Trauma Focused Cognitive Behavioral Therapy (TF-CBT)
TFCBT is an evidence based program that can be used in individual therapy for children or adolescents (or adults) who have experienced trauma to such a degree that it impairs functioning of daily life. TFCBT is a tool that can be very helpful in assisting persons who have survived trauma to take some of the intensity out of the memories. This is to say that step one is assessing the (1) most significant trauma, and (2) how the symptoms of it show up in a regular life. Step 2 is to teach specific skills to assist the person in being able to talk about the trauma in a organized way in which perspective is gained. Step 3 focuses on making a narrative of the traumatic experience and taking control of the memories. A checklist can be re-administered throughout the therapy process to measure the decrease in symptoms. While this approach is not used for every child at CSTC, it is a model that has been presented to all CSTC therapists and there is an ongoing commitment from the administration to support the success of this model. Further information and a free training can be found at https://tfcbt.musc.edu/ The primary handbook on this model is by Cohen, Mannarino, and Deblinger (2006) and it is titled "Treating Trauma and Traumatic Grief in Children and Adolescents."
Dialectical Behavior Therapy (DBT)
DBT is a treatment approach pioneered by Linehan (2001) which combines Cognitive Behavioral therapy techniques for emotion regulation and reality-testing with concepts of distress tolerance, mindful awareness, and acceptance. A Crucial aspect of the therapy is finding a balance between acceptance of a patient just as they are and the need for the patient to change in order to have a "life worth living." One of the major premises of DBT is that patients are doing the best they can, but engage in harmful thoughts and actions because they lack the skills necessary to build a life worth living. At CSTC the DBT approach is used primarily with adolescents to help with handling upsetting feelings and coming to terms with life as it is experienced. Mindfulness, or awareness of one’s feelings, behaviors, and thoughts, is the core component of DBT and is the starting place for teaching the rest of the skills. Both individual and group approaches are used to present DBT to adolescents at CSTC, including DBT Group, individual therapy, DBT skills in the milieu, and special DBT events. Often individual DBT will assist an individual in skill acquisition and use, whereas group settings give the opportunity for processing, trying new skills, and experiencing alternative outcomes. Individual work can also assist in identifying obstacles and patterns that have been problematic in the past. The DBT group focuses mainly on the four key areas of core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills. Adolescents at CSTC have many opportunities to practice these abilities as they develop, whether in Recreation Therapy, on home pass, or on the cottage each of these challenges are present daily. Please do not hesitate to contact the Program Director to ask more about how DBT is used in each cottage program.
Life Space Crisis Intervention (LSCI)
LSCI is one of the many tools in a CSTC staff person’s tool belt. LSCI is an approach assembled by Long, Wood and Fecser (2001) and gives us a framework for looking at "crisis" as a time for growth or opportunity. The work originates from Redl’s (1959) concept of Life Space Interviewing, with some innovations around emergent situations and customized approaches. Life space is defined as a daily experience or the process of going through each day. Many CSTC staff have been to the week long training offered by LSCI instructors. Others have participated in small trainings or staff meeting updates to learn about how specific LSCI tools fit with an individual child or situation. The LSCI model works well in a milieu setting or long-term hospitalization because it emphasizes linking strong emotions and their behavioral expression. Another major component of LSCI is self-regulation, which relates directly to why many children are admitted to CLIP programs. Long et al write "self regulation emerges from understanding people and events in their environment, motivation to change unpleasant conditions, and trust in adults." LSCI brings helpful constructs such as Drain-Off (de-escalate), Timeline (event sequence), Central Issue, Insight, New Skills, and Transfer of Learning. Additionally, LSCI brings irrational beliefs to the surface and teaches about the cycle of conflict. At CSTC we have made posters to prompt staff and clients both with reminders of some of the key ideas of LSCI. The strategies and concepts of LSCI are clearly applicable in our setting, and we encourage you to learn more about the ideas and tools encompassed within this helpful program.
Positive Behavior Support (PBS)
Child Study and Treatment Center (CSTC) uses a Positive Behavior Support (PBS) model across campus to support a positive social culture. Through PBS, we identify center-wide behavioral expectations and ensure that everyone knows what they need to do to be successful. PBS is a model that helps everyone focus on the behaviors that are desired and encourages teaching of the skills needed to meet these expectations. In the classroom and on the cottages we work together to reward and encourage the behavior we would like to see increase while working to ignore or discourage behavior we would like to see decrease. We have organized this program around 4 central behavioral expectations: Respect, Responsibility, Commitment, and Safety. Any child/adolescent on campus may earn a PBS card (or feather) for demonstrating positive behavior in one of these 4 areas. Youth can be nominated by peers or staff for a PBS shirt (see photo), which is earned by demonstrating progress or role model behavior in one of the four PBS areas. Staff are trained to use PBS language in their interactions with children/adolescents at CSTC and try to use more encouragement than limitation in language. CSTC has a PBS committee that meets weekly to ensure that the model continues with momentum and energy. The PBS committee works together to utilize the model put forth by Horner and others (see reference). Some examples of how Commitment is embraced in the campus-wide PBS program include: supporting students in academic and community matters, improving communication, demonstrating commitment to school program, expectation of adult/staff participation, and staff demonstrating commitment to PBS principles. Some examples of how Safety is embraced in the campus wide PBS program include: maintaining a safe environment, actively engaging youth, being proactive, listening to ideas for a safe community from all members, and modeling safe behavior. Some examples of how Respect is embraced in the campus wide PBS program include: demonstrating supportiveness, modeling expected behaviors, being polite, demonstrating punctuality, making positive verbal statements, using technology in a way that supports a respectful environment, and finding ways to get involved. Some examples of how Responsibility is embraced in the campus wide PBS program include: following the guidelines put forth in the other three PBS areas, planning together in advance, being proactive when there are issues that require attention, and supporting the classroom and cottage environments. The PBS committee welcomes participation from all members of the CSTC community.
Motivational Interviewing (MI)
Motivational Interviewing (MI) is a goal-directed, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so that the examination and resolution of ambivalence becomes its key goal. MI has been applied to a wide range of problem behaviors related to alcohol and substance abuse as well as health promotion, medical treatment adherence, and mental health issues. Although many variations in technique exist, the MI counseling style generally includes the following elements 1) Establishing rapport with the client and listening reflectively, 2) Asking open-ended questions to explore the client's own motivations for change, 3) Affirming the client's change-related statements and efforts, 4) Eliciting recognition of the gap between current behavior and desired life goals, 5) Asking permission before providing information or advice, 6) Responding to resistance without direct confrontation. (Resistance is used as a feedback signal to the therapist to adjust the approach.), 7) Encouraging the client's self-efficacy for change and 8) Developing an action plan to which the client is willing to commit.