Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)]

Organizational systems (e.g., residential programs, schools, group homes, hospital settings, etc.) working with and supporting children/adolescents/young adults (0-21 years) who have experienced chronic/complex trauma and their caregivers

ARC is a core components framework designed to support organizational change in agencies that work with youth and families who have experienced complex trauma. The framework is organized around the core domains of attachment (i.e., building safe caregiving systems), regulation (i.e., supporting youth regulation across domains), and developmental competency (i.e., supporting factors associated with resilient outcomes); and is designed to be translatable across service systems. In organizations/systems implementing ARC, (e.g., within a residential program, school, inpatient center, etc.) the system itself is a key target of intervention, with change efforts focused on development of trauma-informed systems structures. ARC can also be used as a client-level trauma treatment intervention on its own or in combination with the system-level program, click here to go to the program’s entry in the Trauma Treatment-Client Level Interventions (Child & Adolescent) topic area.

Margaret Blaustein
Center for Trauma Training

• https://arcframework.org
• Email: mblaustein@centerfortraumatraining.org
• Phone: (617) 232-1303

The goals for Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)] are:

• Integrate routine, rhythms, and structures into intervention approaches and daily functioning to increase felt safety and support skill development
• Support adult caregivers including milieu staff, administrators, support staff, and educators in understanding and managing their own responses to youth in their care
• Build adult/provider/caregiver capacity to effectively understand and respond to the needs driving youth behaviors
• Support effective responses to youth behavior that are trauma-informed and that increase, rather than decrease, safety
• Build child/adolescent understanding of emotional and physiological experience, including a language for experience and an ability to connect and contextualize emotional cues, through systematic approaches that engage youth in reflecting upon their internal experience
• Build child/adolescent ability to effectively manage and tolerate emotional and physiological experience through systematic approaches to supported regulation
• Build organizational structures and supports to engage and support children/adolescents in building and sustaining relational connections with others
• Support children/adolescents in recognizing choice points, managing impulsive behaviors, and actively making choices through staff/caregiver training and systematic structures that support active problem evaluation, decision-making, and empowerment in youth
• Engage systems in developing activities and approaches that support youth understanding of self, including unique characteristics and influences, coherence across time and situations, sources of efficacy and esteem, and future template
• Build organizational structures and systems that support youth in reflecting upon, processing, and developing a narrative of traumatic experience, and integrating this into a coherent and comprehensive understanding of self

The essential components of Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)] include:

• Emphasis on developing child, family, and provider engagement and stake in the organizational framework
• Integration of psychoeducation about traumatic stress at all levels of the work (e.g., system, providers, caregivers, child), including systematic approaches to both foundational and ongoing staff/provider training
• Integration of and attention to the use of routine and rhythm in organizational approach and structure
• Attention to staff and, if applicable, primary caregiver emotional experience through attention to staff systemic supports and structures (i.e., supervision)
• Engaging and building a curious, attuned stance among adult caregivers (e.g., staff, providers, administrators), including an understanding of the trauma-related drivers of behavior and skill in mirroring and responding to youth needs
• System-level approaches to addressing youth behavior that integrate an understanding of the drivers of that behavior and a trauma-sensitive, individualized behavioral approach
• Active, proactive attention to supporting youth physiological, emotional, and behavioral regulation through development of systematic regulation supports and routine engagement in modulating strategies
• Routine integration in treatment plans and milieu processes of attention to and support for development of youth strengths and competencies as a core element of intervention

Recommended Intensity

Once the program is implemented in an organization, the expectation is that it will be part of the system culture and be used all of the time.

Recommended Duration

Once the program is implemented, the expectation is that it will be part of the system culture from that time forward.

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Group or Residential Care
• Hospital
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)
• Shelter (Domestic Violence, Homeless, etc.)

Homework

This program does not include a homework component.

Languages

Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)] has materials available in the following languages other than English:

• Dutch
• Spanish
• Turkish

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:

Commitment of administration to the implementation process; personnel willing and able to commit the time/effort into training and consultation, along with identified change processes. The training/implementation process in a service system typically requires a commitment of a minimum of one-year; systems should anticipate a typical 3-year process of building sustainable organizational change. No specific concrete resources are viewed as essential, as the program is adaptable to the real-world setting in which it is implemented.

Prerequisite/Minimum Provider Qualifications

Integration of ARC into a system requires the appropriate education/licensure/certification of each staff member as required by their position/profession.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Training may be provided on-site to a contracting agency; consultation is typically remote. The two-day foundational training is also available several times/year as an open-registration workshop.

Number of days/hours:

The standard foundational training is 2 days; minimum suggested follow-up consultation is at least one year (1-3 hours/month) for systems change initiatives. In an organizational system offering clinical services, systems change efforts typically incorporate both clinical and systems-focused consultation.

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

• Note: The following studies were not included in rating Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)] on the Scientific Rating Scale.

  Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., Andres, B., Cohen, C., & Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34–51. https://doi.org/10.1080/19361521.2011.545046

  Summary:

  The purpose of the study was to introduce the Attachment, Self-Regulation, and Competency (ARC) model [now called Attachment, Regulation, and Competency (ARC)] and describe its application with young children of diverse ethnocultural backgrounds involved in the child protection system due to maltreatment. Measures utilized include the Trauma Symptom Checklist-Alternate Version (TSCC-A), the UCLA PTSD Index for DSM IV, and the Child Behavior Checklist (CBCL). Results indicate that when comparing clients who completed ARC and those who ended treatment early, those completing treatment demonstrated a far greater level of improvement in CBCL scores. Children completing treatment also achieved a high rate of permanent placement. Limitations include the reliance on self-report measures, the lack of a control group, high drop-out rate, and lack of follow-up. Note: This article was not used in the rating process due to the lack of a control group.

• Note: The following studies were not included in rating Attachment, Regulation, and Competency (ARC) [Trauma Treatment – System-Level Programs (Child & Adolescent)] on the Scientific Rating Scale.

  Hodgdon, H., Kinniburgh, K., Gabowitz, D., Blaustein, M. & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in residential schools using the ARC framework. Journal of Family Violence, 28, 679–692. https://doi.org/10.1007/s10896-013-9531-z

  Summary:

  The purpose of the study was to describe the feasibility, utility, and efficacy of Attachment, Self-Regulation, and Competency (ARC) [now called Attachment, Regulation, and Competency (ARC)] in two residential treatment settings serving female youth with histories of complex childhood trauma. ARC was provided at a system level for both sites, but not at a group or individual level for all residents at both sites. Measures utilized include the Child Behavior Checklist (CBCL) and the UCLA PTSD Reaction Index (PTSD-RI). Results indicate that youth at the two targeted programs demonstrated a significant decrease in trauma-related symptoms over the course of the project period. Notably, youth receiving the ARC client-level intervention evidenced a significant decrease in their overall level of PTSD symptoms, driven by decreases in their Criterion B (re-experiencing) and D (hyperarousal) symptoms. Youth also displayed decreases in aggressive behaviors, attention problems, rule breaking behaviors, anxiety, depression, thought problems, and somatic complaints over the course of the project period, as measured by the CBCL. Limitations include the nonrandomization of participants, lack of a control group, and reliance on self-report measures. Note: This article was not used in the rating process due to the lack of a control group.

• Blaustein, M., & Kinniburgh, K. (2016). The Attachment, Regulation, and Competency (ARC) treatment model. In M. Landolt, U. Schnyder, and M. Cloitre (Eds.). Evidence-based treatments for trauma-related disorders in children and adolescents, Springer International Publishing.

• Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. Guilford Press.

• Ford, J., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental trauma therapy 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). Guilford Press.