The information in this program outline is provided by the program representative and edited by the CEBC staff. The Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) program has been reviewed by the CEBC in the area of: Trauma Treatment (Child & Adolescent), but lacks the necessary research evidence to be given a Scientific Rating.

• Types of Maltreatment: Physical Abuse, Sexual Abuse, Physical Neglect, Emotional Abuse, Exposure to Domestic Violence
• Target Population: Youth ages 10-18 with Post-Traumatic Stress Disorder (PTSD).

TARGET is an educational and therapeutic approach for the prevention and treatment of complex Post-Traumatic Stress Disorder (PTSD). TARGET provides a practical skill-set that can be used by trauma survivors and family members to de-escalate and regulate extreme emotional states, to manage intrusive trauma memories in daily life, and to restore the capacity for information processing and autobiographical memory. TARGET teaches a sequence of seven skills described as the FREEDOM steps. The focus in TARGET is on shifting the way a person processes information and emotions so that s/he is able to live life and make sense of memories they are experiencing.

Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) is designed to address the primary personal issues that are related to trauma, such as PTSD symptoms, rage, traumatic grief, survivor guilt, shame, interpersonal rejection, and existential/spiritual alienation. The FREEDOM steps are the seven core TARGET skills taught through repeated coaching and guided practice:

1. Focus – This step teaches participants to use the SOS skill (Slow down, Orient, Self-check) to pay attention to body signals and the immediate environment, and to use a simple scale to measure stress and control levels.
2. Recognize triggers – Recognizing trauma triggers enables a person to anticipate and re-set alarm signals as they learn to distinguish between a real threat and a reminder.
3. Emotion self-check – The goal of this skill is to identify two types of emotions. The first are "alarm" or reactive emotions such as terror, rage, shame, hopelessness, and guilt. The second type of emotions, "main" emotions, include positive feelings (i.e., happiness, love, comfort, compassion, etc.) and feelings that represent positive strivings (i.e., hope, interest, confidence, sadness, grief, etc.). By balancing both kinds of emotions, a person can reflect and draw on his/her own values and hopes even when the alarm is activated.
4. Evaluate thoughts – When the brain is in alarm mode, thinking tends to be rigid, global, and catastrophic. Evaluating thoughts, like identifying emotions, is about achieving a healthier balance of positive and negative thinking. Through a 2-part process, participants learn to evaluate the situation and their options with a focus on how they choose to act - moving from "reactive" thoughts to "main" thoughts.
5. Define goals – Reactive goals tend to be limited to just making it through the immediate situation or away from the source of danger. This step teaches a person how to begin to create "main" goals that reflect their deeper hopes and values.
6. Options – The only options that are available when the brain's alarm is activated are automatic "flight/fight" or "freeze/submit" reactive behaviors that are necessary in emergencies, but are often unhelpful in ordinary living. This step helps identify the positive intentions that are often hidden by the more extreme reactive options generated by the alarm system.
7. Make a contribution – When the brain's alarm is activated and reacting to ordinary stressors as if they were emergencies, it is very difficult for a person to come away from experiences with a feeling that they have made a positive difference. The ultimate goal of TARGET is to empower adults and youths to be in control of the alarm reactions and, as a result, be able to recognize their unique contribution to life.

Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) was designed with a child component that addresses the following presenting problems and symptoms:

• PTSD and other anxiety disorders, depression, ODD, Reactive Attachment Disorder.

Age range: 10 – 18

Developmental Delays:

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

Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Taking care of children with Post-Traumatic Stress Disorder (PTSD), other anxiety disorders, depression, Oppositional Defiant Disorder (ODD), and Reactive Attachment Disorder symptoms plus their own stress reactions and PTSD symptoms.

Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) was designed to be conducted in a group setting; but has not been tested for use in a group setting.

Recommended group size:

Between 5 and 9 clients.

Recommended Intensity:

One or two sessions per week.

Recommended Duration:

A session typically lasts 50-90 minutes. The group intervention ranges from 3-10 sessions; the individual intervention is 12 sessions.

This program is typically conducted in a(n):

• Birth Family Home
• Community Agency
• Foster Home
• Hospital
• Outpatient Clinic
• Residential Care Facility
• School

Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET) 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.

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

The typical resources for implementing the program are:

Group leaders (1-2 per group) or one-to-one counselor/therapist/case manager (depending on type of implementation), handouts for children and parents (in manual) and art supplies (crayons/colored markers, picture magazines, etc.) for Lifeline.

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

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

Training Contact:

• Judith Ford, MA
  Advanced Trauma Solutions, Inc.
  Ford1223@comcast.net
  phone: (860) 751-9072
  406 Farmington Avenue
  Farmington, CT 06032

Training is obtained:

On-site for agencies, on a regional basis for non-agency affiliated professionals (e.g., private practice) currently in New England and Florida.

Number of days/hours:

Introductory: 2-3 days. On-going consultation: 75 hours.

Additional Resources:

There currently are additional qualified resources for training:

• Marisol Cruz
  University of Connecticut
• Eileen Russo
  Connecticut Trauma Center of Excellence

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

Currently, there are no published, peer-reviewed research studies for Trauma Affect Regulation: Guidelines for Education and Therapy (TARGET).