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intervention after the primary presenting
with effective communication, social skills
care, it is ideal if the clinician conducting the mental health assessment is also the clinician facilitating ongoing psychological treatment and providing therapy services. However, assessment and treatment must be individualized; survivors may need time to disclose what they will at their own pace, and pushing too quickly may in fact be re-traumatizing for the survivor.
Recent studies indicate that prior to reaching 16 years of age, nearly two thirds of children and adolescents in the U.S. will have experienced a traumatic event, ranging from being a witness to domestic violence and abuse to becoming a victim of child maltreatment.21 With such a high incidence of trauma, it is crucial for all clinicians to be aware of the short- and long-term effects that come with these children’s experiences. Not only may the child or adolescent manifest symptoms shortly after experiencing trauma, but trauma survivors can have symptoms
that last into adulthood and lead to long- term complications such as behavioral
and substance abuse disorders.22 The Substance Abuse and Mental Health Services Administration (SAMHSA) addresses the needs of children and youth exposed to traumatic events through many programs, including the National Child Traumatic Stress Network (NCTSN),
a network of grantees from academic, clinical, and community entities that collaborate to develop and provide training on evidence-based practices surrounding trauma-informed treatment and practices for all children and their families exposed to traumatic events.23
Researchers and clinicians have recently begun to recognize the need for evidence- based treatment programs designed to
on the accessibility, utilization, and effect of mental health services to address the psychosocial needs of youth with a history of HT is limited, experts agree that trauma-informed mental health services hold the most promise.24-26 Trauma- focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment grounded in cognitive behavioral principles and integrates concepts
from attachment theory, developmental neurobiology, and family systems, as
well as empowerment and humanistic approaches.27 The TF-CBT model consists of weekly individual sessions for the youth and the non-offending caregiver, as well as conjoint caregiver-youth sessions. It includes several components presented in a parallel manner that research has deemed effective in reducing symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, as well as improving personal resiliency and adaptive functioning in youth affected by sexual abuse.28-30
has been primarily demonstrated in addressing the therapeutic needs of children who have experienced child sexual abuse and their non-offending caregivers,27,31 the treatment model
has been adapted in recent years to successfully treat youth with HT histories.20,32-34 McMullen et al. showed that female child and adolescent HT survivors randomly assigned to the TF-CBT treatment condition exhibited
symptoms, depression, anxiety, and conduct problems, as well as an increase in prosocial behavior by the end of treatment; positive gains made during treatment were maintained many months after treatment concluded.33 A systematic review published in 2018, Interventions That Foster Healing Among Sexually Exploited Children and Adolescents, found that survivors of HT involved in
reduction in psychological symptoms.35
Despite these promising results, gaps remain in the literature; an article LGBTQ youth established a high correlation among this population and HT, but reported little data on long-term medical and mental health outcomes.36
ROLE OF THE MULTIDISCIPLINARY TEAM: COORDINATING SURVIVOR SERVICES
Besides medical and mental health concerns, the child or adolescent
HT survivor has a broad range of socioeconomic, psychosocial, and legal needs requiring a multidisciplinary team (MDT) approach.10 A similar approach has been widely accepted as a successful strategy for delivery of services to child sexual abuse survivors; however, to date, this has been less well developed for HT 10,37-39 Inclusive of trauma-informed medical and mental health care clinicians, social services, and investigative and legal professionals who can address mental and physical health, provide shelters and safe havens, and ensure appropriate investigative
and prosecutorial outcomes for criminal or abusive activities, the MDT creates opportunity for a successful collaborative response. Without an MDT approach,
or if there is a lack of cooperation or consensus among the MDT, services may be inadequately available10 or service provision inappropriately implemented.2
The systems perspective refers to the interplay between individuals’ biological makeup and the social system in
which they live directly affecting these individuals’ overall functioning and behavior;40 the MDT uses this systems perspective when developing a care plan for the HT survivor, considering all the
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Del Med J | January/February 2021 | Vol. 93 | No. 1
