Trauma Intervention Program

Trauma intervention program FOR CHILDREN AND ADOLESCENTS

William Steele, PsyD, MSW

Trauma Intervention Program

Structured Sensory Interventions for Traumatized Children, Adolescents and Parents A program of the Structured Sensory Interventions for Children, Adolescents and Parents (SITCAP®) Model William Steele, PsyD, MSW This program was made possible by the generosity of the Junior League of Detroit, Inc., and the Whitney Fund.

©TLC 1998 Revised 2002 Revised 2009 Revised 2018

ISBN 1-931310-02-5

The National Institute for Trauma and Loss in Children 13725 Starr Commonwealth Road • Albion, MI 49224 www.starr.org/tlc | info@starr.org NOTICE TO NON-PROFESSIONALS: The information contained in this book is not intended as a substitute for consultation with health-care professionals.

The National Institute for Trauma and Loss in Children (TLC) was established in 1990. TLC's mission is to provide school professionals, crisis intervention teams, medical and mental health professionals, child

care professionals and clinicians with trauma education, training, consultation, referral services and trau-

ma-specific intervention programs and resource materials needed to help children, parents, families, and

schools traumatized by violent or non-violent trauma-inducing incidents.

No part of this manual may be reproduced, stored in a retrieval system, or transmitted in any form with-

out the prior written consent of The National Institute for Trauma & Loss in Children. Workbook pages

may be copied for use with each client.

This publication is intended as a general guide. It covers what can be highly technical and complex sub-

jects and is sold as is, without warranty of any kind either expressed or implied respecting the contents

of this publication. The National Institute for Trauma & Loss in Children shall not be liable to the pur-

chaser or any other person or entity with respect to any loss or damage caused or alleged to be caused

directly or indirectly by this publication.

We wish to thank all of you who have participated in TLC programs since 1990. Your encouragement,

support and wonderful feedback related to your experiences with traumatized children and families have

always been the impetus for pursuing the development of this program.

NOTICE TO NON-PROFESSIONALS: The information contained in this book is not intended as a substitute for consultation with health care professionals.

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About the Author

William Steele, PsyD, MSW is the Founder of The National Institute for Trauma and Loss in Children. He has developed, published and produced numerous books, articles, trauma-specific intervention programs and resource materials. He has trained well over 40,000 professionals. After the Gulf War he was one of the first Americans selected by the Kuwait government to provide trauma intervention training for their newly formed mental health staff. Whether in the aftermath of the bombing of the Federal Building in Oklahoma, the tragedy of 9/11, the ravages of the tsunami, the devastation of Hurricanes Katrina and Rita, or the critical incidents that occur in schools and communities, Dr. Steele’s programs and resources are helping thousands of children, families and professionals every day.

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Table of Contents Part One: OVERVIEW

Trauma Intervention Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 TLC Institute Evidence-based Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Defining Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Trauma Intervener Qualifications & Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 35

Part Two: PaREnT SESSIOnS

Preparation for Parent Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Session One: Parent Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Session Two: Helping the Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Session Three: Preparation for Session 7 with Child . . . . . . . . . . . . . . . . . . . . . . . 77 Session Four: Child Tells His Story to the Parent . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Part Three: CHILD SESSIOnS (6-12 Years)

Session One: Education & Debriefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Two: Fear & Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Three: Hurt & Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Four: Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Five: Accountability & Future Hopes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Six: Family & Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Seven: Reuniting with Parent’s Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Session Eight: Saying Goodbye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alternate Activities for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

89 107 115 123 129 137 141 147 151

Part Four: aDOLESCEnT SESSIOnS (13-18 Years)

Session One: Education & Debriefing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Preparation for Session Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Session Two: Who I Am . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Session Three: Surviving & Managing Traumatic Anger . . . . . . . . . . . . . . . . . . . . 193 Session Four: Anger & Hurt, Why Me? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Session Five: Family & Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Session Six: Worry & My Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Parent Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Session Seven: Family & Me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Session Eight: Saying Goodbye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

