Trauma-Focused Coping (TFC)

Children and adolescents in schools who have suffered a traumatic exposure (e.g., disaster, violence, murder, suicide, fire, accidents)

For children/adolescents ages: 9 - 18

TFC targets the internalizing effects of exposure to trauma in children and adolescents, with an emphasis on treating posttraumatic stress disorder (PTSD) and the collateral symptoms of depression, anxiety, anger, and an external locus of control [i.e., tendency to attribute one's experiences to fate, chance, or luck]. The intervention utilizes social learning theory and a skills-oriented cognitive-behavioral approach that is carried out in 14-week sessions of gradual exposure, moving from psycho-education, anxiety management skill building, and cognitive coping training to finally trauma narrative and cognitive restructuring activities.

Lisa Amaya-Jackson, MD, MPH

• Agency/Affiliation: Duke School of Medicine
• Department: National Center for Child Traumatic Stress; Duke Evidence-based Practice Implementation Center
• Email: amaya001@mc.duke.edu
• Phone: (919) 613-9851

The goals of Trauma-Focused Coping (TFC) are:

• Reduction/end of PTSD, depression, and anxiety symptoms
• Reduced anger expression
• A move to internal locus of control (i.e., tendency to believe that one has control one's own destiny)

The essential components of Trauma-Focused Coping (TFC) include:

• Psychoeducation
• Anxiety Management
• Anger Coping
• Grief Management
• Individual Pull-outs (Narrative Exposure)
• Group Narrative Exposure
• Affective Processing
• Relapse Prevention
• Group Intervention (with 4-10 participants per group)
  

Child/Adolescent Services

Trauma-Focused Coping (TFC) directly provides services to children and addresses the following:

• PTSD, depression, anxiety, and anger

Recommended Intensity

14 group sessions (40-50 minutes) + 1½ hour pullout

Recommended Duration

3½ to 4 months

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Group or Residential Care
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Every session children are assigned skills to practice which are reviewed in following session.

Languages

Trauma-Focused Coping (TFC) has materials available in the following languages other than English:

• French

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Manuals, space, trained personnel, flip charts, and blackboard/dry erase board

Prerequisite/Minimum Provider Qualifications

Mental health provider with a Master's Degree and license are required for the group lead. Co-lead can be Bachelor's level guidance counselor. TFC is a trauma-specific cognitive-behavioral therapy (CBT) model with the majority of the same practice components of other trauma-specific CBT evidence-based models. Experience with these models serves as an excellent resource prior or in augmentation of TFC.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Clinicians with cognitive-behavioral therapy (CBT) aptitude and work with schools may only need the treatment manual and accompanying implementation manual. In addition, 2-day trainings with/without additional phone consultation are available on-site.

Number of days/hours:

This is negotiable – 1-2 days is the usual.

Pre-Implementation Materials

The prework tool is the Organizational Readiness and Capacity Assessment developed by the National Child Traumatic Stress Network (NCTSN) which is done with agency/school staff.

Formal Support for Implementation

Duke's Evidence-Based Practice Center or the Center for Child and Family Health (CCFH) would be able to provide the platform via a Learning Collaborative, clinical consultation, and/or implementation consultation. Based on the interest and needs of the requesting agency, school, or organization, training packages can be offered that center primarily around clinical workshops with accompanying training materials and clinical consultation calls, with additional consultation available that works with administrative leadership and focuses on key implementation drivers. Larger scale trainings of at least 5 agencies can consider use of a Learning Collaborative which involves 2-3 face to face sessions, cross-collaborative activities, and progress-monitoring metrics.

Fidelity Measures

In the implementation manual, there is a Trauma Focused Coping Fidelity Checklist measure that supervisors and/or clinicians can use for each session and total fidelity at the end.

Established Psychometrics

There are no established psychometrics for Trauma-Focused Coping.

Fidelity Measures Required

No fidelity measures are required for Trauma-Focused Coping.

Implementation Guides or Manuals

An implementation manual has been created and has sections for Program Administrators, School Teams, Clinical Supervisors, and prework on obtaining buy-in within and outside schools /agencies along with information on what it takes to make implementation successful. It is available from the developer (see contact information at end of entry).

