Trauma Systems Therapy

Mental Health In-home Parent Skill-Based Does Not Currently Meet Criteria

Trauma Systems Therapy (TST) is designed for children ages 4–21 and their families who are experiencing difficulties related to traumatic experiences, such as family and community violence, child abuse and neglect, and parental mental illness and substance abuse. TST aims to improve trauma care for children by coordinating trauma services across providers and systems, such as home and community-based care, emotional regulation skill training, exposure therapy, cognitive processing, legal advocacy, and psychopharmacology.

 

Organizations implementing TST establish TST teams consisting of all providers that work with TST families. Team members can include social workers, psychologists, psychiatrists, nurse specialists, home-based clinicians, and advocacy attorneys.

 

There are three phases of TST. Before TST treatment begins, the TST provider team assesses the child and creates a treatment plan with the child and family. This assessment determines which phase the child should start with based on the safety of their environment and the child’s emotion regulation abilities. Prior to treatment implementation, an engagement strategy, Ready Set Go, is implemented to ensure child and family buy-in, which is necessary for meaningful and successful participation in treatment. Children move through treatment phases as their environment becomes safe and they can better regulate their emotions. 

 

During the safety-focused phase, providers ensure that children’s physical and emotional needs are met by creating safety plans and supporting caregivers. Children start treatment at this phase if they are in a harmful environment or if caregivers are insufficiently helpful and protective to manage children’s dysregulated states. During the regulation-focused phase, providers teach children how to regulate their emotions and increase caregivers’ capacities to help their children. Children enter this phase once their environment is considered safe. During the beyond trauma phase, providers help children and families learn cognitive skills and process trauma, including developing a trauma narrative and future orientation. Children enter this phase once their environment is stable and they can regulate their emotions. 


TST does not currently meet criteria to receive a rating because no studies met eligibility criteria for review.


Date Last Reviewed (Handbook Version 1.0): Apr 2023


Sources

The program or service description, target population, and program or service delivery and implementation information were informed by the following sources: the program or service manual, the program or service developer’s website, the program or service developer’s materials, and the California Evidence-Based Clearinghouse for Child Welfare.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 1.0

Target Population

TST is designed to serve children ages 4–21 and their families who are experiencing difficulties related to traumatic experiences, such as family and community violence, child abuse and neglect, and parental mental illness and substance abuse. 

Dosage

TST dosage varies based on need and phase of treatment but typically lasts 7–9 months.  Providers typically deliver the safety-focused phase in-person 2–3 times per week. Providers typically deliver the regulation-focused and beyond trauma phases in-person weekly for 45–60 minutes. 

Location/Delivery Setting
Recommended Locations/Delivery Settings

Providers deliver TST in-person and delivery settings vary based on phase of treatment. The safety-focused phase is typically delivered in participants’ homes. It can also be delivered in community settings, such as schools or residential facilities. The regulation-focused and beyond trauma phases are typically delivered in clinics or offices. They can also be delivered in school settings, participants’ homes, or other residential settings.

Education, Certifications and Training

Organizations determine the educational requirements for TST providers.

Organizations must receive a minimum of a year of organization-level training and services before being considered eligible to implement TST on their own. During this time, a TST consultant provides input on the TST organizational plan, helps the TST leadership team troubleshoot problems, participates in the TST treatment team meetings, and meets weekly with the organization’s TST experts to provide technical assistance. The leadership team develops and monitors the implementation of the TST organizational plan. TST experts lead case supervision, fidelity monitoring, and internal training.

After the organizational plan is implemented, all members of the TST treatment team attend an initial 2–3-day on-site training from a TST consultant. Training content includes information about child traumatic stress, TST assessment, TST treatment planning, engaging children and families, and the three phases of TST. The TST consultant provides a follow-up 2–3-day on-site training approximately 10 months after the initial training. Training content focuses on sustainability, scaling processes, and organizational readiness to implement TST without TST Training Center support. The TST Training Center is available to provide ongoing training, consultation, and technical assistance as needed after the formal training process ends. 

Once an organization is ready and eligible to implement TST independently, it can apply to become TST certified. TST certification requires: (1) a completed TST organizational plan; (2) an active TST treatment team that has seen at least 15 cases through at least one implementation phase, five of which must be for the beyond trauma phase; (3) a case review of a random 10 cases to determine agency fidelity of TST delivery; (4) at least two TST experts becoming TST expert certified; and (5) at least three TST providers becoming TST provider certified. TST programs must recertify every 3 years. 

