Trauma-Focused Treatments

According to the Chadwick Center for Children and Families' Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators; common, broad goals of trauma-focused treatment include: 

  • Re-establishing a sense of physical and psychological safety for the child
  • Helping the child (and family) manage emotions, particularly in the presence of trauma reminders
  • Helping the child (and family) gain an understanding of the traumatic experience(s), while recognizing that there may be differences in how the trauma experience is understood by those who were exposed to it

The Chadwick article further defines the following as components to be worked toward in effective treatment.  

  • Emotion expression and regulation skills, or identifying feelings and developing coping mechanisms for managing difficult feelings such as sadness or anger
  • Anxiety management and relaxation skills through practices such as visualization, deep breathing exercises, progressive muscle relaxation, etc.
  • Cognitive processing or reframing, or helping the child not to self-blame, and to identify the connection between thoughts, feelings, and behaviors (the “cognitive triangle”) and replace inaccurate thoughts with more helpful thoughts
  • Strategies that allow exposure to traumatic memories and feelings in tolerable doses so that they can be mastered and integrated into the child’s experience. It is important that children be able to integrate their trauma experiences, so they are one/some of many life experiences rather than the defining experience(s); this includes construction of the “trauma narrative,” or telling the trauma story in tolerable doses, while other techniques are utilized, so that the trauma loses its power.
  • Personal safety training and other empowerment activities, or developing healthy boundaries and learning ways to enhance physical and psychological safety
  • Resilience and closure, or, at treatment termination, helping children identify strengths for future coping, and helping children/families prepare for possible trauma reminders and triggers

The Chadwick Center's findings led the researchers to make several recommendations for child welfare agencies regarding trauma-focused treatment. First, agencies should universally screen and assess for trauma experiences and symptoms; they should review assessment tools carefully to ensure that they are valid, reliable, and sensitive enough to distinguish trauma and mental health symptoms. Secondly, because of the important differences between mental health services and trauma-focused treatment, traditional mental health services should not be provided unless trauma screening has first taken place, with trauma being ruled out.

Child welfare agencies should recognize that the mental health field has related, but somewhat differing goals when working with children and parents. Mental health providers tend to work toward ameliorating the manifestations of a specific condition (or conditions) diagnosed, which is a worthwhile goal, but they may fail to recognize how trauma has pervaded and shaped the child’s or adult’s entire sense of self and safety. Because of this, they may sidestep dealing holistically with the wide array of trauma effects and may limit their effectiveness in developing protective and coping factors through their interventions. It is critical that mental health providers understand what the professionals in child welfare, as well as the child and family, hope to accomplish with a referral for mental health services. Additionally, they should know and understand the goals for the child and family, whether or not there is evidence of trauma in the child’s and family’s history, and what strategies the child welfare agency believes should be considered in treatment planning.

In general, when compared to traditional mental health treatments for diagnoses such as bipolar disorder, attention deficit disorder, and conduct disorder, the researchers found that trauma-focused treatments:

  • Keep a greater focus on context, safety, and support
  • Better address symptoms and risk behaviors as part of a broader set of reactions
  • Develop more strengths and protective factors
  • Focus less on medications
  • Are less stigmatizing

Thus, great care should be taken to distinguish between mental health and trauma symptoms in children, and to ensure that treatments selected are appropriate, consider the child as a whole, and help affected children make new meaning of their trauma history.