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Child and Family Traumatic Stress Intervention (CFTSI)

  • Summary

    Exposure to trauma and abuse in childhood can produce psychological effects that may in turn lead to chronic difficulties in the short and long term. Following exposure to potentially traumatic events, children may hide their traumatic reactions from their caregivers to try to protect them from getting upset. This means that caregivers may not be aware of the level of distress being experienced by their children. Furthermore, caregivers may misunderstand some of their children’s reactions; e.g. they may think a child is being willfully aggressive, when in fact their behaviour is a result of anxious hyperarousal.

    For these reasons, the Child and Family Traumatic Stress Intervention (CFTSI) was developed to improve communication between children who have experienced potentially traumatic events and their non-offending caregivers. The intervention also focuses on increasing family support for the child and on providing the skills to help the children and their families cope and overcome trauma reactions.

    The CFTSI was developed and tested in the U.S. by Yale University, who found that it reduced the occurrence of Post-Traumatic Stress Disorder (PTSD). The Anna Freud National Center for Children and Families is running the first UK pilot study is to determine its effectiveness for children and young people in the UK.

    The CFTSI will be offered to children and young people aged 7-17 who are showing at least one traumatic reaction since having experienced trauma in the previous 45 days. Evaluations of the CFTSI will assess changes in Post-Traumatic Stress symptoms and in the number of children who go on to develop diagnoses of PTSD following intervention. Follow-up interviews will be carried out 3 months after the interventions are completed to gain an understanding of young peoples’ experiences of the intervention.

  • Information for Families

    Some events can be shocking or stressful for children and young people, and they may lead to short-term reactions (e.g. in how they feel, behave and think).

    Sometimes, after the event has finished, such reactions become less frequent and the children and young people return to how they were before. But for some, such events can be so difficult to cope with that their reactions continue even after the event has finished.

    What is the Child and Family Traumatic Stress Intervention?

    CFTSI is a time-limited intervention provided shortly after difficult or upsetting events in order to prevent later problems developing. It involves working with the child or young person together with the adult who is looking after them. Research has shown that children and young people who have received such support are much less likely to develop problems later on.

    What will it involve?

    If you agree to receiving their help, one of our small team of trained and experienced practitioners will meet with you and the child or young person concerned to talk about how you are both coping and to explain what the intervention involves. If it seems that it would be a good fit, we will arrange a time to see you again. It consists of five sessions of talking and filling in questionnaires together. If, together, we think it will be helpful, we can also arrange a few more sessions.

    The first session is just with you to find out more about how you and the child or young person is doing. The second session is with the child or young person to find out how they think they are doing. Then the further three sessions are with you and the child or young person together, to discuss their reactions to what has happened and to think about some ways to cope with and overcome any difficulties.

    We can also make sure that any practical needs are being addressed and think with you about whether any longer-term support might be useful.

    Who will be working with me?

    The CFTSI sessions will be provided by the Anna Freud National Centre for Children and Families. There are four of us who have been trained in this particular intervention:

    • Sheila Redfern
    • David Trickey
    • Katherine Mautner
    • Joanne Jackson 

    Working out if it’s been helpful                

    We are very keen to see how helpful this support is, and in order to do this we need your help. There are some questionnaires to complete as part of the sessions, which will help us to work out how helpful it is. In addition, we would also like your permission to follow-up with you three months after your last meeting to see how things are going. We may also ask if one of our colleagues can come and talk with you both about how you found the intervention and whether there are things that were particularly useful or particularly unhelpful in your experience.     

               

  • Information for Professionals

    The Child and Family Traumatic Stress Intervention (CFTSI) is a brief, evidence-based mental health intervention for children and young people who have experienced potentially traumatic events. It is provided by a trained practitioner for the child or young person and their caregiver, and consists of five to eight sessions which focus on:

    • Increasing the family support available for the child or young person
    • Enhancing communication between the caregiver and the child or young person, particularly about their trauma reactions
    • Providing skills to help children, young people and families cope with, and overcome, trauma reactions
    • Helping families address practical needs such as safety, legal issues or medical care
    • Assessing the need for longer-term intervention and, if necessary, providing a smooth transition to other services

     

    CFTSI is implemented in the days and weeks following a potentially traumatic event or the formal disclosure of past abuse, before traumatic stress symptoms become established and when PTSD can be diagnosed.

    To be suitable for CFTSI, the child or young person should be showing at least one traumatic reaction, which has developed since the event or since the disclosure of past abuse. Traumatic reactions include:

    • Having upsetting thoughts or images about the event that come into the child or young person’s head when they do not want them to
    • Having bad dreams or nightmares
    • Acting or feeling as if the event is happening again
    • Feeling upset when they think or hear about the event
    • Having physiological reactions when being reminded about the event (for example, breaking out into a sweat, or heart beating fast)
    • Trying not to think about, talk about, or have feelings about the event
    • Trying to avoid activities, people, or places that remind them of the event
    • Not being able to remember an important part of the event
    • Having much less interest in doing things that they used to enjoy
    • Not feeling close to people around them
    • Not being able to have strong feelings (for example, being unable to cry or unable to feel happy)
    • Feeling as if their future plans or hopes will not come true
    • Having trouble falling or staying asleep
    • Feeling irritable or having fits of anger
    • Having trouble concentrating
    • Being overly careful
    • Being jumpy or easily startled

    Pilot project of CFTSI by the Anna Freud National Centre for Children and Families

    The Anna Freud National Centre for Children and Families has obtained funding to pilot this intervention in the UK with children, young people and their carers who have experienced potentially traumatic abuse (physical, emotional, sexual or domestic in nature). We will be considering whether it is feasible to deliver the intervention throughout the UK; therefore, we are keen to evaluate it fully. We will gather and analyse quantitative data about levels of distress at three time: before the intervention, immediately after the intervention, and three months after completion of the intervention. We will also collect and analyse data about how many families require further input after the intervention. We also hope to interview some families about their experience of CFTSI.

    Multiple children or young people

    CFTSI could be offered to more than one child or young person within a family, but they would each have separate sessions, and so a carer would need to attend these separate sessions. It would be possible for different carers to attend with each child.

    Checklist for suitable referrals to CFTSI Pilot Project:

    • Child or young person aged 7-18
    • Living with at least one supportive carer:
      • who was not a part of any abuse of the child or young person
      • who is willing to participate in the intervention
      • who has known the child or young person for at least 6 months
    • Potentially traumatic event(s) occurred within previous 45 days, or
    • Disclosure of past abuse happened within previous 45 days
    • Presence of at least one post-traumatic reaction which was not present before the event of the disclosure
    • Stable accommodation for at least the next 10 weeks

    To download our information leaflet for families please click here

    To download our information leaflet for professionals please click here

     

  • How to find out more

    Making a referral:

    If you would like to make a referral, you can send a current CAF (Common Assessment Framework) or the CFTSI Referral Form to referrals@annafreud.org

    To download our CFTSI referral form please click here

    If you would like to discuss a possible referral, please contact David Trickey, Consultant Clinical Psychologist david.trickey@annafreud.org  or telephone 020 7794 2313