Trauma Treatment Models and Ratings

Introduction

When a child or adult is scared or feels threatened by something they have seen or been involved in, it is called trauma. Reactions to trauma can include unstable emotions and behavior, nightmares, headaches, nausea and stomach problems. These reactions are normal, but sometimes can make it hard to move forward. Mental/behavioral health care providers can help people to find ways manage these reactive emotions.
There is a wide range or trauma types that children or adults may be exposed to:
  • bullying
  • community violence
  • complex trauma (multiple events)
  • disasters
  • early childhood trauma (ages 0-6)
  • domestic violence (also referred to as “Intimate Partner Violence or IPV”)
  • medical trauma
  • physical abuse
  • refugee trauma
  • sexual abuse
  • terrorism and violence
  • traumatic grief
The Medical Home Portal has put together this information to help families of children and youth with special health care needs understand what trauma treatment is, and how you can access providers and treatment. The Portal’s Services Directory includes information on some mental/behavioral health care providers including their training, certification and approaches used to treat trauma.

Treatment Models for Those Who Have Experienced Trauma

The information below comes from the California Evidence-Based Clearinghouse for Child Welfare (CEBC). It uses a rating scale to help describe available trauma treatment options.
Scientific Rating Scale: This scale is a 1 to 5 rating of the strength of the research evidence supporting a treatment practice or program. A scientific rating of 1 represents a practice with the strongest research evidence, and a 5 represents a practice that appears to pose substantial risk to children and families. Our listings contain only those programs rated 1-3:
  • 1 – well-supported by research evidence
  • 2 – supported by research evidence
  • 3 – promising research evidence
Trauma Treatment (Child & Adolescent) is defined by the CEBC as treatment designed to help a child or adolescent process a trauma or multiple traumas he or she experienced and learn how to cope with the feelings associated with the experience (e.g., fear, posttraumatic stress, anxiety, depression, etc.).
Trauma Treatment (Adult) is defined by the CEBC as treatment developed to assist adults in coping with the effects that come from experiencing trauma. The trauma(s) may have occurred at any point in the individual’s life and may have occurred once or many times. Research finds that more than half of all adults in the United States will experience a traumatic event at some point in their lives.

Children and Adolescents - Models

Scientific Rating: 1 – Well-Supported by Research Evidence

Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR)

EMDR therapy is an 8-phase psychotherapy treatment that was originally designed to alleviate the symptoms of trauma. During the EMDR trauma processing phases, guided by standardized procedures, the client attends to emotionally disturbing material in brief sequential doses that include the client’s beliefs, emotions, and body sensations associated with the traumatic event while simultaneously focusing on an external stimulus. Therapist directed bilateral eye movements are the most commonly used external stimulus, but a variety of other stimuli including hand-tapping and audio bilateral stimulation are often used. Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR)

Prolonged Exposure Therapy for Adolescents (PE-A)

PE-A is a therapeutic treatment where clients are encouraged to repeatedly approach situations or activities they are avoiding because they remind them of their trauma (in vivo exposure) as well as to revisit the traumatic memory several times through retelling it (imaginal exposure). Psychoeducation about common reactions to trauma as well as breathing retraining exercises are also included in the treatment. The aim of in vivo and imaginal exposure is to help clients emotionally process their traumatic memories through imaginal and in vivo exposure. Through these procedures, they learn that they can safely remember the trauma and experience trauma reminders, that the distress that initially results from confrontations with these reminders decreases over time, and that they are capable of tolerating this distress. Prolonged Exposure Therapy for Adolescents (PE-A)

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)

TF-CBT is a conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles. Trauma-Focused Cognitive-Behavioral Therapy; TB-CPT Certified Therapists

Scientific Rating: 2 – Supported by Research Evidence

Child-Parent Psychotherapy (CPP)