TST expert certification includes supervision of at least five cases with at least four of the five cases achieving fidelity, and a score of 85% or above on TST book quizzes. 

TST provider certification includes delivery of TST care for at least five cases with at least four of the five cases achieving fidelity, and a score of 85% or above on TST book quizzes.

Program or Service Documentation
Book/Manual/Available documentation used for review

Saxe, G. N., Ellis, B. H., & Brown, A. D. (2016). Trauma Systems Therapy for children and teens (2nd ed.). The Guilford Press.

Available languages

TST materials are available in English, Korean, and Spanish.

For More Information

Website: https://med.nyu.edu/departments-institutes/child-adolescent-psychiatry/education/trauma-systems-therapy-training-center

Phone: (646) 754-5103

Email: adam.brown2@nyulangone.org


Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for Trauma Systems Therapy
Identified in Search 7
Eligible for Review 0
Rated High 0
Rated Moderate 0
Rated Low 0
Reviewed Only for Risk of Harm 0

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.




Studies Not Eligible for Review

Study 14684

Brown, A., McCauley, K., Navalta, C., & Saxe, G. (2013). Trauma Systems Therapy in residential settings: Improving emotion regulation and the social environment of traumatized children and youth in congregate care. Journal of Family Violence, 28(7), 693-703. https://doi.org/10.1007/s10896-013-9542-9

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).

Study 14685

Ellis, B. H., Fogler, J., Hansen, S., Forbes, P., Navalta, C. P., & Saxe, G. (2012). Trauma Systems Therapy: 15-month outcomes and the importance of effecting environmental change. Psychological Trauma: Theory, Research, Practice, and Policy, 4(6), 624-630. https://doi.org/10.1037/a0025192

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).

Study 14689

Hidalgo, J., Maravic, M., Milet, R., & Beck, J. (2016). Promoting collaborative relationships in residential care of vulnerable and traumatized youth: A playfulness approach integrated with Trauma Systems Therapy. Journal of Child & Adolescent Trauma, 9(1), 17-28. https://doi.org/10.1007/s40653-015-0076-6 

Hidalgo, J., Maravic, M. C., Milet, R. C., & Beck, J. C. (2016). Erratum to: 'Promoting collaborative relationships in residential care of vulnerable and traumatized youth: A playfulness approach integrated with Trauma Systems Therapy'. Journal of Child & Adolescent Trauma, 9(1), 29-29. https://doi.org/10.1007/s40653-016-0083-2 

This study is ineligible for review because it is not a study of the program or service under review (Handbook Version 1.0, Section 4.1.6).

Study 14691

Murphy, K., Moore, K. A., Redd, Z., & Malm, K. (2017). Trauma-informed child welfare systems and children's well-being: A longitudinal evaluation of KVC's Bridging the Way Home initiative. Children & Youth Services Review, 75, 23-34. https://doi.org/10.1016/j.childyouth.2017.02.008 

Redd, Z., Malm, K., Moore, K., Murphy, K., & Beltz, M. (2017). KVC's Bridging the Way Home: An innovative approach to the application of Trauma Systems Therapy in child welfare. Children & Youth Services Review, 76, 170-180. https://doi.org/10.1016/j.childyouth.2017.02.013 

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).

Study 14692

Saxe, G. N., Ellis, B. H., Fogler, J., Hansen, S., & Sorkin, B. (2005). Comprehensive care for traumatized children. Psychiatric Annals, 35(5), 443-448. https://doi.org/10.3928/00485713-20050501-10

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).

Study 14693

Saxe, G. N., Heidi Ellis, B., Fogler, J., & Navalta, C. P. (2012). Innovations in practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress-Trauma Systems Therapy approach to preventing dropout. Child & Adolescent Mental Health, 17(1), 58-61. https://doi.org/10.1111/j.1475-3588.2011.00626.x 

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).

Study 14694

Saxe, G., & Brown, A. (2012). Treating traumatic stress in children and adolescents. Adolescent Psychiatry, 2(4), 313-322. https://doi.org/10.2174/2210676611202040313 

This study is ineligible for review because it does not use an eligible study design (Handbook Version 1.0, Section 4.1.4).