Berkowitz, Stover, and Marans (2010) found the Child and Family Traumatic Stress Intervention (CFTSI) group was less likely to have a posttraumatic stress disorder (PTSD) diagnosis at the 3-month follow up, reducing the odds of PTSD by 65.0 percent, compared with the comparison group. This difference was statistically significant.
Full or Partial PTSD Diagnosis
CFTSI also produced statistically significant differences in the probability of a partial or full PTSD diagnosis at follow up, reducing the odds by 73 percent for the CFTSI group, compared with the comparison group.
Severity of PTSD
Youth in the CFTSI group reported a statistically significant reduction in severity of PTSD symptoms at follow up, compared with the comparison group (8.7 versus 14.7, respectively).
Berkowitz, Stover, and Marans (2010) conducted a randomized controlled trial at the Trauma Section of the Yale Child Study Center with youth aged 7–17 years who were exposed to a potentially traumatic event (PTE) and exhibited at least one symptom of posttraumatic stress disorder (PTSD). Children were referred for service by police or a forensic sexual abuse program. Children were recruited from a pediatric emergency department following a record review, by follow-up phone call. The study recruitment occurred from November 2006 to May 2009, with follow-up interviews completed by September 2009. All screened youth and families were offered services regardless of agreement to participate in the study.
Of the 735 families contacted by phone and screened, youth who had one new symptom since the PTE as reported by either the youth or caregiver were further screened for eligibility. Youth were excluded if they were receiving counseling or metal health services, had a developmental delay or diagnosed psychotic or bipolar disorder, were non–English speaking, or refused participation in the study. After screening all youth for inclusion criteria, researchers obtained consent for a total sample of 112. After randomization to either Child and Family Traumatic Stress Intervention (CFTSI) or the comparison intervention, a final sample of 106 participants was obtained. The treatment youth (n= 53) received the CFTSI model. Comparison youth (n= 53) received a protocolized psycho–educational (including relaxation training) and supportive four-session intervention that included an initial meeting with the adult caregiver, two individual youth sessions, and a fourth feedback session with both the caregiver and the youth. There were no significant differences between groups on age, ethnicity, or PTE type. The average age of youth was 12, with 48 percent male, 32 percent Caucasian, 37 percent African American, 22 percent Hispanic, 7 percent multiethnic, and 2 percent other ethnicities. The nature of the PTEs that brought youth to the study included motor vehicle accidents (24 percent), sexual abuse (18 percent), witnessing violence (19 percent), physical assaults (21 percent), injuries (8 percent), animal bite (5 percent), and threats of violence (5 percent).
Baseline interviews and the first treatment session occurred at the initial visit, within 30 days of the youth’s exposure to a PTE. All participants were interviewed by a research assistant at baseline, immediately following their fourth treatment session (4 weeks from baseline), and at 3 months posttreatment. The UCLA Posttraumatic Stress Disorder Index (Pynoos et al. 1998) was used to assess posttraumatic symptomatology related to subjective distress and PTSD diagnostic criteria B (re-experiencing), C (arousal), and D (avoidance) symptoms and can be used to diagnose full or partial PTSD based on DSM-IV criteria (Steinberg, Brymer, Decker, and Pynoos 2004). The Trauma Symptom Checklist for Children was administered at all time points to evaluate posttraumatic symptomatology (Briere 1996).
Group differences in symptom severity were assessed using repeated measures with mixed-effects models of intervention group, time, and the interaction of intervention and time. Logistic regression analyses were performed to assess treatment condition and any subsequent traumas experienced as predictors for full and partial PTSD diagnosis at 3-month follow-up. An exploratory chi-square analysis was performed to examine the differences in PTSD symptom criteria at follow-up.
The intervention is facilitated by a provider manual containing detailed case vignettes, a decision tree for identifying Child and Family Traumatic Stress Intervention (CFTSI) cases, and easy-to-read handouts for children and caregivers. Spanish-language versions of the clinical assessment tools are available.
Child and Family Traumatic Stress Intervention (CFTSI) is currently in use in child advocacy centers and children’s mental health clinics in New Haven, and in New York City in collaboration with Safe Horizon. It is also being implemented in Philadelphia in collaboration with the Children’s Hospital of Philadelphia and St. Christopher’s Hospital for Children emergency departments.
These sources were used in the development of the program profile:
The National Child Traumatic Stress Network. 2010. “Yale Prepares to Launch Learning Collaborative for Brief Intervention Model.” IMPACT
The National Child Traumatic Stress Network. 2008. “CFTSI: Child and Family Traumatic Stress Intervention.” Trauma-Informed Interventions: General Information Intervention Template
. Los Angeles, Calif., and Durham, N.C.