TF-CBT Toolkit With Color Laminates 1.30.12

TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY
INTRODUCTION TO THE TF-CBT TOOLKIT

Congratulations on completing the online training in TF-CBT! (If you havent there
is still plenty of time to complete this at http://tfcbt.musc.edu/ ). We hope it has
piqued your interest in providing evidence-based treatment services to traumatized
children and their caregivers. We know the online training is not perfect. We would
rate it good (three stars on a four star rating scale). But we also think it is the best
introduction to TF-CBT.
Expert clinicians in TF-CBT strongly believe, however, that clinicians need more
than just the online training in order to be prepared to deliver TF-CBT effectively.
The usual recommended course of training is to follow-up the TF-CBT online
training with in-person training and then ongoing clinical consultation with a TF-CBT
expert until you have mastered TF-CBT. This course of training is not possible for
most of us. That is why the developers of TF-CBT and researchers and clinicians at
the University of Missouri in Columbia and Washington University in St. Louis have
packaged a set of scaffolded learning components designed to help you learn and
deliver TF-CBT effectively in your practice setting.
These activities are based on the educational science of scaffolded learning.
Scaffolded learning is designed to optimize your skill acquisition by taking
advantage of and respecting your existing knowledge and expertise, and tailoring
the learning process to your individual needs. It puts you in charge of your
learning. Scaffolded learning consists of four main components: (a) new
knowledge and skills (in this case, TF-CBT); (b) materials designed to help you recall
and apply the skills; (c) a set of systematic and sequenced activities and tasks
designed to help you practice and master the skills; and (d) expert and peer support
for trying out the new skills.
Individual learners employ these components to tailor a package to best meet their
learning needs, using them when and how they find them most helpful, and
proceeding at their own pace. That being said, the TF-CBT developers and trainers
believe that you will get the most out of this training package when you make use
of all its components.
The TF-CBT Learning Package includes eight parts designed to provide you with the
content, materials, activities and support you need to deliver TF-CBT effectively:
1. TF-CBT Online Training
If you have not yet started your TF-CBT learning, we strongly suggest you begin
with the online TF-CBT training offered through the Medical University of South
Carolina. Go to http://tfcbt.musc.edu/
2. TF-CBT Book
We have included the book, Treating Trauma and Traumatic Grief in Children,
written by the developers of TF-CBT. The book serves as the treatment manual for
TF-CBT. The authors recommend you read the book soon after taking the online TFCBT training.
3. TF-CBT Toolkit
We have also included this toolkit of materials designed to help you recall key
concepts from TF-CBT and apply them with your clients. It includes several of the
materials mentioned in the TF-CBT book. We encourage you to look through the
toolkit and see what you find most helpful. We will be sending additional pieces to
add to your toolkit over the course of the training.
4. TF-CBT Learning Activities
Our toolkit includes a number of learning activities designed to help you practice
the skills of TF-CBT. Most of these are practice activities, where you and another
clinician role play using the skills and components of TF-CBT. Some of these
activities reflect TF-CBT components demonstrated in the online training. Others
are additional skills vital to the successful delivery of TF-CBT. These activities allow
you to practice before you use TF-CBT with clients. These activities also include
videos of expert TF-CBT clinicians modeling some of these skills, discussion
questions, and other assignments to encourage you to think more deeply about
your implementation of TF-CBT.
If you are learning TF-CBT in an agency setting with other clinicians, the learning
activities have been designed to walk you and your group through a sequence of
role plays and discussion questions.
If you are learning TF-CBT mostly on your own, we will provide you with contact
information for a learning partner with whom we encourage you to meet to go
over these learning activities, practice and discuss TF-CBT. You are also welcome to
identify your own learning partner.
We think these learning activities are key. The role-plays and discussion questions
are designed to help you practice the treatment components of TF-CBT with a few
straightforward case examples. As you gain more comfort with the model, we also
encourage you and your learning partner(s) to discuss how you would apply TF-CBT
with more complex cases (e.g., multiple traumas, children in foster care). You can
choose which skills are most important for you to practice, but we believe practice
is a must. Some of these TF-CBT skills are not as easy as they may first seem!
5. TF-CBT Webinars
We will provide you with free access to four webinars presented by the TF-CBT
developers Drs. Judith Cohen, Esther Deblinger, and Anthony Mannarino. We are
really excited to be able to bring this opportunity to Missouri clinicians. They will
teach you the secrets of doing TF-CBT well, using the experiences of their trainees
across the country as their guides.
6. TF-CBT Workshop
We will also provide two free in-person workshops with a TF-CBT expert trainer
Margaret Comford, LCSW that you can choose to attend. One of these workshops
will take place in St Louis and one in Columbia. During these workshops, you will be
provided with more in-depth training in TF-CBT and be able to ask about applying
and using TF-CBT in your practice (i.e., how to apply TF-CBT with the kinds of
children and families you see).
7. TF-CBT Phone Consultation
As you move forward with integrating TF-CBT into your practice, we have also
arranged for free access to monthly phone consultations with a TF-CBT expert
trainer. These phone calls will provide you with the opportunity to ask questions
and seek input from a TF-CBT expert. These calls will also be an opportunity to
listen and learn from the questions and answers with other trainees.
8. TF-CBT Online Discussion Board
We have developed an online discussion board for TF-CBT at the Missouri Therapy
Network web site. Here you can post questions about TF-CBT and read others
questions and the answers they received from others who are learning the same
skills and applying them in their clinical practices. The online discussion board will
also be monitored by a certified trainer in TF-CBT, ensuring that you get expert
answers when needed. Visit motherapynetwork.wustl.edu.
9. TF-CBT Online Consult
You also may want to consider making use of a new free resource offered through
the Medical University of South Carolina (the same group that provides the initial
free web training). This resource is called TF-CBT Consult and can be accessed at
http://etl2.library.musc.edu/tf-cbt-consult/index.php
10.
TF-CBT Emailed Tips
We will also periodically email you with TF-CBT implementation tips, clinical tips,
and suggestions for rounding out your TF-CBT training.
11.
Website of TF-CBT Resources
The Missouri Therapy Network has also developed a website repository of

resources for clinicians using TF-CBT. It includes links to additional training videos,
books, discussions, measures and more. Online resources can be found at
motherapynetwork.wustl.edu.
YOUR NEXT STEPS:

If you have not completed the online TF-CBT training, we encourage you to do so.
Go to http://tfcbt.musc.edu/.
If you have completed the online training in TF-CBT, the next recommended steps
are:
(1) Read the book, Treating Trauma and Traumatic Grief. Some will want to read it
cover to cover. It is a pretty quick read. Others will want to focus on areas where
they know the least, or on the areas where the book provides substantially more
detail than the online training.
(2) Look through the toolkit. Let us know what you find to be most helpful.
We will be in touch soon!!
Kristin Hawley, Ph.D.

University of Missouri, Columbia
Curtis McMillen, Ph.D.
University of Chicago
Enola Proctor, Ph.D.
Washington University in St. Louis
TABLE OF CONTENTS
We have started this notebook of helpful handouts and reminder sheets for using TF-CBT
with your clients. These materials are a starter toolkit that you can add to over time. We
hope to send you additions to your toolkit as we learn from each other.
TF-CBT Model
TF-CBT Memory Jogger
Assessment and Treatment Planning with TF-CBT

CRAFTS acronym for TF-CBT assessment and treatment planning domains
Assessment tips
Sample TF-CBT treatment plan for submission to Missouri Healthnet
Sample frequency rating sheet
Frequency rating sheet
TF-CBT fidelity checklist
TF-CBT treatment steps tracking form
TF-CBT supervisors adherence checklist
TF-CBT supervisee rating form
Psychoeducation about trauma

Educating children and families about trauma and TF-CBT
How stress and PTSD affect our bodies

Domestic violence handout for caregivers
Domestic violence handout for children
Child physical abuse handout for caregivers
Child physical abuse handout for children
Child sexual abuse handout for caregivers
Child sexual abuse handout for children
Parenting Skills
Relaxation
Controlled diaphragmatic breathing instructions
Relaxation script for children
Relaxation script for adolescents and adults
Affective modulation
Ways to feel better right now
Problem solving steps
Cognitive coping and processing

Cognitive Model: Thinking, Feeling, Doing Triangle
Dog poop example of cognitive model
BLUE acronym for types of unhelpful thinking
Four strategies for disputing unhelpful/unhealthy thoughts

