What We Learned

Interventions for PTSD
Community Violence and Urban Families
• Program development
• Programs that allow children to broaden scope of educational experiences and build self-esteem
• Push for extracurricular activities (often no-existent in urban communities)
• Support groups and counseling WITHIN community
• Safety programs for parents and children

(Horowitz, 2002)

Interventions for post-traumatic stress
disorder in children and adolescents
Symptom-monitoring

• Youngsters and/or parents may be invited to keep structured diaries in which they record the frequency and intensity of certain key symptoms (flashbacks, nightmares, etc.)
• Symptom-monitoring systems should be tailored to the unique requirements of each case.
• Symptom monitoring diaries should be reviewed at the start of every session.

Re-establishing routines
• plan normal daily routines including going to school, socializing with peers, engaging in regular pleasant recreational activities, getting regular physical aerobic exercise and regularizing their sleep-waking cycle.
• Sleep management involves setting fixed times for going to bed and getting up
• agreeing on a system for gradually phasing out parental night-time contact in youngsters who have been coping with anxiety by sleeping with their parents
• using relaxation exercise and audiotapes or soothing music to help them sleep when they go to bed initially and following nightmares which have awakened them.

Coping skills training
• Coping skills training equips youngsters with ways of managing anxiety associated with flashbacks and nightmares and anxiety evoked during therapeutic exposure to trauma-related cues and memories.
• With learning relaxation skills children learn a sequence of exercises that reduce muscle tension.
• With cognitive coping skills training children learn to challenge fearful or threatening cognitions and to appraise anxiety-evoking situations in less threatening ways.

Treatment may include one or several of the following:
• graded exposure
• Imaginal exposure
• Media assisted exposure
• In vivo exposure
• Confrontation of abusers
• Grief work as exposure
• Skills training
• Cognitive restructuring
• Using relaxation or breathing exercises
• School consultations
• Relapse prevention planning



School consultations

School staff require psycho-educational input, of the type outlined earlier, when a pupil has been traumatized. A meeting between the school staff, child, parents and therapist may be convened. In this meeting, the profound effects of PTSD symptoms on academic performance should be highlighted. Teachers should be informed of the temporary need for the youngsters’ workload to be tailored to take account of this. Arrangements should also be made for youngsters to have a designated member of the school staff to whom they can go if they become particularly distressed during school hours. This staff member should be briefed in how to facilitate the child in expressing concerns and informed that ventilating feelings and recounting trauma-related memories is a productive rather than a destructive process.

(Carr, 2004)