Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)

About This Program

Target Population: Adolescents and young adults who have been multiply traumatized

For children/adolescents ages: 12 – 21

Program Overview

ITCT-A is a flexible multicomponent therapy for multiply traumatized adolescents and young adults. It involves semistructured protocols, downloadable treatment tools, and interventions that are customized to the specific issues, social context, and capacities of each client.

An important aspect of ITCT-A is its continuous monitoring of treatment effects over time. This involves initial and periodic psychometric and interview-based evaluation of the adolescent's symptomatology, as well as assessment of their socioeconomic status, culture, ongoing level of support systems and coping skills, family and caretaker relationships, attachment issues, and functional self-capacities.

ITCT-A especially focuses on social and cultural issues. Attention is paid to the use of culturally appropriate treatment resources, and the focus and context of treatment is adapted to the adolescent’s sociocultural environment. Also taken into account are cultural phenomena that can assist the client's progress in therapy, including, for some, use of the extended family as a physical, psychological, and social support system.

Program Goals

The goals of Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) are:

  • Develop a positive working relationship with the therapist
  • Increase environmental safety
  • Eliminate self-endangering behaviors
  • Develop communication skills, decision-making, and problem-solving skills
  • Develop emotional and behavioral self-management skills
  • Learn skills to cognitively and emotionally process traumatic experiences
  • Reduce symptoms of depression, anxiety, and posttraumatic distress
  • Manage maladaptive distress reduction behaviors while developing alternative coping strategies
  • Increase ability to build interpersonal relationships

Logic Model

The program representative did not provide information about a Logic Model for Integrative Treatment of Complex Trauma for Adolescents (ITCT-A).

Essential Components

The essential components of Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) include:

  • ITCT-A has been developed to address disparities for adolescents and young adults with complex trauma exposure living in environments that, as compared to the general population, are characterized by:
    • Racial inequality
    • Poverty
    • Unemployment
    • High rates of homelessness
    • Reduced access to quality education
    • Community violence
  • ITCT-A was designed to address the needs of highly traumatized, marginalized adolescents or young adults and their families with:
    • Interventions for complex trauma in clinic, residential, juvenile justice, and hospital settings
    • Outreach through the schools and other external systems
    • Flexible treatment protocols and systemic collaboratives that take into account the effects of poverty and other social or geographical impediments on the accessibility of treatment
    • Cultural adaptations to empirically based interventions
    • Interventions for deliberate self-injury and suicidality
  • Core Features
    • Assessment-driven treatment, with measures and/or interviews administered at 2- to 4-month (typically 3-month) intervals to identify symptoms that may require special clinical attention
    • Attention to complex trauma issues including:
      • Posttraumatic distress
      • Attachment disturbance
      • Affective and/or behavioral dysregulation
      • Interpersonal difficulties
      • Identity-related issues
    • Use of multiple treatment modalities in individual and group therapy, based on the youth’s specific presenting issues, which potentially include:
      • Cognitive therapy
      • Exposure therapy
      • Mindfulness/meditation training
      • Relational treatment
    • Collateral sessions that primary caretakers also participate in, as necessary, to help resolve their own traumatic reactions and to improve their parenting skills
    • Family therapy sessions as needed
    • Development of a positive working relationship with the therapist, which is deemed crucial to the success of therapy
    • Relational processing of early attachment schema and current interpersonal expectations including:
      • Rejection sensitivity
      • Abandonment concerns
      • Issues with authority figures
      • Expectations of loss or maltreatment in current relationships
    • Cultural and developmental adaptations for individual client needs and cultural sensitivity to the form and meaning of trauma symptoms within different belief systems
    • Early attention to immediate trauma-related issues such as:
      • Acute stress disorder
      • Anxiety
      • Depression
      • Posttraumatic distress
    • Use of psychiatric medications, as indicated
    • Exploration of more chronic and complex trauma issues
    • Skills development, both in terms of building emotional regulation and problem-solving skills
    • Therapeutic exposure and exploration of trauma, within a developmentally appropriate and safe context, balanced with attention to the client’s existing affect regulation capacities.
    • Advocacy and interventions at the system level (e.g., family, forensic/protection, and school) to establish healthier functioning and to address safety concerns
    • A flexible time-frame for treatment, since the multiproblem nature of complex trauma sometimes precludes short-term therapy
    • Specific interventions
      • Relationship building and support
      • Safety interventions
      • Psychoeducation
      • Distress reduction and affect regulation training
      • Mindfulness and meditation training
      • Cognitive processing
      • Titrated exposure
      • Trigger identification and intervention
      • Interventions for identity issues
      • Relational processing
      • Managing maladaptive substance use
      • Interventions with caretakers and family members
      • Group therapy sessions