Double Bubble worksheet for challenging unhelpful thinking
Practicing the cognitive triangle
Challenging your thinking mistakes
Trauma narrative
Helpful hints for the trauma narrative
In vivo mastery of trauma reminders

Subjective Units of Distress Scales (SUDS)
Conjoint child-parent sessions
Enhancing future safety and development
TF-CBT Memory Jogger

CRAFTS II: Domains for
Assessment & Treatment
Planning
Cognitive Problems
CRAFTS I: Core Values
Relationship Problems
Components-based treatment emphasizing a set of skills that
progressively build on previously acquired skills. Rather
than a rigid session-by-session approach, TF-CBT has
interrelated components, provided in a manner that best
matches the needs of the child and family.
Respect for individual, family, religious, community, and

cultural values is essential. Therapists work with the child
and caregiver to decide the best way to implement the
core components of TF-CBT for their family. TF-CBT must
occur in harmony with the familys larger community and
cultural context.
Adaptability is crucial to the success of TF-CBT.
Therapists
must be creative and flexible in implementing the core

components of TF-CBT. Therapist clinical judgment and
creativity are highly valued and respected in this approach.
Family Involvement
A primary focus of TF-CBT is improving
caregiver-child interactions, communication, and

closeness. As such, caregivers are integrally involved in the
childs treatment.
Therapeutic relationships are central to TF-CBT.
Affective Problems
Family Problems
Traumatic behavior Problems
Somatic Problems
TF-CBT PRACTICE:
CORE COMPONENTS
Psychoeducation and Parenting
Skills
Relaxation
Affective modulation
Cognitive coping and processing
Trauma narrative
Developing
and maintaining a trusting, accepting, empathic

therapeutic relationship with the therapist is essential to
restoring trust, optimism and self-esteem in traumatized
children and their caregivers.
Self-efficacy including self-regulation of affect, behavior, and

cognitions, is a long-term goal of TF-CBT. TF-CBT aims to
provide life skills and enhance individual strengths so that
children, caregivers, and families continue to thrive long
after therapy has ended.
In vivo mastery of trauma

reminders
Conjoint child-parent sessions
Enhancing future safety and
development
Domains for Assessment and Treatment Planning with

Children who have experienced Trauma
Cognitive problems: Maladaptive patterns of thinking about self, others, and situations,
including distortions or inaccurate thoughts (e.g., self-blame for traumatic events) and
unhelpful thoughts (e.g., dwelling on the worst possibilities)
Relationship problems: Difficulties getting along with peers; poor problem-solving or

social skills; hypersensitivity in interpersonal interactions; maladaptive strategies for
making friends; impaired interpersonal trust
Affective problems: Sadness; anxiety; fear; anger; poor ability to tolerate or regulate
negative affective states; inability to self-soothe
Family problems: Caregiver skill deficits; poor caregiver-child communication;

disturbances in caregiver-child bonding; disruption in family relationships due to
familial abuse or violence
Traumatic behavior problems: Avoidance of trauma reminders; trauma-related,

sexualized, aggressive or oppositional behaviors; unsafe behaviors
Somatic problems: Sleep difficulties; physiological hyperarousal and hypervigilance

toward possible trauma cues; physical tension; somatic symptoms (e.g., headaches,
stomachaches)
ASSESSMENT TIPS
The TF-CBT developers believe that it is important for mental health clinicians to
screen their child clients for the experience of traumatic events and the symptoms
of PTSD. Sometimes clinicians may be afraid of bringing up trauma if the client
doesnt bring it up first. However, experience has shown that clinicians often
discover halfway into therapy that their child clients have had traumatic
experiences that are affecting their current behavior and emotions. If clinicians
screen for these traumatic events up-front, they can better plan for the treatment
of their clients.
We have gained permission from the authors of the UCLA PTSD indexes for DSM-IV
to include them in this packet. You can make copies of these instruments for clinical
or research purposes. There are three forms of the PTSD index: a) one used with
children, b) one used with adolescents and c) one used with parents. The UCLA
PTSD index includes items that screen for the experience of trauma. Then, it moves
on to asking about the symptoms of PTSD.
There are scoring templates for the 3 forms of the UCLA PTSD index as well, if you
decide to use them to help diagnose PTSD or if you want to use them to measure
client progress by determining an overall PTSD severity score. Please familiarize
yourself with these instruments and how they work before you use them with
clients. You may want to use them as interview instruments, where you read the
items aloud to your clients, or you may use them as self-administered
questionnaires.
UCLA PTSD INDEX FOR DSM IV (Revision 1)

INSTRUMENT INFORMATION:
Child Version, Parent Version, Adolescent Version
(Ned Rodriguez, Ph.D., Alan Steinberg, Ph.D., & Robert S. Pynoos, M.D., August, 1999)
For more information, please contact the UCLA Trauma Psychiatry Service via
telephone: (310) 206-8973, or email: [email protected]
Basic Features:
Researchers and clinicians at the UCLA Trauma Psychiatry Service have developed this series of self-report instruments to be used to
screen both for exposure to traumatic events and for all DSM-IV PTSD symptoms in school-age children and adolescents who report
traumatic experiences. These instruments are meant to serve as brief self-report screening tools to provide information regarding
trauma exposure and PTSD symptoms. The items of the UCLA PTSD indices are keyed to DSM-IV criteria and can provide preliminary
PTSD diagnostic information. However, these instruments are not intended to be used in place of a structured clinical interview to
definitively establish a PTSD diagnosis. Instead, the instruments are meant to be used to quickly and efficiently screen for PTSD
symptoms in children and adolescents who have experienced a traumatic event, and to provide information regarding the frequency
of those symptoms.
Intended Populations:
The instruments are designed to assess for exposure to a wide variety of traumatic events and are suitable to be used to evaluate
PTSD symptoms in children and adolescents who have experienced any type of traumatic stress.
The Child Version is worded for school-age children between the ages of 7 and 12. The Parent Version closely mirrors the Child
Version and is intended to be used as the parent report of trauma exposure and PTSD symptoms for children between the ages of 7
and 12. The Parent Version was developed to complement the childs report of PTSD symptoms. Parent report of PTSD symptoms is
often necessary and helpful in providing PTSD diagnostic information, particularly for the following symptoms: repetitive traumatic
play, diminished interest and participation, sleep problems, irritability and angry outbursts, concentration problems, hypervigilance,
and exaggerated startle. The Adolescent Version closely resembles the Child Version with minor changes in wording intended for
youth age 13 or older.
Instrument Design and Item Content:
The content of the questions draws upon clinical and research experience regarding how to evaluate for exposure to traumatic
experiences in children and youth, how they describe their subjective reactions during these experiences, and how traumatized
children and youth describe their experiences of PTSD symptoms. All three versions of the UCLA PTSD Index are organized in the same
format. Questions 1-13 comprise a trauma screen, as they assess for exposure to a variety of traumatic events. If participants report
exposure to multiple events, Question 14 asks them to identify the event that currently distresses them the most. The remainder of
Question 14 inquires when the event occurred and requests participants to provide a brief description of the event. Questions 15-21
assess for DSM-IV PTSD Criterion A1" which concerns aspects of the traumatic event itself. Questions 21-26 evaluate DSM-IV PTSD
Criterion A2" which relates to the child or youths subjective experience during or just after the traumatic event including intense fear
(Question 22), helplessness (Question 23), horror (Question 24), and agitated or disorganized behavior (Questions 25-26). Question
27 assesses for a dissociative reaction at the time of the traumatic event. In questions 15-27, only parents are given the option to
respond do not know for questions pertaining to the childs subjective reactions at the time of traumatic events. Children and youth
are required to answer yes or no for each of these items. The remaining questions on pages 3 and 4 assess for the frequency of
self-reported DSM-IV PTSD symptoms (Criterion B, C, and D,) or associated features on a 4-point scale ranging from none (of
the time) to most (of the time). Subjects refer to the Frequency Rating Sheet on Page 5 to explain their rating choices. The
Frequency Rating Sheet is designed to assess for the occurrence of PTSD symptoms over the past month, but researchers and
clinicians can adapt the Rating Sheet to assess for PTSD symptoms over the time period of their interest, such as the past week. Only
parents are given the option to respond do not know for each question in this section of the instrument, since parents may be
unaware or unsure of many PTSD symptoms experienced by their child.
Each question on pages 3 and 4 of the instrument contains a subscript that denotes the DSM-IV PTSD symptom assessed by that
particular question. For example, question 1 inquires about DSM-IV Criterion D4" (hypervigilance). The subscript AF denotes a
PTSD associated feature. Although each version of the UCLA PTSD Index contains a different total number of questions, questions 119 are nearly identical across each version. These 19 questions assess for the 17 DSM-IV PTSD symptoms delineated in Criteria B, C,
and D, and the PTSD associated feature of trauma-related guilt (Question 13). Note that each version contains one question to assess
for each DSM-IV PTSD symptom except for the symptom of Emotional Numbing (DSM-IV symptom C6). Each version contains 2
questions (Questions 10 and 11) that assess for emotional numbing. Question 10 assesses for numbing of positive emotions, Question
11 assesses for numbing of negative emotions. The instruments are designed such that these 19 questions comprise the core of each
PTSD index in each version.
The Child Version contains a total of 20 questions. In addition to the first 19 questions, Question 20 assesses a common problem
reported by traumatized children, namely a fear that the traumatic event will reoccur.
The Parent Version contains a total of 21 questions. The questions are identical in content to the child version with one exception.
Question 21 has been added to the Adult Version to assess for the DSM-IV PTSD symptom of repetitive traumatic play, an alternate
expression of Criterion B1 in children. A parallel item was not included in the child version since the traumatic etiology of repetitive
play is thought to occur outside of the awareness of the child.
The Adolescent Version contains a total of 22 questions. In addition to the first 19 questions, an alternative question (Question 20)
has been included to assess for another component of DSM-IV Criterion "D2" (anger/irritability). An alternative question (Question
21) has also been included to assess for another dimension of DSM-IV Criterion C7" (foreshortened future). Question 22 assesses a
common problem reported by traumatized youth, namely a fear that the traumatic event will reoccur
Instructions for Administration:

