Pre-Meeting Institutes
Wednesday, November 2, 2011
Institutes are full or half day sessions that provide opportunities for intensive training on topics integral to the conference program, presented by leaders in the field.
Full Day
PMI #1, The Trauma Recovery Group: A Guide for Practitioners
PMI #4, Research-Derived Practical Skills for Treating Couples After War Zone Deployment
PMI #5, Complex PTSD: Complex Diagnosis, Complex Treatment
PMI #6, An Introduction to Cognitive Processing Therapy
Half Day - Morning
PMI #8, Building Attachment Across States: Healing Dissociative Symptoms in Children and Adolescents
PMI #9, Psychological First Aid for Schools
Half Day - Afternoon
Full-Day Institutes – (8:30 a.m. - 5:00 p.m.)
PMI #1, The Trauma Recovery Group: A Guide for Practitioners
Herman, Judith, MD1; Mendelsohn, Michaela,
PhD1; Schatzow, Emily, MEd1; Coco, Melissa,
MSW1; Kallivayalil, Diya, PhD1; Levitan, Jocelyn,
PhD Candidate2
1Cambridge Health Alliance,
Cambridge, Massachusetts, USA
2University of
California-Santa Barbara, Santa Barbara, California, USA
Technical Level: Intermediate
This workshop presents a unique approach to group treatment for survivors of interpersonal trauma. Based on a stage model of recovery, the Trauma Recovery Group (TRG) is explicitly designed to enlist the healing power of relational connection. Members are helped to develop skills in safe self-disclosure and empathic feedback, so that the processing of trauma memories can take place in a context of restored community.
The workshop offers a detailed description of the implementation of the TRG. Invivo role-play demonstrations of group process will be included to illustrate technical challenges of group leadership.
PMI #2, Cultivating the Strength of Collective Survival: Social Support and Survivor to Survivor Support as Elements of Staff Care in Complex Humanitarian EmergenciesGray, Amber Elizabeth, MA,
LPC1; Fawcett, John, LMSW2
1Restorative Resources, Santa Fe, New Mexico, USA
2John Fawcett Consulting, Auckland, New
Zealand
Technical Level: Intermediate
Staff support is an essential component of humanitarian operations in complex humanitarian emergencies. A federally funded mission to the Darfur region of Sudan and Chad to investigate stress levels of humanitarian workers, which were found to be high, catalyzed a train the trainers program designed to be globally adaptable, based on the principles of social support as a protective factor for humanitarian worker well-being and health. In Haiti, a non-governmental organization (NGO) funded staff support program built on survivor-to-survivor support as a foundation of sustainable, culture-centric programming became an international non-governmental organization (INGO) model for staff support.
The presenters describe two staff support programs responding to major disasters/complex humanitarian emergencies (Haiti 2010; Darfur Region of Chad and Sudan, 2007, 2010, 2011) and provide program participants with tools to effectively develop staff support programs in similar organizations and contexts. Both programs were developed to build on local resources and to be informed by local culture, and at the same time, to be flexible enough to serve as templates for similar programs in other countries, cultures or complex emergencies.
Concepts, research and rationale for social support as a core program component; goals, principles, teaching activities and training program modules are presented and shared to demonstrate didactic, experiential, process-focused ways to train in culturally diverse, complex emergency settings. Ongoing participant feedback and creative approaches to social support are described as pillars of program success, and to demonstrate impact in the field.
A trainer’s manual, sample handouts and other materials from the modules of both program curricula are shared so that participants have tools to apply the principles, learning, tools and practices of these unique, cross-culturally adaptable, context-centric programs in their own professional settings. An overview of multi-INGO staff support initiatives in Haiti, based on survivor-to-survivor support and social support, is presented as a model for other countries.
The Sudan/Chad Darfur Train The Trainers program demonstrates how multiple NGOs/INGOs can benefit from a four-day process-oriented training program with objectives to: increase understanding of stress, and its effects on humanitarian workers; develop staff support programs based on principles of psychosocial care, management and strategic planning; cultivate social support and survivor-to-survivor support as an actual training outcome. This is a participatory workshop with ample opportunity for participants to discuss their own needs for staff support in their specific professional settings and to design staff support trainings and programs.
