Trauma-Informed CBT for Children & Adolescents: A Clinical Playbook for Integrating Structure with Client-Centered Flexibility

CPD

Handouts

Speaker

Amy Marschall, PsyD Related seminars and products

Sioux Falls Psychological Services

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Dr. Amy Marschall is a licensed clinical psychologist in South Dakota. Dr. Marschall works primarily with children and adolescents, adopting Telemental health strategies early into her clinical practices, and is a Certified Clinical Telemental Health Provider (CTMH). In 2016, Dr. Marschall helped develop a Telemental health task force at Sioux Falls Psychological Services to develop an ethical and effective model to provide telehealth services to individuals living in rural South Dakota without access to mental health resources. Dr. Marschall co-developed and presented a six-hour seminar on ethical and legal guidelines for Telemental health in 2017 and has been providing these services in South Dakota since that time.  

 

Speaker Disclosures:
Financial: Amy Marschall is the founder of Resiliency Mental Health and has employment relationships with RMH Therapy, A Change for Better, Grayce, ADHD Online, Spring Health, and DotDash Meridith. She is a consultant with VeryWell Mind and receives royalties as a published author. Amy Marschall receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Amy Marschall has no relevant non-financial relationships.

 

Objectives

1. Integrate a trauma-informed approach to assessment, treatment planning, and sessions.
2. Employ a collaborative approach to treatment planning, balancing relevant, specific, and time-measurable goals with each client’s articulated goals for their care.
3. Modify therapeutic interventions based on client feedback of their unique needs, preferences, and history.
4. Utilize trauma-informed, evidence-based cognitive behavioural interventions in sessions, including mindfulness activities, breathing exercises, visualizations, metacognition, and psychoeducation.
5. Apply evidence-based cognitive-behavioural techniques while teaching clients to identify what does or does not work for them about each technique, and adjust interventions appropriately in light of client feedback.
6. Assess behavioural issues from a trauma-informed perspective, with an emphasis on identifying and addressing underlying needs rather than consequences or punishments for problem behaviours, and educate parents on how to implement this approach outside of sessions.

Outline

What Trauma Looks Like in Children & Adolescence

• Adverse Childhood Experiences
• Growing up During COVID: A New Stressor
• Preverbal Trauma
• Trauma-Related Emotional and Behavioural Issues

Trauma-Informed Assessment & Treatment Planning

• Developmental trauma interview; ACEs score; Trauma Symptom Checklist
• Assessment is not finite; how to continually assess client safety and therapeutic needs
• Integrating behavioural and emotional goals
• What does it mean to feel “better”?

How to Elevate Your Practice Utilizing CBT and Trauma Informed Techniques

• Actively engaging kids with a child-centred approach
• Balancing the structure of CBT with flexibility/nuance of a trauma-informed lens
• Integrating concrete skill-building into trauma processing work
• Getting to the root cause of each child’s unique trauma needs

A Playbook for Implementing Trauma-Informed CBT (Worksheets, scripts & demonstrations included)

• Preparing clients for trauma work
  • Psychoeducation: deciding what information is helpful and how to present it
  • Identifying the child’s level of anxiety/physiological arousal
  • Teaching children the language around trauma
• Affective Monitoring
  • When feelings are happening – press pause/go with the flow
  • Noticing when emotions start to get bigger – feelings thermometer/feelings spectrum/volcano
  • Mindfulness and body awareness
• Metacognition –
  • Noticing thoughts as they come – watching the clouds/radio station
  • Emotional reaction to those thoughts – naming feelings/emoji feelings
  • Thought stopping activities
• Narrative therapy
  • With specific trauma memories – writing vs dictating poem/children’s book/ narrative story
  • Without specific memories - exploring when they learned about the trauma/ exploring feelings related to the knowledge of the trauma
• Relaxation Techniques that children enjoy
  • Mindful bowling/juggling
  • Guided safe place visualisation
  • Body scan
  • Muscle relaxation
  • Stong like a tree
  • Art therapy
  • Music

Clinical Considerations

• The art of getting caregiver buy-in for participation in treatment
• Balancing honouring the client’s needs and requests with evidence-based practice and treatment goals created by guardians
• Sometimes developmental trauma needs to be re-processed as the child gets older
• Determining/Discerning how much treatment is “enough” for the child’s developmental age/
• stage
• Cultural diversity considerations for trauma work
• Limitations of the research and potential risks

Target Audience

• Psychologists
• Social Workers
• Counselors
• Marriage & Family Therapists
• Speech-Language Pathologists
• Occupational Therapists
• School Administrators
• Physicians
• Teachers/School-Based Personnel