Implementation Cost

There are no studies of the costs of Trauma-Focused Coping.

Research on How to Implement the Program

Research has not been conducted on how to implement Trauma-Focused Coping.

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• March, J. S., Amaya-Jackson, L., Murray, M. C., & Schulte, A. (1998). Cognitive-behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor. Journal of the American Academy of Child and Adolescent Psychiatry, 37(6), 585–593. https://doi.org/10.1097/00004583-199806000-00008

  Type of Study: One-group pretest–posttest study

  Number of participants: 17

  Population:

  • Age — 10–15 years
  • Race/Ethnicity — 8 Caucasian, 7 African American, 1 American Indian, and 1 Asian
  • Gender — 10 Female and 5 Male
  • Status — Participants were children and adolescents in grades 4 through 9 with PTSD symptoms.

  Location/Institution: Two elementary and two junior high schools in a small Southeastern town

  Summary:

  The purpose of the study was to evaluate the efficacy of an 18-week group-administered cognitive-behavioral psychotherapy protocol [now called Trauma-Focused Coping (TFC)] using a single case across time and setting for pediatric posttraumatic stress disorder (PTSD) after a single-incident stressor. Measures utilized include the Child and Adolescent Trauma Survey (CATS), Clinician-Administered PTSD Scale-Child and Adolescent Version (CAPS-C), Clinical Global Improvement Scale, Multidimensional Anxiety Scale for Children (MASC), Children’s Depression Inventory (CDI), State-Trait Anger Expression Inventory, and the Nowicki-Strickland “What I Am Like” scale. Results indicate significant improvements in PTSD, depression, anxiety, and anger symptoms and additional improvement at 6-month follow-up for all symptoms as well as locus of control. Limitations include the small sample size and lack of randomization.

  Length of controlled postintervention follow-up: None.

• Amaya-Jackson, L., Reynolds, V., Murray, C. M., McCarthy, G., Nelson, A., Cherney, M. S., Lee, R., Foa, E., & March, J. S. (2003). Cognitive-behavioral treatment for pediatric posttraumatic stress disorder: Protocol and application in school and community settings. Cognitive and Behavioral Practice, 10(3), 204–213. https://doi.org/10.1016/S1077-7229(03)80032-9

  Type of Study: One-group pretest–posttest study

  Number of participants: 7

  Population:

  • Age — 10–15 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children and adolescents with posttraumatic stress disorder (PTSD) symptoms referred from an outpatient mental health clinic specializing in trauma treatment.

  Location/Institution: Southeastern United States

  Summary:

  The purpose of the study was to evaluate the efficacy of a 14-session multimodality trauma treatment protocol (MMTT) [now called Trauma-Focused Coping (TFC)] in a sample of children and adolescents with posttraumatic stress disorder (PTSD) and trauma symptoms. Participants were assigned to receive group or individual treatment. Measures utilized include the Child and Adolescent Trauma Survey (CATS) and the Clinician-Administered PTSD Scale-Child and Adolescent Version (CAPS-C). Results indicate that MMTT implemented in community mental health clinical settings may be an effective treatment for PTSD and trauma symptoms. Limitations include the small sample size, lack of a control or comparison group, and lack of randomization.

  Length of controlled postintervention follow-up: None.

• Amaya-Jackson, L., Reynolds, V., Murray, C. M., McCarthy, G., Nelson, A., Cherney, M. S., … March, J. S. (2003). Cognitive-behavioral treatment for pediatric posttraumatic stress disorder: Protocol and application in school and community settings. Cognitive and Behavioral Practice, 10, 204-213.
  

• Berthiaume, C. & et Turgeon, L. (2004). Application d’un traitement cognitivo-comportemental auprès d’un enfant présentant un trouble de stress post-traumatique. Symposium au Congrès de l’Association française des thérapies cognitivo-comportementales, Paris, France.
  

• Michael, K. D., Hill, R., Hudson, M. L. & Furr, R. M. (2002, October). Adjunctive manualized treatment of sexually traumatized youth in a residential milieu: Preliminary results from a small randomized controlled trial. Paper presented at the Kansas Conference in Clinical Child and Adolescent Psychology, Lawrence, KS.