Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART)
About This Program
Target Population: Children ages 4-11 who have a history of child sexual abuse (CSA) and are exhibiting problematic sexual behavior (PSB)
For children/adolescents ages: 4 – 11
For parents/caregivers of children ages: 4 – 11
Program Overview
The SMART Model is an innovative, structured, phase-based, abuse-focused treatment approach to address the emotional and behavioral needs of young children with a history of child sexual abuse (CSA) exhibiting problematic sexual behavior (PSB). A major premise of the model is that the PSB stems from emotional responses to the prior CSA causing the child to form cognitive distortions about themselves, others, and the world around them. The family unit is a major target of treatment. Important aspects of family values and beliefs are integrated into the model including examining the family power structure, perceptions regarding sexuality, gender roles and identity, stigmatization of mental health, and spirituality. Unique to the model is the formation of parallel narratives of the child's experiences as a victim and as one who victimizes others and the development of a family narrative that addresses the impact and difficulties associated with caring for a child with a history of CSA and PSB.
Program Goals
The goals of the Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) model are:
- Reduce/eliminate the problematic sexual behavior
- Address the dual-treatment needs of the child as a victim and one who victimizes others
- Establish stability and a sense of safety for the child and their family
- Increase the child's and family's awareness of personal and familial risk patterns and triggers
- Develop coping skills and strategies aimed at improving emotional and behavioral regulation across domains (home, school, and community)
- Build a strong resource structure that will support the family across the child's life trajectory
Logic Model
The program representative did not provide information about a Logic Model for Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART).
Essential Components
The essential components of the Smart, Mentoring, Advocacy, Recovery, and Treatment (SMART) model include:
- Three clinically essential phases:
- Safety & Stabilization - The initial phase of treatment focuses on:
- Trauma Assessment of the child
- Risk Reduction Plan with a focus on safety
- Family and Community Engagement – Family engagement and the formation of a strong therapeutic relationship are critical.
- Trauma Integration & Recovery - The second phase of the model focuses on:
- Impulse Regulation – helping the child regulate his/her behavior
- Affect Modulation - Helping the child regulate his/her emotions
- Trauma Triggers - helping the child understand what might bring the unwanted behaviors and emotions back
- Cognitive Processing – helping the child develop coping and problem-solving skills
- Trauma Narratives – helping the child be able to talk about what happened
- Re-Socialization & Mastery - The final phase of the model focuses primarily on relapse prevention and supports the child and family to integrate all the skills learned into daily practice:
- Stress/Relaxation – learning to recognize stress and use relaxation skills to alleviate the stress
- Healthy Intimacy – learning to be comfortable with his/her own body
- Self-esteem – teaching the child about self-esteem and helping them acquire it
- Relapse Prevention – integrating above learned skills into daily practice
- Each phase contains content modules that must be mastered in order to move to the next phase of treatment. Each module includes specific activities and interventions.
- The SMART model includes a treatment guide that was developed as a mechanism to standardize and promote fidelity of the model and a specialized treatment workbook. The treatment guide offers indicators of mastery to inform and guide clinical practice.
- Key themes are interwoven within each phase including the use of psycho-education, safety contracting and monitoring, and skill building.
Program Delivery
Child/Adolescent Services
Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) directly provides services to children/adolescents and addresses the following:
- Problematic sexual behavior, placement instability, safety contracting, PTSD symptoms, feelings of shame, distorted beliefs about self and others, and symptoms of anxiety and depression
Parent/Caregiver Services
Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART) directly provides services to parents/caregivers and addresses the following:
- Has a child with problematic sexual behavior (PSB) and failure to recognize familial patterns and communication that exacerbate the PSB; may also be experiencing trauma-related emotional distress
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Family involvement is mandatory at least 2x per month. There are family activities included in the treatment workbook. Extensive safety planning and formal and informal resources are identified and hopefully developed to support the child and family at home, at school, and in the community.
Recommended Intensity:
Number of contacts per week is tailored to the specific needs of the family and is based on risk and family stability. The average length of sessions is 50 minutes.
Recommended Duration:
12-18 months; may vary with the number of contacts per week as needed by the family
Delivery Setting
This program is typically conducted in a(n):
- Outpatient Clinic
Homework
This program does not include a homework component.
Resources Needed to Run Program
The typical resources for implementing the program are:
- A trained clinician
- Confidential space to conduct sessions
- Treatment guide and workbook
- Therapeutic books and supplies
- Crayons, markers, and colored pencils
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Master's Degree in Counseling, Psychology, or Social Work and training in the intervention. At least one year's experience working with children and families impacted by childhood sexual abuse and other childhood traumas.
Manual Information
There is a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- Betsy Offermann, LCSW-C
offermann@kennedykrieger.org
phone: (443) 923-5907
Training Type/Location:
Training can be provided onsite at an agency, or at The Family Center at the Kennedy Krieger Institute.
Number of days/hours:
Initial 2-day didactic training prior to implementation, follow-up monthly consultation calls, and 1-day advanced training to be delivered approximately 6 months later
Relevant Published, Peer-Reviewed Research
Offermann, B., Johnson, E., Johnson-Brooks, S., & Belcher, H. M. E. (2008). Get SMART: Effective treatment for sexually abused children with Problematic sexual behavior. Journal of Child and Adolescent Trauma, 1(3), 179-191.
Type of Study:
One-group pretest-posttest design
Number of Participants:
62
Population:
- Age — 3-11 years
- Race/Ethnicity — 74% African American, 16% Caucasian, and 10% Multiracial
- Gender — 65% Male and 35% Female
- Status — Participants were children with a history of sexual abuse exhibiting problematic sexual behaviors (PSB) and their caregivers.
Location/Institution: Kennedy Krieger Institute Family Center, Baltimore, MD
Summary:
(To include basic study design, measures, results, and notable limitations)
The study evaluated the effectiveness of the SMART model for treating problematic sexual behaviors in children with a history of sexual abuse. Children and their caregivers completed measures at intake, discharge, and at 6 and 12 months post-intervention follow-up. Measures used included the Child and Adolescent Functional Assessment Scale (CAFAS), Preschool and Early Childhood Functional Assessment Scale (PECFAS), SMART Clinic Symptom Checklist, and Child Sexual Behavior Checklist (CSBCL). Results indicated that functional impairment at the end of treatment was half that measured when treatment began. Children completing the SMART model also demonstrated statistically and clinically significant declines on all measures of PSB following treatment. Improvements in behavior were sustained for 6 months following SMART, and analysis of clinical data 12 months after completion of therapy showed continued reductions in PSB. Boys in particular demonstrated continued improvement in total functioning at 12 months after discharge from the program. Limitations included lack of a control or comparison group and the novel combining of CAFAS and PECFAS scores in some cases.
Length of controlled postintervention follow-up: 1 year.
Additional References
No reference materials are currently available for Safety, Mentoring, Advocacy, Recovery, and Treatment (SMART).
Contact Information
- Betsy Offermann, LCSW-C
- Email: offermann@kennedykrieger.org
- Phone: (443) 923-5907
Date Research Evidence Last Reviewed by CEBC: June 2015
Date Program Content Last Reviewed by Program Staff: November 2019
Date Program Originally Loaded onto CEBC: April 2011
