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                            Trauma Therapy for Very Young Children Living in Poverty: A Randomized Controlled Trial
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Marquette University Marquette University

[email protected] [email protected]

Dissertations (1934 -) Dissertations, Theses, and Professional Projects

Trauma Therapy for Very Young Children Living in Poverty: A Trauma Therapy for Very Young Children Living in Poverty: A

Randomized Controlled Trial Randomized Controlled Trial

Joanna Ruth Love
Marquette University

Follow this and additional works at: https://epublications.marquette.edu/dissertations_mu

Part of the Child Psychology Commons, and the Social Psychology Commons

Recommended Citation Recommended Citation
Love, Joanna Ruth, "Trauma Therapy for Very Young Children Living in Poverty: A Randomized Controlled
Trial" (2017). Dissertations (1934 -). 718.
https://epublications.marquette.edu/dissertations_mu/718

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Page 2

TRAUMA THERAPY FOR VERY YOUNG CHILDREN LIVING IN POVERTY:

A RANDOMIZED CONTROLLED TRIAL











by

Joanna R. Love, B.A., M.A.







A Dissertation submitted to the Faculty of the Graduate School,
Marquette University, in Partial Fulfillment of the Requirements

for the Degree of Doctor of Philosophy










Milwaukee, Wisconsin


December 2017

Page 92

83

progress toward treatment goals and completing the weekly assessments. The New Hope

program was designed to take 8-16 weeks to complete, depending on the individual needs

of the child and family. However for this study, a minimum of five treatment sessions

was required to be included. Additional booster sessions were sometimes provided after

the 4-6 week follow-up session, depending on the needs of the family and clinical

judgment of the therapist.

Treatment program. The treatment program involves an integration of the

evidence-based Early Pathways program along with the trauma-informed companion

program, New Hope. The program was piloted with three separate therapists and families

prior to implementation. A sample treatment schedule outlining the integration of Early

Pathways and New Hope is included in an Appendix H. A complete copy of the New

Hope manual may be obtained by contacting the author ([email protected]).

The five core elements of the Early Pathways program were retained as part of

the New Hope treatment program. These elements include: (a) strengthening the parent-

child relationship through child-led play and other nurturing activities; (b) helping

parents maintain developmentally appropriate expectations for their child (c) helping

parents learn cognitive strategies to respond calmly and thoughtfully to their child’s

challenging behaviors; (d) using differential attention and positive reinforcement to

strengthen the child’s pro-social behaviors; and (e) using limit-setting strategies to reduce

the child’s challenging behaviors, such as redirection, ignoring, or time-out (Fox & Gresl,

2014). Limit-setting strategies were modified to reflect best practices in trauma-informed

care. For example, a Time-In strategy would be used in place of time-out or ignoring in

cases where a child’s emotional outburst was triggered by a trauma reminder rather than a

Page 93

84

functional temper tantrum, or in cases where the child has not developed the ability to

self-regulate emotions.

In addition to these core elements, the trauma-informed treatment components

included: Basic Safety, Caregiver-Child Relationship, Predictable and Nurturing

Environment, Trauma-Informed Limit Setting Strategies, Calming Strategies, Naming

and Practicing Feelings, Healthy Thoughts and Feelings, Identifying Sources of Support,

Building Prosocial Skills, and Seeking Closure. A brief overview of each of these

components of the New Hope program follows:

Basic Safety. This chapter was designed to establish basic safety for the child and

family and their environment. This chapter was placed first in the New Hope manual

because basic safety must be established before other treatment components can be

effective. This chapter also provides both the caregiver and child with psychoeducation

throughout the treatment process. It is important that the caregiver has the knowledge

they need to support the child’s healing process. It is equally important that the child is

given developmentally appropriate explanations for the activities they may be asked to

try with the therapist.

