Pre-Meeting Institutes
November 3, 2010

PMI #1  Addressing Clinical Complexities in Prolonged Exposure  
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Norah Feeny, PhD1; Lori Zoellner, PhD2; Edna Foa, PhD3
1Case Western Reserve University, Cleveland, OH, USA
2University of Washington, Seattle, WA, USA
3University of Pennsylvania, Philadelphia, PA, USA
  
Many mental health professionals often experience the delivery of exposure therapy quite challenging with clients who exhibit both PTSD and comorbid Axis I or II disorders. Treatment manuals describe the treatment procedures and provide guidelines, but it is difficult to articulate in a manual all the fine distinctions that experienced clinicians utilize in therapy. In this advanced workshop, experts in the “Prolonged Exposure” (PE) treatment will share their years of experience in how to modify procedures in order to maximize success with challenging clients. This will include addressing anger, shame, and rumination within the PE program. We will also address problems of avoidance, resistance to engage with treatment experiences. These procedural modifications will be demonstrated with clients’ videotapes. Examples will include clients with PTSD related to civilian as well as combat traumas.  

PMI #2  Clinical Nuance in Complex Trauma Treatment: Analysis of a   Single Case from the Vantage Point of Four of the National Child Traumatic Stress Network's Leading Child Trauma Intervention Models
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Joseph Spinazzola, PhD1; Julian Ford, PhD2; Mandy Habib, PsyD3; Richard Kagan, PhD4; Joshua Arvidson, MS5
1The Trauma Center at Justice Resource Institute, Brookline, MA, USA
2University of Connecticut Medical School, Farmington, CT, USA
3North Shore University Hospital, Manhasset, NY, USA
4Parsons Child and Family Center, Albany, NY, USA
5Anchorage Community Mental Health Services, Anchorage, AK, USA

An official submission of the Complex Trauma Workgroup of the National Child Traumatic Stress Network, this workshop will feature the intensive consideration of a single case from the perspective of four of the NCTSN's most promising empirically-based treatments of children and adolescents exhibiting complex adaptation to serial and repeated exposure to child maltreatment. The four intervention models to be featured are as follows: ARC (Attachment, Regulation &amp; Competency), SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress), TARGET-A (Trauma Affect Regulation: Guidelines for Education and Therapy for Adolescents and Pre-Adolescents), and Real Life Heroes. The focal case will be drawn from a detailed clinical vignette developed for the Core Concepts Curriculum of the NCTSN. This vignette describes an extended initial evaluation of a 14-year old boy with history of exposure to chronic emotional and physical abuse, neglect, witnessed DV, and rearing by impaired caregivers with history of polysubstance abuse, familial mental illness and and intergenerational trauma exposure.<br />This intermediate workshop blends introductory and advanced elements by introducing the audience to the complex trauma construct and core components in complex trauma intervention and providing brief overviews and review of the emerging evidence-base of each model, as well as offering more in-depth illustration of clinical application of each model in relation to the target case. Case analyses will be ordered to build upon each other incrementally, highlighting such topics as overlapping and unique model components, client readiness for treatment, and contextually based model adaptations. For instance, presenters, all developers or lead trainers of the selected models, will describe adaptations based upon potential variation in the ethnicity (e.g., Alaskan Native, Hispanic), living environment (e.g., foster care, residential, juvenile justice facility), and community context (e.g., inner-city, rural) of the target case. This pre-meeting institute will conclude with a lengthy audience discussion of current service gaps and future directions in the development, evaluation and dissemination of effective interventions for complex trauma in children and adolescents.

