1. Assessment and Treatment in Barnahus
Guðríður Haraldsdóttir
Specialist in child clinical psychology

2. Treatment Services Victim therapy can start soon after the interview
For children who disclose abuse treatment is always suggested
Children are assigned to a therapist (different from the interviewer) who provides treatment and follow-up
Therapy is practiced in the child´s hometown
Psychotherapist at Barnahus are all mental health professionals, trained in evidence-based treatment approaches
Beside the treatment/interviewing we collaborate with different agencies, writing final report to CPS, give opinion of expertise to police/legal system and often important witness in court proceedings
After children go through an exploratory interviews or a court hearing interviews, a decision is made on wheter the child requires or need further services in Barnahus.
For children who disclose abuse therapeutic - intervention is always suggested
Children are assigned to a psychotherapist who provides treatment and follow-up. Some children older than fifteen give statements at the police station but they are entitled to the therapeutic intervention services offered at Barnahus.
Therapy is practiced in the child´s hometown and usualy starts soon after the interview
Psychotherapists at Barnahus are all mental health professionals trained in evidence-based treatment approaches
And beside the treatment the psychotherapist have a role in collaborting with different agencies, writing final report to CPS, give opinion of expertise to police/legal system and are often important witness in court proceedings

3. Assessment Provides a understanding and a overall picture of the child
Assessment helps to determine
Presenting symptoms and the
history of the traumatic exposure
Strenght and weeknesess
Parenting skills and support
Need of a treatment
Helps in development of treatment plan
The first three to four therapy sessions are devoted to assessment and psycho-education and establishing a good therapautic relationship with the child.
The goal is to gather as much information as possible about the child functioning across the domains to provide best understanding of the child as possible. Without assessment it is difficult to know what treatment is best for the child and the caregivers
Because traumatic experiences can affect childrens functioning in a variety of ways assessment helps to determine presenting symtoms and the history of the traumatic exposure and in order to indentify PTSD symptoms
Assessment can give us valuable informations about strenght and weeknesess of the child, developmental level, individual charateristic, parenting skills, family engagement and support and information about if there are any developmental difficulties, delays or children with special needs.
Sometimes even after experiencing traumatic events many children do not develop trauma symptoms, and that can be depening on a individual differences, the child‘s age and developmental level.
F. example it appears that for short lived traumas, younger children are more dependent on their parent‘s reaction to that trauma than older children if their parents cope well, most children do not develop serious or long lasting trauma symptoms.
On a background of these information assessment provides us treatment plan is developed and what approach is best suited.

4. Methods
Formal, standardized measuresment with different scales and semistructured interviews
Clinical Interview with the child and the family (timeline and family-map)
Clinical observation and information gathered from other sourses
We use formal standard measures to evaluate trauma history and ptsd symtoms, depression and anxiety. Children older than 8 years of age usaually fill out self- assessment questionnaires or go through structured clinical interviews.
With preschoolers and children up to 7 years of age it is better to get the caregiver’s perspective about the child’s symptoms and behaviors. One way of assessing younger children is by reading to the child a book and asking about symptoms (Sleep, mood, appetite, behavior concentration).
We also colllect information about the child in the first sessions - about overall daly functions, wellbeing in school, relationship with family and friends, activity and ect.
Often drawing timeline in order to find out both what has happen to them and the impact of different events or trauma (good and bad).
We interview parents as well asking about theyr child/children - often making familiy map to get a information about relationship between familimembers

5. Assessment tools Depression and anxiety scales
BDI-II – Becks Depression Inventory
BYI – Becks Youth Inventories
CDI – Kovack´s Children´s Depression Inventory
DASS – Depression Anxiety Stress Scales
MASC – Multidimensional Anxiety Scale for children
ADIS (Anxiety Disorders Interview Schedule for DSM-IV)
K-SADS- PL (Semi-structured diagnostic interview to assess psychopataholgy in children and adolescents)
The most frequently used assessment tools at Barnahus are the these standardized mesurings scales. I am not going into any details, just showing you this list that gives us information about symptoms of anxiety, depression, negative thoughts, self-esteem among other tings.
Somtimes we use semistructural interviews to assess further or other psychiatric disorders like:
The ADIS interview to diagnose different anxiety disorders.
We also have the K-SADS interview to assess current and past episodes of psychopathology in children and adolescents according to DSM-III-R and DSM-IV criteria.
Kiddie-Schedule for Affective Disorders and Schizophrenia
Affective Disorders
Supplement #2: Psychotic Disorders
Supplement #3: Anxiety Disorders
Supplement #4: Behavioral Disorders
Supplement #5: Substance Abuse and Other Disorders
Permitted Usage

