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Trauma Treatment – System-Level Programs (Child & Adolescent)

Scientific Ratings in this Topic
  • 1 Well-Supported by Research Evidence
  • 2 Supported by Research Evidence
  • 3 Promising Research Evidence
  • 4 Evidence Fails to Demonstrate Effect
  • 5 Concerning Practice
  • NR Not able to be Rated

Topic Areas

Topic Areas

Definition

Trauma Treatment - System-Level Programs (Child & Adolescent) are defined by the CEBC as programs for service providers and agencies designed to create a therapeutic environment that is more conducive for clients who have experienced trauma and their families, reducing the risk of retraumatization by service providers and agencies. This topic area includes programs that are designed to help an organization provide trauma-informed care or trauma-informed services. Click here to see the overall Trauma Treatment (Child & Adolescent) topic area page.

  • Target population: Service providers and agencies, such as behavioral/mental health and child welfare, that work with children and adolescents who have experienced trauma. A diagnosis of Post-Traumatic Stress Disorder (PTSD) is not required.
  • Services/types that fit: System-level interventions, training programs, and resource materials for staff and service providers
  • Delivered by: Trained paraprofessionals, educators, and health and mental health professionals
  • In order to be included: Program must specifically target developing a more therapeutic environment for clients who have experienced trauma as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes for providers working with this population (e.g., changes in attitudes or performance, knowledge of techniques or curricula) and/or client level trauma-related outcomes, such changes in symptom levels, behaviors, and/or functioning

Definition

Trauma Treatment - System-Level Programs (Child & Adolescent) are defined by the CEBC as programs for service providers and agencies designed to create a therapeutic environment that is more conducive for clients who have experienced trauma and their families, reducing the risk of retraumatization by service providers and agencies. This topic area includes programs that are designed to help an organization provide trauma-informed care or trauma-informed services. Click here to see the overall Trauma Treatment (Child & Adolescent) topic area page.

  • Target population: Service providers and agencies, such as behavioral/mental health and child welfare, that work with children and adolescents who have experienced trauma. A diagnosis of Post-Traumatic Stress Disorder (PTSD) is not required.
  • Services/types that fit: System-level interventions, training programs, and resource materials for staff and service providers
  • Delivered by: Trained paraprofessionals, educators, and health and mental health professionals
  • In order to be included: Program must specifically target developing a more therapeutic environment for clients who have experienced trauma as a goal
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes for providers working with this population (e.g., changes in attitudes or performance, knowledge of techniques or curricula) and/or client level trauma-related outcomes, such changes in symptom levels, behaviors, and/or functioning

Why was this topic chosen by the Advisory Committee?

The Trauma Treatment - System-Level Interventions (Child & Adolescent) topic area is relevant to child welfare because it is important that the systems that work with children and adolescents who have experienced trauma are sensitive to their trauma histories. These youth are at risk for being triggered and retraumatized. The professionals that work with these children and adolescents should have knowledge and practices in place that decrease the likelihood of retraumatization and promote the physical and psychological safety of the youth. Furthermore, systems that have taken the time to become more trauma-informed are better positioned to effectively implement client-level trauma interventions.

Why was this topic chosen by the Advisory Committee?

The Trauma Treatment - System-Level Interventions (Child & Adolescent) topic area is relevant to child welfare because it is important that the systems that work with children and adolescents who have experienced trauma are sensitive to their trauma histories. These youth are at risk for being triggered and retraumatized. The professionals that work with these children and adolescents should have knowledge and practices in place that decrease the likelihood of retraumatization and promote the physical and psychological safety of the youth. Furthermore, systems that have taken the time to become more trauma-informed are better positioned to effectively implement client-level trauma interventions.

Topic Expert

When the CEBC launched in 2006, Trauma Treatment (Child & Adolescent) was one of its two original topic areas. Benjamin E. Saunders, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date of June 2006 (as found on the bottom of the program's page on the CEBC). The topic area has grown over the years and in 2016, the topic area was split and expanded. All of the Trauma Treatment - System-Level Programs (Child & Adolescent) added since 2006 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Saunders was not involved in identifying or rating them.

Topic Expert

When the CEBC launched in 2006, Trauma Treatment (Child & Adolescent) was one of its two original topic areas. Benjamin E. Saunders, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date of June 2006 (as found on the bottom of the program's page on the CEBC). The topic area has grown over the years and in 2016, the topic area was split and expanded. All of the Trauma Treatment - System-Level Programs (Child & Adolescent) added since 2006 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Saunders was not involved in identifying or rating them.