PMI #3  Psychodynamic Contributions to Trauma-focused Psychotherapy 
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Lutz Wittmann, PhD4; Elizabeth Brett, PhD1; Mardi Horowitz, MD2; Jacob Lindy, MD3;
1Yale University; School of Medicine, New Haven, CT, USA
2University of California, San Francisco, Department of Psychiatry, CA, USA,
3University of Cincinnati, College of Medicine, Cincinnati, OH, USA
4University Hospital Zurich, Zurich, Switzerland

Trauma has been a central concept for psychodynamic theory and practice for more than 100 years resulting in strong mutual influences between psychotraumatology and psychodynamic therapy. In this pre-meeting institute, psychodynamic concepts and techniques will be illustrated without jargon, and will be evaluated for their evidence base. Prominent examples are the interaction of trauma and the personality of the trauma survivor and his/her working alliance with the therapist. Using information from patient-therapist interaction for individually tailoring interventions and the role of therapists’ emotional reactions will be further topics. Participants will be introduced to the new version of Horowitz’s manualized psychodynamic PTSD treatment which has proved to be effective in comparison to hypno- and exposure therapy and a waiting-list control condition in a randomized controlled trial (n = 112). The possibilities of integrating psychodynamic approaches into non-psychodynamic trauma therapy will be illustrated by clinical examples and participants will be invited to discuss their own clinical cases.

PMI#4  Using Cognitive Processing Therapy in a Group Setting  
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Kathleen Chard, PhD
Cincinnati VA Medical Center, Cincinnati, OH, USA
 
With the increased demand for services in many agencies, group modalities can provide a cost -efficient way to deliver evidenced-based treatment to many individuals at the same time. Cognitive Processing Therapy (CPT) has been shown to be an effective treatment of PTSD for civilian and veteran males and females with various trauma histories. Although often used as an individual therapy, CPT has been found to be an effective group or combined group and individual therapy modality in two randomized clinical trials. This workshop will provide training in the use of Cognitive Processing Therapy in various group formats, including combinations with individual therapy. The presenter will conduct a brief review of the utility of group CPT, including data supporting its use in treating PTSD and related symptoms. A session by session overview of the 12 session CPT model will be reviewed including a discussion of all practice assignments and worksheets. Videotape will be used to demonstrate techniques and the audience will be asked to practice exercises over the course of the training. The presenter will make note of ways in which the group session structure differs from individual therapy. Issues regarding pre-treatment assessment, readiness for group, dealing with difficult patients, and after care will be discussed. Finally ways that CPT can be adapted to various settings will be offered including the benefits and drawbacks of the group format. The presenter is the author of the Cognitive Processing Therapy for Sexual Abuse manual and she is co-author of the Cognitive Processing Therapy Veteran/Military Basic and Group manuals. She has conducted numerous clinical trials on CPT including studies involving group and combined group and individual treatment protocols.

PMI#5 Acceptance and Commitment Therapy (ACT) and the Treatment of Trauma: Regaining Self and Values
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Robyn Walser, PhD1; Darrah Westrup, PhD2
1National Center for PTSD, Menlo Park, CA, USA
2VA Palo Alto Health Care System, Menlo Park, CA, USA

Many individuals who have experienced a trauma or who have been diagnosed with PTSD are struggling with traumatic memories, painful feelings and unwanted thoughts; and avoidance or control of theses private internal experiences is a common goal. Often, however, the avoidance itself can lead to further struggle and difficulty returning to valued activities in life. One therapeutic alternative to emotional or experiential avoidance is acceptance. Acceptance can create a new context from which the trauma survivor may view the world and the self. If efforts to control private experience are relinquished as a means to mental health, then efforts to take healthy action, while still acknowledging emotion and thought without effort to control, can lead to valued and life enhancing behavioral changes. Acceptance and Commitment Therapy is one of the “third wave” behavioral therapies (Hayes, Follette, & Linehan, 2004) along with others such as dialectical behavior therapy (DBT; Linehan, 1993), and mindfulness based cognitive therapy for depression (MBCT; Segal, Williams, & Teasdale, 2001) that specifically focus on acceptance of internal experience as an alternative to avoidance and they use defusion and/or mindfulness processes to achieve this goal. In ACT, the function of the internal experience is changed rather than the experience itself. The therapeutic work done in ACT is specifically designed to foster acceptance in the service of valued and vital living. We will present the basic theory and application of ACT and explore its adaptation to individual and group, inpatient and outpatient settings, and state of the evidence.

