Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway (TAP) Chadwick Center for Children & Families Chadwick Center for Children and Families, Rady Children’s Hospital, San Diego The Chadwick Center for Children and Families is a Child Advocacy Center and department of Rady Children’s Hospital and Health Center in San Diego, CA. It is one of the largest centers of its kind and is staffed with more than 120 professionals and paraprofessionals in the field of medicine, social work, psychology, child development, nursing, and education technology. The Chadwick Center has made lasting differences in the lives of thousands of children and families since opening its doors in 1976. The staff is committed to family- centered care and a multidisciplinary approach to child abuse and family violence. The center’s mission is to promote the health and well-being of abused and traumatized children and their families. This is accomplished through excellence and leadership in evaluation, treatment, prevention, education, advocacy, and research. The center’s vision is to create a world where children and families are healthy and free from abuse and neglect. The National Child Traumatic Stress Network (NCTSN) Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) is a unique collaboration of academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children and their families across the United States. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and attention to cultural perspectives, the NCTSN serves as a national resource for developing and disseminating evidence-based interventions, trauma-informed services, and public and professional education. The Network is funded by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services through a congressional initiative: the Donald J. Cohen National Child Traumatic Stress Initiative. As of April 2010, the Network comprises 63 members. Affiliate members—sites that were formerly funded—and individuals currently or previously associated with those sites continue to be active in the Network as affiliates. Suggested Citation: Chadwick Center for Children and Families. (2009). Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway (TAP). San Diego, CA: Author. Copyright 2009 by the Chadwick Center for Children and Families, Rady Children’s Hospital and Health Center, San Diego. All Rights Reserved. Funding Information This document was supported with funding from grant award No. 5-U79- SM054289-01 from the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. This document reflects the thinking of many individuals and organizations, as well as information from valuable resource documents. It does not necessarily represent official policy or positions of the funding source. Document Available from: Chadwick Center for Children and Families Rady Children’s Hospital, San Diego 3020 Children’s Way, MC 5131 San Diego, CA 92123 Also available on the web at www.TAPtraining.net Trauma Assessment Pathway (TAP) Chadwick Center for Children & Families Table of Contents Preface and Acknowledgements ...............................................................i Introduction ......................................................................... ...................1 -Definition of Trauma................................................................... ......3 -Level of Traumatic Exposure ..............................................................4 -Assessment-Based Treatment ............................................................5 -Clinical Pathways................................................................. .............6 -Chadwick Center’s Philosophy: Understanding the Child and Resolving Trauma...............................................................7 Part I: Assessing the Traumatized Child...................................................9 Chapter 1: Setting up an Assessment-Based Treatment Program....... 10 -Standardized Assessment Choices..................................................... 10 Identifying Areas of Concern for the Center’s Trauma-Treatment Clientele.....................................................10 Multiple Individuals Assessing the Client’s Problems ......................... 13 Psychometric Properties ............................................................... 14 -Assessment Pathway.................................................................. ..... 16 -Providing Assessment Feedback to Clinicians......................................17 Chapter 2: Using a Comprehensive Assessment Process to Create the Unique Client Picture............................................... 19 -Initial Screening and Referral ........................................................... 19 -Comprehensive Assessment Process.................................................. 20 Conducting a Culturally Sensitive and Appropriate Assessment .......... 21 -Interpreting Standardized Assessment Measures................................. 23 -Making Sense of Assessment Information .......................................... 25 -Using Assesment Domains to Create the Unique Client Picture .............. 28 -Synthesizing Information and Generating Clinical Hypotheses ............... 29 -Developing Treatment Goals and Treatment Planning .......................... 30 Chapter 3: Triaging Clients ............................................................... 33 -Generalized Triage: Center-Wide Triage Considerations ....................... 33 -Individual Triage ......................................................................... ... 34 A Global Pathway: Overview of Multiple Interventions....................... 35 Specific Pathways for Each Intervention ......................................... 36 Part II: Treating the Traumatized Child ................................................. 39 Chapter 4: The TAP Treatment Component ........................................ 40 -Modalities of Treatment................................................................ ...40 Individual Therapy ...................................................................... 41 Family Involvement in Therapy ..................................................... 41 Group Therapy.................................................................. .......... 42 -The Trauma Wheel ......................................................................... 42 Child Development ...................................................................... 43 Relationship Building ................................................................... 44 Culture ......................................................................... ............. 45 Trauma Assessment Pathway (TAP) Chadwick Center for Children & Families Trauma Integration ..................................................................... 47 Affect Regulation............................................................... .......... 48 Addressing Maladaptive Cognitions ................................................ 49 Skill Building and Psychoeducation................................................. 50 Systemic Dynamics ..................................................................... 51 Chapter 5: Using the Trauma Wheel Via a Treatment Pathway........... 54 -Safety and High-Risk Concerns.........................................................55 -Identifying Primary Concerns through Assessment .............................. 57 Affect Regulation............................................................... .......... 57 Maladaptive Cognitions and Cognitive Distortions............................. 58 Problematic Behaviors................................................................ .. 59 Family System or Other System Dysruption .................................... 59 Unresolved Trauma ..................................................................... 60 -Asymptomatic Clients.................................................................. .... 61 Chapter 6: Monitoring Progress in Treatment ................................... 63 -Ongoing Assessment............................................................... ........ 63 -Periodic Re-administration of Standardized Measures........................... 63 -Assessment of Client Progress and Readiness for Termination...............64 -Clinical Supervision.............................................................. ........... 64 Chapter 7: Conclusion ....................................................................... 67 References ......................................................................... ................... 69 Glossary ......................................................................... ....................... 75 Appendices Appendix A: Example of Some Standardized Measurement Options Based Upon Domain and Reporter Appendix B: Resources for Ordering Assessment Measures Appendix C: Core Clinical Characteristics Form Appendix D: Pathway for Triage to Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) Appendix E: Pathway for Triage to Parent-Child Interaction Therapy (PCIT) Appendix F: Pathway for Triage to Alternatives for Families: A Cognitive- Behavioral Therapy (AF-CBT) Appendix G: Pathway for Triage to Child-Parent Psychotherapy