PMI #3, Strengthening Family Coping Resources: Multi-Family Group for Families Coping with Multiple Trauma
Kiser, Laurel, PhD, MBA; Beck, Vickie, APRN
University of
Maryland School of Medicine, Baltimore, Maryland, USA
Technical Level: Intermediate
This institute presents a comprehensive overview of Strengthening Family Coping Resources (SFCR). SFCR is a trauma-focused, skill-building intervention designed for families living in chronically traumatic circumstances with the goal of building constructive and collaborative family coping skills to reduce traumatic distress, support positive adaptation and protective functioning. SFCR consists of a 15-week multi-family group divided into three modules. Module I introduces families to the concepts of family mealtimes, ritual, routine and storytelling as a foundation for supporting basic family processes. Module II builds constructive family coping resources. Sessions help families increase their sense of safety, incorporate anxiety management strategies into their daily routine, improve planning and follow through and build spiritual and support resources. Module III, through co-construction of a family trauma narrative, helps families deal with their trauma history, reconnect and move beyond their traumas.
Sessions include segments involving individual families working together, age-related break-out segments focused on developmentally appropriate skill-building, and segments focused on network building inclusive of the entire multifamily group. Between sessions, families are assigned activities that extend the concepts to their daily life. Open trials demonstrate the feasibility of SFCR and its effectiveness at reducing child symptoms of traumatic stress. Working with the family necessitates a life span perspective with promises of change across generations.
PMI #4, Research-Derived Practical Skills for Treating Couples After War Zone Deployment
O'Brien, Robert, PhD; Wills, Sharon, PhD
VA Central Texas
Health Care, Austin, Texas, USA
Technical Level: Intermediate
This workshop will describe a research-derived model of therapy for working with couples in which one or both partners have been exposed to combat trauma, teaching an assessment methodology to assess the impact of combat trauma on the relationship and teaching key interventions necessary to work with this population. The workshop will include didactic instruction, case presentation and discussion, video review and role-playing exercises.
More than a million men and women have served in Iraq and Afghanistan. They range in age, vary in ethnicity and live throughout the United States. Most are either involved in long-term intimate relationships or are hoping to establish such a relationship, and many have found their wartime experiences to have a profound impact on these relationships. Divorce rates, separations, substance abuse, domestic violence and suicide are all too common in this population. While many of these men and women are reticent to seek mental health care, many can and do seek help with their intimate relationships.
This workshop will be practical and skill-based and will teach clinicians strategies for assessing these couples and intervening in their negative conflict cycles and enhancing their marital friendships (i.e., the emotional glue that holds the relationship together.) The workshop will present both research-derived assessment strategies and research-derived intervention strategies. We will work to integrate key findings from John Gottman’s work, Susan Johnson’s Emotionally Focused Couples Therapy and Jaak Panksepp’s work in Affective Neuroscience. In addition to practical skills in couple’s assessment, the workshop will teach key interventions designed to down-regulate negative affect during conflict, and up-regulate positive affect both during conflict and non-conflict interactions. The finding that simply down regulating negative affect during conflict is not sufficient in and of itself to increase positive affect is a key research finding that is often neglected by clinicians working with couples. These interventions will be illustrated with case material, role play and the attendees will be given the opportunity to role play the interventions to further assist learning.
The workshop will conclude with a summary of the material, address a
variety of ethical concerns (such as the decision to implement this
model of treatment when you know that the soldier will re-deploy to a
war zone within a few months) and provide a final opportunity for
participants to ask questions.
Courtois,
Christine, PhD, ABPP; Ades, Lisa, PhD; Marotta, Sylvia, PhD, ABPP;
Hensler, Nancy, PhD; Doyle, Glenn, PsyD; Sanness, Kelli, MA, LPC;
Bauman, Emily, PhD
Courtois & Associates, PC, Washington,
D.C., USA
Technical Level: Introductory
Christine Courtois, PhD, ABPP, and her associates utilize empirical research, recent clinical writings and case studies to describe the diagnosis and treatment of complex posttraumatic conditions that develop as a result of chronic and cumulative interpersonal trauma. The curriculum includes: common characteristics and symptoms, assessment strategies and instruments, a sequenced and hierarchical approach to treatment and the function of the therapeutic relationship in treatment. The relationship between complex traumatic stress disorders and dissociation is examined in this workshop, and recommendations for identifying, assessing and treating dissociative disorders are presented. Issues related to therapist self-care, compassion fatigue and vicarious trauma are also highlighted.
The three-stage model of treatment, first proposed by Herman in her book Trauma and Recovery is presented. This model describes the importance of pacing, titration and containment in trauma treatment and stresses safety and stabilization as primary treatment objectives. Trauma processing techniques are used after the client has been stabilized and has developed skills for emotion regulation and safety. Trauma treatment is presented from a relational/attachment perspective. Issues of transference and countertransference are addressed and interwoven throughout the workshop presentation. An overview of major areas of risk in treating cases of complex trauma is presented. Case examples are used to illustrate various treatment approaches, dilemmas and suggested risk management.