6. Assessment tools PTSD scales UCLA-PTSD index for DSM-IV
PSS-SR – PTSD Symtom Scale – Self Report
CAPS – Clinician Administered PTSD Scale
Semistructured interview
And here are list of the most frequently scales we use to identify PTSD symtoms

7. Treatment PTSD - often requires a full treatment of TF-CBT or CPT
Children with few/light symtoms would benefit from a light version of tf-cbt
Young children – psychoeducation and parent involvment
Children that have a long history of abuse/domestic violance/Developmental trauma
After the assessment an individual treatment plan is designed and discussed with the child (depending on the age) and parents
The diagnosis of PTSD requires that children have a specified number of symtoms in several criteral – Children that fullfill the diagnostic criteria of PTSD often need a full trauma – fokus therapy
Children who do not have symptoms of PTSD, depression or anxiety will likely not need all of the components covered in the trauma focused treatment approach. They would benefit from a light version of tf-cbt that would include psychoeducation, relaxation training, affective modulation about feelings and thoughts and selfesteem and setting personal bounderies.
Working with parents is importent and especially when the child is a preschooler or á young child. It is important that the child feels supported and thet therapy continues at home. Important educations - topics to discuss with the child is: private parts, my body, boundaries and what things I dont´t like, and the good secrets and bad secrets. I
Important topics to discuss with parents and caregivers is education about the trauma symtoms, normalixe feelings and behavior, teach parents a coping skills
After implemention of servicees for children of domestic violance in Barnahus we are now experiencing cases that are more complex in nature because of a long history of abuse and long term consequenses of childrens development and behavior. These cases ofen demans further colloboration of different agencies and even extended period of treatment for the child

8. Type of therapy
The treatment are evidence based and best practice approaches
TF-CBT is most researched and most supported of all vurrent treatments for childhood PTSD and child trauma
Psychoeducation
Family support/therapy
Play / sand therapy
Group therapy/self esteem
Psychotherapist in Barnahus work with evidence-based treatment approaches wich means that the treatment qualifyes specifik standarsd theoreticly and in studiy trials and therfore accepted in clinical practice
TF-CBT is the most researched and most supported of all current treatments for childhood PTSD and child trauma and based on cognitive behavioral therapy
The first components in Tf-cbt is assessment and psychoeducation to the child and the parents along with communicating about positive parenting skills and stragies
The most importent goals of psychoeducation is to provide information about the impact of trauma and hope for recovery. Learning about the impact of trauma and common responses can help child and parent normalize their responses and putting the physical or emotional problems with the child´s in context to the trauma experiences.
In psychoeducation we talk about facts about trauma/abuse, prevalence, who offends, why children don‘t tell
Normalize emotional and behavioral reactions
Instill hope for recovery
Educate family about the benefits of early treatment
We use all kinds of methods: books, handouts, worksheets, games, internet, open-ended quuestions, socratic type of questions.
Besides psychoeduations we provide sessions with the family where we support, educate, and communicates about positive parenting strategies and skills. In some cases we need to go deeper into working with the family in cases where there is more difficulties
We ofen use play therapy for younger children and have been developing and running groups for teenager to strengthen their self esteem
Treatment intervention at Barnahus begins with assessment and psychoeducation and if the child requires further treatment then evidence-based trauma-focused treatment is available.

9. Type of therapy
According to WHO (world health organisation) for children with PTSD (post traumatic stress disorder)
TF-CBT (Trauma-focused cognitive-behavioural therapy)
CPT (cognitive-processing therapy)
EMDR (eye movement desensitization and reprocessing)
Like I said before TF- cbt is most accepded approch working with PTSD and trauma issues and recumented as best practice according to WHO
NCTSN
The national child traumatic stress network

10. What is TF-CBT?
An evidence-based treatment for children experiencing trauma related difficulties
Adresses wide range of traumas
Developed for youth ages 3-18 years
Components-based treatment protocol
Time limited, structured (12-20 sessions)
Parents are an integral part of treatment
Like I said before TF- CBT is designed to assist children, adolescents and their parents in the aftermath of traumatic experiences.
The approch is adressed to work with wide range of traumas with youth of different age
The treatment protocol is components based to fit the variation of need of detaild treatment depening on presenting symtoms and the age of the child.

