Our Program Model

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

TF-CBT is designed to reduce negative emotional and behavioral responses following trauma including child sexual abuse (and other forms of child maltreatment), exposure to domestic violence, traumatic loss, multiple traumas, complex trauma, and other traumatic events.

What is your program philosophy?

It is our philosophy and vision that our residents will develop trust, stability, increased self-esteem, and a sense of purpose and hope for their futures. Our team at Dream Residential Treatment Center (RTC) is committed to providing a safe, structured, and therapeutic environment, in which our residents are treated with compassion, kindness, and respect during their stay in the program. Our dedicated professionals, the resident, family, and /or managing conservator are essential partners working together providing our youth with the tools necessary to thrive. We are client-centered, strengths-based, and trauma informed as cornerstones to our treatment approach. Our philosophy includes a commitment to individualized care, respecting the uniqueness of each child. At Dream RTC, we believe that daily encouragement, building safe, trusting, and healthy relationships, building self-esteem, developing coping and life skills, and empowering our residents will result in positive interactions with others, improved behavioral outcomes, and ultimately enable our residents to become successful in life.

Is your program accredited? If so by whom?

Our program is not currently accredited.

What is the agencies Program Model?

Our program model is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). The model is an evidence-based treatment approach shown to help children, adolescents, and their families and caregivers to address and overcome trauma-related difficulties.TF-CBT is designed to reduce negative emotional and behavioral responses following trauma including child sexual abuse (and other forms of child maltreatment), exposure to domestic violence, traumatic loss, multiple traumas, complex trauma, and other traumatic events.

Why has your agency chosen this program model?

We adopted this model for several reasons, including but not limited to the fact that the children we serve have all experienced various types and levels of trauma, it’s alignment with our program’s philosophy, and because it is one of the primary modalities utilized by our program psychotherapist. Moreover, the TF-CBT model is an evidence-based treatment model that helps children to: address the negative effects of trauma; provides the opportunity for children to process their traumatic memories with their psychotherapist; overcome problematic thoughts and behaviors; and the develop effective coping and interpersonal skills. We also chose the TF-CBT model because the target population includes children and adolescents (ages 3 to 18) who remember being exposed to at least one trauma (e.g., child maltreatment or loss of a loved one) and who experience either depression, anxiety, shame, inappropriate sexualized behaviors, symptoms of PTSD, or other dysfunctional abuse-related feelings, thoughts, and behaviors. Lastly, we chose this model because it includes a treatment component for caregivers to learn skills related to stress management, positive caregiving, behavior management, and effective communication, all of which will assist our direct care staff and clinical team members to understand and apply best practices for working with trauma-exposed children who are actively in the process of working through their trauma.

What are the core components of your program model?

TF-CBT provides flexibility for short-term, as well as long-term treatment for youth who present with complex or multiple traumas (Cohen, Mannarino, & Deblinger, 2017). The therapist will make an assessment of each individual child’s therapeutic needs. Most children can benefit from additional services once the trauma-specific impact has been resolved. Other treatment approaches that emphasis trauma-informed care and/ or cognitive-behavioral therapeutic elements are complementary to TF-CBT and may be utilized before or after TF-CBT specific treatment.

In addition to TF-CBT our program model and therapeutic approaches include Cognitive Behavioral Therapy, Reality Therapy, and Solution Focused Therapy. We respect our residents’ right to individuality and we meet them where they are relative to their readiness and willingness to address their respective traumas. As such, there is some flexibility on the part of the clients’ and the clinician with regard to meeting the therapeutic needs of each child.

Each individual session is designed to build the therapeutic relationship while providing education, skills, and a safe environment in which to address and process traumatic memories. The therapist and child all work together to identify common goals and attain them. If appropriate, joint parent-child sessions are designed to help parents and children practice and use the skills they learned and assist children in sharing their trauma narratives. TC-CBT sessions can also foster more effective parent-child communication about the abuse and related issues particularly in cases where the permanency plan is family reunification.

Core components of the TF-CBT model include:

  • Psychoeducation
  • Relaxation techniques
  • Affective expression and regulation
  • Cognitive coping and processing
  • Trauma narration and processing
  • Enhancing personal safety and future growth

How will the current and new caregivers be trained on the program model and by whom?

The current caregivers received a recent introductory training on TF-CBT and informed that we are proposing to adopt this model contingent upon approval from Youth for Tomorrow (YFT). The training was facilitated by our treatment director (Mr. Byron Parker, MSW, LCCA, who has 25 years of experience as an educator and 35 years of experience in residential childcare). Subsequent trainings may be facilitated by our program therapist and/ or other practitioners certified, licensed, and or supervised in TF-CBT. Our new caregivers will receive 2 hours of training as a pre-service requirement, then receive subsequent training quarterly. Aside from the training schedule, the skills and principles are integrated throughout the program by the expectation that caregivers and other treatment team members will:

  1. Ensure that the children’s environment is and feels as safe as possible.
    • a. Minimize fighting, arguing, or raised voices that might seem like they will lead to violence.
    • b. Keep doors locked.
    • c. Review how to handle calls or someone coming to the door that is unfamiliar.
  2. Create a safety plan for situations where there may be ongoing dangers (e.g., bullying, inappropriate sexual behaviors, self-harming behaviors, threats to go AWOL, suicidal behaviors, etc).
    • a. Set up a written plan for specific risky situations.
    • b. Increase supervision levels to close supervision (5-minute increments, or one-to-one)
    • c. Identify safe people and places that children call or request to go to.
    • d. Refer child for psychiatric assessment and evaluation.
  3. Increase support and reassurance from caregivers.
    • a. Give a lot of reassurance. Be specific that the situation is safe now.
    • b. Be careful not to communicate that because of the trauma the world should be seen as a very dangerous place.
  4. Help children face up to non-dangerous situations to learn they can handle them.
    • a. Identify people, places, and topics, things that may be reminders of the trauma but are not in themselves dangerous, that the child seems to be reacting strongly to or avoiding.
    • b. Support children in approaching, not avoiding, these non-dangerous reminders.
    • c. Help them learn to tell the difference between danger and non-dangerous reminders (e.g., every raised voice is not a sign of impending DV).
  5. ake sure children have coping skills they can use.
    • a. Review coping skills such as relaxation, breathing, distraction (listening to a favorite song, game), meditating. Identify which ones the child is likely to use and practice it with him or her.
    • b. Prompt the child to use the coping skills when he or she seems to be getting anxious or worried unnecessarily.

How does the leadership ensure that the model is being implemented / integrated as intended?

The administrative team, along with the clinical team at Dream RTC will ensure that the model is being implemented and integrated as intended by maintaining the training schedule, daily supervision of direct care staff and children, and through the evaluation of the model’s implementation and effectiveness through regular treatment team meetings, and monitoring and tracking in clinical documentation such as daily progress notes, therapy progress notes, and treatment plans.

Upon approval of this treatment model, we will implement a policy that captures: the model, training, integration, and evaluation. The administrative and clinical team is jointly responsible for preserving the integrity of the program model.


Trauma-Focused Cognitive Behavioral Therapy for Children in Foster Care: An Implementation Manual (2018) Esther Deblinger, Ph.D., Anthony P. Mannarino, Ph.D., Melissa K. Runyon, Ph.D., Elisabeth Pollio, Ph.D., and Judith Cohen, M.D.