Program Goals

The goals of TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) are:

For youth:

• Improving PTSD, depressive and anxiety symptoms
• Improving emotional and behavioral regulation
• Improving communication with caregiver
• Improving attachment to caregiver
• Improving adaptive functioning
• Reducing shame and embarrassment related to traumatic experiences
• Enhanced safety and reduced risk of future trauma including T/CSE

For caregiver:

• Improving developmentally appropriate behavior management skills and caregiver support of the child, and reducing caregiver distress
• Enhancing communication with the child
• Enhancing attachment to the child
• Enhancing ability to maintain safety
• Reducing shame and embarrassment related to the traumatic experiences

Logic Model

View the Logic Model for TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE).

Essential Components

The essential components of TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) include:

• The program components are:
• P – Psychoeducation:
• Provide information about trauma and its impact, educate about specific traumas including T/CSE
• Normalize and validate youth and caregiver responses to trauma and T/CSE experiences
• Provide information about TF-CBT and its value
• Instill hope for recovery
• P – Parenting skills:
• Enhance support of nonoffending (nonperpetrator) caregivers and optimize recognition and response to the youth’s trauma and T/CSE-related difficulties
• Enhance developmentally appropriate behavior management
• R – Relaxation:
• Develop and practice individualized relaxation strategies that the youth can use in a variety of settings to:
• Reverse physiological and psychological trauma-related hyperarousal
• Differentiate tense and relaxed states
• Recognize early indicators of arousal
• Skillfully and appropriately achieve relaxed states
• A – Affective expression and regulation:
• Provide the youth with vocabulary to describe the full range of affective states (feelings)
• Provide individualized skills to the youth and parent to modulate (regulate) negative states.
• C – Cognitive coping:
• Help youth and caregivers understand connections among their thoughts, feelings, and behaviors and to gain mastery in replacing inaccurate or unhelpful cognitions related to everyday (i.e., nontraumatic) situations
• T – Trauma narrative and processing:
• Unpair thoughts and reminders of the trauma(s) with overwhelming negative emotions and decrease avoidance and hyperarousal (Exposure)
• Uncover and process inaccurate or unhelpful thoughts about their experiences (Cognitive Processing)
• Understand, process, synthesize and integrate trauma experiences into a coherent and balanced life story (Contextualization and Meaning Making)
• An additional key goal of this component is to prepare the caregiver to support and affirm the youth in sharing their trauma experiences with them in subsequent conjoint youth-caregiver sessions.
• Trauma narration with clients who have experienced T/CSE often includes addressing multiple traumas, caregiver challenges, and processing T/CSE-specific cognitions.
• I – In vivo exposure:
• Overcome avoidance in real life situations, for those youth who have developed overgeneralized fear and avoidance of innocuous situations.
• This component is only implemented if the situation is innocuous, (i.e., safe). If the situation is not safe, the therapist does not implement this component, but rather focuses on the Enhancing Safety component.
• C – Conjoint parent/child sessions:
• Sessions are held with both the youth and caregiver to:
• Enhance direct, supportive trauma-focused communication between the youth and caregiver, including (in most cases) facilitating the youth to directly share the trauma narration and processing with the caregiver
• Address other trauma-related issues collaboratively with the youth and caregiver (e.g., trauma-related behavior problems; sexual health; safety concerns)
• Transfer direct, supportive trauma-related communication with youth from therapist to caregiver
• E – Enhancing personal safety and future growth:
• Identify and strengthen developmentally appropriate safety strategies that the youth can utilize in a range of everyday situations and in response to specific safety threats and trauma reminders
• This may include:
• Ongoing exploitation through commercial sex
• Threats by a former exploiter
• Contact by a purchaser
• T/CSE re-engagement efforts by peers, internet and social media
• Substance use
• Gradual exposure is included in all components
• Other topics covered include common challenges and strategies for this population such as:
• Client and caregiver engagement, including youth not acknowledging T/CSE experiences; impacts of prior systems involvement
• Safety concerns including runaway risk and behavior, harm reduction
• Healthy Relationships and Reproductive Health
• Dysregulation and survival coping
• TF-CBT in different settings

Program Delivery

Child/Adolescent Services

TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) directly provides services to children/adolescents and addresses the following:

• Posttraumatic stress disorder (PTSD) symptoms, whether or not they meet full diagnostic criteria; depression, anxiety, and/or shame related to their T/CSE and other traumatic exposure, distorted beliefs about self and others, dysregulation and related safety concerns, impaired youth-caregiver relationships

Parent/Caregiver Services

TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) directly provides services to parents/caregivers and addresses the following:

• Caring for a youth who has been trafficked or commercially sexually exploited, inappropriate parenting practices, and parental trauma-related emotional distress

Recommended Intensity:

Weekly 60-90 minutes are recommended, initially meeting with the child and caregiver separately, incorporating conjoint sessions as appropriate for treatment goals and as the nature and quality of the youth-caregiver relationship is better understood. It is NOT required that a caregiver participate in the treatment with youth. Sessions may be held more frequently as clinically indicated. If provided in group format, it can also be provided in a more compressed manner (i.e., 3x/week for 90-minute groups over 5 weeks - 15 group sessions total).

