The information in this program outline is provided by the program representative and edited by the CEBC staff. The Trauma Outcome Process Assessment Model (TOPA) program has been reviewed by the CEBC in the areas of: Sexual Behavior Problems in Children, Treatment of and Sexual Behavior Problems in Adolescents, Treatment of, 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: The TOPA treatment program focuses on two populations: (a) sexually abused children and adolescents; and (b) children and adolescents who have sexual behavior problems or manifest sexually abusive behavior. This includes males and females ages 4 to 19, including youths with low intellectual functioning.

The TOPA program is designed to help sexually abused and sexually abusive children/youths: (a) recognize how self-destructive and/or sexually abusive behaviors connect to past sexual abuse and other traumatic experiences (e.g., physical abuse, exposure to domestic violence); (b) take responsibility for maladaptive behaviors; and (c) make adaptive choices when current stressors trigger feelings or memories related to past traumas. Therapists take a directive role by creating a safe therapeutic environment, then implementing cognitive-behavioral interventions through experiential methods (art therapy, play therapy, sand tray, bibliotherapy, role play, drama, relaxation). Therapist also works with parents or caregivers to ensure that the home environment supports and maintains the child’s treatment gains.

The overall goals of the Trauma Outcome Process Assessment (TOPA) are to:

• Increase child’s self-awareness of feelings, thoughts, body sensations, motivations, and behaviors, as related to a traumatic experience or triggers related to the traumatic experience.
• Increase adaptive responses and decrease maladaptive responses (i.e., self-destructive behavior, sexual behavior problems, sexually abusive behaviors) to traumatic experiences or triggers related to traumatic experiences.

Treatment objectives – the child will:

• Take responsibility for self-destructive behaviors, sexual behavior problems, and/or sexually abusive behaviors.
• Demonstrate increased self-esteem and self-caring behaviors.
• Demonstrate increased empathy for others.
• Demonstrate improved social skills.
• Cease to engage in self-destructive behaviors, sexual behavior problems and/or sexually abusive behaviors.
• Utilize positive coping skills when confronted with stressful events reminiscent of past sexual abuse or other trauma.

Expected outcomes are that the child/youth will have increased self-awareness, decreased self-destructive and/or sexually abusive behaviors, and improved coping skills when confronted with feelings and/or memories associated with past sexual abuse or other traumas.

Four-step assessment process:

• Identify risk and protective factors that make the child or adolescent vulnerable or resilient to maladaptive responses to trauma.
• Identify outcomes of trauma.
• Assess child’s self-awareness.
• Identify and focus on child’s primary response to trauma.

Treatment modules on:

• Taking responsibility for self-destructive and/or sexually abusive behaviors.
• Improving self-esteem and increasing self-caring behaviors.
• Increasing empathy for feelings of others, including their victims, victims’ families, and their own families.
• Coping with effects of past sexual abuse and other traumatic experiences.
• Improving social skills.
• Developing positive relationships with others.
• Learning about positive sexuality.
• Improving family relationships (involves conjoint sessions with children and parents).

Modules are implemented through integrating cognitive-behavioral interventions with:

• Bibliotherapy
• Art therapy
• Sand tray therapy
• Play therapy
• Role play
• Drama
• Progressive relaxation

Parent support groups that focus on helping parents:

• Understand the reasons their child engaged in self-destructive and/or abusive behaviors.
• Assist their child in applying what is learned in therapy at home.
• Provide appropriate supervision to prevent child/youth from re-engaging in self-destructive behaviors, sexual behavior problems, and/or sexually abusive behaviors.
• Learn positive parenting techniques.

If parent has been abusive to the child/youth, therapist will refer parents to their own therapist.

Trauma Outcome Process Assessment Model (TOPA) was designed with a child component that addresses the following presenting problems and symptoms:

• Self-destructive behaviors (e.g., cutting, suicide attempts), sexual behavior problems, and sexually abusive behaviors (sexually behaviors that are harmful to others that involve coercion, threats, or use of weapons), PTSD symptoms, aggressive behaviors.

Age range: 4 – 19

Developmental Delays:

This program was developed for children with developmental delays; but has not been tested for children with developmental delays.

Treatment Involves Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Conjoint sessions with family members

Trauma Outcome Process Assessment Model (TOPA) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Lack of understanding of their children; and poor parenting skills (including physically and/or sexually abusive behaviors)

Trauma Outcome Process Assessment Model (TOPA) was designed to be conducted in a group setting; but has not been tested for use in a group setting.

Recommended group size:

4-6

Recommended Intensity:

1-2 hours per week

Recommended Duration:

No set recommendation

This program is typically conducted in a(n):

• Community Agency
• Outpatient Clinic
• Residential Care Facility

Trauma Outcome Process Assessment Model (TOPA) includes a homework component:

Cognitive Behavioral Therapy (CBT) worksheets that can be completed. 

Trauma Outcome Process Assessment Model (TOPA) does not have materials available in a language other than English.

The typical resources for implementing the program are:

Art supplies, toys, puppets, sand tray, therapists, therapy offices, and group room

Master’s degree in social work or marriage and family therapy

There is not a manual that describes how to implement this program; but there is training available for this program.

Training Contact:

• Lucinda Rasmussen, PhD, LCSW
  lucindarasmussen@cox.net
  phone: (619) 301-8231

Training is obtained:

Onsite

Number of days/hours:

½ day to 1 day

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 Outcome Process Assessment Model (TOPA).