Program Goals

The goals of Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) are:

• Develop a positive working relationship with the therapist
• Increase environmental safety
• Eliminate self-endangering behaviors
• Develop communication skills, decision-making, and problem-solving skills
• Develop emotional and behavioral self-management skills
• Learn skills to cognitively and emotionally process traumatic experiences
• Reduce symptoms of depression, anxiety, and posttraumatic distress
• Manage maladaptive distress reduction behaviors while developing alternative coping strategies
• Increase ability to build interpersonal relationships

Logic Model

The program representative did not provide information about a Logic Model for Integrative Treatment of Complex Trauma for Adolescents (ITCT-A).

Essential Components

The essential components of Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) include:

• ITCT-A has been developed to address disparities for adolescents and young adults with complex trauma exposure living in environments that, as compared to the general population, are characterized by:
• Racial inequality
• Poverty
• Unemployment
• High rates of homelessness
• Reduced access to quality education
• Community violence
• ITCT-A was designed to address the needs of highly traumatized, marginalized adolescents or young adults and their families with:
• Interventions for complex trauma in clinic, residential, juvenile justice, and hospital settings
• Outreach through the schools and other external systems
• Flexible treatment protocols and systemic collaboratives that take into account the effects of poverty and other social or geographical impediments on the accessibility of treatment
• Cultural adaptations to empirically based interventions
• Interventions for deliberate self-injury and suicidality
• Core Features
• Assessment-driven treatment, with measures and/or interviews administered at 2- to 4-month (typically 3-month) intervals to identify symptoms that may require special clinical attention
• Attention to complex trauma issues including:
• Posttraumatic distress
• Attachment disturbance
• Affective and/or behavioral dysregulation
• Interpersonal difficulties
• Identity-related issues
• Use of multiple treatment modalities in individual and group therapy, based on the youth’s specific presenting issues, which potentially include:
• Cognitive therapy
• Exposure therapy
• Mindfulness/meditation training
• Relational treatment
• Collateral sessions that primary caretakers also participate in, as necessary, to help resolve their own traumatic reactions and to improve their parenting skills
• Family therapy sessions as needed
• Development of a positive working relationship with the therapist, which is deemed crucial to the success of therapy
• Relational processing of early attachment schema and current interpersonal expectations including:
• Rejection sensitivity
• Abandonment concerns
• Issues with authority figures
• Expectations of loss or maltreatment in current relationships
• Cultural and developmental adaptations for individual client needs and cultural sensitivity to the form and meaning of trauma symptoms within different belief systems
• Early attention to immediate trauma-related issues such as:
• Acute stress disorder
• Anxiety
• Depression
• Posttraumatic distress
• Use of psychiatric medications, as indicated
• Exploration of more chronic and complex trauma issues
• Skills development, both in terms of building emotional regulation and problem-solving skills
• Therapeutic exposure and exploration of trauma, within a developmentally appropriate and safe context, balanced with attention to the client’s existing affect regulation capacities.
• Advocacy and interventions at the system level (e.g., family, forensic/protection, and school) to establish healthier functioning and to address safety concerns
• A flexible time-frame for treatment, since the multiproblem nature of complex trauma sometimes precludes short-term therapy
• Specific interventions
• Relationship building and support
• Safety interventions
• Psychoeducation
• Distress reduction and affect regulation training
• Mindfulness and meditation training
• Cognitive processing
• Titrated exposure
• Trigger identification and intervention
• Interventions for identity issues
• Relational processing
• Managing maladaptive substance use
• Interventions with caretakers and family members
• Group therapy sessions

Program Delivery

Child/Adolescent Services

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) directly provides services to children/adolescents and addresses the following:

• Complex trauma, which can manifest as anxiety and depression; suicidality; dissociation; sleep or appetite changes; hypervigilance; hyperreactivity; relational, identity, and affect regulation disturbances; cognitive distortions; somatization; self-mutilation, dysfunctional sexual behaviors; destructive behaviors or violence towards others; alcohol or substance abuse; eating disorders; susceptibility to revictimization; and traumatic bereavement associated with loss of family members and other significant attachment figures

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Primary caretakers may participate in collateral sessions, as necessary, to help resolve their own traumatic reactions and to improve their parenting skills. Family therapy sessions are optional, but frequently included. Systems advocacy can involve working with teachers, physicians, and other service providers.

Recommended Intensity:

One weekly 45- to 60-minute individual therapy session (more frequent sessions may be conducted as needed). Biweekly-to-weekly 30- to 45-minute individual caretaker collateral sessions (as needed, not required). Concurrent family therapy sessions are frequently included later in the course of treatment (as needed, not required). Weekly group therapy sessions are frequently included for the adolescent client and/or caretaker (as needed, not required).

Recommended Duration:

Varies by client per their needs and the constraints of the setting

Delivery Settings

This program is typically conducted in a(n):

• 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.)

Homework

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) includes a homework component:

A written trauma processing homework component involves use of a worksheet, "Written Homework About My Trauma." This is used only when the client can tolerate between-session exposure exercises and has a safe place in which to do so.

Languages

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, 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:

• Clinicians who are trained to conduct ITCT-A
• Appropriate clinical supervision
• Individual therapy and group therapy room space

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Master's degree (or equivalent) that includes clinical training in a mental health-related field. This may be in the fields of psychiatry, psychology, social work, marriage and family therapy, counseling, etc.

Manual Information

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

Program Manual(s)

Treatment Manual Citations:

• Briere, J., & Lanktree, C. B. (2013). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): A guide for the treatment of multiply-traumatized youth (2nd ed.). University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.
• Briere, J., & Lanktree, C. B. (2014). Treating substance use issues in traumatized adolescents and young adults: Key principles and components. USC Adolescent Trauma Training Center, National Child Traumatic Stress Network, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
• Briere, J., Lanktree, C. B., & Semple, R. J. (2019). Using ITCT-A to treat self-injury in traumatized youth. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.
• Chen, K., Lanktree, C. B., Semple, R. J., Briere, J., & Maida, C. (2019). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A): An implementation guide for organizations. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.
• Semple, R. J., & Briere, J. (2020). Increasing mindfulness and metacognitive awareness in multi-traumatized adolescents: An optional module for ITCT-A and other treatment approaches. University of Southern California-Adolescent Trauma Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration.

PDFs of all the ITCT-A treatment guides, the ITCT-A implementation guide, and assessment measures are available from the program representatives (see contact information at the end of the entry).

Training Information

There is training available for this program.

Training Contact:

• Cheryl Lanktree, PhD
  lanktree@usc.edu

Training Type/Location:

Trainings are conducted onsite at trainee organizations and at local and national conferences.

A national ITCT-A Clinician Certification program is available. There is no cost associated with trainings offered by the Clinician Certification program. National training requirements to become a Level I Certified ITCT-A Clinician are available from the program representatives (see contact information at the end of the entry).

Number of days/hours:

• One- and two-day trainings are available for clinicians.
• A half-day training is available for clinical supervisors.

Relevant Published, Peer-Reviewed Research

Additional References