Caregiver-Child Relationship. Strengthening the caregiver-child relationship is a

foundational component in the Early Pathways program. This should occur very early in

treatment and should be an ongoing activity throughout the counseling process. A strong

and supportive caregiver-child relationship is necessary before continuing to the second

phase of treatment. Additional information for building healthy attachment in young

children and creating a safe relationship for processing early childhood trauma is

Page 184

Appendix I



175

New
 Hope
 Fidelity
 Checklist
 

 
SAFETY
 Fidelity
 Checklist
 
 
 
 
 
 

 
 
 
 
 
Chapter
 1:
 Basic
 Safety
 
 
 
 
 
 
  _____________
 

 
 
 
 
 
 

1.1 Safety
 in
 the
 Therapy
 Session
 
 
 
 
 
 
 

1.2 Family
 Safety
 
 
 
 
 
 
 
 
 
 

1.3 Physical
 Safety
 
 
 
 
 
 
 
 
 


 
Chapter
 2:
 Caregiver-­‐Child
 Relationship
 
 
 
  _____________
 

 
 

2.1 Nurturing
 activities
 
 
 
 
 
 
 
 
 

2.2 Caregiver
 Attribution
 
 
 
 
 
 
 
 

2.3
 Caregiver
 Response
 to
 Trauma
 
 
 
 
 
 
 

 

2.4
 Healthy
 Attachment
 
 
 
 
 
 
 
 
 

 
Chapter
 3:
 Predictable
 and
 Nurturing
 Environment
 
 
  _____________
 


 
3.1 Consistent
 Daily
 and
 Nightly
 Routines
 
 
 
 
 
 

3.2 Managing
 Unpredictable
 Situations
 
 
 
 
 
 
 


 
Chapter
 4:
 Trauma
 Informed
 Limit
 Setting
 Strategies
 
  _____________
 

 
 

4.1 Understanding
 Challenging
 Behaviors
 
 
 
 
 
 

4.2 Responding
 to
 Aggression
 
 
 
 
 
 
 
 

4.3
 Managing
 Temper
 Tantrums
 
 
 
 
 
 
 

 
Chapter
 5:
 Calming
 Strategies
 
 
 
 
 
  _____________
 

 

5.1 Progressive
 Muscle
 Relaxation
 
 
 
 
 
 
 

5.2 Deep
 breathing
 strategies
 
 
 
 
 
 
 
 
 

5.3 Other
 calming
 strategies

Page 185

Appendix I



176

STORY
 Fidelity
 Checklist
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 

 
 
 
 
 
 
Chapter
 6:
 Naming
 and
 Practicing
 Feelings
 
 
 
  _____________
 

 
 

6.1 Naming
 Feelings
 
 
 
 
 
 
 
 
 

6.2 Practicing
 Feelings
 
 
 
 
 
 
 
 

Chapter
 7:
 Fostering
 Healthy
 Thoughts
 
 
 
 
  _____________
 

 

7.1 Reinforcing
 Positive
 Beliefs
 in
 Child
 
 
 
 
 
 

7.2 Narratives
 Reflecting
 Actual
 Trauma
 
 
 
 
 
 

7.3 Caregiver
 Feelings
 About
 the
 Trauma
 
 
 
 
 
 

7.4
 Sharing
 Trauma
 Related
 Feelings
 
 
 
 
 
 
 

 


 
RECOVERY
 Fidelity
 Checklist
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 
Chapter
 8:
 Identifying
 Sources
 of
 Support
 
 
 
  _____________
 

 

8.1
 Reconnecting
 With
 Safe
 People
 
 
 
 
 
 

 
Chapter
 9:
 Building
 Prosocial
 Skills
 
 
 
 
  _____________
 

 

9.1
 Prosocial
 Behaviors
 
 
 
 
 
 
 
 
 

 
Chapter
 10:
 Seeking
 Closure
 
 
 
 
 
  _____________
 

 

10.1
 Closure
 Activities
 
 
 
 
 
 
 
 
 

 
10.2
 The
 End

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