It is common for clinicians who specialize in trauma treatment to be impacted personally as a direct result of this specialty. Therefore, this workshop presents the issues of compassion fatigue, secondary trauma, vicarious trauma and burnout. Resources for coping and therapist self-care are discussed and the importance of collaboration and consultation with other professionals is stressed.
Participant Distress: Case material will be presented that may include some disturbing details, however details are minimal.
PMI #6, An Introduction to Cognitive Processing Therapy
Resick, Patricia, PhD, ABPP1; Collie, Claire,
PhD2; Copland, Laura, MS, LMHC3; Morris, Kris,
PhD4
1National Center for PTSD, Boston,
Massachusetts, USA
2Durham VA Medical Center,
Durham, North Carolina, USA
3Center for
Deployment Study, Washington, D.C., USA
4Washington DC VA Medical Center, Washington, D.C.,
USA
The purpose of this pre-meeting institute is to provide attendees the basics of cognitive processing therapy (CPT). CPT is an evidence-based cognitive therapy for PTSD and comorbid symptoms that can be implemented with or without a written narrative and can be implemented as either an individual or group therapy. It has been demonstrated to be effective across a range of traumas as well as very complex trauma histories and symptom presentations. Because it is very difficult to teach CPT in less than two or three days, this year we would like to conduct the workshop somewhat differently than usual and take into account the participants’ readiness to learn the protocol for implementation. Even when announcing advanced workshops, some individuals sign up for a workshop without the requisite skills and both the prepared members of the audience and the workshop presenters must try to balance basic explanations with more advanced concepts.
This year we are proposing to do a basic one-day workshop but also recognize that some attendees will have more advanced training and different goals than other participants. Therefore, we are proposing to divide participants into two groups based on their pre-conference preparations. One group will be for those participants who intend to implement the protocol and have already read the manual and bring it with them (requests can be made to Patricia.Resick@va.gov for a PDF copy) and/or have completed the online CPT course (http://cpt.musc.edu) and can provide their completion certificate. The participants in this group will be taught at a more specific and advanced level for how to implement the therapy protocol, including role plays of Socratic dialogue with feedback and the opportunity to practice therapist skills needed for implementation.
The second group, targeting those who are attending just to learn more about CPT, who sign up at the last minute, or who are not sure whether they want to implement the therapy, will be provided a rationale for the therapy, information about effectiveness, an overview of the protocol, videotaped examples of the therapy and will be walked through the sessions with case examples as well as information about how the different formats are conducted. There will be no expectation that this latter group of attendees will have the skills by the end of the workshop to implement the therapy.
PMI #7, Using the Core Curriculum on Childhood Trauma to Create “Gold Standard” Training for Evidence-Based Students and New PractitionersLayne, Christopher, PhD1; Strand, Virginia, DSW2; Abramovitz, Robert, MD3; Stuber, Margaret, MD4; Ghosh Ippen, Chandra, PhD5; Ross, Leslie, PsyD6; Collins, Kathryn, MSW, PhD7; Henry, James, PhD8; Amaya-Jackson, Lisa, MD, MPH9
1UCLA/Duke University National Center for Child
Traumatic Stress, Los Angeles, California, USA
2Fordham University, West Harrison, New York, USA
3Hunter College, New York, New York, USA
4Semel Institute at UCLA, Los Angeles, California,
USA
5University of California, San Francisco,
California, USA
6Children’s Institute Inc.,
Los Angeles, California, USA
7University of
Maryland, Baltimore, Maryland, USA
8Western
Michigan University, Kalamazoo, Michigan, USA
9UCLA-Duke National Center for Child
Traumatic Stress, Durham, North Carolina, USA
Technical Level: Intermediate
A recent national survey in graduate schools of clinical psychology and social work revealed a widespread need for formal training in evidence-based treatment (EBT) (Weissman et al., 2006). The National Child Traumatic Stress Network is developing a “gold standard” curriculum that integrates both didactic training and clinical supervision in implementing trauma focused EBT. The Core Curriculum on Childhood Trauma (CCCT) lays a foundation for training in specific EBTs.