All three versions have been designed as self-report instruments and can be administered as paper-and-pencil measures. Researchers
should note that subjects often neglect to consult the Frequency Rating Sheet on Page 5 when completing pages 3 and 4 of the
instrument. Therefore, it is helpful for researchers to detach this sheet and instruct subjects to refer to it when they complete pages 3
and 4.
While the Parent Version is easily administered via self-report, the Child and Adolescent Versions can easily be adapted to 1-on-1
verbal administration or to classroom administration to larger groups of children or youth.
A. 1-on-1 Verbal Administration for Child and Adolescent Versions: Based on prior work with the earlier generation instrument of the
UCLA Trauma Psychiatry Service, the Child Posttraumatic Stress Disorder Reaction Index (Frederick, Pynoos, & Nader, 1992), the Child
Version can be effectively administered verbally in a 1-on-1 format, where the evaluator reads the instructions and the questions to
the children. Children readily respond to this interactive format, which helps to insure that they comprehend the instructions of the
instrument and the task of self report. Evaluators begin by reading the instructions for each section and emphasize that if the child
hears a word he/she does not understand, he/she should ask the evaluator for clarification. Evaluators proceed through the trauma
screen and criterion A assessment questions on pages 1 and 2 in a fairly straightforward manner. For pages 1 and 2, evaluators
inform the child of their response options for each question (Yes or No), and proceed to read the child each question and record their
response. After completing pages 1 and 2, evaluators read the instructions for pages 3 and 4 of the instrument. The evaluator should
next familiarize the child with their response options on the Frequency Rating Sheet.
For each question, I want to know how often these things have been true for you (in the past month)
Here are your choices (show them the Frequency Rating Sheet and point to each choice and the boxed calendar pictorial
representation as you read the choice to the child)
None of the time means not at all (in the past month)
Little of the time means about two times (in the past month)
Some of the time means about once a week (in the past month)
Much of the time means two or three days a week (in the past month)
Most of the time means almost every day (in the past month)
Children can be asked to point to their choice on the Frequency Rating Sheet to indicate how often they have experienced the
symptom in question over the past month or designated time period. Evaluators then circle the childs response to each question on
the grid provided. To orient the child to the task of the self-report of symptoms, before beginning the first question on page 3, the
child is given 2 practice questions and asked to point to the choice on the Frequency Rating Sheet to answer how often in the past
month the following statements have been true for the child:
I have had green hair-Child should point to 0 to denote none of the time
I have had a headache-Child should point the choice denoting the number of times (in the past month) when they have had
a headache
If children do not understand the concept of self-reporting on the frequency they experience a particular problem, this will become
apparent during the practice questions, and evaluators should clarify the task as necessary to help children to understand the task.
When evaluators read the questions to the child or adolescent that assess for the DSM-IV PTSD Trauma-specific symptoms [Child
Version Questions numbers (DSM-IV PTSD Symptom): 2(B4), 3(B1), 5(B2), 6(B3), 9(C1), 14(AF), 15(C3), 17 (C2), 18(B5), 20(AF)],
[Adolescent Version Question numbers (DSM-IV PTSD Symptom): 2(B4), 3(B1), 5(B2), 6(B3), 9(C1), 14(AF), 15(C3), 17 (C2), 18(B5),
22(AF)], they should alter the wording of these questions to tailor them to the specific traumatic event experienced by the child or
adolescent. Clinical experience with index administration indicates that a direct verbal reference in each of these questions to the
specific traumatic event experienced by the child helps the child to better focus on that experience and its link to the symptom in
question. Children with posttraumatic avoidance often have difficulty keeping the traumatic event in mind during instrument
administration. Repeatedly bringing the specific traumatic event into the awareness of the child helps to facilitate their ability to
report on explicitly trauma-linked symptoms. Thus, tailoring the above questions to the specific traumatic event experienced by the
child helps to increase the reliability of the child's self report, particularly in children and adolescents suffering from posttraumatic
avoidance. For example if the child or had witnessed a violent shooting, the evaluator should alter the wording of the questions as
follows:
Question
Number
Questions with reference to a generic

traumatic event
Suggested alternative wording for

questions tailored to a specific traumatic
event, in this example a violent shooting
2 (B4)
When something reminds me of what happened, I

get very upset, afraid, or sad.
When something reminds me of the shooting, I

get very upset, afraid, or sad.
3(B1)
I have upsetting thoughts, pictures, or sounds of

what happened come into my mind when I do not
want them to.
I have upsetting thoughts, pictures, or sounds of

the shooting come into my mind when I do not
want them to.
5(B2)
I have dreams about what happened or other bad

dreams.
I have dreams about the shooting or other bad

dreams.
6(B3)
I feel like I am back at the time when the bad thing

happened, living through it again.
I feel like I am back at the time when the

shooting happened, living through it again.
9(C1)
I try not to talk about, think about, or have feelings

about what happened.
I try not to talk about, think about, or have

feelings about the shooting.
14(AF)
I think that some part of what happened is my fault.
I think that some part of what happened during

the shooting is my fault.
15(C3)
I have trouble remembering important parts of what

happened.
I have trouble remembering important parts of

what happened during the shooting.
17(C2)
I try to stay away from people, places, or things that

make me remember what happened.
I try to stay away from people, places, or things

that make me remember the shooting.
18(B5)
When something reminds me of what happened, I

have strong feelings in my body like my heart beats
fast, my head aches, or my stomach aches.
When something reminds me of the shooting, I