CPP is a treatment for trauma-exposed children aged 0-5. Typically, the child is seen with his or her primary caregiver, and the dyad is the unit of treatment. CPP examines how the trauma and the caregivers’ relational history affect the caregiver-child relationship and the child’s developmental trajectory. A central goal is to support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child’s mental health. Treatment also focuses on contextual factors that may affect the caregiver-child relationship (e.g., culture and socioeconomic and immigration related stressors). Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other and interactions and behaviors that interfere with the child’s mental health. Over the course of treatment, caregiver and child are guided to create a joint narrative of the psychological traumatic event and identify and address traumatic triggers that generate dysregulated behaviors and affect. Child Parent Psychotherapy

Scientific Rating: 3 – Promising Research Evidence

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT)

AF-CBT is an evidence-based treatment (EBT) designed to improve the relationships between children and caregivers in families involved in arguments, frequent conflict, physical force/discipline, child physical abuse, or child behavior problems. Alternatives for Families: A Cognitive Behavioral Therapy

Child and Family Traumatic Stress Intervention (CFTSI)

CFTSI is a brief early intervention model for children and adolescents 7-18 that is implemented soon after exposure to a potentially traumatic event, or in the wake of disclosure of physical and sexual abuse. Developed at the Yale Child Study Center, CFTSI fills a gap between acute responses/crisis intervention and evidence-based, longer-term treatments designed to address traumatic stress symptoms and disorders that have become established. The goal of this family-strengthening model is to improve the caregiver’s ability to respond to, and support, a child who has endorsed at least one posttraumatic symptom. By raising awareness of the child’s symptoms, increasing communication and providing skills to help master trauma reactions, CFTSI aims to reduce symptoms and prevent onset of posttraumatic stress disorder (PTSD). In addition, CFTSI offers an opportunity to assess which children and families need longer-term treatment. CFTSI is provided by master’s-level clinicians who have been trained by CFTSI master trainers. Child and Family Traumatic Stress Intervention

Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

CBITS is a school-based, group and individual intervention designed to reduce symptoms of posttraumatic stress disorder (PTSD), depression, and behavioral problems among students exposed to traumatic life events, such as exposure to community and school violence, accidents, physical abuse, and domestic violence. It is designed for students, who have experienced a traumatic event and have current distress related to that event. The goals of the intervention are to reduce symptoms and behavior problems and improve functioning, improve peer and parent support, and enhance coping skills. The program includes 10 student group sessions, 1-3 student individual sessions, 2 parent sessions, and a teacher educational session. Developed for the school setting in close collaboration with school personnel, the program is well suited to the school environment. Cognitive Behavioral Intervention for Trauma in Schools

Combined Parent-Child Cognitive-Behavioral Therapy

CPC-CBT: Empowering Families Who Are at Risk for Physical Abuse is a short-term (16-20 sessions), strength-based therapy program for children ages 3-17 and their parents (or caregivers) in families where parents engage in a continuum of coercive parenting strategies. These families can include those who have been substantiated for physical abuse, those who have had multiple unsubstantiated referrals, and those who fear they may lose control with their child. Children may present with PTSD symptoms, depression, externalizing behaviors and a host of difficulties that are targeted within CPC-CBT. The program is grounded in cognitive behavioral theory and incorporates elements (e.g., trauma narrative and processing, positive reinforcement, timeout, behavioral contracting) from CBT models for families who have experienced sexual abuse, physical abuse, and/or domestic violence, as well as elements from motivational, family systems, trauma, and developmental theories. CPC-CBT helps the child heal from the trauma of the physical abuse, empowers and motivates parents to modulate their emotions and use effective non-coercive parenting strategies, and strengthens parent-child relationships while helping families stop the cycle of violence. Combined Parent-Child Cognitive-Behavioral Therapy

Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)

The Fairy Tale Model is a model of trauma-informed psychotherapy and is so named because it is taught with the telling of a fairy tale, in which each element of the story corresponds to one of the phases in treatment. Following the treatment manual, Treating Problem Behaviors: A Trauma-Informed Approach, this phase model of trauma-informed treatment calls for a given phase of treatment to be pursued until the client outcome specified for that phase has been achieved. The treatment manual has scripted interventions for working with teens individually. Fairy Tale Model (Treating Problem Behaviors: A Trauma-Informed Approach)

Preschool PTSD Treatment (PPT)