The primary aim of the CCCT is to promote the acquisition of expert clinical judgment through training in foundational trauma-related concepts, information gathering skills, case conceptualization skills and clinical reasoning skills. The
CCCT uses richly detailed clinical cases and cutting-edge learning methods to simulate evidence-based practice in “real world” settings. We will present: 1) the conceptual framework that undergirds the CCCT, consisting of Core Concepts, Intervention Objectives, Practice Elements and Skills; 2) “hands on” experiential training in problem-based/team-based learning methods and their use in developing trauma-informed, culturally competent and developmentally appropriate clinical reasoning skills; and 3) the format and outcomes of the CCCT as implemented in seven major pre-professional graduate training programs. 4) We will then conduct a “how to” discussion on integrating didactic classroom training in trauma-informed evidence-based practice with field placements in the implementation of specific trauma-informed EBTs. This will include a facilitated discussion of how to build faculty and field instructor capacity to implement the integrated training model. In the last part of the session, we will describe our ongoing efforts to develop 5) competency-based training standards for graduate training programs, 6) methods for assessing and remediating foundational competencies and 7) methods for enhancing the sustainability of “gold standard” training in ways that promote the development of a trauma-informed national workforce.
Half-Day Institutes – Mornings (8:30 a.m. - 12:00 p.m.)
PMI #8, Building Attachment Across States: Healing Dissociative Symptoms in Children and Adolescents
Silberg, Joyanna, PhD
Sheppard Pratt Health System,
Baltimore, Maryland, USA
Technical Level: Intermediate
This workshop will teach effective techniques to reverse dissociative symptoms in traumatized children. Children with dissociative symptoms may demonstrate radical behavior and affective shifts, have amnestic episodes and show shifting patterns of relating to their primary caregivers. These pathological patterns may stem from early relationship deficits, compounded by experienced traumatic events in the absence of soothing. The techniques reviewed build internal awareness, decrease the child’s phobic avoidance of affect states and help caregivers approach the “whole child” with acceptance. These theories and techniques are grounded in current neuroscientific findings about attachment, trauma and dissociation and based on years of experience working with this population.
PMI #9, Psychological First Aid for Schools
Brymer, Melissa, PhD, PsyD1; Watson, Patricia,
PhD1; Walker, Doug, PhD2; Reyes, Gilbert,
PhD3; Taylor, Matthew, MA4
1National Center for Child Traumatic Stress - UCLA, Los
Angeles, California, USA
2Project Fleur-de-lis,
Metairie, Louisiana, USA
3Fielding Graduate
University, Santa Barbara, California, USA
4The
Institute for Educational Research and Service - University of Montana,
Missoula, Montana, USA
Technical Level: Intermediate
Following disasters, mass violence and local community crises, interventions for school settings are among the most frequent requests of the National Child Traumatic Stress Network. Psychological First Aid for Schools (PFA-S) is an evidence-informed intervention model for assisting students, families and school personnel in the immediate aftermath of a traumatic event. Core elements of PFA-S focus on facilitating survivor-to-survivor support, strengthening protective factors, linking survivors to social support networks and decreasing chances for secondary traumatization — including of school and disaster relief personnel.
The presenters will highlight how schools play a critical role in times of crisis, whether the emergency occurs on school campus (e.g., school shootings) or after a community disaster (e.g., earthquakes, floods) where schools will be a place of recovery. Presenters will describe the eight core actions of PFA-S and how to adapt the intervention for different groups, cultures and age groups. All members of a school community play important roles in delivering PFA-S. Presenters will review the roles and responsibility of disaster mental health providers, administrators, teachers and other school personnel, as well as integration into the Incident Command System. This PMI is designed around a scenario where participants will actively practice provision of support to students and staff at a school that was recently exposed to a critical incident. At the end of the exercise, participants and presenters will conduct an after-action review and address lessons learned.
Half-Day Institutes – Afternoon (1:30 p.m. - 5:00 p.m.)
PMI #10, Innovative Approaches to the Treatment of Developmental Trauma Disorder in Children and Adolescents
Zelechoski, Amanda, PhD; Warner, Elizabeth, PsyD; Emerson, David,
E-RYT; van der Kolk, Bessel, MD
Trauma Center at JRI,
Brookline, Massachusetts, USA
Technical Level: Intermediate
Children and adolescents in residential treatment settings have high rates of exposure to interpersonal, caregiver-related trauma (Levin, 2009), or what has been proposed as Developmental Trauma Disorder (van der Kolk, 2005). The lack of understanding about this complex symptom presentation can lead to ineffective or inappropriate psychological or psychopharmacological treatment interventions. Using a clinical case format, this half-day workshop will present three innovative, body-based approaches to treating youth with Developmental Trauma Disorder in residential treatment settings.
First, Sensory Motor Arousal Regulation Treatment (SMART) engages children in sensory motor activity as a way to regulate their arousal systems, their bodies and their feelings. Using segments of videotaped sessions, participants will examine dysregulation, caregiver co-regulation and trauma processing.