have strong feelings in my body like my heart
beats fast, my head aches, or my stomach
aches.
20(AF)
I am afraid that the bad thing will happen again.
I am afraid that the shooting will happen again.
B. Classroom or Group Administration for Child and Adolescent Versions: The Child and Adolescent Versions can be easily adapted for
classroom or group administration. Based on previous work with the Child Posttraumatic Stress Disorder Reaction Index, UCLA
researchers have employed two different strategies for classroom evaluation of student self-report of PTSD symptoms.
1. Evaluation Team: In this form of classroom administration, a team of trained evaluators goes to a classroom where the
evaluators divide the students into subgroups. Each evaluator then administers the Index in a 1-on-1 format to each student in the
subgroup assigned to them. While evaluators are going around the room administering the Index 1-on-1 to each student at their desk,
students are asked to engage in a quiet individual task such as drawing or coloring. Instructions for 1-on-1 classroom administration in
this team format are identical to the instructions just delineated for 1-on-1 verbal administration. Prior to evaluation, the team should
decide on a set of uniform responses to common student questions to minimize the interevaluator variability in Index administration.
2. One Evaluator per Classroom: In this form of administration, a single evaluator administers the Index to the entire
classroom of students. As in 1-on-1 administration, the evaluator reads the instructions to each section of the Index to the classroom
and then proceeds by reading each question in that section. While the evaluator reads the questions, students who are seated at
their desks, mark their responses on their own copies of the Index. It is important that classroom evaluators stress that students
should answer all questions and leave no blanks. The evaluator can closely adapt the previous instructions for 1-on-1 verbal
administration to this format, although the interactive component of the 1-on-1 format is not possible in the classroom setting.
Evaluators can answer student questions to clarify the task of self-report and explain how to record answers, etc. However, if
evaluators are administering the Index to various classrooms in a given school, it is suggested that evaluators not attempt to answer
student questions relating to the meaning of a particular item, since different questions may arise in each classroom which if
answered may alter the administration and response conditions in each classroom. In this scenario, the potentially different
administration conditions in each classroom would confound Index scores and make interclassroom comparison difficult. Instead of
answering student questions regarding item content, in this administration format UCLA researchers suggest that evaluators respond
neutrally to student questions stating: Answer each question according to the meaning that question has for you OR The question
means whatever it means to you, please try and understand the question as best as you can.
Scoring, Interpretation, and Psychometric Properties:
Questions 1-11 screen for exposure to events that may be experienced as traumatic. Questions 13-19 evaluate if the event meets
DSM-IV Criterion A1, and Questions 20-23 assess if the participants subjective response during or just after the event meets DSM-IV
Criterion A2. If participants meet both Criterion A1 and A2 for the event endorsed, that experience can be classified as constituting
exposure to a traumatic event according to DSM-IV.
As stated previously, the first 18 questions of each version comprise the core of each PTSD Index for evaluating Criterion B, C, and D
Symptoms (the first 19 questions in the case of the Parent Version). All 17 DSM-IV PTSD symptoms are assessed by these questions,
with the exception of question 13 which evaluates the associated feature of trauma-related guilt. Question 13 is excluded from
scoring on all three versions. The remaining questions (Questions 19 and higher for the Child and Adolescent Versions, and Questions
20 and higher for the Parent Version) are included for experimental purposes only and are excluded from scoring.
The developers of the indices assume that the more often a symptom occurs, the more severely that symptom impacts the child or
adolescent. In addition, the developers assume that the higher the number of symptoms reported by a participant, the higher the
severity of their PTSD. Based on this rationale, two types of PTSD severity scores can be calculated from each index. An Overall PTSD
Severity Score can be calculated by summing the scores for each question that corresponds to a DSM-IV Symptom. In addition, a
separate PTSD Severity Subscore can be calculated for Criterion B, C, and D Symptoms by summing the scores for each question that
assesses the symptoms belonging to each particular category. Finally, preliminary PTSD diagnostic information can be obtained by
determining if participants endorse the number of symptoms from Criterion B, C, and D required for a DSM-IV PTSD diagnosis. Please
note that investigators must make a determination regarding the minimum frequency reported for each item necessary for that
question to be counted as a symptom. Certainly problems reported to occur Much of the time or Most of the time would likely
qualify as symptoms. Whether or not problems reported to occur Some of the time or Little of the time would qualify as
symptoms is best answered as an empirical question. Please refer to the Scoring Worksheets for step-by-step instructions for scoring
each version.
These instruments have only recently been developed. At the current time, the psychometric properties of these instruments have
not yet been established. However, researchers at the UCLA Trauma Psychiatry Service are currently conducting psychometric studies
of the instruments. In one study involving the Child and Parent Versions in a sample of acutely traumatized children, researchers are
investigating the test-retest reliability of each version. Researchers are cross-validating the trauma-screen portion of the Child and
Parent Versions with other standardized self-report measures of trauma exposure. Researchers are cross-validating the Criterion B, C,
and D portions of the Child Version with the Child Posttraumatic Stress Disorder Reaction Index (Frederick, Pynoos, & Nader, 1992)
and cross-validating the Criterion A, B, C, and D portions of the Child version with a structured clinical PTSD diagnostic interview. In
this study, UCLA researchers are also cross-validating the Criterion A, B, C, and D portions of the Parent Version with a structured
clinical PTSD diagnostic interview.
Since the psychometric properties of these instruments are currently under investigation, UCLA researchers suggest that other
researchers who use these instruments conduct empirical studies to determine the optimal scoring procedures for their particular
research populations. To conduct these studies, researchers should consider conducting structured clinical interviews to diagnose
PTSD in a randomly-selected subsample of their participants with a known standardized PTSD assessment instrument. The PTSD
diagnostic status and intensity scores of this subsample could then serve as gold standards in empirical studies which evaluate the
overall PTSD severity score on each version that would most efficiently classify subsample cases according to PTSD diagnostic status.
Researchers could then utilize this empirically-determined cutoff score to classify cases in their larger sample according to likelihood
of a PTSD diagnosis. Researchers could also then consider the individual item scores that are necessary to generate the empiricallydetermined cutoff score. For example, if statistical analysis indicated that a cutoff score of 32 most efficiently classified the cases in
the subsample according to PTSD diagnostic status, a score of 2 on each of the 17 questions could be considered as the symptom
cutoff score for each question. In this case, any questions answered 2 or above would likely indicate the presence of a PTSD symptom.
If sample size permits, investigators may choose to conduct a series of statistical analyses that investigate the relationships between
Index-derived severity scores for each DSM-IV Symptom Category (B, C, D) and DSM-IV PTSD diagnostic status for those Criteria as
determined by structured clinical interview. These analyses could yield separate empirically-determined cutoff Index severity scores
that would most efficiently classify cases according to PTSD diagnostic status for Criterion B, C, and D. For more information, please
contact the UCLA Trauma Psychiatry Service via any of the following: writing to the letterhead address, telephone: (310) 206-8973, or
email: [email protected]
UCLA PTSD INDEX FOR

DSM-IV:
CHILD VERSION
Name ________________________________ Age _______
Sex (Circle): Girl
Boy
Todays Date (write month, day and year) _______________ Grade in School ____________
School ________________ Teacher _______________________ Town __________________
Below is a list of VERY SCARY, DANGEROUS, OR VIOLENT things that sometimes happen
to people. These are times where someone was HURT VERY BADLY OR KILLED, or could
have been. Some people have had these experiences, some people have not had these
experiences. Please be honest in answering if the violent thing happened to you, or if it did not
happen to you.
FOR EACH QUESTION:
1)
Check "Yes" if this scary thing HAPPENED TO YOU

Check "No" if it DID NOT HAPPEN TO YOU
Being in a big earthquake that badly damaged the building you were in.
Yes [ ] No [ ]
2) Being in another kind of disaster, like a fire, tornado, flood or hurricane.

Yes [ ] No [ ]
3)
Being in a bad accident, like a very serious car accident.

Yes [ ] No [ ]
4) Being in place where a war was going on around you.

Yes [ ] No [ ]
5)
Being hit, punched, or kicked very hard at home.

(DO NOT INCLUDE ordinary fights between brothers & sisters).
Yes [ ] No [ ]
6)
Seeing a family member being hit, punched or kicked very hard at home.
Yes [ ] No [ ]
7)
Being beaten up, shot at or threatened to be hurt badly in your town.

Yes [ ] No [ ]
8)
Seeing someone in your town being beaten up, shot at or killed.

Yes [ ] No [ ]
9)
Seeing a dead body in your town (do not include funerals).

Yes [ ] No [ ]
10) Having an adult or someone much older touch your private sexual body parts
when you did not want them to.
Yes [ ] No [ ]
11) Hearing about the violent death or serious injury of a loved one.
Yes [ ] No [ ]
12) Having painful and scary medical treatment in a hospital when you were
very sick or badly injured.
Yes [ ]
No [ ]
13) OTHER than the situations described above, has ANYTHING ELSE ever
happened to you that was really SCARY, DANGEROUS, OR VIOLENT?
Yes [ ] No [ ]
14) a) If you answered "YES" to only ONE thing in the above list of questions #1
to #13, place the number of that thing (#1 to #13) in this blank:
# ____________
b) If you answered "YES" to MORE THAN ONE THING, place the number
of the thing that BOTHERS YOU THE MOST NOW in this blank:
#___________
c) About how long ago did this bad thing (your answer to [a] or [b]) happen to
you? _____________________________________________________________
d) Please write what happened:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
FOR THE NEXT QUESTIONS, please CHECK [YES] or [NO] to answer HOW
YOU FELT during or right after the bad thing happened that you just wrote about
in Question 14.
15) Were you scared that you would die?