PPT is a manualized, 12-session cognitive behavioral therapy protocol to treat very young children with posttraumatic stress disorder (PTSD) and trauma-related symptoms. The sessions are either with the therapist working individually with the child (with the parent observing via a video feed) or with the parent and child together. Preschool PTSD Treatment

Seeking Safety for Adolescents

Seeking Safety was originally designed for adults and has been rated by the CEBC in the area of Substance Abuse Treatment (Adult). Seeking Safety for Adolescents is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format for adolescents (both females, and males) in various settings (e.g., outpatient, inpatient, residential, home care, and schools). Seeking Safety for Adolescents consists of 25 topics that can be conducted in any order and number. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety for Adolescents

SITCAP-ART

The SITCAP-ART program is a comprehensive trauma intervention program, modified from the original Structured Sensory Intervention for Traumatized Children, Adolescents and Parents (SITCAP) program initially researched in 2001. SITCAP-ART is designed specifically for at-risk and adjudicated youth. SITCAP-ART integrates cognitive strategies with sensory/implicit strategies. When memory cannot be linked linguistically in a contextual framework, it remains at the symbolic level for which there are no words to describe. To retrieve that memory so it can be encoded, given a language, and then integrated into consciousness, it must be retrieved and externalized in its symbolic perceptual (iconic) form. SITCAP-ART, which is followed by cognitive or explicit strategies, supports moving from victim to survivor thinking allowing changes in negative behaviors (aggressive and rule-breaking behavior) and making adolescents more resilient to future traumas. SITCAP-ART

Trauma Affect Regulation: Guide for Education and Therapy for Adolescents (TARGET)

TARGET is an educational and therapeutic approach for the prevention and treatment of complex Post-Traumatic Stress Disorder (PTSD). TARGET provides a practical skill-set that can be used by trauma survivors and family members to de-escalate and regulate extreme emotional states, to manage intrusive trauma memories in daily life, and to restore the capacity for information processing and autobiographical memory. TARGET teaches a sequence of seven skills described as the FREEDOM steps. Trauma Affect Regulation: Guide for Education and Therapy for Adolescents

Trauma-Focused Coping (TFC)

TFC targets the internalizing effects of exposure to trauma in children and adolescents, with an emphasis on treating posttraumatic stress disorder (PTSD) and the collateral symptoms of depression, anxiety, anger, and an external locus of control [i.e., tendency to attribute one’s experiences to fate, chance, or luck]. The intervention utilizes social learning theory and a skills-oriented cognitive-behavioral approach that is carried out in 14-week sessions of gradual exposure, moving from psycho-education, anxiety management skill building, and cognitive coping training, to finally, trauma narrative and cognitive restructuring activities. Trauma-Focused Coping

Adults - Models

Scientific Rating: 1 – Well-Supported by Research Evidence

Cognitive Processing Therapy (CPT)

Developed originally for use with rape and crime victims, CPT begins with the trauma memory and focuses on feelings, beliefs, and thoughts which directly emanated from the traumatic event. The therapist then helps the clients examine whether the trauma appeared to disrupt or confirm beliefs prior to this experience, and how much the clients have over-generalized (over-accommodated) from the event to their beliefs about themselves and the world. Clients are then taught to challenge their own self-statements using a Socratic style of therapy (leading clients to understand their reasoning processes and beliefs through questions), and to modify their extreme beliefs to bring them into balance. CPT can be conducted individually or in groups where the written trauma account is completed in an individual session. Cognitive Processing Therapy

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR therapy is an 8-phase psychotherapy treatment that was originally designed to alleviate the symptoms of trauma. During the EMDR trauma processing phases, guided by standardized procedures, the client attends to emotionally disturbing material in brief sequential doses that include the client’s beliefs, emotions, and body sensations associated with the traumatic event while simultaneously focusing on an external stimulus. Therapist directed bilateral eye movements are the most commonly used external stimulus, but a variety of other stimuli including hand-tapping and audio bilateral stimulation are often used. Eye Movement Desensitization and Processing

Prolonged Exposure Therapy (PE)

