Home Program Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)]

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)]

Topic Areas
Scientific Rating
Child Welfare Relevance
Trauma Treatment - Client-Level Interventions (Child & Adolescent)
NR  — Not able to be Rated
High

About This Program

Target Population: Children/adolescents/young adults (0-21 years) who have experienced chronic/complex trauma and their caregiving systems (e.g., primary, resource, and/or others in their social environment)

For children/adolescents ages: 0 – 21

For parents/caregivers of children ages: 0 – 21

Program Overview

ARC is a core components framework designed to support individual/familial/dyadic intervention with youth and families who have experienced complex trauma within a wide range of systems. The framework is organized around the core domains of attachment (e.g., building safe caregiving systems), regulation (e.g., supporting youth regulation across domains), and developmental competency (e.g., supporting factors associated with resilient outcomes). ARC concepts can be integrated into individual, group, dyadic, and familial therapy; caregiver supports; and provider supervision. ARC can also be used as a system-level trauma treatment program on its own or in combination with the client-level intervention, click here to go to the program's entry in the Trauma Treatment-System Level Programs (Child & Adolescent) topic area.

Program Goals

The goals for Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] are:

  • Integrate routine, rhythms, and structures into intervention approaches, child daily routine, and familial functioning to increase felt safety and support skill development
  • Support adult caregivers in understanding and managing their own responses to youth in their care, and in identifying and accessing appropriate support resources
  • Build caregiver capacity to effectively understand and respond to the needs driving youth behaviors
  • Support effective responses to youth behavior that are trauma-informed and that increase, rather than decrease, safety
  • Build child/adolescent understanding of emotional and physiological experience, including a language for experience and an ability to connect and contextualize emotional cues
  • Build child/adolescent ability to effectively manage and tolerate emotional and physiological experience, and support systems to facilitate this
  • Build child/adolescent ability to effectively share internal experience with others and sustain relational connections
  • Support children/adolescents in recognizing choice points, managing impulsive behaviors, and actively making choices
  • Support development of developmentally appropriate understanding of self, including unique characteristics and influences, coherence across time and situations, sources of efficacy and esteem, and future template
  • Support youth in reflecting upon, processing, and developing a narrative of traumatic experience, and integrating this into a coherent and comprehensive understanding of self

Logic Model

The program representative did not provide information about a Logic Model for Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)].

Essential Components

The essential components of Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] include:

  • Emphasis on building and sustaining child, family, and provider engagement and stake in all treatment components
  • Integration of psychoeducation about traumatic stress and its role in all aspects of the intervention (e.g., intervention approach, treatment targets, identified problem behaviors)
  • Integration of and attention to the use of routine and rhythm in intervention approach and structure
  • Direct attention to caregiver emotional experience, through individual intervention, caregiver supports, establishment of caregiver resources, and/or attention to provider systemic supports and structures (i.e., supervision, support regarding vicarious trauma)
  • Engaging and building a curious, attuned stance among adult caregivers, including an understanding of the trauma-related drivers of behavior and skill in mirroring and responding to youth needs
  • Approaches to addressing youth behavior that integrate an understanding of the drivers of that behavior and a trauma-sensitive, individualized behavioral approach
  • Active, proactive attention to supporting youth physiological, emotional, and behavioral regulation through development of systematic regulation supports and routine engagement in modulating strategies both within and outside of the intervention session
  • Routine integration in treatment plans of attention to and support for development of youth strengths and competencies as a core element of intervention

Program Delivery

Child/Adolescent Services

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] directly provides services to children/adolescents and addresses the following:

  • Complex/developmental trauma symptoms including challenges with relational connection; emotional, behavioral, and physiological dysregulation; hypervigilance toward danger and sensitized danger response; impacted sense of self and identity; and difficulty with executive functions and cognitive controls

Parent/Caregiver Services

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] directly provides services to parents/caregivers and addresses the following:

  • Caregivers of youth with complex trauma; may be primary (i.e., biological, kinship, foster, adoptive, or other resource caregivers) or milieu/provider (e.g., residential staff, teachers, or hospital personnel) caregivers
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: ARC is designed to address both the child and the family/system/context in which the family is embedded. In outpatient treatment, parents and/or other primary caregivers are a primary target of intervention and frequently take part in either individual (caregiver) or dyadic/familial sessions; caregivers may also be supported through group or psychoeducational interventions. Adapted curricula exist for foster parent training and for in-home caregiver skills building and support.

Recommended Intensity:

Varies dependent on client and type of setting

Recommended Duration:

Varies dependent on client and type of setting

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Shelter (Domestic Violence, Homeless, etc.)

Homework

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] includes a homework component:

There can be homework in the form of daily "practice" assignments for caregivers and/or youth.