PMI #6 Under the Shadow of Complicated Grief: The Clinical Impact of Violent Death in the Middle East   
8:30 a.m. – Noon and 1:30 – 5:00 p.m.

Edward Rynearson, MD1; Alison Salloum, PhD2; Ruth Malkinson, PhD3; Brigitte Khoury, PhD4; Alean Al-Krenawi, PhD5; Abdel Aziz Thabet, PhD6; Khader Rasras, MA7; Kathleen Nader, DSW8
1Virginia Mason Medical Center, Seattle, WA, USA
2University of South Florida, Tampa, FL, USA
3Tel Aviv University; Israeli Center for REBT, Rehovot, Israel
4American University of Beirut Medical Center, Beirut, Lebanon
5Ben-Gurion University of the Negev, Beer-Sheva, Israel
6Child Institute- Al Quds University-Director of Academic Programs/Gaza Branch, Gaza, Palestinian Territory, Occupied
7Treatment & Rehabilitation Center for Victims of Torture (TRC), Ramallah, Palestinian Territory, Occupied
8Two Suns, for the Assistance of Traumatized Children and Adolescents, Cedar Park, TX, USA 

More than 9,000 people have died violently in conflicts between Israel, Palestine and Lebanon since the beginning of the second intifada in 2000. Over 7,000 of those killed were non-combatant civilians and over 2000 were children. Recognizing that 15% of surviving loved ones are likely to suffer prolonged grief after violent death, this pre meeting institute features a study group of USA and Middle Eastern clinician/researchers working collaboratively to develop community based outreach and time limited intervention programs for their underserved communities. A series of lectures followed by morning and afternoon panel discussions describes the results of a four year working partnership of regional clinicians meeting for mutual trainings in a neutral setting (Istanbul, Turkey) and establishing a collegial network and a shared website (www.vdbs.org) where an intervention manual (collaboratively endorsed and translated in English, Hebrew and Arabic) can be downloaded. The full day training will begin with the clarification of a clinical model of prolonged grief after violent death including empirical evidence of the effectiveness of time limited group and individual interventions for children and adults. Subsequent individual presentations from collaborative participants will clarify the unique socio-cultural matrix surrounding violent death and grief in their communities which must be respected and included in protocol designing for specific structuring of psychological outreach, support and intervention. 

PMI #7  Complex Trauma: Case Conceptualization and Implementation of Cognitive Processing Therapy and Prolonged Exposure Therapy
8:30 a.m. - Noon

Kelly Maieritsch, PhD1; Diane Castillo, PhD2; Elizabeth Frazier, PhD1
1Edward Hines Jr. VA Hospital, Hines, IL, USA
2New Mexico VA Health Care System, Albuquerque, NM, USA

Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) are two evidence-based treatments for PTSD. They have been widely disseminated within the VA/Department of Defense organizations, as well as among civilian clinicians. It has recently been suggested however that the effective utilization of these treatments can be limited when presented with difficult patient presentations that require additional skills to remain adherent to the model of the treatment (Ruzek & Rosen, 2009). To ensure that clinicians are willing and able to implement these treatments with fidelity to the treatment model, opportunities for additional training and skill development need to be made available. This PMI will offer the opportunity to review how to conceptualize these often difficult case presentations from both the CPT and PE frameworks. Three cases will be presented which incorporate often reported “difficult” features that challenge clinicians to stay adherent to protocol. These cases will include patients who present with dual-diagnosis of PTSD and Substance Abuse, strong expressions of anger/dissociation/guilt, and multiple severe trauma experiences (e.g., combat & childhood sexual assault). The theoretical underpinnings of CPT and PE will be reviewed and applied to each of the three cases. This presentation will incorporate highlighting the “unique”; aspects of these complex cases and how each approach addresses them. An overview of additional techniques will be presented in regard to establishing a therapeutic alliance, addressing avoidance, and increasing compliance with key components of the treatments (e.g., CPT worksheets, PE in-vivo exposure hierarchy). Teaching tools will include presentation, video examples, role-plays, and practice.