11. TF-CBT Components Assessment Psychoeducation and Parenting skills
Relaxation
Affective Modulation
Cognitive Processing
Trauma Narrative
Conjoint parent-child sessions
Enhanching safety and social skills
Those are the TF-CBT components that are typically provided separately to children and parents in individual sessions with conjoint child-parent sessions occuring toward the end of herapy.

12. What is CPT A short term evidence based treatment for PTSD
A specific protocol
With or without written account
Can be conducted in groups and individually
12 sessions

13. CPT components Education regarding PTSD, thoughts and emotions
Processing the trauma
Learning to challenge thoughts
Trauma themes
Facing the future

14. What is EMDR
An evidence-based treatment for children experiencing trauma related difficulties
Re-processing of traumatic memories
Standardized protocol
For all ages of people
One to four sessions
Complicated trauma needs more sessions

15. Family therapy Three family therapists in Barnahus
Always two therapists
When the abuser is a family member
Young „offender“
When severe conflicts in the family interrupts child´s recovery
When the non-abusive parent is not supportive
The are tree family therapist in Barnahus.
We usely go more into detailed family therapy when cases are more complicated like
When the abuser is a family member or a young offender like sibling
When severe conflicts in the family interupts child‘s recovery or
When the non- abusive parent is not supportive

16. Group therapy For adolesents that have finished therapy Two therapists
Same sex – similar age
Meeting others who have been through similar experiance
6-8 sessions
Focus on self esteem, self respect, self regulation
We have been developing and running groups for adelesents that have finished therapy

17. Play/sand therapy For young children
TF-CBT through playful interventions
Sand, art, games, puppets, stories
Has proven to be effective for children
Play is the language of children
Motivate children to participate in treatment
We provide play sand therapy for young children where we focus on feelings and empowerment in order to reduce the symptoms of trauma
It also motivate children to participate in treatment and has proven to be effective.

18. DSM-5 criteria A
Exposure to actual or threatned death, serious injury or sexual violation
The individual...
Directly experiences the traumatic event
Witnesses the traumatic event in person
Learns that the traumatic event occurred to a close family member or close friend
Experiences first-hand repeated or extreme exposure to aversive details of the traumatic event
Briefly the diagnosis of PTSD rewuires that children have a specified number of symptoms in
Reexperiencing: intrusive upsetting thoughts or dreams about the trauma event
Avoidance and emotional numing: avoiding people, places (skoða DSM 5)
Hyperarousal and mood – increased startle reaction
Assessing other psychiatric disorders:
If they have active suicidal thoughts – plans or serious substance abuse which might be worsened during certain portion of the tf-cbt like trauma narrative og fragile children.
Aðrar geðraskanir
Children that have a long exixting history of conduct problems may need a more extended period of treatment focused on emotional and behavioral stabilization before initiation in tf-cbt.

19. DSM-5 symtoms
These symtoms have to have lasted at least a month, seriously affect one´s ability to function and can´t be due to substance use, medical illness or anything except the event itself

20. DSM-5 symtoms Criterion B - Re-experiencing (1)
Spontaneous memories of the traumatic event
Recurrent dreams related to it
Flashbacks, feeling like the event is happening again
Psychological and physical reactions to reminders of the traumatic event

21. DSM-5 symtoms
Criterion D – Negative alertions in mood and cognitions (2)
Memory problems that are exclusive to the event (inability to remember key aspects of the event)
Negative beliefs about one´s self or the world
Distorted sense of blame for one´s self or others, related to the event
Being stuck in severe emotions related to the trauma (e.g. horror, shame, sadness)
Severely reduced interest in pre-trauma activities
Feeling detached, isolated or disconnected from other people

22. DSM-5 symtoms Criterion C – Avoidance (1)
Avoiding thoughts or feelings connected to the traumatic event (distressing memories)
Avoiding people or situations connected to the traumatic event (external reminders)