Therapists at the Crisis Center of Tampa Bay conducted more than 2,000 counseling sessions last year with children who had experienced some kind of trauma – what Meredith Grau, director of clinical services, describes as “anything that’s bad, sad or scary.”
She recalls a boy who had witnessed the suicide of his stepfather.
“His behavior and his performance in school changed, as did his relationship with his mother,” Grau says.
But, through a partnership with Alison Salloum, professor of social work at the University of South Florida, the center has been field testing a different approach to treating childhood trauma that has resulted in positive outcomes.
“With that boy, I know the relationship with his mother was strengthened,” Grau says, adding that his behavior and performance in school also improved.
Over the past nine years, Salloum has conducted three research trials at the Crisis Center on the effectiveness of greater involvement of parents in the treatment of children who range in age from 3 to 12.
“Most of the children we see at the Crisis Center have experienced sexual abuse,” she says. “But I was interested in working with the center because they also serve children who have experienced all kinds of trauma. They have experienced or witnessed neglect, physical abuse, domestic violence; some are children of a parent who died in a car accident or by suicide, or children with medical trauma, such as cancer or multiple heart surgeries. There are a lot of children who are experiencing traumatic grief.”
Clara Reynolds, president and CEO of the Crisis Center of Tampa Bay, noted that Hillsborough County leads the state in the number of children removed from homes due to abuse or parental neglect.
“These removals are not voluntary but are necessary to ensure the safety of the child,” Reynolds says. “Removing a child from even a very dangerous environment is extremely traumatic.”
In most cases, children are reunited with their families once the danger has been resolved, but additional trauma work with the family is necessary to get them “back on track,” she says.
According to Salloum, it is common for children to avoid thinking about what caused their trauma, so anything that triggers those memories upsets them to the point they won’t discuss those experiences.
“The effort not to think about what happened keeps traumatic memories, thoughts and feelings present,” Salloum says. “We work with the child to help them feel calm, to reduce the stress level by self-regulating. Once they learn how to do that, then we help them to process those traumatic memories so they learn what happened to them was in the past and they’re safe now.”
She used the example of a child who was sexually abused at a park.
“They might want to avoid the park and every time they go by one, they get upset,” Salloum says. “We work with the child so they learn that ‘yes, that happened, but now if I go to a park it doesn’t mean something bad is going to happen.’ ”
Using essential elements of a proven approach, Trauma-Focused Cognitive Behavior Therapy, Salloum developed a “stepped care” program.
“We wanted parents to learn these proven tools in a way that allows them to work with their child at home so the child can start getting those post-traumatic symptoms to go away faster with more efficient treatment,” she says. “If a child is in a six-month treatment program, it’s hard for parents to get away from work, deal with traffic, and get to a therapist’s office every week.”
Among the keys to the new approach is “Stepping together: Parent-child workbook for children (ages 3 to 12) after trauma,” written by Salloum and three contributors, which was adapted from the Preschool PTSD Treatment program.
While the process calls for greater parental involvement, it is not, as Salloum describes it, “do-it-yourself.”
She explained the process: After the parent and child meet with a therapist, they have four parent-child meetings at home and work on the activity book together. They then again meet with a therapist and discuss what they accomplished and set up a plan for continued progress at home and with the therapist.
“Over a six-week period, there are three therapy sessions and 11 parent-child meetings,” Salloum says. “That’s the equivalent of three months of treatment.”
Interviews conducted with parents suggested the new process was effective.
“Parents like the tools because they help them to know what to do,” she says. “The activity book gave them a framework of how to talk to their child. When something traumatic has happened, many parents will say ‘tell me what to do.’ As a therapist, I might say ‘let’s help the parent,’ but the parent believes that by helping the child, we are helping them. With these tools, they can take action to help their child.”
Salloum recalled a father who came to the Crisis Center with his daughter, who had been sexually abused within the family. Though initially reluctant to participate in the stepped care trial – “he said he was so angry about what happened that he didn’t know if he could discuss it with his daughter,” Salloum says – he did finally agree to try it.
“When they finished stepped care, we conducted an interview with the father and the daughter, and they both said the same thing,” Salloum says. “The daughter said ‘I feel like I can talk to my father about anything now,’ and her father said the same thing about his daughter. I just thought, what a gift. We really empowered him and together they can get through this.”
Salloum and therapists at the Crisis Center recognize that the stepped care model may not be appropriate for every family. During the final research trial, which recently concluded, they explored the characteristics that might predict who would benefit the most from either standard therapy or the stepped care approach.
“We want to have the best outcome either way,” Salloum says, adding that she expects to have final results from the trial this summer. “There is always more to learn about children and trauma. This trial also will help us to see areas that were strong and those that need improvement. We don’t want them to have a lifetime of suffering from the trauma they endured.”
Reynolds, the Crisis Center president and CEO, calls the partnership “an amazing example of how the university and non-profits should work together.”
“We don’t always have the luxury to conduct research and find these new treatment modalities,” she says. “The clinical trials opened doors for us that we wouldn’t have explored otherwise, specifically in the child welfare arena. We’ve done a much better job of interfacing with children in the system because of this work.”
The work with Salloum, Reynolds says, “has benefitted hundreds of children in the community.”
“It has made our clinicians better and our clinical practice is stronger,” she added. “This has been great for our center and for the university, and amazing for the clients who had an opportunity to participate in these trials.”