PMI #8  What Trauma Therapists Should Know about Panic, Phobias and OCD
8:30 a.m. – Noon

Sally Winston, PsyD
Anxiety and Stress Disorders Institute of Maryland, Towson, MD, USA

Both the acute and chronic states of hyperarousal in the wake of traumatic experience can precipitate or exacerbate anxiety disorders other than PTSD in those genetically or psychologically predisposed. There are effective specific evidence-supported treatments for panic attacks, generalized anxiety, phobias and symptoms of OCD that can dramatically improve outcomes, both in patients whose anxiety disorders have become functionally autonomous from the original traumatic material and in those whose symptoms remain linked to trauma issues. This presentation will present an overview designed specifically for trauma therapists of basic treatment principles with an emphasis on phenomenology, common misconceptions and clinical oversights. Covered topics include in vivo, interoceptive and imaginal exposure and response prevention, management of anticipatory anxiety and worry, psychoeducation and the paradoxical nature of effort with respect to anxiety. We will also address the double-edged swords of avoidance, stress management and safety behaviors in these patients, the distinctions between panic attacks and flashbacks, and the dangers of interpretation of content in true OCD. The subtle distinctions between worry, rumination, preoccupation and obsession - which lead to different interventions -- will be elucidated.

 

PMI #9 An Early Intervention Model for Traumatic Stress in Humanitarian 
8:30 a.m. - Noon
Aid Workers In The Field: Challenges And Complexities

Penelope Curling, MA1; Monica Indart, PsyD2; Linda Andersson, MSc1; Sara Kahn, MPH, MSW3
1UNICEF, New York, NY, USA
2Rutgers University, Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA
3New York University School of Social Work, New York, NY, USA

The challenges faced by aid workers in an increasingly complex and dangerous humanitarian environment are well-documented, both through the empirical literature as well as frequent media reports. Humanitarian aid workers operate for prolonged periods of time in an environment with high levels of chronic stress, punctuated by exposure to potentially traumatic events (PTE) that further challenge their neurophysiological systems and coping mechanisms. Additionally, international relief efforts result in the formation of new communities, comprised of citizens from various parts of the world with significantly divergent definitions and conceptualizations of stress, trauma, recovery and healing. These emergent communities represent a rich, complicated tapestry of national and international aid workers with varying levels of exposure to traumatic events, past and present, and a range of resources to support recovery from such events. This experiential and didactic institute presents an early intervention model specifically designed for humanitarian aid workers in the field. Informed by evidence-based early intervention models, empirical findings of the particular impact of chronic and acute traumatic stress in humanitarian workers, the results of field research studies conducted by one of the presenters, and the presenters' collective experiences working in a wide range of humanitarian settings in more than 30 countries around the globe, the model is developed around core concepts of cultural responsiveness. Utilizing case examples and drawing on a meaningful understanding of culturally based idioms of distress, the presentation will elucidate how evidence-based strategies (e.g., psychological first aid, cognitive-behaviorally based techniques, mindfulness-based stress reduction) can be implemented in a complex variety of field settings. Emerging consensus on identifying risk indicators and mediators that influence the development of trauma-spectrum reactions following exposure is addressed in the model through specific prevention and intervention strategies for reducing hyperarousal, screening for previous exposure to PTE's, and mobilizing social support. The critical role of enhanced social support is a thematic element of the model, utilizing individually and organizationally-based peer support programs as a specific intervention paradigm. Participants will have an opportunity to review the research upon which the model is based, as well as examine phases and levels of intervention included in the model. Presenters will discuss the challenges of designing interventions for field use in widely diverse settings, including ethical dilemmas; the importance of conducting culturally sensitive needs assessments; and the necessity of providing ongoing support for humanitarian workers and those who assist them.

