Strengthening Family Coping Resources

Intervention for Families Impacted by Trauma

Laurel Kiser

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317860020
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Strengthening Family Coping Resources (SFCR) uses a skill-building, multi-family group framework to teach constructive resources to families who have a high exposure to stress and trauma. As an intervention for high-risk families, SFCR can cause a reduction in symptoms of traumatic distress and behavior problems and help families demonstrate higher functioning. The SFCR manual is based on a systemic, family approach and uses empirically-supported trauma treatment that focuses on family ritual, storytelling, and narration, which improves communication and understanding within family members. The manual is organized into three accessible parts:
•Part 1 details the theoretical and empirical foundations of SFCR
•Part 2 focuses on implementation and the clinical guidelines for conducting SFCR
•Part 3 contains session guidelines focused on the multi-family group versions of SFCR
Each session included in the intervention is structured according to specific guidelines, and instructions provide examples of what facilitators might say to a group. Formed through the input of psychiatrists, psychologists, social workers, and anthropologists, Strengthening Family Coping Resources will help you reduce the symptoms of traumatic stress disorders and increase coping resources in children, adult caregivers, and the family system. It also provides a novel approach to addressing co-occurring traumatic reactions in multiple family members by including developmentally appropriate skill-building activities that are reinforced with family practice. For anyone working with families in a therapeutic capacity, this manual is a must-have resource.

PART I

THEORETICAL AND EMPIRICAL FOUNDATIONS

CHAPTER 1

INTRODUCTION TO SFCR

OVERVIEW

Strengthening Family Coping Resources (SFCR) is a manualized, skills-based, family-focused, and trauma-specific treatment. This empirically supported, clinic- and community-based intervention was developed using a participatory research methodology to assure acceptability and tolerability with populations living in traumatic contexts. Since most families living in traumatic contexts contend with multiple traumas, as well as ongoing stressors and threats, SFCR is designed to meet two primary goals: (1) to decrease the impact of chronic trauma on families and identified family members; and (2) to increase the protective function of the family by improving constructive coping.

As an intervention for families experiencing traumatic stress, SFCR provides accepted, empirically supported trauma treatment within a family format. The model includes work on family story-telling, which builds to a family trauma narrative, providing families with an opportunity to improve communication about, and understanding of, the traumas they have experienced.

In SFCR, trauma treatment strategies are coupled with skill building to increase coping resources in children, adult caregivers, and in the family system to support family protection and resilience. SFCR includes therapeutic strategies, based on family ritual and routine theory, to address the unpredictable and often uncontrollable nature of ongoing stress and threats of exposure faced by families. These strategies help families boost their sense of safety, function with stability, regulate their stress reactions, emotions, and behaviors, and make use of support resources.

In taking a systemic, family approach to addressing the effects of high stress and trauma, SFCR provides a fundamentally different intervention option. The majority of current empirically supported models of trauma prevention/treatment is focused either on individuals or dyads, and largely neglects the critical issue of how the family does or does not contribute to healing. The model of family treatment used in SFCR, which includes developmentally appropriate skill-building activities that are reinforced with family practice, provides a novel approach to addressing co-occurring traumatic reactions in multiple family members.

SFCR is being widely implemented by clinic- and community-based providers who are excited about a model that can address the needs of multi-problem families whose lives are permeated with stress and trauma. Practice-based evidence demonstrates that SFCR is feasible, tolerable, and effective. Children experience significant reductions in symptoms of PTSD and in behavior problems. In addition, families gain skills in coping and stress reduction, and demonstrate healthier functioning, which increases their capacity to serve as a source of support and protection.

SFCR INTERVENTION DEVELOPMENT

A multidisciplinary team of psychiatrists, psychologists, social workers, and anthropologists provided input into the formation of SFCR. Development of this family skill-building program was also greatly influenced by other successful prevention intervention programs.