PE consists of 8 -15 weekly or semi-weekly treatment sessions that are 60-90 minutes each. Clients are encouraged to repeatedly approach situations or activities they are avoiding because they remind them of their trauma (in vivo exposure) as well as to revisit the traumatic memory several times through retelling it (imaginal exposure). Psychoeducation about common reactions to trauma as well as breathing retraining exercises are also included in the treatment. The aim of in vivo and imaginal exposure is to help clients emotionally process their traumatic memories through imaginal and in vivo exposure. Through these procedures, they learn that they can safely remember the trauma and experience trauma reminders, that the distress that initially results from confrontations with these reminders decreases over time, and that they are capable of tolerating this distress. Prolonged Exposure Therapy for PTSD for Adults (PE)
Target Population: Adults with a variety of traumas such as combat, sexual assault, car accidents, violent crimes, and acts of terrorism.

Scientific Rating: 2 – Supported by Research Evidence

Cognitive Behavioral Therapy for Acute Stress Disorder

Cognitive Behavioral Therapy for Acute Stress Disorder is a form of therapy used in the early stages of traumatic response. Cognitive-behavioral therapy helps people with acute stress disorder change their way of thinking about the traumatic event and alter their behaviors in anxiety-provoking situations. Like posttraumatic stress disorder (PTSD), acute stress disorder may develop in an individual who has experienced or witnessed a traumatic event. Unlike PTSD, however, the anxiety which accompanies acute stress disorder lasts for a minimum of 2 days and a maximum of 4 weeks. If symptoms persist for longer than 4 weeks, or begin more than a month after the trauma was initially experienced or witnessed, a diagnosis of PTSD may be appropriate. Cognitive Behavioral Therapy for Acute Stress Disorder

Seeking Safety

Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format; with females and males; and in various settings (e.g., outpatient, inpatient, residential, home care, schools). Seeking Safety consists of 25 topics that can be conducted in as many sessions as time allows, and in any order. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety for Adolescents is also highlighted on the CEBC in the Trauma Treatment (Child and Adolescent) topic area. Seeking Safety

Scientific Rating: 3 – Promising Research Evidence

Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder

The 16-session Brief Eclectic Psychotherapy for PTSD (BEPP) protocol starts with psychoeducation on posttraumatic stress disorder (PTSD). The patient and his/her partner learn to understand the symptoms of PTSD as dysfunctional, and caused by the traumatic event. The patient will then receive 4-6 sessions of relaxation and imaginary exposure, focused on the suppressed intense emotions of sorrow.
Memorabilia are used to stimulate remembrances of the traumatic event and the patient is tasked to write a letter to a person or an institution blamed for the traumatic incident. The letter is specifically used to express aggressive feelings. Symptoms will then typically disappear and the patient will be able to concentrate on the impact of the trauma on his/her view of self and the world. The treatment is ended with a farewell ritual. Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder

Trauma Affect Regulation: Guide for Education and Therapy for Adults (TARGET)

TARGET is an educational and therapeutic approach for the prevention and treatment of complex Post-Traumatic Stress Disorder (PTSD). TARGET provides a practical skill-set that can be used by trauma survivors and family members to de-escalate and regulate extreme emotional states, to manage intrusive trauma memories in daily life, and to restore the capacity for information processing and autobiographical memory. TARGET teaches a sequence of seven skills described as the FREEDOM steps. Trauma Affect Regulation: Guide for Education and Therapy for Adults (TARGET)

Other

Somatic Experiencing

Not listed on California Clearinghouse
3-year training program with 3 levels: beginning, intermediate, advanced. Each level has more than one training module. Supervision sessions are required for each level. A certificate is given upon completion. Somatic Experiencing Program

Resources

Information & Support

For Parents and Patients

The National Child Traumatic Stress Network (NCTSN)
In-depth information about trauma-informed clinical interventions, screening and assessment practices, disaster behavioral health response and recovery, culture and trauma, and more.

Services for Patients & Families in Rhode Island (RI)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: February 2016; last update/revision: February 2021
Current Authors and Reviewers:
Author: Mindy Tueller, MS, MCHES
Reviewer: Tina Persels