PMI #10 When Trauma Comes Home: Training on Reintegrating Returning Warriors to the Workplace and Family
8:30 a.m. - Noon

Jeffrey Yarvis, PhD, MSW
Walter Reed Army Medical Center, Fort Belvoir, VA, USA.
 
The presenter will examine three inter-related military experiences that significantly impact and, in some ways, help define the lives of today's service members and their families: deployment, Post Traumatic Stress Disorder (PTSD) and reintegration. To date (2010) over 2 million international soldiers have deployed as part of the U. S. and NATO war efforts in Iraq and Afghanistan. In some instances, military service members have endured repeat deployments, separating from and then returning to spouses and children, with short intervals between tours of duty. In many cases, these service members have either experienced firsthand frontline trauma or have witnessed instances of injury or loss of life while deployed. Almost universally, these service members experience extreme stress or anxiety related to safety and the persistent anticipation of danger. The pre-institute will closely examine the experiences associated with military deployment wherein the objective is to provide an in-depth understanding of the daily life events for the deployed war-fighter in the combat theatre of operations as well as for the families left behind on the home front. Although military service personnel are very willing to defend our nation, even with their life if necessary, deployment is now understood, for this very reason, to be a traumatic experience. Put simply, military deployment is a unique experience marked by the separation of connections with loved ones, heightened danger, and the distinct possibility of loss of life. The workshop will also examine the onset of Post Traumatic Stress Disorder symptomatology in war returnees and the now recognized and identified secondary/vicarious traumatic symptoms in spouses and children. The workshop will identify and illuminate the requisite clinical practice skills to effectively provide prevention, assessment and the wide range of necessary intervention services when working with service members and their families upon return from deployment. Offered by all branches of the military, reintegration services to assist service members upon return from deployment are provided to facilitate the reunion process. Although safe return for service members is joyfully anticipated by everyone, return from the combat theatre is indeed a major psychosocial adjustment as “nothing is the same.” The presenter will discuss the impact of deployment and PTSD on reintegration and the psycho-educational training and support needed during this critical period of re-adjustment. Research, cases, and first hand combat experiences will be shared to heighten participant cultural, clinical, and evidenced-based awareness of war-related trauma-induced spectrum disorders.

PMI #11 My Client Suffering From Post Traumatic Stress is Not Getting Better: How to Come Out From the Therapeutic Dead End?
Mon client souffrant de stress post-traumatique ne s’améliore pas: Comment sortir de l’impasse thérapeutique ?  
1:30 – 5:00 p.m.

Pascale Brillon, PhD
Hôpital du Sacré-Coeur de Montreal, Montréal, Quebec, Canada

Post traumatic stress disorder is extremely difficult to treat. The clinician therefore often finds himself powerless in front of a victim suffering and presenting invading and refractory symptoms to the treatment. I tried everything with this client and he still suffers as much, why? How to help this victim attenuate this invading rage? I tried cognitive restructuration, but these thoughts are still imprinted, how to help in other ways? Exposition does not work, why? This victim seems to be presenting narcissistic traits instead of a post traumatic stress, is this possible? Some secondary gains seem to be present, is there something I can do? This formation is directed to therapists who already have a regular practice with victims suffering from post-traumatic stress, who already master the cognitive-behavioral techniques (cognitive restructuration, relaxation strategies, gradual exposition in vivo, exposition to the trauma memory) but find themselves at a dead end with some clients. This formation will try to give leads to concrete therapeutic solutions when: 1) the victim presents a lot of difficulties with some emotions, 2) some cognitions are too crystallized and resistant to the therapeutic work, 3) exposition techniques do not work, 4) the presence of narcissistic impede on the therapeutic process and 5) when the victim seems to benefit from secondary gains to his post traumatic symptoms.