Yes [ ] No [ ]
16) Were you scared that you would be hurt badly?
Yes [ ] No [ ]
17) Were you hurt badly?
Yes [ ] No [ ]
18) Were you scared that someone else would die?
Yes [ ] No [ ]
19) Were you scared that someone else would be hurt badly?
Yes [ ] No [ ]
20) Was someone else hurt badly?
Yes [ ] No [ ]
21) Did someone die?
Yes [ ] No [ ]
22) Did you feel very scared, like this was one of your most scary experiences ever?
Yes [ ] No [ ]
23) Did you feel that you could not stop what was happening or that you needed
someone to help?
Yes [ ] No [ ]
24) Did you feel that what you saw was disgusting or gross?
Yes [ ] No [ ]
25) Did you run around or act like you were very upset?
Yes [ ] No [ ]
26) Did you feel very confused?

Yes [ ] No [ ]
27) Did you feel like what was happening did not seem real in some way, like
it was going on in a movie instead of real life?
Yes [ ] No [ ]
Here is a list of problems people sometimes have after very bad things happen. Please THINK
about the bad thing that happened to you that you wrote about in Question #14 on the page 2.
Then, READ each problem on the list carefully. CIRCLE ONE of the numbers (0, 1, 2, 3 or 4)
that tells how often the problem has happened to you in the past month. Use the Rating Sheet
on Page 5 to help you decide how often the problem has happened in the past month.
PLEASE BE SURE TO ANSWER ALL QUESTIONS
HOW MUCH OF THE TIME DURING THE PAST MONTH
None
Little
Some
Much
Most
THE
MONTH
1D4 I watch out
forPAST
danger
or things that I am
afraid of.
2B4 When something reminds me of what

happened, I get very upset, afraid, or sad.
3B1 I have upsetting thoughts, pictures, or sounds

of what happened come into my mind when I do
not want them to.
4D2 I feel grouchy, angry or mad.
5B2 I have dreams about what happened or other

bad dreams.
6B3 I feel like I am back at the time when the bad

thing happened, living through it again.
7C4 I feel like staying by myself and not being with

my friends.
8C5
9C1
10C6
I feel alone inside and not close to other

people.
I try not to talk about, think about, or have
feelings about what happened.
I have trouble feeling happiness or love.
11C6 I have trouble feeling sadness or anger.

12D5 I feel jumpy or startle easily, like when I hear
a loud noise or when something surprises me.
13D1 I have trouble going to sleep or I wake up
often during the night.
14AF I think that some part of what happened is my
fault.
15C3 I have trouble remembering important parts of
what happened.
16D3 I have trouble concentrating or paying
attention.
17C2 I try to stay away from people, places, or
things that make me remember what
happened.
happened, I have strong feelings in my body,
like my heart beats fast, my head aches, or my
stomach aches.
19C7 I think that I will not live a long life.
20AF I am afraid that the bad thing will happen
again.
1998 Pynoos, Rodriguez, Steinberg, Stuber, & Frederick
None
Little
Some
Much
Most
SAMPLE FREQUENCY RATING SHEET
HOW OFTEN OR HOW MUCH OF THE TIME

DURING THE PAST MONTH, THAT IS SINCE
____________________,
DOES THE PROBLEM HAPPEN?
NONE
LITTLE
SOME
MUCH
MOST
M T WH F S S M T WH F S S M T W H F S S M T WH F S S M T WH F S
SS
X
X
X
NEVER
X
X
X
X
X
X
X
X
XX XX X XX
X XX X
XX X
TWO TIMES
1-2 TIMES
2-3 TIMES
A MONTH
A WEEK
EACH WEEK
XX
XX
XX XX X XX
EVERYDAY
FREQUENCY RATING SHEET

____________________,
NONE
LITTLE
SOME
MUCH
MOST
M T WH F S S M T WH F S S M T WH F S S M T WH F S S M T WH F S
SS
NEVER
TWO TIMES
1-2 TIMES
2-3 TIMES
A MONTH
A WEEK
EACH WEEK
EVERYDAY
UCLA PTSD INDEX FOR

DSM-IV:
ADOLESCENT VERSION
Name ________________________________
Age _______
Sex (Circle): Girl
Boy
Todays Date (write month, day and year) ________________ Grade in School ___________
School ________________ Teacher _____________________ Town __________________
Below is a list of VERY SCARY, DANGEROUS, OR VIOLENT things that sometimes happen
to people. These are times where someone was HURT VERY BADLY OR KILLED, or could
have been. Some people have had these experiences; some people have not had these
experiences. Please be honest in answering if the violent thing happened to you, or if it did not
happen to you.
FOR EACH QUESTION:
1)
Check "Yes" if this scary thing HAPPENED TO YOU

Check "No" if it DID NOT HAPPEN TO YOU
Being in a big earthquake that badly damaged the building you were in.
Yes [ ] No [ ]
2) Being in another kind of disaster, like a fire, tornado, flood or hurricane.

Yes [ ] No [ ]
3) Being in a bad accident, like a very serious car accident.
Yes [ ] No [ ]
4) Being in place where a war was going on around you.
Yes [ ] No [ ]
6)

Yes [ ] No [ ]
6)
Yes [ ] No [ ]
7)

Yes [ ] No [ ]
8)

Yes [ ] No [ ]
9)

Yes [ ] No [ ]
10) Having an adult or someone much older touch your private sexual body parts
when you did not want them to.
Yes [ ] No [ ]
11) Hearing about the violent death or serious injury of a loved one.
Yes [ ] No [ ]
12) Having painful and scary medical treatment in a hospital when you were
very sick or badly injured.
Yes [ ] No [ ]
13) OTHER than the situations described above, has ANYTHING ELSE ever
happened to you that was really SCARY, DANGEROUS OR VIOLENT?
Yes [ ] No [ ]
14) a) If you answered "YES" to only ONE thing in the above list of questions #1
to #13, place the number of that thing (#1 to #13) in this blank:
# ____________
b) If you answered "YES" to MORE THAN ONE THING, place the number
of the thing that BOTHERS YOU THE MOST NOW in this blank:
#___________
c) About how long ago did this bad thing (your answer to [a] or [b]) happen to
you? ____________
d) Please write what happened:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
FOR THE NEXT QUESTIONS, please CHECK [YES] or [NO] to answer HOW
YOU FELT during or right after the bad thing happened that you just wrote about
in Question 14.
15) Were you scared that you would die?
Yes [ ] No [ ]
16) Were you scared that you would be hurt badly?
Yes [ ] No [ ]
17) Were you hurt badly?
Yes [ ] No [ ]
18) Were you scared that someone else would die?
Yes [ ] No [ ]
19) Were you scared that someone else would be hurt badly?
Yes [ ] No [ ]
20) Was someone else hurt badly?
Yes [ ] No [ ]
21) Did someone die?
Yes [ ] No [ ]
22) Did you feel very scared, like this was one of your most scary experiences ever?
Yes [ ] No [ ]
23) Did you feel that you could not stop what was happening or that
you needed someone to help?
Yes [ ] No [ ]
24) Did you feel that what you saw was disgusting or gross?
Yes [ ] No [ ]
25) Did you run around or act like you were very upset?
Yes [ ] No [ ]
26) Did you feel very confused?

Yes [ ] No [ ]
27) Did you feel like what was happening did not seem real in some way, like
it was going on in a movie instead of real life?
Yes [ ] No [ ]
Here is a list of problems people sometimes have after very bad things happen. Please THINK
about the bad thing that happened to you that you wrote about in Question #14 on the page 2.
Then, READ each problem on the list carefully. CIRCLE ONE of the numbers (0, 1, 2, 3 or 4)
that tells how often the problem has happened to you in the past month. Use the Rating Sheet
on Page 5 to help you decide how often the problem has happened in the past month.
PLEASE BE SURE TO ANSWER ALL QUESTIONS
None
Little
Some
Much
Most
THE
MONTH
1D4 I watch out
forPAST
danger
or things that I am afraid
of.

happened, I get very upset, afraid or sad.
3B1 I have upsetting thoughts, pictures, or sounds of

what happened come into my mind when I do not
want them to.
4D2 I feel grouchy, angry or mad.
5B2 I have dreams about what happened or other

bad dreams.
6B3 I feel like I am back at the time when the bad

thing happened, living through it again.
7C4 I feel like staying by myself and not being with

my friends.

