced PTSD.

Location/Institution: Hartford, Connecticut

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared the outcomes of adolescent girls who were randomly assigned to either Trauma Affect Regulation: Guide for Education and Therapy (TARGET) [now called Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A)] or a relational supportive therapy (Enhanced Treatment as Usual, or ETAU). All subjects were delinquent girls who met criteria for full or partial PTSD. Measures utilized include Traumatic Events Screening Inventory–Child/Self Report, Generalized Expectancies for Negative Mood Regulation, Clinician Administered PTSD Scale, Post-Traumatic Cognitions Inventory, Trauma Symptom Checklist for Children, and the Hope Scale. Results indicated small to medium effects favoring TARGET for change in PTSD and anxiety symptoms, posttraumatic cognitions, and emotion regulation, and favoring ETAU for change in hope and anger. Results also provided preliminary support for TARGET as a potentially efficacious therapy for PTSD with delinquent girls. Limitations include small sample size, attrition, possible reporter bias, and generalizability due to gender

Length of postintervention follow-up: 4 months.

Ford J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21(4), 365-384.

Type of Study: Nonequivalent control group design using matching
Number of Participants: 394

Population:

  • Age — 11-16 years
  • Race/Ethnicity — 43% African American, 32% Hispanic, and 24% White
  • Gender — 91% Male and 9% Female
  • Status — Participants were juveniles in detention center who have experienced some form of PTSD

Location/Institution: Hartford, Bridgeport, & New Haven, Connecticut

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reports outcomes of Trauma Affect Regulation: Guide for Education and Therapy (TARGET) [now called Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A)], a group and milieu intervention. Measures utilized include the Traumatic Events Screening Inventory–Child/Self Report (TESI-C/SR), Massachusetts Youth Screening Instrument, Second Version (MAYSI–2), and the Traumatic Experiences (TE) Scale. Results showed that every session of TARGET received in the first seven days of detention was associated with 54% fewer disciplinary incidents and 72 fewer minutes of disciplinary seclusion for each youth during the modal stay (14 days) in detention. TARGET group participation was unrelated to recidivism, but recidivism declined significantly following implementation of TARGET. Limitations include non-randomization of participants, attrition, and generalizability due to population and gender.

Length of postintervention follow-up: 6 months.

Marrow, M. T., Knudsen, K. J., Olafson, E., & Bucher, S. E. (2012). The value of implementing TARGET within a trauma-informed juvenile justice setting. Journal of Child & Adolescent Trauma, 5(3), 257-270.

Type of Study: Non-equivalent control groups design
Number of Participants: 74

Population:

  • Age — 11–19 years (Mean=17.4 years)
  • Race/Ethnicity — 75% Caucasian, 23% African American, and 2% Other
  • Gender — 91% Male and 9% Female
  • Status — Participants were youth committed to state custody as a result of a range of felony level offenses. All youth resided in a moderate-high security correctional facility.

Location/Institution: Large Midwestern U.S. juvenile justice system

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article examines the application of Trauma Affect Regulation: Guide for Education and Therapy (TARGET) [now called Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET-A)] for youth incarcerated for felony-level offenses in a juvenile justice setting. This article examines the application of TARGET for youth incarcerated for felony-level offenses in a juvenile justice setting. Thirty-eight youth previously assigned to two mental health units were provided with treatment as usual (TAU) plus a one-day trauma training for staff, while 36 youth placed on three mental health units during the same time frame were provided with the intervention, which included TAU combined with environmental modifications, additional trauma training for staff, and a TARGET group for youth. Measures included the Mood and Feelings Questionnaire (MFQ), the Self-Report for Childhood Anxiety Related Disorders (SCARED), the UCLA PTSD Reaction Index, and the Massachusetts Youth Screening Instrument (MAYSI 2). Results showed significant reductions in depression, youth threats toward staff, use of physical restraints, and seclusion rates for youth on the intervention program units when compared with youth on the TAU program units. The youth involved in the intervention program also reported greater hope and optimism. Limitations include the use of multiple interventions simultaneously, making it difficult to determine which intervention(s) had an effect, small sample size, lack of randomization, and lack of post-intervention follow-up.

Length of postintervention follow-up: None.

References

Ford, J. D. (2013). Identifying and caring for acutely traumatized children. Consultant for Pediatricians, 12(4), April, 182-187.

Ford, J. D., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental trauma-focused treatment 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.

Ford, J. D., & Ford, J. G., (2011). Trauma Affect Regulation/Guide for Education and Therapy (TARGET): A case study moving toward trauma-informed juvenile justice systems. Corrections and Mental Health. Retrieved from http://community.nicic.gov/blogs/mentalhealth/archive/2011/03/11/trauma-affect-regulation-guide-for-education-and-therapy-target-a-case-study-of-moving-toward-trauma-informed-juvenile-justice-systems.aspx

Contact Information

Name: Julian Ford
Agency/Affiliation: University of Connecticut Health Center
Department: Dept. of Psychiatry
Website: www.advancedtrauma.com/Services.html
Email:
Phone: (860) 679-8778
Fax: (860) 679-4326

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: February 2017

Date Program Originally Loaded onto CEBC: May 2006