Today’s workshop, “Assessment and Treatment of Child and Adolescent Trauma: The Trauma Systems Therapy Approach,” was interesting, informative and long overdue. Dr. Adam Brown from the NYU Child Study Center was able to squeeze over 20 years of trauma theory research and state-of-the-art intervention techniques into 3 hours. Aside from the useful information that he presented, his workshop was fun. Somehow he managed to inject humor into a very serious topic. For the most part, the audience was attentive and remained interested throughout the Workshop. I’ll talk about my pet-peeve – distracting and irrelevant questions later.

Dr. Brown mentioned that the use of the word “trauma” in behavioral health treatment is a relatively new concept. He said that the word was not common during his training as a psychologist. When I thought about this, I agreed. In my almost 40 years in the field (I look younger in the photo), I only began to hear of “trauma informed treatment” about 15 years ago. The behavioral health field is a slow learner. After listening to Dr. Brown, It now makes sense to look to traumatic events as the cause of behavioral problems with many children and adolescents. It also makes sense to link treatment closely with the trauma.

There were two definitions of “trauma” presented by Dr. Brown.  Both suggested that the traumatic event or series of events was greater than the individual’s adaptive coping mechanisms, leading to emotional and/or behavioral dysregulation in the presence of trauma reminders. In other words, “Post Traumatic Stress Disorder” symptoms occur.  PTSD includes re-experiencing the event (intrusive thoughts), avoiding similar feelings or situations (memory lapses or detachment), uncontrolled emotional arousal (sleep problems or angry outbursts). Dr. Brown pointed out that some children and adolescents are more resilient than others in the face of trauma. These individual may not suffer PTSD to the same degree as more vulnerable children. He said that factors including supportive parents, higher intelligence, a safe social environment, and no history of previous trauma are factors that may mitigate the negative effects of trauma later in life.

During the first half of the workshop, Dr. Brown discussed the full impact of early trauma on the developing child. Aside from the obvious physical damage to the brain with traumatic brain injury, Dr. Brown presented research showing brain structure changes as a result of mental health trauma. The continued impact on the development of the child from non-physical trauma was irrefutable. The bottom line is that psychological trauma in childhood and adolescents can have a life-long negative consequence for the individual and society without adequate treatment.

Today’s workshop was also focused on the Trauma Systems Therapy (TST) approach to treatment. Dr. Brown’s discussion of this intervention technique was clear.  This approach is research based with many publications to support its effectiveness. This is a “Team” approach to treatment . The team includes the family, psychopharmacology, psychotherapy, home based and community support, and legal advocacy.

From a very simplistic point of view, this technique appears to have evolved nicely from multiple schools of thought. While there may be little new in the elements of the treatment, the “genius” is in the collaborative use of several intervention strategies in this model.  Dr. Brown stated that “Success stands or falls on whether a treatment alliance can be formed.” He also stressed that the treatment equation includes the need to treat the child and the social environment/system-of-care. The goals of TST treatment are: 1. Maintain a Regulating State. 2. Prevent Re-experiencing States.  3 Build Cognition to Allow Choices.

Although Dr. Brown was successful in meeting his goals for this workshop, I would have liked more discussion on the use of the TST model. He ran out of time and had to rush through the last 15-20 minutes.

Now for my pet-peeve: distracting and irrelevant questions. During the first 30 minutes of today’s workshop, I counted 11 questions or lengthy statements from participants. Four were simply showing off by clinicians. Five questions were deferred by Dr. Brown because they were to be discussed later in the presentation. Two were relevant to the moment. I knew after 30 minutes that Dr. Brown would not complete his 57 pages of slides in the handout.

Suggestions!  1. Perhaps participants who wish to make lengthy statements about their own practice should be reminded at the beginning of the workshop that the participants paid a fee to hear the presenter, not them. 2. Perhaps the presenters should be encouraged to provide a quick overview of the topics so that the participants don’t ask lengthy questions about topics that will be addressed later. 3. Perhaps the participants should be reminded to review the handouts for all topics to avoid distracting the presenter with unnecessary questions.