1. Trauma Focused Cognitive Behavioral Therapy in Schools
Jes Springer, LCSW
NorthLakes Community Clinic
Jennifer Evancy, LCSW, SAC
Professional Services Group

2. 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

3. 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

4. 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

5. 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

6. 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.

7. 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

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

9. 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

10. 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

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

12. 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

13. 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