None
Little
Some
Much
Most
8C5 I feel alone inside and not close to other

people.
9C1 I try not to talk about, think about, or have

10C6 I have trouble feeling happiness or love.
11C6 I have trouble feeling sadness or anger.
12D5 I feel jumpy or startle easily, like when I hear

a loud noise or when something surprises me.
13D1 I have trouble going to sleep or I wake up

14AF I think that some part of what happened is my

fault.
15C3 I have trouble remembering important parts of

what happened.
16D3 I have trouble concentrating or paying

attention.
17C2 I try to stay away from people, places, or

things that make me remember what
happened.

happened, I have strong feelings in my body, like
my heart beats fast, my head aches, or my stomach
aches.
19C7 I think that I will not live a long life.
20D2 I have arguments or physical fights.
21C7 I feel pessimistic or negative about my future.
22AF I am afraid that the bad thing will happen

again.
SAMPLE FREQUENCY RATING SHEET

DURING THE PAST MONTH, THAT IS SINCE ____________________,
NONE
LITTLE
SOME
MUCH
MOST
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
X
X
NEVER
X
X
X
X
X
X
X
X
X X X X X X X
X X X X
X X X
X X
X X
X X X X X X X
TWO TIMES
1-2 TIMES
2-3 TIMES
ALMOST
A MONTH
A WEEK
EACH WEEK
EVERY DAY

____________________,
NONE
LITTLE
SOME
MUCH
MOST
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
NEVER
TWO TIMES
1-2 TIMES
2-3 TIMES
ALMOST
A MONTH
A WEEK
EACH WEEK
EVERY DAY
UCLA PTSD INDEX FOR

DSM-IV:
PARENT VERSION
Child's Name ________________________________ Age _______ Sex (Circle): Girl Boy

Person Completing this Form _______________________ Relationship to Child ____________
Todays Date (write month, day and year) ____________________ Grade in School ____________
School ________________ Teacher _____________________ Town __________________
Below is a list of VERY SCARY, DANGEROUS, OR VIOLENT things that sometimes happen to children. These are
times where someone was HURT VERY BADLY OR KILLED, or could have been. Some children have had these
experiences, some children have not had these experiences.
___________________________________________________________________________________________
FOR EACH QUESTION: Check "Yes" if this scary thing HAPPENED TO YOUR CHILD
Check "No" if it DID NOT HAPPEN TO YOUR CHILD_____
1)
Being in a big earthquake that badly damaged the building your child was in.
Yes [ ]
No [ ]
------------------------------------------------------------------------------------------------------------------------------------
2)
Being in another kind of disaster, like a fire, tornado, flood or hurricane.
Yes [
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------3)
Being in a bad accident, like a very serious car accident.
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------4)
Being in place where a war was going on around your child.
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------5)

Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------6)
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------7)
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------8)
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------9)
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------10)
Having an adult or someone much older touch your child's

private sexual body parts when your child did not want them to.
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------11)
Hearing about the violent death or serious injury of a loved one.
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------12)
Having painful and scary medical treatment in a hospital when your child
was very sick or badly injured.
Yes [ ]
No [ ]
-----------------------------------------------------------------------------------------------------------------------------------13)
OTHER than the situations described above, has ANYTHING ELSE ever happened
to your child that was REALLY SCARY, DANGEROUS, OR VIOLENT?
Yes [ ]
No [ ]
Please write what happened: ______________________________________________________________

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
14)
a) If you answered "YES" to only ONE thing in the above list of questions #1 to #13, place the
number of that thing (#1 to #13) in this blank. # ____________
b) If you answered "YES" to MORE THAN ONE THING, place the number of the thing that
BOTHERS YOUR CHILD THE MOST NOW in this blank.
#___________
c) About how long ago did this bad thing (your answer to a or b) happen to your child? __________
d) Please write what happened: ____________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
________________________________________________________________________________________
FOR THE NEXT QUESTIONS, please CHECK "Yes, No, or Do not know" to answer HOW YOUR CHILD FELT
during or right after the experience happened that you just wrote about in Question 14. Only check "Do not Know" if you
absolutely cannot give an answer.
-----------------------------------------------------------------------------------------------------------------------------------15) Was your child afraid that he/she would die?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------16) Was your child afraid that he/she would
be seriously injured?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------17) Was your child seriously injured?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------18) Was your child afraid that someone

else would die?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------19) Was your child afraid that someone else

would be seriously injured?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------20) Was someone else seriously injured?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------21) Did someone die?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------22) Did your child feel terrified?
Yes [ ]
No [
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------23) Did your child feel intense helplessness?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------24) Did your child feel horrified; was what

he/she saw disgusting or gross?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------25) Did your child get hysterical or run around?
Yes [ ]
No [ ]
Do not know [ ]
-----------------------------------------------------------------------------------------------------------------------------------26) Did your child feel very confused?
Yes [ ]
No [ ]
Do not know [ ]
27) Did your child feel like what was happening did not seem real in some way, like it was going on in a movie instead
of real life?
1998 Pynoos, Rodriguez, Steinberg , Stuber & Frederick
Yes [ ]
No [ ]
Do not know [ ]
Here is a list of problems children sometimes have after very stressful experiences. Please think about your child's
stressful experience that you wrote about in Question #14. Then, read each problem on the list carefully. CIRCLE one of
the numbers (0, 1, 2, 3, 4 or 5) that tells how often the problem has happened to your child in the past month. Refer to
the Rating Sheet (on page 5) to help you decide how often the problem has happened. Note: If you are unsure about how
often your child has experienced a particular problem, then try to make your best estimation. Only circle "Do not Know"
if you absolutely cannot give an answer. PLEASE BE SURE TO ANSWER ALL QUESTIONS
None
Little
Some
Much
Most
Do not
Know
1D4 My child watches out for danger or things that

he/she is afraid of.
0
2B4 When something reminds my child of what

happened he/she gets very upset, scared or sad.
3B1 My child has upsetting thoughts, pictures or sounds

of what happened come into his/her mind when
he/she does not want them to.
4D2 My child feels grouchy, angry or mad.
5B2 My child has dreams about what happened or other

bad dreams
6B3 My child has flashbacks of what happened; he/she

feels like he/she is back at the time when the bad
thing happened living through it again.
7C4 My child feels like staying by him/her self and not

being with his/her friends.
8C5 My child feels alone inside and not close to other

people.
10C6 My child has trouble feeling happiness or love.
11 C6 My child has trouble feeling sadness or anger.
9C1 My child tries not to talk about, think about, or have

12D5 My child feels jumpy or startles easily, for example,

when he/she hears a loud noise or when something
surprises him/her.
13D1 My child has trouble going to sleep or wakes up

14AF My child feels that some part of what happened is

his/her fault.
None
Little
Some
Much
Most
Do not
Know
15C3 My child has trouble remembering important parts of

what happened.
0
19C7 My child thinks that he/she will not live a long life.
20AF My child is afraid that the bad thing will happen

again.
16D3 My child has trouble concentrating or paying

attention.
17C2 My child tries to stay away from people, places, or

things that make him/her remember what happened.
18B5 When something reminds my child of what happened,

he/she has strong feelings in his/her body like heart
beating fast, head aches, or stomach aches.
21B1My child plays games or draws pictures that are like

some part of what happened.
SAMPLE

____________________,
NONE
LITTLE
SOME
MUCH
MOST
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
M T W H F S
X
X
NEVER
X
X
X
X
X
X
X
X
X X X X X X X
X X X X
X X X
X X
X X
X X X X X X X
TWO TIMES
1-2 TIMES
2-3 TIMES
ALMOST
A MONTH
A WEEK
EACH WEEK
EVERY DAY

____________________,
NONE
LITTLE
SOME
MUCH
MOST
S M T W H F S
S M T W H F S
S M T W H F S
S M T W H F S
M T W H F S
NEVER
TWO TIMES
1-2 TIMES
2-3 TIMES
ALMOST
A MONTH
A WEEK
EACH WEEK
EVERY DAY
UCLA PTSD INDEX FOR

DSM-IV:
SCORING SHEETS
SCORING WORKSHEET FOR UCLA PTSD INDEX FOR DSM-IV, Revision 1: CHILD VERSION
Subject ID#__________
Age_____
Sex (circle): M
CRITERION A-TRAUMATIC EVENT
# of days since traumatic event _____
PTSD SEVERITY: OVERALL SCORE
Exposure to Traumatic Event
Question # /Score
Questions 1-13: at least 1 Yes answer
YES
NO
Question # /Score
1._____
12._____
2._____
13._____
Type of Traumatic Event rated as most
3._____
[Omit 14].
distressing (Question 14: write trauma
4. _____
15._____
type in the blank)
5._____
16._____
6._____
17._____
7. _____
18._____
8. _____
19._____
9. _____
[Omit 20].
_________________
Criterion A1 met
YES
NO
Criterion A2 met
* 10. or
YES
NO
11._____
(Sum the items from the above 2 columns, write sum below)
Criterion A met
YES
NO
(Sum total
PTSD SEVERITY
of scores) = ______
Peritraumatic Dissociation
YES
Question 27: answer "Yes"
CRITERION B (REEXPERIENCING) SX.
NO
SCORE
*Place the highest Score from either Question 10 or 11 in the

blank above: Score Question 10.____/Score Question 11.____
CRITERION C (AVOIDANCE) SX.
Question #/DSM-IV Symptom
Score
3. (B1) Intrusive recollections
_____
9. (C1) Avoiding thoughts/feelings _____
5. (B2) Trauma/bad dreams
_____
17. (C2) Avoiding activities/people _____
6. (B3) Flashbacks
2. (B4) Cues: Psychological
_____ # of Criterion B
Questions with
15. (C3) Forgetting

