1. Trauma, Therapy, & TestimonY
Dr. April Garofano Brown, Ph.D., LPC-S, RPT-S, CCPT-S, MS, LSSP

2. CPS CASE TEAM PLAYERS:
Parents
Children
Caseworker
CASA
Attorneys
Therapists
Other Service Providers
Foster/Kinship Providers

3. TYPES OF TRAUMA:
Physical Abuse
Psychological/Emotional Abuse
Sexual Abuse
Neglect
Abandonment
Attachment Disruption
Death/Grief
Injury/Accidents
In Utero /Traumatic Birth Incidents

4. “JUST NEGLECT” AND OTHER MISCONCEPTIONS REGARDING TRAUMA AND CHILDREN:
Myth: The earlier/younger the child experiences trauma, the better the prognosis
Myth: Babies and young children will not remember the trauma and thus will recover easier
Myth: : “This child didn’t really experience trauma, just neglect”
Myth: “Family is ALWAYS a better placement than foster care”

5. EFFECTS OF REPEATED EXPOSURE TO TRAUMA:
In utero-infancy
Toddlers
Young children-under 7
Children over 8

6. CHILD INTERVENTIONS STABLE PLACEMENT EVALUATIONS FOR SERVICES:
ADDRESS MEDICAL/PSYCHOLOGICAL NEEDS
ADDRESS LEARNING/ADAPTIVE NEEDS

7. ROLE OF THERAPISTS Provide: Individual Therapy Family Therapy
Group Therapy
Couples Therapy
LIMITATIONS:
Texas Family Code : A person may not offer an expert opinion or recommendation to the conservatorship of or possession of or access to a child at issue in a suit unless the person has conducted a child custody evaluation relating to the child under Subchapter D, Chapter 107
ADDRESS LEARNING/ADAPTIVE NEEDS

8. THERAPISTS AND TESTIMONY:
-Therapy notes are written for the therapist's use and only require demographic and treatment information required for insurance billing and for therapists to review for future sessions.
-Notes are not written for court, or to be interpreted by others without clinician’s review.
-Request for records even under subpoena must include Hipaa release or therapist must get release from client. Otherwise therapist must be ordered by judge in court to release records to avoid ethical and Hipaa violation.

9. PARENT INTERVENTIONS ASSESS STENGTHS AND DEFICITS
IDENTIFIY AREAS OF SUPPORT
EVALUATE MEDICAL/PSYCHOLOGICAL NEEDS
PROVIDE SERVICES
ASSESS PATTERNS AND RISKS
ASSESS CAPACITY TO PARENT

10. THERAPY NOTES: What to look for:
Goals: What client/therapist is working toward
Progress: How client is responding to therapy; hindrances
Recommendations: Therapist documents any recommendations deemed helpful
What to Ask for:
Case Conceptualization /Therapeutic Summary

11. Progress Note Example:
Goals: Client will demonstrate age appropriate social boundaries
Client will follow directions within two prompts
Session Focus: Client presented with bright affect and happy mood. Participated in therapeutic activity. Showed improvement in coping with frustration. Will continue to monitor.
Recommendations: Speech therapy evaluation to address articulation difficulties.

12. Case Summary Example:
Client has participated in therapy for 20 sessions and initially presented after removal from parents for domestic violence and neglectful supervision. Client appears well adjusted in new placement. Client initially presented with anxiety and fearful responding to loud noises, sudden movement, and attempted to please adults with her behavior. She experienced frequent and excessive tantrums when told no and demonstrated sleep disturbance. During play therapy sessions she frequently played out violence with male and female dolls and verbalized curse words and threatening statements between the dolls. Over time, client demonstrated more nurturing and relational themes in the playroom and appeared to tolerate changes in routine without anxiety. Parent child visits continue weekly, and client experiences behavioral outbursts the day before and after visits. Therapist consulted with parent’s therapist and based on report of parent’s instability in mood and anger, family therapy is not recommended at this time. Therapy will continue weekly for child.

13. ASSESSING PARENTS PROGRESS:
-Court ordered services are only a starting point
-Therapist and caseworker consultation is imperative
-Ask about risk factors and continued patterns of concerns
-Clients should make progress when inundated with supportive services. If not, ask for a psychological evaluation to determine presence of larger impairment
-Determine if client is “UNSKILLED” OR “UNAVAILABE”
-Child therapist and Adult therapist consultation should be facilitated by caseworker

14. USING CRITICAL THINKING IN DECISION MAKING:
-TEAM CONSULTATION APPROACH
-AVOID “ALL OR NOTHING” THINKING
-CONSULT WITH SERVICE PROVIDERS BEFORE ORDERING SERVICES TO ASSESS BENEFIT
-USE DATA TO SUPPORT DECISIONS

15. IMPORTANCE OF SELF CARE:
-EMOTIONAL VAMPIRES
-SECONDARY TRAUMA/COMPASSION FATIGUE
-BURNOUT