The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
Usability - Rating: 3
3 - Somewhat Usable
The intervention has operationalised principles and values and core components that are measurable and observable but does not have a fidelity resource; modifiable components are not identified
Core Components
Child and Family traumatic Stress Intervention (CFTSI) is an evidence-based, prevention and early intervention programme, designed to reduce traumatic stress reactions and prevent the development of PTSD in children and adolescents (7-18 years). This intervention is delivered to the child(ren), with one or more new trauma symptoms, and their non-offending parent(s)/ caregiver(s) in the immediate aftermath (i.e. within 30-45 days) of the traumatic experience or disclosure of physical or sexual abuse.
CFTSI targets two factors associated with the development of PTSD;
1) Insufficient familial support
2) Inadequate coping skills.
CFTSI therefore aims to address these identified risk factors by; 1) increasing caregiver understanding of the child’s and their own post-traumatic experience; 2) increasing child and caregiver ability to recognise trauma stress reactions; 3) enhancing caregiver support provided to the child by strengthening communication between them; and 4) teaching caregiver and child the coping skills and techniques needed to address trauma stress reactions. As part of its treatment goals, CFTSI also aims to access the child’s need for, and entry into longer term treatment, as well as to help caregivers address other pragmatic issues to manage external stressors (including judicial matters, medical treatment, child safety).
This brief manualised intervention is delivered in 1-hour weekly sessions, over 5-8 weeks. Session-by-session content are as follows;
- Session 1: Delivered to the caregiver(s) alone. Covers step-by-step explanation of the therapy process, and the CFTSI rationale. Provides psychoeducation that includes common reactions to potentially traumatic events, and the protective role of familial support. This session also involves standardised assessments of trauma history and trauma symptoms (for caregiver and caregiver’s report of child). Case management plans and care coordination issues are also addressed.
- Session 2: Delivered to child alone within seven days of completing session one. It covers psychoeducation to explain common reactions to potentially traumatic events, and the normalisation of these reactions. It also includes standardised assessments of child’s trauma history and trauma symptoms.
- Session 3: Delivered to child and caregiver within seven days of completing session 2. It includes comparison (i.e. agreement and discrepancies) of child and caregiver’s report of trauma history and trauma symptoms, as a way of improving communication. This helps to increase caregiver’s understanding of the child’s symptoms, and enhance emotional support provided by caregiver. It also involves the introduction of coping strategies most suited to specific trauma reactions earlier identified.
- Session 4: Delivered to the caregiver and the child within seven days of session 3. It includes symptom monitoring and practice of coping skills to manage these symptoms. This session also aims to further improve communication and assess the effectiveness of behavioural skills modules and support measures.
- Session 5: Delivered to caregiver and child within seven days of session 4. Covers the same areas as session four. It also includes discussion of next steps which may include future appointments, therapy for other evident mental-health problem or extensive treatment for PTSD.
Pre-assessments and post-assessments are typically conducted to evaluate pre and post levels of trauma symptoms.
Fidelity
Fidelity to the Child and Family traumatic Stress Intervention (CFTSI) protocol can be accessed during supervisory meetings and supervisors can track adherence to the CFTSI model. But no specific fidelity measure available.
Modifiable Components
Child and Family traumatic Stress Intervention (CFTSI) has been delivered across a wide range of traumas (e.g. sexual and physical abuse, domestic and community violence, and car accidents), as well as for single and multiple trauma histories. CFTSI has also been developed for use in younger children (aged 3-6 years), and children in foster care. This intervention can be delivered in a variety of settings including outpatient clinic setting, hospital and community setting. Programme materials are available in English and Spanish.
Supports - Rating: 2
2 - Minimally Supported
Limited resources are available beyond a curriculum or once-off training
Support for Organisation / Practice
Implementation Support
Child and Family traumatic Stress Intervention (CFTSI) was developed at the Childhood Violent Trauma Centre (CVTC), Yale University. CVTC offers training to support delivery of CFTSI. In addition, they provide access to a peritraumatic case tally sheet to help services determine their need for CFTSI. The tally sheet can be accessed at peritraumatic_case_tally_sheet_2_5_14_168574_284_55316_v3.pdf (yale.edu). To support CFTSI sustainability within services, CFTSI provides access to the CFTSI Site Sustainability and Evaluation System (CS3), a data management system that supports data collection, analysis, reporting, and usage. The system supports clinicians to monitor of individual outcomes; supervisors to track adherence to the CFTSI model; and agency leaders to gain access to treatment outcome data. The CS3 platform can be accessed remotely.
Start-up Costs
Training can be provided by CVTC. There are costs associated with training and an enquiry can be made about these here (Training & Professional Development < Child Study Center (yale.edu))
Building Staff Competency
Qualifications Required
Child and Family traumatic Stress Intervention (CFTSI) is delivered by Masters or Doctoral level psychological therapists or psychological intervention clinicians, with prior training in child development, trauma, and trauma reactions.
Training Requirements
Therapists attend a 2-day training that covers the Child and Family Traumatic Stress Intervention (CFTSI) model.
A research study that evaluated CFTSI mentioned that, in addition to the training, therapists participated in at least nine 1-hour consultation calls within six months of the initial training, and therapists successfully completed at least three cases within the 6-months period.
Supervision Requirements
It is recommended practice in Scotland that this psychological intervention is conducted under regular supervision with a practitioner who has expertise in a) the intervention b) the clinical area and c) has completed training in supervision of psychological therapies and interventions (further information: NES - Supervision of psychological therapies and interventions)
Evidence - Rating: 3
3 - Some Evidence
The intervention shows some evidence of effectiveness through less rigorous research studies with the focus population and comparison groups.