Languages

Attachment, Regulation, and Competency (ARC) [Trauma Treatment - Client-Level Interventions (Child & Adolescent)] has materials available in languages other than English:

Dutch, Spanish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Commitment of administration to the implementation process; personnel willing and able to commit the time/effort into training and consultation, along with identified change processes. No specific concrete resources are viewed as essential, as the program is adaptable to the real-world setting in which it is implemented.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Integration of ARC into clinical intervention requires the appropriate education/licensure/certification of the provider in their profession.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training may be provided on-site to a contracting agency; consultation is typically remote. The two-day foundational training is also available several times/year as an open-registration workshop.

Number of days/hours:

The standard foundational training is 2 days; training in the in-home caregiver coaching curriculum is 3 days. The minimum suggested follow-up consultation is 12 hours or one year (1-2 hours/month) for clinical implementation. Additional consultation to support development of infrastructure, supervisory skills and supports, and ongoing internal training is helpful and often recommended, depending on agency size/structure.

Relevant Published, Peer-Reviewed Research

Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., Andres, B., Cohen, C., & Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34-51. https://doi.org/10.1080/19361521.2011.545046

Type of Study: One-group pretest-posttest study
Number of Participants: 93

Population:

  • Age — Children: 3-12 years; Parents: Not specified
  • Race/Ethnicity — Children: 65.6% American Indian/Alaska Native, 39.8% Caucasian, 20.4% African American, 4.3% Native Hawaiian/Pacific Islander, 2.2% Asian; Parents: Not specified
  • Gender — Not specified
  • Status — Participants were caregivers and children in the child welfare system who have were exposed to multiple traumatic experiences.

Location/Institution: Alaska Child Trauma Center at Anchorage Community Mental Health Services

Summary: (To include basic study design, measures, results, and notable limitations)
This article introduces the Attachment, Self-Regulation, and Competency (ARC) model [now called Attachment, Regulation, and Competency (ARC) - Client] and describes its application with young children of diverse ethnocultural backgrounds involved in the child protection system due to maltreatment. Measures included the Trauma Symptom Checklist-Alternate Version (TSCC-A), the UCLA PTSD Index for DSM IV, and the Child Behavior Checklist (CBCL). Results indicate that comparing clients who completed ARC and those who ended treatment early, those completing treatment demonstrated a far greater level of improvement in CBCL scores. Children completing treatment also achieved a high rate of permanent placement. Limitations include reliance on self-report measures, high drop-out rate, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Hodgdon, H., Kinniburgh, K., Gabowitz, D., Blaustein, M., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in residential schools using the ARC framework. Journal of Family Violence, 28, 679-692. https://doi.org/10.1007/s10896-013-9531-z

Type of Study: One-group pretest-posttest study
Number of Participants: 126

Population:

  • Age — Children: Mean=16.1 years, Parents: Not specified
  • Race/Ethnicity — Children: 87% White, 19% Black, 6.4% 1% Asian, 1% Indian, and 18% Other; Parents: Not specified
  • Gender — Children: 100% Female, Parents: Not specified
  • Status — Participants were youth in residential centers in the child welfare system who have were exposed to multiple traumatic experiences

Location/Institution: Two residential treatment programs in Massachusetts

Summary: (To include basic study design, measures, results, and notable limitations)
This article describes the feasibility, utility and efficacy of Attachment, Self-Regulation and Competency (ARC) [now called Attachment, Regulation, and Competency (ARC) - Client], in 2 residential treatment settings serving female youth with histories of complex childhood trauma. ARC was provided at a system level for both sites, but not at a group or individual level for all residents at both sites. Measures included the Child Behavior Checklist (CBCL) and the UCLA PTSD Reaction Index (PTSD-RI). Results indicated that youth at the two targeted programs demonstrated a significant decrease in trauma-related symptoms over the course of the project period. Notably, youth receiving the ARC client-level intervention evinced a significant decrease in their overall level of posttraumatic stress disorder (PTSD) symptoms, driven by decreases in their Criterion B (re-experiencing) and D (hyperarousal) symptoms. Youth also displayed decreases in aggressive behaviors, attention problems, rule breaking behaviors, anxiety, depression, thought problems, and somatic complaints over the course of the project period, as measured by the CBCL. Limitations include nonrandomization of participants, lack of control group, and reliance on self-report measures.

Length of controlled postintervention follow-up: None.

Hodgdon, H., Blaustein, M., Kinniburgh, K., Peterson, M. & Spinazzola, J. (2015). Application of the ARC model with adopted children: Supporting resiliency and family well being. Journal of Child and Adolescent Trauma, 9(1), 43-53. https://doi.org/10.1007/s40653-015-0050-3

Type of Study: One group pretest-posttest study
Number of Participants: 481

Population:

  • Age — Children: 6-12 years, Parents: Not specified
  • Race/Ethnicity — Children: 56.5% Caucasian, 18.3% African American, 6.4% Hispanic, 5.2% Biracial, 2.3% Asian, 0.2% Native American, and 1.6% Other; Parents: Not specified
  • Gender — Children: 48.8% Male and 51.2% Female, Parents: Not specified
  • Status — Participants were children and their caretakers enrolled in the ADOPTS Program.