The intervention development process comprised specification of content and treatment procedures in the form of a manual, creation of training materials, clinician competence and adherence measures, and determination of measures of change within an interactive process to assure cultural sensitivity and family engagement.

Using a context-specific, interactive intervention development model, a stakeholder group of population experts (community residents, opinion leaders, and community-based clinicians) provided input and feedback at all stages of the process. Stake holder input was gathered around the following four issues: content and structure of the intervention, engaging families, measuring outcomes, and assessing family participation. Specific activities, materials, and methods created for SFCR were reviewed for sensitivity, readability, support of different family forms, and consistency with an approach that values the strengths within each family. Academic experts in family work and trauma also reviewed the manual and materials.

Initial versions of SFCR were implemented in a variety of settings using a multiple-baseline design to gather information on the manualized treatment and on the dynamics involved in the multi-family group (MFG) format. The outcomes of interest were the process measures indicating participation in the groups, cultural sensitivity and acceptability, clinician competence, and intervention integrity. The multiple-baseline design allowed for cycles of feedback, revision, and retesting.

SFCR VERSIONS

SFCR can be implemented using a variety of formats. The different formats allow the content of SFCR to be delivered in multiple settings using a variety of staffing patterns.

Multi-Family Groups

SFCR has primarily been delivered using an MFG format. Each SFCR MFG session is family-focused with everyone in the family encouraged to attend. In treating multiple families simultaneously, SFCR is an intervention with the reach necessary for addressing the public health needs of vulnerable families.

There are three versions of SFCR that use the MFG format. These include the trauma treatment MFG, the high-risk MFG, and the workshop MFG. The session guidelines in Part III of the manual provide instructions for implementing the trauma treatment and the high-risk MFGs.

Each MFG version is described briefly:

The trauma treatment MFG is a 15-session closed-enrollment intervention. This version of SFCR targets families impacted by traumas and ongoing threats as evidenced by one or more family members with symptoms of traumatic stress disorders. Families are recruited for enrollment, assessed for appropriateness, and asked to participate in weekly two-hour sessions. The trauma treatment MFG is conducted by a facilitator team primarily made up of professionals with clinical training and expertise.

The trauma treatment MFG focuses on symptom reduction and on improving family coping resources to increase protection and support recovery, resilience, and thriving. It is a phased intervention; concepts and skills introduced and practiced in early sessions are mastered and scaffolded in later sessions.

The 15-week trauma treatment MFG is divided into three modules. Module I introduces the families to the concept of family ritual, routine, and storytelling. Module II focuses on building constructive family coping resources for dealing with stress. Sessions in Module III engage families in narrative work either to build narrative skills or to talk explicitly about their trauma experiences. If a family is ready, their narrative work deals with specific traumatic events, helps them reconnect, reach shared meaning about their experiences, and move beyond their traumas.

The high-risk MFG is a 10-session intervention with closed enrollment. The high-risk version is most appropriate for families likely to experience trauma or families who have been exposed and are vulnerable to traumatic stress disorders. The high-risk MFG is also conducted by facilitator teams but does not require as many clinically trained team members.

This version of SFCR is divided into two modules covering all of the coping components of the trauma treatment MFG. The high-risk version includes sessions 1–9 and a final celebration session (a combination of sessions 14 and 15 of the trauma treatment MFG). The primary difference between the trauma treatment and the high-risk MFGs is that the high-risk version does not include the five-session module in which families engage in narrative.

The third MFG version is a workshop model. The workshop MFG is an open-enrollment group in which families can drop in for any number of sessions. The workshop MFG covers essentially the same content as the high-risk version with some adaptations made for the different format. For example, instead of asking families to complete homework between sessions, they are given tips for practicing at home what was learned during each session.

SFCR-Family Trauma Therapy (SFCR-FTT)

SFCR-FTT, a version of SFCR for individual families, provides trauma treatment using a family-driven approach. It includes many of the same therapeutic strategies used in the MFG models.

