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 are able to put the event behind them. 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 time-limited support provided shortly after extremely difficult or upsetting events in order to prevent problems from developing later on. The support starts within 45 days of the event(s), or of the disclosure of past abuse. 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 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 type of support:

    • 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. 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 structured approach to offering support to children and young people who have experienced very distressing events which have the potential to be traumatic.

    CFTSI is offered in the weeks following potentially traumatic events or formal disclosure of past abuse; before traumatic stress symptoms become established.

    The support is offered by experienced mental health professionals who have been trained in delivering the approach. It involves working in collaboration with the child or young person together with their caregiver for five to eight sessions which focus on:

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

    The approach was developed by Yale University in the USA. Research shows that it significantly reduces the likelihood that a child or young person will develop mental health difficulties such as Post-Traumatic Stress Disorder following distressing events.

    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 bad dreams or nightmares about the event, or having images or thoughts coming to mind without wanting them to
    • Feeling as if it is happening again
    • Losing temper easily
    • Trouble concentrating
    • Being more careful than needed
    • Getting very upset when reminded of it
    • Trying hard not to think about or talk about it
    • Avoiding things, people or places that might trigger a memory of it
    • Feeling emotionally numb or cut off from people around
    • Sleep difficulties
    • Being easily startled

    CFTSI Pilot Project

    The Anna Freud National Centre for Children and Families has won funding to pilot this particular type of support in the UK with children, young people and their carers following abuse (physical, emotional, sexual or domestic), or other potentially traumatic events involving actual or threatened injury, or traumatic bereavement.

    We will be considering whether it is worthwhile offering CFTSI in the UK; therefore, we are keen to assess it thoroughly. We intend to gather and analyse information from the families about how they are doing at three times: before the intervention, after the intervention, and three months later. We will also collect and analyse data about how many families require further input after the work. We will interview some families about their experience of the support.

    Can multiple children or young people from a single family participate?

    If more than one child or young person is referred from a single household it may be sensible for us to work with just one of them initially as it is likely that the support will end up being helpful for other children and young people in the family. Alternatively, CFTSI could be offered to more than one child or young person within a family, but each of them would each need separate sessions accompanied by a carer. In such situations one carer would need to attend every set of sessions, or different carers could attend with each child or young person.

    What if there is a criminal investigation

    CFTSI can be offered to children and young people even if there is an on-going criminal investigation involving the child or young person giving evidence. The support focuses on developing coping strategies to deal with the reactions, and not the details of the event, and the professionals will liaise with other agencies involved if appropriate.

    Referrals to the CFTSI Project:

    Use the check list below to ensure that the child or young person is likely to be appropriate:

    • Child or young person aged 7-18
    • Living with at least one supportive carer:
      • who was not an active part of any abuse
      • 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