Program Delivery

Child/Adolescent Services

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) directly provides services to children/adolescents and addresses the following:

  • Complex trauma, which can manifest as anxiety and depression; suicidality; dissociation; sleep or appetite changes; hypervigilance; hyperreactivity; relational, identity, and affect regulation disturbances; cognitive distortions; somatization; self-mutilation, dysfunctional sexual behaviors; destructive behaviors or violence towards others; alcohol or substance abuse; eating disorders; susceptibility to revictimization; and traumatic bereavement associated with loss of family members and other significant attachment figures
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Primary caretakers may participate in collateral sessions, as necessary, to help resolve their own traumatic reactions and to improve their parenting skills. Family therapy sessions are optional, but frequently included. Systems advocacy can involve working with teachers, physicians, and other service providers.

Recommended Intensity:

One weekly 45- to 60-minute individual therapy session (more frequent sessions may be conducted as needed). Biweekly-to-weekly 30- to 45-minute individual caretaker collateral sessions (as needed, not required). Concurrent family therapy sessions are frequently included later in the course of treatment (as needed, not required). Weekly group therapy sessions are frequently included for the adolescent client and/or caretaker (as needed, not required).

Recommended Duration:

Varies by client per their needs and the constraints of the setting

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) includes a homework component:

A written trauma processing homework component involves use of a worksheet, “Written Homework About My Trauma.” This is used only when the client can tolerate between-session exposure exercises and has a safe place in which to do so.

Languages

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) has materials available in a language other than English:

Spanish

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 at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Clinicians who are trained to conduct ITCT-A
  • Appropriate clinical supervision
  • Individual therapy and group therapy room space

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Master’s degree (or equivalent) that includes clinical training in a mental health-related field. This may be in the fields of psychiatry, psychology, social work, marriage and family therapy, counseling, etc.

Manual Information

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

Program Manual(s)

Treatment Manual Citations:

  • Briere, J., & Lanktree, C. B. (2013). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): A guide for the treatment of multiply-traumatized youth (2nd ed.). University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.
  • Briere, J., & Lanktree, C. B. (2014). Treating substance use issues in traumatized adolescents and young adults: Key principles and components. USC Adolescent Trauma Training Center, National Child Traumatic Stress Network, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
  • Briere, J., Lanktree, C. B., & Semple, R. J. (2019). Using ITCT-A to treat self-injury in traumatized youth. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
  • Chen, K., Lanktree, C. B., Semple, R. J., Briere, J., & Maida, C. (2019). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): An implementation guide for organizations. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.
  • Semple, R. J., & Briere, J. (2020). Increasing mindfulness and metacognitive awareness in multi-traumatized adolescents: An optional module for ITCT-A and other treatment approaches. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.

PDFs of all the ITCT-A treatment guides, the ITCT-A implementation guide, and assessment measures can be downloaded from the USC-ATTC website at no cost: attc.usc.edu

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Trainings are conducted at the USC Adolescent Trauma Training Center in Torrance, CA, onsite at trainee organizations, and at local and national conferences.