SFCR-FTT is delivered in weekly one-hour sessions. It uses the phased approach of the trauma treatment MFG and is comprised of three similar modules. The order and number of the sessions (especially those focused on coping skill development in Module II) can be customized to a certain degree to best reflect the needs of each family. SFCR-FTT requires a clinically trained professional to work with each family.

SFCR-Peer-to-Peer (SFCR-PP)

SFCR materials and strategies have also been adapted for use as a peer-to-peer group model. SFCR-PP involves one-hour weekly groups led by a peer facilitator. SFCR-PP groups are conducted using an open-enrollment model in which individuals can drop in for any number of sessions. SFCR-PP groups are typically conducted by trained and experienced peer mentors.

Along with their peer group leaders, participants focus on reconstructing intergenerational relationships whenever possible, “letting go” when reconciliation is not possible (or perhaps not desirable, as with family perpetrators of violence), interrupting the cross-generational transmission of trauma, violence, and substance abuse, and leaving a legacy of guidance based on their own experiences and learning. The groups support individuals in recovery to make connections between trauma, violence, substance abuse, and parenting practices. The desired outcomes for participants who attend these groups are twofold: (1) enhancing/strengthening an individual’s own recovery; and (2) better positioning individuals in recovery to help family members with whom he or she has meaningful relationships avoid substance abuse, violence, and victimization.

Refer to Chapter 6 for additional information on the SFCR-FTT and SFCR-PP versions.

CHAPTER 2

CONCEPTUAL FOUNDATION FOR FAMILY TRAUMA

FAMILIES EXPOSED TO ACCUMULATED TRAUMATIC CONDITIONS¹

As a field, we are just beginning to understand complex adaptations to trauma in families and to grapple with how best to provide treatment. We have been much more successful at understanding and treating individual psychopathology. As our understanding of complex trauma and developmental trauma disorder has improved, empirically derived treatments have been developed targeting the most distressing and debilitating symptoms. The well-developed complex trauma construct is now the foundation for such treatments as Attachment, Regulation, Competency (ARC; Kinniburgh, Blaustein, Spinazzola, & van der Kolk, 2005), Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS; DeRosa et al., 2006), and Trauma Affect Regulation: Guidelines for Education and Therapy for Adolescents and Pre-Adolescents (TARGET-A; Ford & Russo, 2006). All include a set of essential strategies or core components necessary for intervention with complex trauma.

In a similar fashion, describing the hallmark characteristics of complex adaptations to trauma in families has implications for organizing our clinical conceptualization of families who present for treatment. It provides a framework for looking at systemic adaptations in a way that is manageable and meaningful. As our understanding of how families adapt to chronic stress and trauma becomes more sophisticated, we can develop empirically derived treatments targeting the most pervasive family symptoms.

Because SFCR was developed specifically for families who have experienced chronically high levels of stress and multiple traumas related to living in a traumatic context, this chapter provides an in-depth look at the complex adaptations that families often make to survive so that SFCR facilitators can:

1. increase awareness of the contextual conditions or accumulated traumatic circumstances that influence families;

2. be familiar with adaptation processes that families use and appreciate the complex systemic maladaptations that result from living in a traumatic context;

3. recognize the clinical characteristics of such families and be able to adequately observe their concerns and strengths as they interact and react to the activities offered in SFCR; and

4. use this understanding to assist families in building new coping skills and resources.

DEFINITION

The family is one example of a “trauma membrane,” the protective environment surrounding a trauma survivor (Martz & Lindy, 2010; Nelson Goff & Schwerdtfeger, 2004). Under the best of circumstances, the family provides extra support, structure, and coping resources for a family member who is traumatized, and, with such support, a h...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• What is in the SFCR Manual?
• PART I: THEORETICAL AND EMPIRICAL FOUNDATIONS
• PART II: THE PRACTICE OF SFCR
• PART III: SESSION GUIDELINES
• Index