Le trouble de stress post-traumatique constitue une condition extrêmement difficile à traiter. Le clinicien se retrouve donc souvent impuissant face à une victime souffrante et qui présente des symptômes envahissants et réfractaires au traitement. J’ai tout essayé avec ce client et il souffre toujours autant, pourquoi? Comment aider cette victime à diminuer sa rage envahissante? J’ai tenté la restructuration cognitive, mais cette pensée reste toujours ancrée, comment faire pour l’aider autrement? L’exposition ne fonctionne pas, pourquoi? Cette victime semble présenter des traits narcissiques plutôt qu’un stress post-traumatique, est-ce possible? Certains gains secondaires semblent très présents, y a-t-il quelque chose à faire?  La présente formation s’adresse aux thérapeutes qui ont déjà une pratique régulière avec des victimes souffrant de stress post-traumatique, qui maitrisent déjà les stratégies cognitivo-comportementales usuelles (restructuration cognitive, stratégies de relaxation, exposition graduelle in vivo, exposition au souvenir du trauma) mais qui se butent à des impasses thérapeutiques avec certains clients. Cette formation tentera de donner des pistes de solution thérapeutiques concrètes lorsque : 1) La victime présente beaucoup de difficulté avec certaines émotions, 2) certaines cognitions sont trop cristallisées et sont résistantes au travail thérapeutique, 3) les stratégies d’exposition ne fonctionnent pas, 4) la présence de traits narcissiques nuit à la démarche thérapeutique et 5) lorsque la victime semble profiter de gains secondaires à ses symptômes post-traumatiques.

PMI #12 Treating Posttraumatic Sleep Problems: Applying CBT for Insomnia to Traumatized Populations
1:30 – 5:00 p.m.
   
Jason DeViva, PhD1; Claudia Zayfert, PhD2
1Connecticut Health Care System, Newington, CT, USA
2Dartmouth Medical School, Lebanon, NH, USA

Difficulty falling and staying asleep is one of the most common clinical complaints after trauma. Insomnia is associated with impaired concentration and memory, elevated levels of anxiety and depression, decreased pain threshold, and worsening of overall health functioning, all of which are also effects of trauma. In this institute, clinicians will learn how they can improve trauma survivors&#8217; sleep and mitigate the negative effects of sleep disturbances on mental and physical health and functioning. Participants will learn strategies to address various factors that precipitate and maintain sleep problems following traumatic experiences. We will describe the interactions between disturbed sleep and other symptoms and associated features of PTSD. We will present a model for understanding the initiation and maintenance of sleep problems, integrating predisposing, precipitating, and perpetuating factors that contribute to trauma-related insomnia. Participants will then learn to address the factors contributing to trauma-related insomnia using evidence-based cognitive-behavioral methods. We will cover strategies that treat precipitating factors (e.g., nightmares and vigilance) as well as perpetuating patterns of behavior and cognition (e.g., maladaptive sleep-related behavior). This will include detailing basic components of cognitive behavioral treatment for insomnia, including assessment of sleep using a sleep diary and other measures, assessment of maladaptive beliefs about sleep, fear of sleep, and other relevant constructs, psychoeducation about sleep, stimulus control, sleep restriction, sleep hygiene, cognitive restructuring, and relaxation strategies. We will discuss the research supporting use of these components for treatment of insomnia in general and with trauma populations. In addition, we will use extensive case material to demonstrate how to tailor application of these components to address specific manifestations of insomnia among survivors of trauma. Participants will learn how to determine when evidence-based treatments for insomnia are indicated, when they may be contraindicated, and how sequence them with evidence-based treatments for PTSD. Particular attention will be paid to the role of fear of sleep in perpetuating sleep problems. Factors affecting sleep of returning military personnel will also be specifically addressed.

PMI#13 Provider Resiliency: A Train-the-Trainer Mini Course on Compassion Satisfaction and Compassion Fatigue
1:30 – 5:00 p.m.

