SPARCS_Hab_DeRosa_7

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					          SPARCS
                                                  SM




Structured Psychotherapy for Adolescents
      Responding to Chronic Stress:
   A Guide for Trauma-Focused Groups

    Mandy Habib, Psy.D.             Ruth DeRosa, Ph.D.



         North Shore-Long Island Jewish Health System
        Adolescent Trauma Treatment Development Center
                      Manhasset, New York
                       mhabib@nshs.edu



                                                         1
“Still in the Middle of the Hurricane”




                                         2
3
                            Complex PTSD
Problems with
   Regulation of Affect & Impulses
   Cognitive Functioning/
    Dissociation
   Somatization
   Sense of Self
   Relationships
   Systems of Meaning

                                           4
              Development of the Manual
 Adapted From…
 Dialectical Behavior Therapy
 for Adolescents
                                          DBT
  Miller, Rathus & Linehan, in press            TARGET


 TARGET
 Ford & Russo, 2006                              UCLA


 UCLA Trauma/Grief                             PROGRAM
  Group Psychotherapy
  Layne, Saltzman, Pynoos, et al., 2000

                                                          5
SPARCS Collaborations
• Outpatient Clinics:
    –   Children’s Institute Incorporated, LA, CA
    –   The Village Family Services, North Hollywood, CA
    –   Mental Health Center of Dane County, Madison, WI
    –   Open Arms, Albany, GA
    –   New York Foundling, NYC
    –   Adolescent HIV Clinic, North Shore LIJ
    –   Dept. of Children & Family Services, (foster care), Chicago, Illinois
• Residential & Day Treatment
    –   Madonna Heights RTC & RTF, Dix Hills, NY
    –   Andrus Children’s Center, Yonkers, NY
    –   Dane County Group Home, Madison, WI
    –   St. Mary’s Group Home, Boston, MA
    –   Adolescent Substance Abuse Program, North Shore LIJ
• School-based groups
    –   St. Vincent’s, NYC
    –   Safe Horizon, NYC
    –   Center for Child and Family Health, Durham, NC
    –   Teenage Parenting Program, Seaford, NY


                                                                                6
                  SPARCS:
               Group Members
   For adolescents between 12-19 years old

   History of chronic (interpersonal) trauma

   Designed for adolescents who may be living with significant
    ongoing stressors

   May or may never have met full criteria for PTSD

   Exhibit functional impairment


                                                                  7
                SPARCS

   16 Sessions (60 minutes per session)

   Present-focused

   No systematic exposure component included

   Strength-based




                                                8
    Broad Goals of the Program
           Enhance Resilience
The C’s:
   Connect with others (communicate)
   Cope more effectively in the moment
   Cultivate awareness
   Create meaning


                                          9
  SPARCS Core Skills
• MAKE A LINK =
    communication & connecting with others

• Let ‘M Go =
      problem-solving and creating meaning

• Distress Tolerance =
      coping more effectively in the moment

• Mindfulness =
     cultivating awareness


                                              10
          Session Structure
• Check In
• Mindfulness practice
• Review of application of previous week’s topics
• Session-specific content
• Activities: role plays, movie clips, projects
• Snack
• Check-out


                                                    11
                   Psychoeducation re:
                      Stress Reactions



Bottle About to Burst




                                     12
        Reactions to Trauma
               Mental Shutdown (Dissociation)
               People tell me I’m spacing out a lot.
               I fee like I’m in a dream or don’t know myself.
               I feel like I’m watching myself from outside,
               It’s like separate parts of me take control of my life.


Trying to Feel Safe/In Control
I won’t let myself eat. I make myself throw up because I
am afraid of losing control of my eating and gaining weight.
I eat to feel better. I drink or drug to try to forget.


         Extreme Risk-Taking or Self-Harm
         I do dangerous things, hanging out where I could get hurt.
         I get relief by cutting, punching, or hurting my body.




                                                                         13
Preliminary SPARCS Outcome Data
  • All subjects:
    – Completed SPARCS group treatment
    – Had previous trauma
    – Had pre-treatment Youth Outcome Questionnaire
      total scores in clinical range, i.e.>47
    – Were female, mean age 15.46 years




                                                      14
                                                                                          15
                       Community norm
                       total: 10.6-37.2


                                                     Post
                                               Pre
*




                                                                      Total
                                                                      Critical items
YOQ (n=20)




                                                                       Behavioral
                                                       *




                                                                      Dysfunction
                                                                      Social Problems
                                                                      Interpersonal
                                                            *
                                                                        relations
                                                                      Somatic
                                                                      Intrapersonal
                                                                         distress




                                                                      0
     80

             70

                  60

                         50

                                          40

                                                     30

                                                            20

                                                                 10




                                                                                 *p<.05

				
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posted:8/20/2012
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