Trauma Focused Cognitive Behavioral Therapy in Schools Jes Springer, LCSW NorthLakes 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