Organizations can apply to request a training workshop here: https://attc2014.wufoo.com/forms/q1yg5ei61km7tw7

A national ITCT-A Clinician Certification program is available. There is no cost associated with trainings offered by the USC-ATTC or the Clinician Certification program. National training requirements to become a Level I Certified ITCT-A Clinician include:

  • Before completing the certification, candidates must have:
    • Completed a master’s degree (or equivalent) that includes clinical training in a mental health-related field. This may be in the fields of psychiatry, psychology, social work, marriage and family therapy, counseling, etc.
    • A state license that allows independent or supervised clinical practice. Certification requirements may be completed before receiving licensure.
  • Candidates must attend at least six (6) hours of in-person training provided by the USC-ATTC (minimum one full-day workshop).
  • Candidates must complete the web-based training on the USC-ATTC manual: Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) Treatment Guide, 2nd edition.
  • Candidates must attend two (2) ITCT-A webinars (approximately one hour each) and pass a knowledge-based quiz for each webinar.
  • Candidates must complete a written case report. Submit a sample case of an adolescent that you have treated with ITCT-A. The case report must be prepared using the template provided in the USC-ATTC Learning Portal (https://usc-attc.virtualvenues.com).
  • Active participation in at least six (6) regularly scheduled video consultation calls. These consultation calls are generally held once monthly for 90-minutes. The six consultation calls do not need to be attended in consecutive months.
  • During one video consultation call, present a clinical case that utilizes ITCT-A (a minimum 30-minute formal case presentation). A presentation format similar to the written case report is suggested.
  • Completion of a minimum of two (2) separate ITCT-A cases with appropriate adolescent clients. A complete case must consist of at least 12 face-to-face sessions with the client, and ideally result in a natural termination.

More information about clinician certification is available at: attc.usc.edu

Request a free Learning Portal Account: https://usc-attc.virtualvenues.com

Number of days/hours:
  • One- and two-day trainings are available for clinicians.
  • A half-day training is available for clinical supervisors.

Relevant Published, Peer-Reviewed Research

Lanktree, C. B., Briere, J., Godbout, N., Hodges, M., Chen, K., Trimm, L., Adams, B., Maida, C.A., & Freed, W. (2012). Treating multitraumatized, socially marginalized children: Results of a naturalistic treatment outcome study. Journal of Aggression, Maltreatment & Trauma, 21, 813-828. https://doi.org/10.1080/10926771.2012.722588  

Type of Study: One-group pretest-posttest
Number of Participants: 151

Population:

  • Age — 8-17 years (Mean=11.43 years)
  • Race/Ethnicity — 48% Hispanic, 25% Black or African American, 14% Non-Hispanic White, and 13% Asian or other
  • Gender — 65% Female and 35% Male
  • Status — Participants were clients at a specialized child trauma center.

Location/Institution: Long Beach, California

Summary: (To include basic study design, measures, results, and notable limitations)
This article examines the potential effectiveness of Integrative Treatment of Complex Trauma (ITCT) [now called Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)] in assisting 151 traumatized children living in an economically deprived environment. Measures utilized include the Trauma Symptom Checklist for Children (TSCC). Results indicated exposure to this treatment was associated with reductions in anxiety, depression, posttraumatic distress, and, to a slightly lesser extent, anger, dissociation, and sexual issues. Additionally, the longer a child was in therapy, the greater his or her symptomatic improvement. Limitations include nonrandomization of participants, lack of control group, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Briere, J. (2019). Treating risky and compulsive behavior in trauma survivors. Guilford.

Briere, J., & Lanktree, C. B. (2012). Treating complex trauma in adolescents and young adults. Sage Publications.

Semple, R. J., & Briere, J. (2015). Mindfulness training to reduce substance abuse in adolescent trauma survivors. Journal of Substance Abuse and Alcoholism, 3(2), Article 1033.

Contact Information

Karianne Chen, MS, LMFT
Agency/Affiliation: University of Southern California (USC)
Department: Adolescent Trauma Training Center
Website: attc.usc.edu
Email:
Phone: (310) 370-9208
Cheryl Lanktree, PhD
Agency/Affiliation: University of Southern California (USC)
Website: attc.usc.edu
Email:
Phone: (310) 370-9208
John Briere, PhD
Agency/Affiliation: University of Southern California (USC)
Website: attc.usc.edu
Email:
Phone: (310) 370-9208

Date Research Evidence Last Reviewed by CEBC: July 2016

Date Program Content Last Reviewed by Program Staff: May 2020

Date Program Originally Loaded onto CEBC: August 2016