TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY IN SCHOOLS Jes

TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY IN SCHOOLS Jes Springer, LCSW North. Lakes Community Clinic Jennifer Evancy, LCSW, SAC Professional Services Group

SBBH: The Basics • Consistent day of week • Consistent and comfortable office space • Operate by bell schedule (except elementary) • Roughly 42 minute sessions • Excused absence from class • ROI differs per student/family wishes • At very least, for scheduling purposes, though consultation is desirable

Referral Process • • Referrals can come from: • Client/Family • Social Workers • School Admin Team (Kent, Brian, Troy, Joel) • Doctors • Criminal Justice System • Community If staff are concerned about a student and believe SBBH services would be helpful, go to admin team at the school to discuss the case. • School needs to have discussed the service with parent/guardian prior to referral • Upon receive of the referral: • • Providing agency contacts family to confirm interest and insurance • Schedules intake based on course schedule and availability • Notifies school of intake No ROI is in place yet, only limited information is shared

Intake Process • Parent/Legal Guardian is required • Location depends on Parent/guardian availability and preference • Paperwork is signed, including ROI • ROI may be only for appointments or could be all information • Preferred if the client is present as well • May go full 60 minutes, try to keep to bell • Establish consistent appointment time

Therapy Process • Frequency is based on client need • Operates the same as in office • May include art, music, play, relaxation training • TF-CBT and most types of concerns • Cannot be interrupted unless true emergency • Do not knock on door or call the room • Consistency is key • Family sessions may occur at school or at the clinic

Confidentiality • Terminology: meeting or appointment: NOT THERAPY! • Being called down/absent from class: • Please don’t hassle them • Be discrete: don’t announce to the class or over loud speaker that they have to go see Jes. • No check in before leaving class, come straight to therapy room • Even if an ROI is in place, still on a need to know basis • Discussed with each client at intake, including knowledge of peers in therapy • May ask certain staff members for updates, but won’t go to each teacher • If staff have a concern that therapist should know about, pass it along to school team, which helps keep them in the loop as well.

Why TF-CBT? “An evidence-based trauma treatment proven to decrease symptoms of PTSD, anxiety, depression, and other child behavior problems…also proven to decrease sham, improve parenting skills and strengthen the child-caregiver relationship. ” – The National Child Traumatic Stress Network

What is TF-CBT • Evidence-based • For ages 3 to 18 years old • Time limited (roughly 12 -30 sessions) • Components based (PRACTICE) • Adaptable and flexible • Treats single and complex trauma • Attachment based; requires a strong therapeutic relationship • Family-focused

What is TF-CBT • P = Psychoeducation & Parenting Skills • R = Relaxation • A = Affect Regulation • C = Cognitive Coping • T = Trauma narrative developed and practiced • I = In-vivo exposure to trauma reminders • C = Conjoint sessions (share the narrative) • E = Enhancing future safety & social skills

Components • P = Psychoeducation & Parenting Skills • R = Relaxation • A = Affect Regulation • C = Cognitive Coping • T = Trauma narrative developed and practiced • I = In-vivo exposure to trauma reminders • C = Conjoint sessions (share the narrative) • E = Enhancing future safety & social skills **Remember they are flexible, though not fluid

Ending TF-CBT • Graduation party • Maintenance sessions as needed • Change diagnosis and treatment plan • Administer UCLA PTSD index

Adapting TF-CBT in School Based Behavioral Health Services • Consider the appropriate time of day for SB appointments • May need to shift to end of day as you near the narrative • May need to shift to the office/clinic • Family sessions-clinic vs. school, time of day • Communication with school staff (ROI dependent) • Beginning to write the narrative • Check in/heads up if rough session • Managing Crisis of the Week • Tend to be more of them in school as they are fresh out of the situation • Compartmentalize, Relax, Cognitively shift at end of session • Requires paying more attention to the clock/bell

• Communicate with school staff the skills used to help youth when they are struggling or PTSD symptoms are triggered. • Even better, help the youth to teach school staff “what works” (skills) for them • May need to shift to end of day as you near the narrative • May need to shift to the office/clinic