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Overview

Trauma Intervention Program Introduction tructured Sensory Intervention for Traumatized Children, Adolescents

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and Parents (SITCAP) is the result of 19 years of development, field testing in school and agency settings, and evidence-based research by

the National Institute for Trauma and Loss in Children (TLC). The SITCAP

model includes trauma-specific individual and group intervention programs for pre-school children ages 3-6 (What Color Is Your Hurt?, 1998); children

ages 6-12 (I Feel Better Now! Program, 2007); at-risk adjudicated youth ages 13-18 (Trauma Intervention for At-Risk and Adjudicated Youth [SITCAP-ART]

2005); and children 6-12 and adolescents 13-18 (Trauma Intervention

Program [TIP, 2009]) and a program for parents (Parents in Trauma: Learning to Survive, 2001).

A combination of formal and evidence-based research, case studies, focused feedback sessions, and anecdotal accounts have been used since 1990 to develop these programs. They are now being used across the country in school and agency settings with children and families exposed to such incidents as murder, sexual/physical assault, domestic violence and other forms of violent acts; car fatalities, house fires, drowning, critical injuries, terminal illness, divorce and separation from parents.

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Program Overview

The SITCAP programs address ten major trauma themes: fear, terror, worry, hurt, anger, revenge, accountability, powerlessness, absence of safety, and victim versus survivor thinking. Primary intervention strategies include exposure, trauma narrative, and cognitive reframing. Drawing is used as the major component of exposure. The trauma narrative is facilitated with the use of trauma-specific questions and educational materials facilitate cognitive reframing. Each intervention is structured for the purpose of creating a sense of safety for the child, adolescent, or parent while re-experiencing, retelling, and reframing the major trauma reactions. The restoration of a sense of safety and power is of primary concern in each program. The activities are primarily sensory activities, as trauma is experienced at a sensory, not cognitive level. The structure of intervention, however directs those sensory experiences into a cognitive framework, which can then be reordered in a way that is manageable and empowering.

The Trauma Intervention Program (TIP), based upon TLC’s SITCAP Model, is a short-term, eight-session, sensory-based trauma intervention program.

Why SITCAP is Unique R

The interventions are designed to meet the unique intervention parameters in school settings where children are most accessible, or to support more clinically focused interventions in agency settings.

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The program addresses both grief and trauma-specific reactions.

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The program is very structured in its directions, interventions, and activities, which are sequentially and systematically designed to ensure that the individual is given the opportunity to safely address each of the major themes of trauma.

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The program provides education materials related to trauma and the interventions, which are beneficial to the recovery process for children, adolescents and parents.

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The program focuses on trauma themes: fear, terror, worry, hurt, anger, revenge, accountability, powerlessness, absence of safety and being a survivor versus a victim, rather than on symptoms.

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Parent involvement through specifically structured sessions designed to obtain necessary information to allow parents to witness how the trauma has impacted their child is included.

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Resource materials, in a structured booklet format are provided for parents to ensure they receive information on the differences between grief and trauma as well as the course the intervention will take.

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Exposure is accomplished through structured drawing activities, developing the trauma narrative by asking trauma specific questions, and cognitive reframing through the use of scripts.

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The model is outcome driven and includes pre and post PTSD questionnaires for both child and adolescent components that provide a baseline to compare final outcomes with the initial assessment. This tool is clinically based so it serves as a diagnostic tool to support third party insurance requirements for approved treatment and if needed, continuation beyond the short-term period.

TIP: A Comprehensive Program The Trauma Intervention Program comes complete with:

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Intervener’s manual that contains comprehensive “scripted” interventions.

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Reproducible worksheets that are supported with sensory-based activities.

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Resource materials including TLC’s booklets, You Are Not Alone, A Trauma Is Like No Other Experience and What Parents Need To Know.

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Program Overview

The Trauma Intervention Program can be used with children and adolescents that have experienced both violent and non-violent trauma experiences including traumas such as; murder, physical and sexual assault, domestic violence, suicide, critical injuries due to various accidents, terminal illness, chronically mentally ill parents, substance abusing parents, neglect, abandonment, forced displacement, adoption, foster care placement, homelessness, house fire, drowning, sudden death from natural causes and divorce.