Theory of Change
Child and Family traumatic Stress Intervention (CFTSI) is influenced by psychoanalytic, behavioural, and cognitive theories of development and human functioning. CFTSI proposes that the peritraumatic period provides opportunities for delivery of prevention/ early interventions, with the goal of gaining control over trauma symptoms, and preventing the development of PTSD. By applying recognised protective factors (i.e. familial support and communication) within this peritraumatic period, CFTSI targets trauma symptoms before they become entrenched. Hence, CFTSI teaches children and their caregivers to understand their post-traumatic experiences, recognise traumatic stress reactions, communicate trauma symptoms and apply coping skills and techniques to address trauma stress reactions.
Research Design & Number of Studies
The best available evidence for Child and Family traumatic Stress Intervention (CFTSI) comes from one Randomised Controlled Trial (RCT) that included children and adolescents (aged 7-17 years) with a wide range of traumas. The study was conducted at the Yale Child Study Centre, USA, and recruited 107 participants with at least one new distressing post traumatic stress symptom that had developed within 30 days of the Potentially Traumatic Event (PTE).
Compared to the control group who did not receive CFTSI, the following outcomes were observed;
Outcomes Achieved
- Significantly lower posttraumatic and anxiety scores at post-treatment. Effects on posttraumatic scores sustained at 3-months follow-up
- Significantly less likelihood of PTSD diagnosis at 3-month follow-up
Need
Comparable Population
Child and Family traumatic Stress Intervention (CFTSI) is delivered to children and adolescents (7-18 years) and their non-offending caregiver(s). CFTSI is delivered in the immediate aftermath (i.e. within 30-45 days) of the traumatic experience or disclosure of physical or sexual abuse. Evidence of effectiveness comes from one RCT that included children and adolescents (aged 7-17 years) with a wide range of traumas. Participants had at least one new distressing posttraumatic stress symptom that had developed within 30 days of the Potentially Traumatic Event (PTE). Services can use a CFTSI peritraumatic case tally sheet to determine their need for this intervention.
Desired Outcome
Child and Family traumatic Stress Intervention (CFTSI) delivery is associated with significant reductions in PTSD symptoms, anxiety symptoms, and reversal of PTSD diagnosis.
1 - Does Not Meet Need
The intervention has not demonstrated meeting need for the identified population
2 - Minimally Meets Need
The intervention has demonstrated meeting need for the identified population through practice experience; data has not been analysed for specific subpopulations
3 - Somewhat Meets Need
The intervention has demonstrated meeting need for the identified population through less rigorous research design with a comparable population; data has not been analysed for specific subpopulations
4 - Meets Need
The intervention has demonstrated meeting need for the identified population through rigorous research with a comparable population; data has not been analysed for specific subpopulations
5 - Strongly Meets Need
The intervention has demonstrated meeting the need for the identified population through rigorous research with a comparable population; data demonstrates the intervention meets the need of specific subpopulations
Fit
Values
Child and Family traumatic Stress Intervention (CFTSI) is an evidence-based, prevention and early intervention programme, designed to reduce traumatic stress reactions and prevent the development of PTSD in children and adolescents (7-18 years). CFTSI aims to help children and their caregivers understand their post-traumatic experiences, recognise traumatic stress reactions, communicate trauma symptoms, and apply coping skills and techniques to address trauma stress reactions.
Priorities
Child and Family traumatic Stress Intervention (CFTSI) is delivered to the child(ren), with one or more new trauma symptoms, and their non-offending caregiver(s) in the immediate aftermath (i.e. within 30-45 days) of the traumatic experience or disclosure of physical or sexual abuse.
Existing Initiatives
1 - Does Not Fit
The intervention does not fit with the priorities of the implementing site or local community values
2 - Minimal Fit
The intervention fits with some of the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
3 - Somewhat Fit
The intervention fits with the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
4 - Fit
The intervention fits with the priorities of the implementing site and local community values; however, the values of culturally and linguistically specific population have not been assessed for fit
5 - Strong Fit
The intervention fits with the priorities of the implementing site; local community values, including the values of culturally and linguistically specific populations; and other existing initiatives
Capacity
Workforce
Child and Family traumatic Stress Intervention (CFTSI) is delivered by Masters or Doctoral level mental health clinicians, with prior training in child development, trauma, and trauma reactions. Therapists attend a 2-day CFTSI training prior to delivering the intervention. CFTSI sessions are typically delivered in 1-hour weekly sessions, over 5-8 weeks.
Technology Support
Child and Family traumatic Stress Intervention (CFTSI) can be delivered without access to technology. Agencies delivering CFTSI are invited to be part of the CFTSI Site Sustainability and Evaluation System (CS3). CS3 is accessed remotely.
Administrative Support
Child and Family traumatic Stress Intervention (CFTSI) can be delivered in outpatient clinic settings, hospitals, and community settings. Administrative support is needed to manage appointments, make copies of standardised assessments, as well as to collate and input outcome measures.
Financial Support
No specific financial support is known for this intervention at date of review (August 2021).
1 - No Capacity
The implementing site adopting this intervention does not have the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
2 - Minimal Capacity
The implementing site adopting this intervention has minimal capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
3 - Some Capacity
The implementing site adopting this intervention has some of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
4 - Adequate Capacity
The implementing site adopting this intervention has most of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
5 - Strong Capacity
Implementing site adopting this intervention has a qualified workforce and all of the financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
