Adapted Trauma Focused Cognitive Behavior Therapy

NCTSNClusterCallCharlton20071AdaptedTraumaFocusedCognitiveBehaviorTherapyMargaretCharlton,PhD,ABPPNCTSNClusterCallCharlton20072InterceptCenteratAuroraMentalHealthCollaborativeprogrambetweenAuroraMentalHealthandAuroraPublicSchoolsforyouthwithco-morbidmajormentalillnessesanddevelopmentaldisabilities.NCTSNClusterCallCharlton20073HowToReachMeMargaretCharlton(303)[e-mail]11023E.5thAvenueAurora,CO80010NCTSNClusterCallCharlton20074OutlineofPresentationDiscussionoffactorsinfluencingincidenceoftraumaforpeoplewithdevelopmentaldisabilitiesReviewoffactorsthatresultinimpairedresilienceforpeoplewithdevelopmentaldisabilitiesDiscussofhowthemodelcanbemodifiedforusewithchildrenwithdevelopmentaldisabilitiesNCTSNClusterCallCharlton20075CautionThecurrentpresentationisbasedonCohen,MannarinoandDeblinger’smodelofTraumaFocusedCognitiveBehaviorTherapy(TF-CBT)TheinformationinthispresentationisablendofstandardTF-CBTtraining,originalthoughtandmodificationofTF-CBTmaterialforspecialpopulations.ThisworkisnotintendedtoreplacestandardTF-CBTtraining.ThematerialpresentedhereshouldnotbeusedbythoseunfamiliarwithTF-CBT.NCTSNClusterCallCharlton20076WhatisaDevelopmentalDisability?AlegaldefinitionnotapsychiatricdiagnosisThedisablingconditionisapparentbeforethepersonis22yearsoldItconstitutesasubstantialdisabilitytotheaffectedindividualItisattributabletomentalretardationorrelatedconditionswhichincludecerebralpalsy,epilepsy,autismorotherneurologicalconditionsTheconditionresultsinimpairmentofgeneralintellectualfunctionoradaptivebehaviorsimilartothatofapersonwithmentalretardationCharlton,M.,Fowler,T.,&Ivandick,M.J.(2006).B.Sales&M.O.Miller(Eds.),Law&MentalHealthProfessionals:Colorado.Washington,DC:AmericanPsychologicalAssociation.(Pages442-3)NCTSNClusterCallCharlton20077CommunityNeeds1.8%ofthepopulationoftheUSOrabout5millionpeopleSoinanylargescaledisaster,nearly2%ofthepopulationmayrequireadaptedtraumatreatment.NCTSNClusterCallCharlton20078CommunityNeedsContinuedHigherratesofmaltreatmentthanthegeneralpopulation.Perpetratorsperceptions:IdealvictimsLackcredibilityUnabletoreportNCTSNClusterCallCharlton20079AbuseandDevelopmentalDisability3to6%ofmaltreatedchildrenhaveapermanentdevelopmentaldisabilityasaresultofabuseorneglectChildmaltreatmentisafactorin10to25%ofalldevelopmentaldisabilitiesSobsey,1994NCTSNClusterCallCharlton200710OtherFactorsforPeoplewithDisabilitiesHigherlevelofassistancefromcaregiversForlongerperiodsoftimeForinvasivedailyfunctionsHigherlevelofstressonthefamilyChildrenarelessabletomeetparentalexpectationsCharlton,Kliethermes,Tallant,Taverne,&Tishelman(2004)NCTSNClusterCallCharlton200711OtherFactorsforPeoplewithDisabilitiesContinuedCognitivedisabilityinterfereswith:Theabilitytopredicthigh-risksituationsUnderstandwhatishappeninginanabusivesituationBarrierstoreporting:MobilitychallengesRestrictedabilitytocommunicateCharlton,Kliethermes,Tallant,Taverne,&Tishelman(2004)NCTSNClusterCallCharlton200712OtherFactorsforPeoplewithDisabilitiesContinuedTrainedtobecomplianttoauthorityfigures(Valenti-Hein&Schwartz,1995)44%hadarelationshipwiththeirabuserdirectlyrelatedtotheirdisability(Davis,2004)NCTSNClusterCallCharlton200713TheneedforadaptedtreatmentPeoplewithdevelopmentaldisabilitiesaremorelikelytobeimpactedbythatabuseduetoavarietyoffactorsthatimpairtheirresilienceorabilitytospontaneouslyrecovertheirformerleveloffunctioningfollowinganabusiveincident.Charltonetal.,2004;Burrows&Kochurka,1995;andMansell,Sobsey,&Moskal,1998NCTSNClusterCallCharlton200714MythsPeoplewithdevelopmentaldisabilitiesdonothavethesameresponsetotraumaaspeopleinthegeneralpopulation(Charltonetal.,2004)Peoplewithdevelopmentaldisabilitiescannotbenefitfromtherapy(Manselletal.,1998)NCTSNClusterCallCharlton200715CommunityRealitiesFewprofessionalsaretrainedtomeettheneedsofchildrenwithdevelopmentaldisabilitiesWedon’thaveadequateresearchonhowbesttoadapttraumatreatmentforthispopulationNCTSNClusterCallCharlton200716WhyshouldweadaptTF-CBTforchildrenwithdevelopmentaldisabilities?ChildrenwithdevelopmentaldisabilitiesaremorelikelytobeexposedtotraumathanthoseinthegeneralpopulationTheyaremorelikelytoexperiencenegativeeffectsontheirmentalhealthasaresultoftheirexposuretotraumaNCTSNClusterCallCharlton200717WhyshouldTF-CBTworkforchildrenwithdevelopmentaldisabilities?ItisastrengthbasedapproachItfocusesondevelopmentofcompetencyskillsItusescognitivebehavioraltreatmenttechniqueswhicharerelativelyeasytoadaptforchildrenatdifferentdevelopmentallevelsIthasalreadybeenstructuredforuseacrossawiderangeofdevelopmentallevelsNCTSNClusterCallCharlton200718AdditionalReasonforAdaptationOneofthereasonsthattraumahassuchanegativeimpactonpeoplewithdevelopmentaldisabilitiesistheirimpairedresilienceTF-CBTfocusesondevelopingskillsthatareassociatedwithgreaterresilienceinchildrenStrongself-esteemAbilitytoself-soothFeelingsofcompetencytodealwithchallengingsituationsNCTSNClusterCallCharlton200719AdaptingPsychotherapyforPeoplewithDevelopmentalDisabilitiesSlowdownyourspeechUselanguagethatiscomprehens