Recommended Duration:

12- 25 weeks; group model may be provided in as little as 5 weeks

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Foster / Kinship Care
• 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.)
• Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) includes a homework component:

Youth and or Caregivers are given weekly assignments during the PRAC components to reinforce and practice skills learned in therapy sessions.

Languages

TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) has materials available in languages other than English:

Arabic, Dutch, French, German, Hebrew, Italian, Japanese, Korean, Norwegian, Polish, Russian, Spanish, Ukrainian

The TF-CBT for T/CSE Implementation Manual is only available in English. TF-CBT materials are available in the above languages.

Resources Needed to Run Program

The typical resources for implementing the program are:

The typical resources for implementing the program are:

• Private space to conduct sessions
• Waiting area for children when parents are being seen
• Therapeutic books and materials
  

Manuals and Training

Prerequisite/Minimum Provider Qualifications

• Master's degree in a mental health-related field; Currently licensed or license-eligible and practicing under the supervision of a licensed provider
• Completed a TF-CBT 12-hour (2-day, minimum) training and consultation calls with an approved national trainer
• Completed T/CSE Awareness training (may be provided/accessed as part of TF-CBT for T/CSE “Pre-work”)
• Experience working with children and families

Note: TF-CBT and CSEC apprentice training can be provided to individuals with lower levels of education in low and middle resource countries.

Manual Information

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

Program Manual(s)

Manual details:

• Kinnish, K., Cohen, J. A., Mannarino, A., Kliethermes, M., Rubialies, R., & Wozniak, J. (2021). TF-CBT for the Commercial Sexual Exploitation of Children (CSEC): An implementation manual. Allegheny General Hospital. Unpublished manual. Available at https://tfcbt.org/tf-cbt-for-csec-implementation-manual/

• Cohen, J. A., Mannarino, A. P., & Kinnish, K. (2016). Trauma-Focused Cognitive Behavioral Therapy for commercially sexually exploited youth. Journal of Child & Adolescent Trauma, 10, 175–185. https://doi.org/10.1007/S40653-015-0073-9

Training Information

There is training available for this program.

Training Contact:

• Kelly Kinnish, PhD
  ncct.gsu.edu/professional-development
  kkinnish@gsu.edu

Training Type/Location:

TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) is offered annually through the National Center for Child Trafficking (SAMHSA/NCTSN-funded center) and may also be available to other organizations.

Number of days/hours:

• Introductory TF-CBT web-based training: 11-hour web-based course, TF-CBTWeb 2.0, available at: http://tfcbt2.musc.edu
• Basic TF-CBT Training: 2 days live or 3 half days virtually from an approved national TF-CBT trainer
• Ongoing Phone or Video Consultation (twice monthly for 6months or monthly for 12 months): groups of 5-12 clinicians receive ongoing case consultation from an approved national TF-CBT trainer or consultant to implement TF-CBT for patients in their setting
• T/CSE 3-hour Awareness Training (through local provider or other T/CSE national organization)
• Advanced TF-CBT for T/CSE Training: 2 full days (12 hours total) in-person training through the National Center for Child Trafficking (NCCT)
• Bi-monthly video consultation meetings after TF-CBT for T/CSE for 12 months.
  

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) as listed below:

The TF-CBT for the Commercial Sexual Exploitation of Children (CSEC): An implementation manual describes the organizational readiness process. It is available from the program representative listed at the end of the entry.

Formal Support for Implementation

There is formal support available for implementation of TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) as listed below:

There is a formal structure for therapists to become certified in TF-CBT (www.tfcbt.org) as well as a structure for official training of TF-CBT trainers, organizational supervisors, and consultants to support large implementation programs.

Following the in-person training, there will be 6 bi-monthly (every other month) video consultation meetings. The focus of consultation will be on developing and refining clinical competencies to effectively deliver the intervention (TF-CBT) with youth who have experienced T/CSE or are at high risk, and to address any implementation challenges that arise.

Fidelity Measures

There are fidelity measures for TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) as listed below:

The TF-CBT Brief Practice Checklist is a self-report form that is available in Appendix 4 of the TF-CBT Implementation Manual. The manual is available from the program representative listed at the end of the entry.

Implementation Guides or Manuals

There are implementation guides or manuals for TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) as listed below:

The TF-CBT for the Commercial Sexual Exploitation of Children (CSEC): An implementation manual describes the implementation process. It is available from the program representative listed at the end of the entry.

Implementation Cost

There are no studies of the costs of TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE).

Research on How to Implement the Program

Research has been conducted on how to implement TF-CBT for Youth who have Experienced Trafficking and Commercial Sexual Exploitation (TF-CBT for T/CSE) as listed below:

Orengo-Aguayo, R., Stewart, R. W., Villalobos, B. T., Hernandez Rodriguez, J., Dueweke, A. R., de Arellano, M. A., & Young, J. (2020). Listen, don't tell: Partnership and adaptation to implement trauma-focused cognitive behavioral therapy in low-resourced settings. American Psychologist, 75(8), 1158–1174. https://doi.org/10.1037/amp0000691

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References