Can you see me now: Disseminating Treatments for Trauma Related Disorders in Children and Adolescents Using Videoconference

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1 Can you see me now: Disseminating Treatments for Trauma Related Disorders in Children and Adolescents Using Videoconference Kay Jankowski, Ph.D. Dartmouth Trauma Interventions Research Center Department of Psychiatry Dartmouth Medical School

2 In September, 2005, the Dartmouth Trauma Interventions Research Center (DTIRC) was awarded a competitive 4 year federal grant to provide evidence based treatments to New Hampshire children and their families who have experienced traumatic events and have developed emotional reactions and problems related to the traumas Awarded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), the NH grant was one of 19 national grants funding a network of community based treatment and services centers The funds awarded to NH were dedicated to carrying out a specific project: The New Hampshire Project for Adolescent Trauma Treatment

3 The National Child Traumatic Stress Network was established in 2001 and is supported through funding from the Donald J. Cohen National Child Traumatic Stress Initiative, administered by the Department of Health and Human Services (DHHS), Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA). The mission of the National Child Traumatic Stress Network (NCTSN) is to raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States.

4 A series of federal grants ($30 million dollars) were awarded by the U.S. Department of Health and Human Services under the auspices of SAMSHA and the Center for Mental Health Services to establish the National Child Traumatic Stress Network consisting of: National Center for Child Traumatic Stress (Category 1 Center) a joint effort of the UCLA School of Medicine and Duke Medical Center to provide coordinating leadership Intervention Development and Evaluation Centers (18 Category 2 Centers) to use grant funds to identify, support, improve and develop effective treatment and service approaches Community Treatment and Service Centers (53 Category 3 Centers) that will use funds to provide direct communitylevel service and treatment

5 The goal of The New Hampshire Project for Adolescent Trauma Treatment was to implement, evaluate and disseminate best practices for severely emotionally disturbed adolescents who had experienced trauma and who were served by the community mental health system in New Hampshire

6 Project had 2 phases Phase 1: We began by working with clinicians, administrators and clients at one State supported lead agency, West Central Behavioral Health (WCBH), located close to Dartmouth Phase 2: Disseminate PATT across the state, training providers at remaining 9 lead cmhcs

7 Trauma Focused CBT (Cohen, Mannarino and Deblinger, 2006) Time limited treatment for posttraumatic symptoms for children and adolescents (12 18 sessions) Evidence based (approximately 10 RCTs and has more research support than any other child trauma treatment to date) Components include: education, relaxation training, affect identification, cognitive coping, trauma narrative, cognitive processing, behavior management Primarily child treatment, but does have a parental component

8 Initially trained PATT supervisors and 6 WCBH child clinicians in treatment (Dec. 2005); Provided weekly 2 hour intensive group supervision for approximately 12 months. Supervision was conducted face to face. Demand from providers in other areas of the State grew from seeing success at West Central. Wasn t possible to provide supervision/consultation in person.

9 In September, 2006, the NH Based Endowment for Health Foundation awarded a 6 month technical assistance grant to the Dartmouth Trauma Interventions Research Center to assess the feasibility of a child/adolescent trauma telehealth project. In early 2007, The Fidelity Foundation provided financial resources to the 7 community mental health centers without hardware to acquire high quality videoconferencing equipment, thus eliminating one of the few remaining barriers to participation across the state public mental health system.

10 In October, 2007, Endowment for Health awarded us a 3 year grant to fund a demonstration program to establish and assess the value and sustainability of a child mental health videoconferencing network across the state of New Hampshire. The goal of this network was to help meet a documented need to train public sector clinicians in evidencebased practices for treatment of youth who have been exposed to trauma, and who suffer from posttraumatic reactions and associated problems such as depression and disruptive behavior disorders.

11 We have trained over 300 NH providers in TF CBT, and approximately 130 providers have in addition completed year long weekly consultation of cases with our group We estimate over 400 children have been treated with TF CBT We have post treatment data for 125 cases, of those 75% no longer meet criteria for PTSD

12 Helping the Noncompliant Child for Disruptive Behavior Disorders (McMahon & Forehand) DBDs are common referral problems and the most common comorbid condition with PTSD in children 10 consultation groups launched via videoconference ( ) to train providers across 10 cmhcs New trainings and consultations scheduled for Fall 2010

13 Child Parent Psychotherapy (Lieberman & Van Horn) Treatment for young, traumatized and at risk children and their caretakers Dyadic, attachment based treatment Our group of supervisors received biweekly consultation from Joy Osofsky to be trained in model Our group currently runs videoconference consultation groups with providers from 2 community mental health centers

14 Three year SAMHSA funded project through NCTSN awarded to DTIRC in Fall, 2009 to create more traumainformed services in 3 child serving systems: The Family Courts, Juvenile Justice and Child Welfare. Also training residential and ISO providers in traumafocused treatments via videoconference.

15 Openness to consider use of new technology; break from standard practice Patience is required to negotiate minor hassles (vagaries of the Internet, human error, etc.) Requires buy in from administrators, supervisors, clinicians and IT technicians Technical assistance is a must

16 Not a barrier to achieving rapport/connection for supervision/consultation Clinicians and consultants alike report satisfaction with modality Provides expert training, which would otherwise be difficult to find Would require clinicians to travel long distances or expertise simply wouldn t be available (e.g., one of our consultants is located in N.J.)

17 Videoconferencing connects staff from remote sites Reports of increased job satisfaction related to participation in consultation Lots of interest from clinicians to participate in additional training and consultation experiences (i.e. new treatment models)

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