Programs

CARE: Creating Conditions for Change

CARE: Creating Conditions for Change (3rd edition) is a principle-based program designed to enhance the social dynamics in residential care settings through targeted staff development, ongoing reflective practice, and data-informed decision-making. Using an ecological approach, CARE aims to engage all staff at a residential care agency in a systematic effort to orient practices in order to provide trauma-informed and developmentally enriched living environments and to create a sense of normality for children and young people. CARE is organized around six principles related to attachment, trauma, resiliency, and ecological theory. The principles state that child care practices must be:

  • Relationship-based
  • Trauma-informed
  • Developmentally focused
  • Competence-centered
  • Family-involved
  • Ecologically oriented

Cornell University CARE consultants follow a standardized set of steps to train and support staff over the 4-year implementation period. An essential activity is the formation of a local Implementation Team with multilevel representation that provides support, modeling, and mentoring to staff at all levels as they incorporate CARE principles into their work. This approach is designed to cultivate personal investment and ownership among all staff levels at the agency

Scientific Rating 3

Sanctuary Model

The Sanctuary Model® is a blueprint for clinical and organizational change which, at its core, promotes safety and recovery from adversity through the active creation of a trauma-informed community. A recognition that trauma is pervasive in the experience of human beings forms the basis for the Sanctuary Model's focus not only on the people who seek services, but equally on the people and systems who provide those services. Sanctuary has been used in organizations that provide residential treatment for youth, juvenile justice programs, homeless and domestic violence shelters as well as a range of community-based, school-based and mental health programs.

Scientific Rating 3

Support for Students Exposed to Trauma

Designed for implementation by school teachers or counselors, SSET is a cognitive-behavioral and skills-based 10-session support group for middle school children (ages 10-16) who have been exposed to traumatic events (such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or injured) and who are experiencing moderate to severe levels of posttraumatic stress disorder (PTSD) symptoms. Its aim is to relieve symptoms of child traumatic stress, anxiety, depression, and functional impairment. It is designed to be used in schools with children from a variety of ethnic and socioeconomic backgrounds and acculturation levels. Delivery of mental health programs through schools can overcome logistical barriers (transportation, scheduling) as well as reduce stigma and reach disadvantaged and minority youth who have limited access to mental health care. Developed as an adaptation of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program, SSET contains many of the same therapeutic elements but is designed to be implemented by school staff members without clinical training.

Scientific Rating 3

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

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.

Scientific Rating NR

Child Welfare Trauma Training Toolkit

The CWTTT is a training toolkit that is comprised of a Trainer's guide, a Slidekit (i.e., PowerPoint slides to be used in the training), a Participant Manual, Supplemental Handouts, Recommended Reading and Resources, and a Comprehensive Guide. The CWTTT is designed to teach knowledge, skills, and values about working with children in the child welfare system who have experienced trauma. The CWTTT teaches strategies that child welfare professionals can use to effectively address trauma among the families they serve and to enhance child, family, and provider resilience.

Scientific Rating NR

Developmental Trauma and Attachment Program

The Developmental Trauma and Attachment Program (DTAP) provides a comprehensive approach for children facing the lasting effects of trauma and attachment disruption. Through a fully integrated model combining attachment-focused therapy with trauma-informed practices, DTAP is designed to address foundational needs for trust, emotional regulation, and resilience.

DTAP also prioritizes caregiver involvement, creating a context for healing that is designed to strengthen the family system and foster lasting change.

Scientific Rating NR

Risking Connection®

Risking Connection® is a foundational trauma training program that grew out of a consumer trauma survivor lawsuit. It is based on constructivist self-development theory (CSDT), an integrative theory drawing on attachment theory, relational psychoanalytic theory, developmental psychopathology, and theory of cognitive schemas. Risking Connection® provides a way for organizations and systems to change their culture to one that is trauma-informed and trauma-responsive. It uses a train-the-trainer model of dissemination whereby organizations gain the internal capacity to conduct Risking Connection® trainings and sustain a trauma-informed culture.

This model emphasizes:

  • A framework for understanding common trauma symptoms
  • A common inclusive language
  • Relationships as the primary agent of change
  • Respect for, and care of, both the client and the service provider (vicarious traumatization) as critical to healing
  • Strategies and tools to support adoption of the model in clinical, social, and organizational processes

Scientific Rating NR

The Restorative Approach

The Restorative Approach™ a trauma-informed alternative to traditional "point and level" systems for child congregate care. Based on brain science, attachment theory, and restorative justice, it answers the question, "Now that I understand how trauma affects children, what should I do on Monday?"The Restorative Approach translates knowledge about trauma, the brain, and healing into suggestions for all program treatment providers within an organization. It includes a system for responding when children hurt others, using restorative tasks to teach children skills and to make amends. It includes taking care of the staff that do this difficult work.