Location/Institution: Bethany Christian Services

Summary: (To include basic study design, measures, results, and notable limitations)
This article describes the efficacy of Attachment, Regulation and Competency (ARC) [now called Attachment, Regulation and Competency (ARC) - Client], with adopted children impacted by complex trauma and their caregivers. Data for this study was derived from clinical evaluation data of the ADOPTS Program. Measures included the Clinician Administered PTSD Scale (CAPS), the Trauma Questionnaire, the Behavioral Assessment System for Children, 2nd Edition (BASC-2), the Parenting Stress Index, Short Form (PSI-SF), and the Trauma Symptom Checklist for Children (TSCC). Results indicated that ARC treatment was associated with significant decreases in child symptoms and caregiver stress from pretest to posttreatment, which were maintained over a 12-month follow-up period. Changes in child symptoms included reductions in internalizing, externalizing, posttraumatic stress, depression, anxiety, anger and dissociative symptoms from pretreatment to posttreatment gains. ARC treatment was also associated with improved caregiver functioning: namely, significant reductions in caregiver perception of child difficulty, as well as on all measured domains of maternal reported stress. Limitations include nonrandomization of participants, lack of control group, and reliance on self-report measures.

Length of controlled postintervention follow-up: 12 months.

Bartlett, J. D., Griffin, J. L., Spinazzola, J., Fraser, J. G., Noroña, C. R., Bodian, R., Todd, M., Montagna, C., & Barto, B. (2018). The impact of a statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma. Children and Youth Services Review, 84, 110-117. https://doi.org/10.1016/j.childyouth.2017.11.015

Type of Study: Nonequivalent control group design
Number of Participants: 842

Population:

  • Age — Children: Mean=9.4 years, Adults: Not specified
  • Race/Ethnicity — Children: 70.31% White, 18.65% African American, 4.35 Hispanic, 1.7% American Indian or Alaskan Native, and 1.31% Asian; Adults: Not specified
  • Gender — Children: 54% Female, Adults: Not specified
  • Status — Participants were children involved in the child welfare system who have were exposed to multiple traumatic experiences.

Location/Institution: Massachusetts

Summary: (To include basic study design, measures, results, and notable limitations)
The current study examined the effectiveness of three trauma treatments (Attachment, Self-Regulation and Competency [ARC], Child-Parent Psychotherapy [CCP], and Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT]) in the context of a statewide, trauma Informed child welfare initiative to improve outcomes for children with complex trauma. Measures included the General Trauma Information Form of the clinician-administered Core Clinical Characteristics (CCC), the Child and Adolescent Needs and Strengths–Mental Health (CANS Mental Health), the Young Child PTSD Checklist (YCPC), the Child Behavior Checklist (CBCL), and the UCLA PTSD Reaction Index (PTSD-RI). Results indicated that by 6 months, reductions were found in parent/caregiver and youth reported symptoms of PTSD and improvements were found in parent/caregiver reported child behavior problems and in strengths and needs of children/youth for both younger and older children. At 12 months, the association between trauma treatment and symptomatology were less consistent, with positive findings only for avoidance/numbing symptoms. Results demonstrated that ARC and TF-CBT predicted significant reductions in child behavior problems across all domains at both time points. Positive findings for CPP were found for Internalizing and Total Problem Behaviors at 6 months. At 6 and 12 months, youth in ARC and TF-CBT had better outcomes for re-experiencing, arousal, and severity. Only TF-CBT was associated with improvements in avoidance/numbing. Parents/caregivers of older children reported fewer improvements than youth. Results for younger children were mixed. Children in ARC and TF-CBT exhibited less avoidance/numbing, arousal, and functional impairment at 6 months, and those in ARC had fewer re-experiencing symptoms, but CPP treatment predicted only reduced Functional Impairment. At 12 months, only TF-CBT was associated with decreased symptoms of PTSD. Limitations include nonrandomization of participants, lack of control group, and reliance on self-report measures.

Length of controlled postintervention follow-up: None.

Additional References

Blaustein, M., & Kinniburgh, K. (2016). The Attachment, Regulation, and Competency (ARC) treatment model. In M. Landolt, U. Schnyder, and M. Cloitre (Eds.). Evidence-based treatments for trauma-related disorders in children and adolescents, Springer International Publishing.

Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. Guilford Press.

Ford, J., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental trauma therapy models. In J. D. Ford & C. A. Courtois (Eds.), Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models (pp. 261-276). Guilford Press.

Contact Information

Margaret Blaustein, PhD
Agency/Affiliation: Center for Trauma Training
Website: arcframework.org
Email:
Phone: (617) 232-1303
Fax: (617) 232-1280

Date Research Evidence Last Reviewed by CEBC: June 2019

Date Program Content Last Reviewed by Program Staff: April 2018

Date Program Originally Loaded onto CEBC: August 2016