Structured Sensory Intervention for Traumatized Children, Adolescents and Parents (SITCAP), (Steele & Raider, 2009). The SITCAP model is a compre-

hensive treatment approach designed to diminish the terror that exposed individuals experience and facilitate feelings of safety. When trauma reactions are normalized, the distinction between trauma and grief is emphasized. This structured protocol provides a session-by-session, situation-specific (e.g., school vs. agency) guide to intervention. It is appropriate for individuals who have experienced violent or non-violent trauma and is age-specific (preschoolers, 6 to12 year olds, adolescents, and adults). Focusing on themes such as ‘hurt and ‘worry’ that accompany both violent and non-violent types of trauma enhances the generalizability of the model. The parent component encourages a supportive caretaker response and addresses past

and present traumas in the parent’s life (Steele & Raider, 2009). SITCAP inte-

grates cognitive strategies with “sensory” and “implicit” strategies. SITCAP is

designed to achieve the successful cognitive re-ordering of traumatic experiences in ways that move children and adolescents from victim to survivor thinking and in ways that allow them to become more resilient to future traumas. With increased cognitive functioning resulting from sensory based processing, the adolescent has a greater chance of benefiting from intervention that addresses the maladaptive coping behaviors characteristic of adolescents who have experienced long-term trauma reactions.

The Program The program consists of 8-10 sessions, depending upon the progress made each session. The intervention process utilizes the following techniques: 4

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Normalization through education;

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Understanding through cognitive restructuring;

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Anxiety management through psychomotor activities;

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Empowerment through discovery and reframing of responsibilities;

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Relief through telling and showing, restructuring, and replacement.

The Goals of SITCAP are: R

Stabilization (return to previous level of functioning or prevention of further dysfunction);

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Identification of PTSD reactions;

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The opportunity to revisit the trauma in the supportive, reassuring presence of an adult (professional) who understands the value of providing this opportunity;

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An opportunity to find relief from trauma-induced terror, worry, hurt, anger, revenge, accountability, powerlessness, and the need for safety;

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An opportunity to re-establish a positive “connectedness� to the

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Normalization of current and future reactions;

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Support of the heroic efforts to become a survivor rather than a vic-

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When appropriate, assistance for parents in resolving those reac-

adult world;

tim of their experience;

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Program Overview

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Replacement of the traumatic sensory experience with positive sen-

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Identification of additional needs and recognition of the role parents

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The provisioning of parents with ways to respond to their trauma-

sory experiences;

can take to help meet those needs;

tized child’s reactions.

The Initial Session: Education & Debriefing In this program, education is critical to recovery and it is also the first step in creating a sense of empowerment and safety for participants. Structuring statements, which provide the program facilitator with specific wording, are used at intake, and clearly identify how the process works, what will be expected, and what outcome can be anticipated. The time devoted to “structuring” the process helps to reduce anxiety. It also helps victims to make an informed consent. All too often interveners simply move directly into treatment without addressing the implications for the client. The client is not pre-

pared to really confirm, “Yes, this is what I want.” SITCAP uses specific resource materials for this educational component to ensure the child has some sense of what he is about to experience as well as learn.

It is also of value to mention that, participants consistently report in final session surveys that the trauma educational component, that is included in all TLC trauma programs, has been extremely helpful and encouraging to them.

The debriefing session is a critical first step in helping to reduce the child’s

trauma reactions as well as anxiety about the SITCAP process. It is therefore, important that the child has your undivided attention.

This is an abbreviated debriefing session, which provides the child with an opportunity to confidentially revisit their trauma in the supportive, reassuring presence of an adult and helps to normalize the adolescent’s experiences.

It also becomes an opportunity through the use of specific questions to redi-

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rect the child’s understanding of the impact that this experience has had on their life and how this intervention process will help bring the child relief from the trauma specific symptoms.