7. (C4) Diminished interest etc.
Score
_____ # of Criterion C
_____ Questions with
reactivity
_____ Score > Symptom
18. (B5) Cues: Physiological

reactivity
Cutoff: _____
_____
8. (C5) Detachment/estrangement _____ Scores > Symptom

*10. or 11. (C6) Affect restricted
_____ Cutoff: _____
19. (C7) Foreshort. future
_____
[*Place the highest Score from either Question 10 or 11 in the

blank above.]
CRITERION B SEVERITY
SCORE (Sum of above scores): = _____
CRITERION C SEVERITY
DSM-IV CRITERION B MET:
(Diagnosis requires at least 1 B Symptom): YES
NO
DSM-IV CRITERION C MET:

(Diagnosis requires at least 3 C Symptoms): YES
CRITERION D (INCREASED AROUSAL) SX.

Score
13. (D1) Sleep problems
_____
4. (D2) Irritability/anger
_____
NO
DSM-IV PTSD DIAGNOSTIC INFO.
16. (D3) Concentration problems _____ # of Criterion D

1. (D4) Hypervigilance
12. (D5) Exaggerated startle
DSM-IV FULL PTSD DIAGNOSIS LIKELY
(Criteria A, B, C, D all met)
YES
NO
Cutoff: _____
PARTIAL PTSD LIKELY
CRITERION D SEVERITY
[Criterion A met and:
Criteria (B + C) or (B + D) or (C + D)]
YES
DSM-IV CRITERION D MET:

(Diagnosis requires at least 2 D Symptoms): YES
NO
1998 Robert Pynoos, M.D., Ned Rodriguez, Ph.D., Alan Steinberg, Ph.D., Margaret Stuber, M.D., Calvin Frederick, M.D. All Rights Reserved.
NO
SCORING WORKSHEET FOR UCLA PTSD INDEX FOR DSM-IV, Revision 1: ADOLESCENT VERSION
Age_____
Sex (circle): M
Question # /Score
YES
NO
Question # /Score
1. _____
12._____
2. _____
13._____
3. _____
[Omit 14].
*4. or
15._____
type in the blank)
20. _____
16._____
5. _____
17._____
6. _____
18._____
_________________
Criterion A1 met
YES
NO
Criterion A2 met
YES
NO
7. _____
8. _____
21._____
9. _____
[Omit 22].
**10. or
11._____
Criterion A met
YES
***19. or
(Sum total
PTSD SEVERITY
of scores) = ______
SCORE
NO
Peritraumatic Dissociation
YES
NO
**Place the highest Score from either Question 10 or 11 in the
Question 27: answer "Yes"
***Place the highest Score from either Question 19 or 21 in the

Score
_____
9. (C1) Avoiding thoughts/feelings _____
_____
17. (C2) Avoiding activities/people _____
6. (B3) Flashbacks
15. (C3) Forgetting
Score

reactivity
Questions with

reactivity
Cutoff: _____

*10. or 11. (C6) Affect restricted
_____
_____ Cutoff: _____
**19. or 21. (C7) Foreshortened future
_____

blank above; **Place the highest Score from either Question
19 or 21 in the blank above.]
NO


Score
_____
NO
*4. or 20. (D2) Irritability/anger _____

16. (D3) Concentration problems _____ # of Criterion D
YES
NO
YES
NO
Cutoff: _____
blank above.]
PARTIAL PTSD LIKELY

(Criterion A met and:
Criteria B + C or B + D or C + D)

NO
1998 Robert Pynoos, M.D., Ned Rodriguez, Ph.D., Alan Steinberg, Ph.D., Margaret Stuber, M.D., Calvin Frederick, M.D. All Rights Reserved.
SCORING WORKSHEET FOR UCLA PTSD INDEX FOR DSM-IV, Revision 1: PARENT VERSION
Age_____
Sex (circle): M F
Question # /Score
YES
NO
1. _____
**10 or
2. _____
Question # /Score
11._____
* 3 or
12._____
21. _____
13._____
type in the blank)
4. _____
[Omit 14].
5. _____
15._____
6. _____
16._____
7. _____
17._____
8. _____
18._____
9. _____
19._____ [Omit 20].
_________________
Criterion A1 met
YES
NO
Criterion A2 met
YES
NO
(Sum the items from the above 2 columns, write sum below)
(Sum total
Criterion A met
YES
NO
PTSD SEVERITY
of scores) = ______
SCORE

blank above: Score Question 3. ____/Score Question 21._____
**Place the highest Score from either Question 10 or 11 in the
Score

or
6. (B3) Flashbacks
Score
9. (C1) Avoiding thoughts/feelings_____

____*
21. (B1)Repetitive Traumatic Play

17. (C2) Avoiding activities/people_____

15. (C3) Forgetting
_____

reactivity
Questions with

reactivity
*10. or 11. (C6) Affect restricted _____ Cutoff: _____

19. (C7) Foreshortened future
_____
Cutoff: _____
_____

blank above: Score Question 3 (Intrusive recollections) _____
Score Question 21(Repetitive play) _____
NO


Score
_____
4. (D2) Irritability/anger
_____
NO
16. (D3) Concentration problems_____ # of Criterion D

YES
NO
YES
NO
Cutoff: _____
PARTIAL PTSD LIKELY
(Criterion A met and:
Criteria B + C or B + D or C + D)

NO
1998 Robert Pynoos, M.D., Ned Rodriguez, Ph.D., Alan Steinberg, Ph.D., Margaret Stuber, M.D., Calvin Frederick, M.D. All Rights Reserved .
Sample TF-CBT Treatment Plan

Participant Information
Provider Information
Name: Jane Doe
Therapist: John Smith, MSW, LCSW
MO HealthNet Number: ########
Group NPI Number: ##########
DOB: ##/##/####
Treatment Plan Date: ##/##/####
Other Agencies Involved:
Plan to Coordinate Services:
-Missouri Childrens Division
Therapist will coordinate services with Janes caseworker as appropriate.
Diagnosis:
Axis I:
309.81
PTSD, chronic
Axis II:
V71.09
No diagnosis
Axis III:
V71.09
No diagnosis
Axis IV:
Problems with primary support group, problems related to social

environment
Axis V: Current CGAS=50
Justification for Diagnosis Change: (omit if Initial Treatment Plan)
1. Problem/Symptom: Jane presents with clinically significant symptoms of Posttraumatic Stress Disorder.
Long Term Goal: Jane will experience a clinically significant reduction in PTSD symptoms as demonstrated by
day-to-day functioning and results on assessment measures.
Anticipated completion date: ##/##/####

Date
Established
Current Goals/Objectives: (Add more as needed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Projected
Completion Date
Date Achieved
Jane will demonstrate accurate and healthy knowledge

about trauma & PTSD as evidenced by the retention of at
least 50% of this information when quizzed.
Jane will be able to recognize and talk about some of the
ways that stress/trauma has affected his life.
Ms. Doe, Janes grandmother, will implement a behavior
management system at home such as a reinforcement
chart or time out.
Ms. Doe will learn skills and knowledge (i.e., relaxation,
psychoeducation, affect regulation, active listening,
cognitive coping and processing, safety skills) in parallel
sessions and will demonstrate mastery in joint sessions
with the client.
Jane will learn and successfully practice at least two
relaxation techniques in session and report successful
practice outside of session at least once a week for two
weeks.
Jane will be able to identify and rate her the intensity of
her emotions and explain the meaning of at least seven
emotion words
Jane will be able to verbalize ways in which feelings are
experience physiologically in his body.
Jane will be able to explain the relationship between
thoughts, emotions, and feelings and give one example
of how the three are related.
Jane will write a first draft of her trauma narrative
Jane will revise her trauma narrative to include
additional details
Jane will revise her trauma narrative to include her
thoughts and feelings
Jane will use cognitive processing to modify and
distortions identified via her trauma narrative. She will
report more accurate and/or more helpful beliefs
Jane will process memories of previous traumatic
experiences and will demonstrate significantly reduced
distress during this activity (as measured by SUD).
Jane will report knowing behaviors and information to
enhance her future safety.
Jane reports significant improvement in her day-to-day
functioning at home, school, and in the community,
which is confirmed by her Ms. Does and/or caseworker
and is evident more times than not.
Jane comes up with and implements effective ways to
deal with problems more times than not. Jane talks to
other people respectfully and explains her own point of
view successfully more times than not.
Intervention/Action
Responsible Person(s)
1. John Smith, MSW, LCSW
Intervention/actions:
2.
3.
Responsible Person(s):
2.
3.
2.
3.
2.
3.
Distress tolerance training
Gradual exposure to traumatic experiences
Cognitive processing/restructuring
Review Date:
Progress: (omit if Initial Treatment Plan)
Review Date:
Progress:
Involvement of Family: Janes grandmother, Ms. Doe, is actively involved in Janes treatment.
Services Needed beyond scope of organization or program: N/A
Estimated Completion date for level of care: ##/##/####

