Trauma Outcome Process Assessment Model (TOPA)

About This Program

Target Population: Sexually abused children and adolescents and children and adolescents who have sexual behavior problems or manifest sexually abusive behavior including males and females ages 4 to 19 years and youth with low intellectual functioning

For children/adolescents ages: 4 – 19

For parents/caregivers of children ages: 4 – 19

Program Overview

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.

Program Goals

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

  • 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 child's adaptive responses (e.g., coping skills) and decrease maladaptive responses (e.g., self-destructive behavior, sexual behavior problems, sexually abusive behaviors) to traumatic experiences or triggers related to traumatic experiences
  • Have child take responsibility for self-destructive behaviors, sexual behavior problems, and/or sexually abusive behaviors
  • Have child demonstrate increased self-esteem and self-caring behaviors
  • Have child demonstrate increased empathy for others
  • Have child demonstrate improved social skills
  • Have child cease in engaging in self-destructive behaviors, sexual behavior problems, and/or sexually abusive behaviors
  • Have child utilize positive coping skills when confronted with stressful events reminiscent of past sexual abuse or other trauma

Essential Components

The essential components of the Trauma Outcome Process Assessment Model (TOPA) include:

  • 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 (of 4 to 6 participants) 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
  • Therapist will refer parents to their own therapist if parent has been abusive to child

Program Delivery

Child/Adolescent Services

Trauma Outcome Process Assessment Model (TOPA) directly provides services to children/adolescents and addresses the following:

  • 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
Services Involve Family/Support Structures:

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

Parent/Caregiver Services

Trauma Outcome Process Assessment Model (TOPA) directly provides services to parents/caregivers and addresses the following:

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

Recommended Intensity:

1-2 hours per week

Recommended Duration:

No set recommendation

Delivery Settings

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.

Resources Needed to Run Program

The typical resources for implementing the program are:

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

Education and Training

Prerequisite/Minimum Provider Qualifications

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

Education and Training Resources

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

Training Contact:
Training is obtained:


Number of days/hours:

½ day to 1 day

Relevant Published, Peer-Reviewed Research

Currently, there are no published, peer-reviewed research studies for Trauma Outcome Process Assessment Model (TOPA).

Additional References

Rasmussen, L. A. (2012). Trauma Outcome Process Assessment (TOPA Model): An ecological paradigm for treating traumatized sexually abusive youth. Journal of Child and Adolescent Trauma, 5(1), 63-80. doi:10.1080/19361521.2012.646645

Rasmussen, L. A. (2004). Differentiating youth with sexual behavior problems: Applying a multidimensional framework when assessing and treating subtypes. Special Edition, Journal of Child Sexual Abuse, 13(3/4), 57-82. 

Rasmussen, L. A. (1999). The Trauma Outcome Process: An integrated model for guiding clinical practice with children with sexually abusive behavior problems. Journal of Child Sexual Abuse, 8(4), 3-33.

Contact Information

Lucinda Lee Rasmussen, PhD, LCSW
Agency/Affiliation: Center for the Integration and Resolution of Traumatic Experiences (CIRTE)
Phone: (619) 301-8231
Fax: (619) 594-5991

Date Research Evidence Last Reviewed by CEBC: September 2013

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: October 2011