Sessions 2 through 8 Focus on Themes, Not Behavior SITCAP focuses on major experiences, sensations or themes of trauma throughout the process shifting the child from victim thinking to survivor thinking. This process, therefore, does not direct itself to attempting to treat behavior, but rather the sensory experiences of trauma that fuel and drive the child’s behavior. To accomplish this the intervener must remain in role of the witness versus clinician. To be a witness, the intervener must be involved in the child’s telling of their experience by being curious about all that happened. To engage this “witness” role, the intervener must be very concrete and literal in response to all the elements of the experience, its details and the visual representations provide by the child. If the intervener attempts to make sense of the child’s’ emotional status by analyzing “why” they will not be able to experience the trauma as they are experiencing it. They will not “know it” as the child knows it, and the child will not experience the intervener as a witness, as someone who is with them in their experience. They will sense that they are alone and will withdraw to protect themselves. Part of becoming a witness is seeing how the victim now views them self and the world around them following the trauma. To see what the victim sees is to understand and know what will be helpful. Because trauma is a sensory experience the memory is often stored symbolically. Images – how they look at themselves and the world around them – defines what the trauma was like. A brief example might be the traditional therapeutic role of a therapist analyzing how a youngster is thinking or feeling instead of simply asking, “Of all the things that are going on in your life right now what is your biggest worry?” For some children what the therapist might think may be a major concern related to the incidents the child has been exposed to, may be completely different from what the child is experiencing as a result of their exposure.

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Program Overview

Drawing Drawing is a major component of SITCAP. The experience of trauma is stored in implicit memory and is transcribed into iconic representations/visualizations. Iconic symbolization is the process of giving our experience a visual identity. Images are created to contain all the elements of that experience what happened, our emotional reactions to it, the horror and terror of the experience. The trauma experience therefore is more easily communicated through imagery. “When a terrifying incident such as trauma is experienced and does not fit into a contextual memory, a new memory or dissociation is established” (van der Kolk, 1996, p. 287). When memory cannot be linked linguistically in a contextual framework, it remains at a symbolic level for which there is no words to describe it. To retrieve that memory so it can be encoded, given a language, and then integrated into consciousness, it must be retrieved and externalized in its symbolic perceptual (iconic) form (Steele, 2003).

In order to access this experience we must therefore use "sensory" interventions that allow adolescents the opportunity to actually make us witnesses to their experiences, to present us with their "iconic" representations, to give us the opportunity to see what they are now seeing as they look at themselves and the world around them following their exposure to a traumatic experience. In this sense “a picture is worth a thousand words”. Drawings provide a representation of those “iconic” symbols that implicitly define what that experience was like for the child, how that child now views themselves and those around them. Drawing becomes a vehicle for communicating and externalizing what that experience was like.

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Drawing is a psychomotor activity. Because trauma is a sensory experience, not a cognitive experience, intervention is necessary to trigger those sensory memories. Drawing triggers those sensory memories when it is trauma focused. It provides a safe vehicle to communicate what children, adolescents, and even adults, often have few words to describe.

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Drawing engages the children in the active involvement with their own healing. It takes them from passive to an active, directed, controlled externalization of that trauma and its reactions.

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Drawing provides a symbolic representation of the trauma experience in a format that is now external, concrete, and therefore manageable. The paper acts as a container of that trauma.

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Drawing provides a visual focus on details that encourage the client via trauma-specific questions, to tell his story, to give it a language so it can be reordered in a way that is manageable.

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Drawing also provides for the diminishing of reactivity (anxiety) to trauma memories through repeated visual re-exposure in a medium that is perceived and felt by the client to be safe.

Details Obtaining details is another very important component of the SITCAP process as it helps to make sense of the experience. Trauma specific questions have been designed to help in the telling of the story and the provision of those details that allow intervener witnesses to better understand what the experience has been like for the child. For the victim, details can provide a sense of control as well as sense of relief. For the intervener, details can

point the way to helping the child find relief. The structure of SITCAP keeps the intervener and child focused on details as a way of being able to later “see� the experience differently, to cognitively reframe it in a way that is manageable. Details also can provide information that helps to make sense out of what happened and may still be happening with the child.