The Restorative Approach includes strategies for:

  • Using the relationship to build hope
  • Interacting in an attuned manner
  • Using modern brain science to direct the milieu and individual interactions
  • Using and understanding the adaptive role of behavior to create change
  • Designing unit structure and programming to promote healing relationships
  • Individually responding to problem behaviors based on this understanding
  • Applying principles of restorative justice to treatment settings

Scientific Rating NR

Think Trauma

Think Trauma: A Training for Working with Justice-Involved Youth. is a skills-based, interactive trauma-focused training curriculum for frontline staff, educators, administrators, and others who work with adolescents in juvenile justice residential settings. The curriculum is developed in four modules and designed to be used in any program serving adolescents with trauma experiences that need all staff to have a common understanding of trauma and its impact. It can be used prior to implementing more trauma-specific services or beginning the journey of becoming a more trauma-responsive program. The manual contains specific and detailed information regarding with whom to implement, how to prepare for training, and provides prework which must be considered to prepare the organization. The curriculum itself is designed to be delivered either in full-day or modular form.

Scientific Rating NR

Trauma Systems Therapy

Trauma Systems Therapy (TST) is a comprehensive, phase-based treatment program for children and adolescents who have experienced traumatic events and/or who live in environments with ongoing stress and/or traumatic reminders. TST is designed to address the complicated needs of a trauma system, which is defined as the combination of a traumatized child/adolescent who, when exposed to trauma reminders, has difficulty regulating his/her emotions and behavior and his/her caregiver/system of care who is not able to adequately protect the youth or help him/her to manage this dysregulation. The most common setting in which TST is implemented is for youth involved with the child welfare system who may be in birth homes, foster care, residential treatment centers, community-based prevention programs, juvenile justice settings, school-based programs, and programs for unaccompanied alien minors.

TST aims to stabilize the child's environment while simultaneously enhancing his/her ability to regulate emotions and behaviors. TST begins by assessing each child and his/her environment. Based on this assessment, the child is placed into one of three treatment phases. A TST priority problem is established, and a TST treatment team is assembled to address this priority problem from multiple perspectives. Different interventions and therapies are indicated within each phase, designed to both help the youth to better regulate survival states, and to help caregivers and providers to become better able to meet the child's needs.

Scientific Rating NR

Programs

CARE: Creating Conditions for Change

CARE: Creating Conditions for Change (3rd edition) is a principle-based program designed to enhance the social dynamics in residential care settings through targeted staff development, ongoing reflective practice, and data-informed decision-making. Using an ecological approach, CARE aims to engage all staff at a residential care agency in a systematic effort to orient practices in order to provide trauma-informed and developmentally enriched living environments and to create a sense of normality for children and young people. CARE is organized around six principles related to attachment, trauma, resiliency, and ecological theory. The principles state that child care practices must be:

  • Relationship-based
  • Trauma-informed
  • Developmentally focused
  • Competence-centered
  • Family-involved
  • Ecologically oriented

Cornell University CARE consultants follow a standardized set of steps to train and support staff over the 4-year implementation period. An essential activity is the formation of a local Implementation Team with multilevel representation that provides support, modeling, and mentoring to staff at all levels as they incorporate CARE principles into their work. This approach is designed to cultivate personal investment and ownership among all staff levels at the agency

Scientific Rating 3

Sanctuary Model

The Sanctuary Model® is a blueprint for clinical and organizational change which, at its core, promotes safety and recovery from adversity through the active creation of a trauma-informed community. A recognition that trauma is pervasive in the experience of human beings forms the basis for the Sanctuary Model's focus not only on the people who seek services, but equally on the people and systems who provide those services. Sanctuary has been used in organizations that provide residential treatment for youth, juvenile justice programs, homeless and domestic violence shelters as well as a range of community-based, school-based and mental health programs.

Scientific Rating 3

Support for Students Exposed to Trauma

Designed for implementation by school teachers or counselors, SSET is a cognitive-behavioral and skills-based 10-session support group for middle school children (ages 10-16) who have been exposed to traumatic events (such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or injured) and who are experiencing moderate to severe levels of posttraumatic stress disorder (PTSD) symptoms. Its aim is to relieve symptoms of child traumatic stress, anxiety, depression, and functional impairment. It is designed to be used in schools with children from a variety of ethnic and socioeconomic backgrounds and acculturation levels. Delivery of mental health programs through schools can overcome logistical barriers (transportation, scheduling) as well as reduce stigma and reach disadvantaged and minority youth who have limited access to mental health care. Developed as an adaptation of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program, SSET contains many of the same therapeutic elements but is designed to be implemented by school staff members without clinical training.

Scientific Rating 3

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

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.