Next, the use of neurofeedback as an alternative to psychopharmacological intervention, and to address hyperarousal in traumatized adolescents, will be described. Neurofeedback combines technology from multiple disciplines to teach the brain how to prolong healthy brain wave patterns, leading to improvements in self-regulation and concentration.
Finally, a trauma-informed yoga intervention will be presented. Through yoga, many traumatized youth are discovering new ways to feel safe in their bodies and to self-regulate. This experiential and didactic workshop will engage participants in an interactive discussion about the application of these interventions to complexly traumatized youth.
PMI #11, Rapid Evidence-Based Guidance for Post-Impact Disaster Mental Health Response: Trauma Signature (TSIG) Analysis
Shultz, James, MS, PhD1; Kelly, Fiona, PhD2;
Espinel, Zelde, MD, MPH1; Neria, Yuval, PhD3
1DEEP Center, University of Miami, Miami, Florida,
USA
2Mater Misercordiae University Hospital,
Dublin, Ireland
3Department of Psychiatry,
Columbia University, New York, New York, USA
Technical Level: Introductory
This PMI presents an applied workshop on Trauma Signature (TSIG) Analysis. TSIG is a systematic framework for generating and providing rapid post-impact/pre-deployment disaster mental health response guidance based on risk factor assessment. The workshop will be presented by the TSIG development team.
Introduction: Each disaster leaves an imprint on the affected population, a singular signature. A critical unmet need in the field of disaster mental health (DMH) is the capability to tailor mental health and psychosocial support (MHPSS) to the unique constellation of psychological risk factors operating within each disaster event.
Problem Statement: MHPSS response to disasters is frequently unguided, uncoordinated and unscientific. Prevailing challenges include 1) mass convergence of responders to the disaster scene, 2) provision of a multitude of non-evidence-based “psychosocial” programs, 3) failure to target programs to event specific psychological risks, 4) failure to conduct on-scene DMH needs assessments, 5) failure to identify persons at high-risk for psychopathology, 6) lack of DMH services maintained throughout the recovery period, 7) absence of ongoing monitoring of survivor mental health status and 8) failure to evaluate MHPSS intervention efficacy.
Approach: Trauma Signature (TSIG) Analysis has been developed to address these challenges sequentially. TSIG begins by formalizing tools to perform rapid post-impact analysis to jump-start an empirically-based DMH response. TSIG is premised on the fact that risk factors for disaster-related psychological distress and impairment have been documented empirically and can be identified from early disaster situation reports. This facilitates guidance to tailor MHPSS response to the defining features of each disaster.
Workshop: The interactive, participatory TSIG workshop will use real-world disaster case examples to present the steps involved in TSIG analysis:
First, create a database of evidence-based risk factors for psychological distress and psychopathology in disasters. Second, develop a system to capture real-time disaster information and convert these data into a unique hazard profile for the event, with a corresponding stressor matrix. Third, define algorithms to generate actionable, evidence-based guidance for early MHPSS response matched to the spectrum of identified psychological risk factors summarized in the TSIG analysis. The TSIG Team has created tools and resources for each of these action steps.
The PMI will also discuss subsequent steps for onsite MHPSS response: adaptation of mental health assessment templates to facilitate a validated needs assessment, identification and referral of high-risk survivors to evidence-based MHPSS support and DMH interventions, monitoring survivor mental health and evaluation of intervention efficacy.
PMI #12, Parent-Child Interaction Therapy: Evidence Based Treatment for Improving Family Bonds and Social Relationships
Gurwitch, Robin, PhD; Pearl, Erica, PsyD
Cincinnati
Children's Hospital Medical Center, Cincinnati, Ohio, USA
Technical Level: Intermediate
Parent-Child Interaction Therapy (PCIT) is an evidenced based treatment for young children with significant behavior problems. The Kauffman Best Practices Report cited PCIT as one of the three best treatments in the field of child abuse/neglect. Although originally developed to address externalizing problems in young children, PCIT is now being successfully used with children in foster care and co-occurring problems like children from homes characterized by child maltreatment, domestic violence and/ or substance abuse. Improving the bonds in the family and the child’s abilities to be successful in other settings (e.g., school, social settings) are important factors in helping children meet their full potential, especially after exposure to traumatic events. PCIT is a short-term intervention involving the caregivers and the child with a strong focus on treatment success through improving the parent-child relationship. Empirical research consistently finds significant improvements in child behaviors, parenting stress and maternal depression, with improved relationships and generalization to school settings and untreated siblings. This workshop will provide an overview of PCIT and its use with children with trauma history. Through didactics, video clips and brief experiential exercises, participants will learn how PCIT can be effectively implemented to improve outcomes in the lives of children.