Trauma-Specific Questions Questions are directed to trauma themes and focus on trauma sensations, www.starr.org/tlc

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Program Overview

and are also directed to the details of the trauma incident itself. Following are some examples:

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“What do you remember seeing or hearing?” relates to the overall

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“Do you sometimes think about what happened even when you don’t

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“Do certain sounds, sights, smells, etc., sometimes suddenly remind

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“What would you like to see happen to the person (or thing) that

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“Do you sometimes think it should have been you instead?” is an

sensory imploding of detailed components of the trauma.

want to?” deals with intrusive thoughts.

you of what happened?” refers to startle reactions.

caused this to happen?” deals with anger and revenge.

accountability (survivor guilt) question.

Multiple questions are asked because the specific trauma reference may be worry, not anger, or revenge. The child’s trauma reference may be about the hurt experienced at a sensory level not the physical level. It may be accountability for some, fear for others. SITCAP encourages the systematic presenta-

tion of all questions and attention to all themes to give the victim the opportunity to make the intervener a witness to the child’s specific trauma reference.

Cognitive Reframing Cognitive reframing is scripted in SITCAP to insure that the victim is provided a “survivors” way of making sense of their trauma experiences. The goal is to help move participants from “victim thinking” to “survivor thinking” which leads to empowerment, choice, and active involvement in their own healing process and a renewed sense of safety and hope.

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Activities also assist in supporting the reframing of the experience in ways that are more manageable for them. Therapies that engage “explicit” cognitive processes are likely to be ineffective when traumatized children are in the state of intense fear or terror. Steele (2003), Stein & Kendall (2004) and others now agree that children must re-experience a sense of safety from and control (regulation) over those reactions induced by trauma before they can actually engage those explicit processes which are needed for cognitive restructuring the reordering of the experience in a way they can now manage; in a way that this memory now becomes a resource versus a memory to be avoided.

For example, “Your experience has left you worried about what might happen

next. This is certainly normal, but keep in mind, just as a storm doesn’t stay forever, your worry won’t stay forever either.”

Parent, Foster Parent, Guardian, Primary Caregiver and Therapist Involvement Parents, foster parents, guardians, primary caregivers and therapists generally underestimate the impact trauma has on children. Learning about trauma helps them to more adequately respond to the child. Education is also helpful for primary caregivers who themselves have been traumatized.

Education is an essential, necessary component to help them become aware of how their own unresolved traumas block their abilities to allow the child to feel safe with them. Primary caregivers with their own history often discover that the child’s experience threatens to bring all the terror of their own experience back to life. Unknowingly, they reject their child’s cry for help or minimize the child’s terror in hopes of avoiding their own fears and anxiety.

This is a primary reason why the SITCAP program is as structured for the trauma specialist or clinician as it is for the child.

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Program Overview

Session Format The session format is used to provide a structured, systematic progression of activities and objectives supporting and building on one another. A session includes:

R R R R R R

Session Title Session Objectives Resource Materials Needed Intervention Steps Notes Framing and Reframing Statements

This program includes instructions for parent sessions, child sessions, and adolescent session. Workbooks for use with children 6-12 years of age, and adolescents 13-18 years of age are also included and may be duplicated.

Sessions contain required interventions. Because this is a short-term model, it is our belief that traumatized children experience similar reactions.

Trauma-specific reactions like arousal, re-experiencing or avoidance of the incident are incorporated into and specifically responded to through the required activities. Please use each session in its sequential order, as one sets the foundation for the next session.

By using required interventions, we help to insure that in a brief period, critical areas are at least normalized should they be too terrifying for the child/adolescent to otherwise confront.

A session refers to the objectives to be achieved using the interventions and resource materials described in that session.

Session Length Sessions are expected to last approximately 50 minutes. Keep in mind that 12

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the children will dictate the pace at which they move through the activities.