Scientific Rating NR

Child Welfare Trauma Training Toolkit

The CWTTT is a training toolkit that is comprised of a Trainer's guide, a Slidekit (i.e., PowerPoint slides to be used in the training), a Participant Manual, Supplemental Handouts, Recommended Reading and Resources, and a Comprehensive Guide. The CWTTT is designed to teach knowledge, skills, and values about working with children in the child welfare system who have experienced trauma. The CWTTT teaches strategies that child welfare professionals can use to effectively address trauma among the families they serve and to enhance child, family, and provider resilience.

Scientific Rating NR

Developmental Trauma and Attachment Program

The Developmental Trauma and Attachment Program (DTAP) provides a comprehensive approach for children facing the lasting effects of trauma and attachment disruption. Through a fully integrated model combining attachment-focused therapy with trauma-informed practices, DTAP is designed to address foundational needs for trust, emotional regulation, and resilience.

DTAP also prioritizes caregiver involvement, creating a context for healing that is designed to strengthen the family system and foster lasting change.

Scientific Rating NR

Risking Connection®

Risking Connection® is a foundational trauma training program that grew out of a consumer trauma survivor lawsuit. It is based on constructivist self-development theory (CSDT), an integrative theory drawing on attachment theory, relational psychoanalytic theory, developmental psychopathology, and theory of cognitive schemas. Risking Connection® provides a way for organizations and systems to change their culture to one that is trauma-informed and trauma-responsive. It uses a train-the-trainer model of dissemination whereby organizations gain the internal capacity to conduct Risking Connection® trainings and sustain a trauma-informed culture.

This model emphasizes:

  • A framework for understanding common trauma symptoms
  • A common inclusive language
  • Relationships as the primary agent of change
  • Respect for, and care of, both the client and the service provider (vicarious traumatization) as critical to healing
  • Strategies and tools to support adoption of the model in clinical, social, and organizational processes

Scientific Rating NR

The Restorative Approach

The Restorative Approach™ a trauma-informed alternative to traditional "point and level" systems for child congregate care. Based on brain science, attachment theory, and restorative justice, it answers the question, "Now that I understand how trauma affects children, what should I do on Monday?"The Restorative Approach translates knowledge about trauma, the brain, and healing into suggestions for all program treatment providers within an organization. It includes a system for responding when children hurt others, using restorative tasks to teach children skills and to make amends. It includes taking care of the staff that do this difficult work.

The Restorative Approach includes strategies for:

  • Using the relationship to build hope
  • Interacting in an attuned manner
  • Using modern brain science to direct the milieu and individual interactions
  • Using and understanding the adaptive role of behavior to create change
  • Designing unit structure and programming to promote healing relationships
  • Individually responding to problem behaviors based on this understanding
  • Applying principles of restorative justice to treatment settings

Scientific Rating NR

Think Trauma

Think Trauma: A Training for Working with Justice-Involved Youth. is a skills-based, interactive trauma-focused training curriculum for frontline staff, educators, administrators, and others who work with adolescents in juvenile justice residential settings. The curriculum is developed in four modules and designed to be used in any program serving adolescents with trauma experiences that need all staff to have a common understanding of trauma and its impact. It can be used prior to implementing more trauma-specific services or beginning the journey of becoming a more trauma-responsive program. The manual contains specific and detailed information regarding with whom to implement, how to prepare for training, and provides prework which must be considered to prepare the organization. The curriculum itself is designed to be delivered either in full-day or modular form.

Scientific Rating NR

Trauma Systems Therapy

Trauma Systems Therapy (TST) is a comprehensive, phase-based treatment program for children and adolescents who have experienced traumatic events and/or who live in environments with ongoing stress and/or traumatic reminders. TST is designed to address the complicated needs of a trauma system, which is defined as the combination of a traumatized child/adolescent who, when exposed to trauma reminders, has difficulty regulating his/her emotions and behavior and his/her caregiver/system of care who is not able to adequately protect the youth or help him/her to manage this dysregulation. The most common setting in which TST is implemented is for youth involved with the child welfare system who may be in birth homes, foster care, residential treatment centers, community-based prevention programs, juvenile justice settings, school-based programs, and programs for unaccompanied alien minors.

TST aims to stabilize the child's environment while simultaneously enhancing his/her ability to regulate emotions and behaviors. TST begins by assessing each child and his/her environment. Based on this assessment, the child is placed into one of three treatment phases. A TST priority problem is established, and a TST treatment team is assembled to address this priority problem from multiple perspectives. Different interventions and therapies are indicated within each phase, designed to both help the youth to better regulate survival states, and to help caregivers and providers to become better able to meet the child's needs.

Scientific Rating NR