Beth Hudnall Stamm, PhD1; Charles Figley, PhD2; Kathleen Figley, MS3
1Idaho State University, Pocatello, ID, USA
2Tulane University Traumatology Institute, New Orleans, LA, USA
3Figley Institute, Tallahassee, FL, USA
  
This is a short course in understanding, addressing and assessing resiliency. It is an active, hands-on learning experience that benefits the participants directly and teaches skills for participants to provide training to others. Advances have been made in addressing resiliency in professions that are most affected working with trauma survivors or within potentially traumatizing environments. Research has shown that those who help people that have been exposed to traumatic stressors find satisfaction in their ability to help but also are at risk for developing negative symptoms associated with burnout, depression, and posttraumatic stress disorder. While the incidence of developing problems associated with the negative aspects of providing care seems to be low, they are serious and can affect an individual, their family and close others, the care they provide, and their organizations. This course concentrates on strengthening resiliency of those providing care. Resiliency is complex as and is associated with characteristics of the work environment (organizational and task-wise), characteristics of the people being helped and the helper’s individual's personal characteristics (e.g. resiliency, social support, previous exposure to trauma, other health issues, sleep, diet, exercise) including exposure to primary and secondary trauma in the work setting. This complexity can be understood as Compassion Satisfaction, CS) and negative (Compassion Fatigue, CF) aspects of helping. CF breaks into two parts. The first part concerns things such like exhaustion, frustration, anger and depression typical of burnout. Secondary Traumatic Stress is a negative feeling driven by fear and work-related trauma. Some trauma at work can be direct (primary) trauma. Participants in this course will learn about CS and CF and techniques understanding the client, work and personal environments to build resiliency. The first part of the course Resilience by Design: Orientation to Work-Related Stress and Self Care (Kathryn Figley) will cover work-related stress and self-care. In this section, participants will learn how to create a resiliency plan that builds on strengths. The second session is Resilience for Practitioners: Medical, Mental and Spiritual Caregivers (Charles R Figley). This section provides an in-depth examination of the principals and applications of resiliency. The final section is The ProQOL as a Measure of Resilience (Stamm). This section of the workshop covers methods for assessing one’s resiliency and process across time. Attendees will participate in activities during the workshop. They will also receive materials that can be uses for training others. The materials include presentation slides, worksheets, handouts, the ProQOL 5 measure, and learning games.

PMI #14 Parent-Child Interaction Therapy: Global Dissemination and Transfer of an Evidenced Based Practice for Young Children and Trauma
1:30 – 5:00 p.m.

Robin Gurwitch, PhD; Erica Pearl, PsyD
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Parent-Child Interaction Therapy (PCIT) is an evidenced based treatment for young children with significant behavior problems. Recently, the Kauffman Best Practices Report cited PCIT as one of the three best treatments in the field of child abuse and neglect. Although originally developed to address externalizing problems in young children, PCIT is now being successfully used with children in foster care, children with anxiety disorders and co-occurring problems like children from homes characterized by domestic violence and/or substance abuse. Most recently, PCIT is being evaluated for use with military families coping with deployment stressors. The combination of behavior problems and child history impacts children’s safety, physical health, and mental health; the majority of children in high-risk environments often become involved in the child welfare system. As children enter the system, they often experience additional trauma with multiple moves, as the presenting behavior problems are listed as the top reason for failed placements. Reunification may also fail as parents are ill-equipped to manage the behavioral difficulties of their children. PCIT is a relatively short-term intervention (average of 14 sessions) that involves the caregivers and the child. With several decades of empirical research, PCIT has been shown to maintain gains made for over six years (longest study to date), generalize to the school setting, and generalize to untreated siblings. Measures of parenting stress, maternal depression, and child behavior problems are shown to move from the clinically significant range to the normal range by the end of treatment. PCIT is being disseminated to settings across the United States and internationally, with an eye toward cultural issues. New advances in technology have enhanced dissemination efforts. This workshop will provide an overview of PCIT and its use with children, particularly those with trauma history. It will provide a discussion of dissemination challenges and solutions as well as what variables are needed for successful implementation and sustainability. The workshop will highlight the global reach of PCIT and cultural adaptations that have been made. Through didactics, video-clips, and brief experiential exercises, participants will learn how PCIT can improve the outcomes in the lives of young children and their families.