It is important to understand that each child will be different.

Some children will draw and process quicker than others. Some children, for example, may want to spend more time on “fear” activities than other children. A session, therefore, provides activities that may be extended through to the next session when a child spends more than the anticipated amount of time on any one activity.

The program is for the benefit of traumatized children. If they are really involved in a particular intervention activity, do not be concerned about completing that session in one meeting. It can be continued and carried over to your next meeting.

Age-Specific Two models are included in this program; one designed to address children 6-12 years and the other to address adolescents 13-18 years of age. It is understood that these groupings allow for a variance of 2-3 years. We know that some 10 year olds have had the kind of exposure other 13 year olds have yet to experience. Intervention strategies designed, therefore, for a 13 year old may, in fact, be appropriate for some 10 year olds and vice versa.

Parental Involvement Parental involvement is strongly encouraged. Traumatization is just as terrifying for parents. They need to learn what it does to their child’s cognitive functioning, behavior, perception of self and the world, and their emotional well being. A section of the program offers guidelines for engaging parents.

If a parent her/himself has been traumatized and is needing assistance with their own trauma, we recommend TLC’s program, Adults and Parents in Trauma.

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Program Overview

Process The process is based upon a model of teaching, exploring, guiding, normalizing, and reframing of experiences. Feelings are addressed in order to be normalized, as well as explored clinically.

Drawing, storytelling, the use of puppets, DVD, and other activities are the major processes children and adolescents will be encouraged to utilize.

This program is meant to offer support and to help normalize reactions, thereby reducing or minimizing the trauma’s impact. It also provides varying levels of therapeutic interventions. Some children do very well when given the opportunity to share their stories and then have their reactions normalized. Teaching, exploring, reframing of experiences can be very beneficial in these cases. Others will need more work in specific areas such as anger or arousal behaviors. A variety of intervention strategies are provided for the more common reactions. Assessment, of course, plays a critical role in identifying the more frequent and/or difficult reactions the child is experiencing.

The real value of the Trauma Intervention Program is its ability to generally be helpful even when only a few sessions are available. The trauma-specific focus allows the process to quickly engage children as well as provide them with some relief from the terror of their experience.

Materials Needed Colored pencils or pastels, 8-1/2” x 11”, 11” x 14”, 18” x 24” plain paper, clay, helium balloon (optional), camera, washable ink pads for the “thumb print” activity are highly recommended as children love this activity, clay (optional), and a work table is suggested. A DVD player and monitor, or a computer with the ability to play DVDs is helpful. Or you can use the booklets included in this program. They are designed to help to educate children, adolescents and parents about trauma-specific reactions as well as normalize these reactions.

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The child and adolescent workbooks contain worksheets you may copy for use with each client you work with.

NOTE: If all that you have available is this program and a pencil, the interventions remain very effective.

About the DVD and Booklets Three segments are included on the DVD, for parents: What Parents Need to

Know: Help for Your Traumatized Child; for adolescents: A Trauma is Like No

Other Experience; and for children: You Are Not Alone. Each segment is designed to inform and normalize and each is accompanied by a booklet of the same title. This DVD is to be used in the initial visits, or the booklets can

be used in place of the video segments.

We strongly recommend previewing these segments so you may judge their appropriateness for your clients, students or families. Should you decide they may not be appropriate, the booklets proved to also successfully educate children, adolescents and parents about trauma and normalize any reactions they may experience.

Framing and Reframing Statements Framing statements prepare the child for the activity. Reframing statements help the child to “see� their trauma reactions differently, as well as promote survivor thinking.

Reminder: Please do not use intervention strategies out of sequence or as part of another process. These activities are designed to develop a sense of safety, while dealing with terrifying memories and reactions. To use out of sequence or outside the parameters of this program, may place the trauma victim at risk for additional anxiety.

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Program Overview

Should you have any concerns or questions about any these strategies or need some consultation about situations you are working with or about to work with, please call TLC toll-free at 877-306-5256 or email info@starr.org.

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