Date:
Therapist Signature:
Therapist Name/Title: (Print) John Smith, MSW, LCSW
TF-CBT Fidelity Checklist

*Modality
Individual session with child: IC
Individual session with parent: IP
Conjoint session with client and parent(s): con
Family Session: FS
TF-CBT Techniques
a. Psychoeducation
b. Parenting Skills
c. Relaxation
d. Affective Expression
and Regulation
e. Cognitive Coping and
Processing
f. Trauma Narrative
g. Traumatic Grief
h. In Vivo Exposure
i. Conjoint Parent-Child
Treatment
j. Enhanced Safety Skills
Session Dates
*Modality
Notes
TF-CBT Tracking Form-Treatment Steps

Treatment Phases
Parenting/Behavior Management
o Behavioral problems
o Id specific problem
o Modeled how to praise
o Taught active ignoring
o Role played strategies
o Systematically measured goals
o Others experience trauma
o Provided info about post trauma
o Talked about who perpetrates
o Provided fact sheet
o Assessed clients understanding
o Reviewed information
o Played psychoeducation game
Emotion Id and expression
o Talk about feelings to assess skill
o Expand feelings vocab
o Improve expression of feelings
o Identified physiological response
o Worked w/caregiver to prepare
for further support
Coping skills (regulation)
o Mindfulness
o Grounding
o Deep breathing
o Muscle relaxation
o Guided meditation
o Thought stopping
o Positive self-talk
o Had client use own strategy
o Had youth teach caregiver
Cognitive Coping
o Taught cognitive triangle
o Provided relevant examples
o Practiced scenarios
o Explained cognitive distortions
o Taught caregiver cognitive
triangle
o Helped caregiver id thoughts
o Coping statements with
caregiver
Date
Crisis of the Week
Homework/Modality Notes/Suggestions
TF-CBT Supervisors Clinical Adherence

Checklist
Therapist: _____________________ Session date: __________ TF-CBT session number: ___
Indicate whether component was addressed in given session and estimate the level of skill in
adherence to each component.
Skill rating: (-) = needs improvement; (0)= adequately addressed; (+)= addressed with
enhances skill or creativity.
Please use comments section when scoring at (-) or (+) level.
This session was with (circle): Parent
Child
Conjoint parent/child
TF-CBT Component
Demo
Y / N (-)
(P) Psychoeducation: about TFCBT model, about abuse, typical

reactions, normalizing reactions,
safety skills, healthy sexuality
Parenting Skills: responding to
behavior (praise, active ignoring,
quiet time, etc.), effective
communication
(R) Relaxation Skills: focused &
deep breathing, mindfulness,
muscle relaxation
(A) Affective Expression &
Regulation: feelings vocabulary,
identification, expression and
management
(C) Cognitive Coping & Processing:
cognitive triangle, skills for (+) vs.(-)
focus on events, ID and correct
inaccurate attributions, self/world
view, (+) self-talk, learned
optimism, distraction techniques,
coping with feelings
Skill Rating:
(0)
(+)
Comments:
TF-CBT Supervisee Rating Form

Please rate your supervisor on each of the items below using the following scale:
1
Not at all
2
A little/rarely
3
Somewhat
4
Often
5
Almost Always
Please circle the appropriate number on the right.
1. My supervisor effectively helps me identify children for

whom TF-CBT would be a good fit.
2. My supervisor encourages me to directly discuss traumatic

experiences with children in treatment sessions.
3. My supervisor helps me prioritize which trauma to address

1
for children who have experienced multiple types of traumatic events.
4. My supervisor helps me implement TF-CBT in culturally

competent ways and for culturally diverse clients.
5. My supervisor helps me prioritize problems with families

that have multiple problems and crises.
6. My supervisor is able to provide me with several alternative

ways of implementing each of the TF-CBT components.
7. My supervisor is able to structure and process group

supervision effectively.
8. My supervisor is skillful at balancing issues of flexibility

and fidelity to the TF-CBT treatment protocol.
POINTS TO MAKE WHEN EDUCATING CHILDREN

AND FAMILIES AND TRAUMA AND TF-CBT
The child is having significant PTSD or other trauma-related symptoms (e.g.,

depression, anxiety, sexual behavior problems based on the clinical assessment
that has been completed prior to treatment initiation).
Clinical experience and research both suggest that these PTSD and other traumarelated symptoms need to be addressed as early as possible to prevent long-term
difficulties.
Talking directly about the trauma is important in resolving these difficulties and
integrating the experience into the childs life in an optimal way (e.g., similar to
taking out a splinter or cleaning a wound).
This component will be implemented in a gradual, supportive manner so that the
child will be able to tolerate the discomfort associated with such discussion;
furthermore, it will typically not be initiated until the child has learned some skills
to help him/her cope with the discomfort.
The therapist will work in collaboration with the caregiver throughout treatment,
and the therapist welcomes the caregivers suggestions at any time.
People of different religions, ethnicities, and cultures have different ways of
expressing and dealing with trauma responses; the therapist is eager to learn from
the child and caregiver the traditions of their culture, religion, and family and will
remain respectful of these in the treatment process.
How Stress and PTSD Affect Our Bodies

Stress and trauma can affect us by stimulating the production of
chemicals and causing changes in our brains. The good news is that all of these effects
can be reduced through the use of relaxation.
The amygdala is responsible for assigning emotional meaning to the things we hear,
see, smell, and feel. Trauma can cause the amygdala to start giving more emotional
meaning to things. For example, after a traumatic event, things that we usually would
not see as being scary are now labeled scary by the amygdala.
The prefrontal cortex is responsible for extinguishing learned fear responses. However,
trauma can cause the prefrontal cortex to become less active, which makes it harder to
get over things that scared us in the past, even when there is no more danger.
In response to stress, the brain increases production of the neurotransmitter
norepinephrine (also called noradrenaline), which leads to an increased presence of
epinephrine (also called adrenaline). Increased levels of cortisol and epinephrine lead to:
Increased heart rate

Pounding heart
Shortness of breath
Sweating
Weakness, dizziness
Muscle tension
Stomach upset
Skin rashes
Fight, flight, or freeze response
Also in response to stress, the hypothalamus produces a chemical called CRF. CRF
stimulates the pituitary gland to release a chemical called ACTH. ACTH then acts on the
adrenal glands to increase the production of cortisol.
Cortisol stops the brain from doing a lot of things. This can be good in the moment of
crisis, but cortisol is bad news at all other times. People who have experienced severe
traumas often have cortisol levels higher than the rest of us. It is believed that effective
treatment for the trauma and increases in life stability can restore normal cortisol levels.
DOMESTIC VIOLENCE INFORMATION FOR CAREGIVERS

WHAT IS DOMESTIC VIOLENCE?
Domestic violence is a pattern of control over the behavior, emotions, and choices of a
partner. The methods of control can include physical abuse, sexual abuse, psychological
abuse, financial abuse, social restrictions, and the destruction of property and/or family
pets. Other terms that are often used when referring to domestic violence include, but
are not limited to, spouse abuse, intimate partner violence, and battering. Regardless of
the term used, domestic violence is a social problem where ones property, health, or
life is endangered as a result of the intentional behavior of a partner. Current estimates
are that in heterosexual relationships, domestic violence is most frequently committed
by men against women. Domestic violence is as frequent in gay and lesbian
relationships as in heterosexual ones. Domestic violence is also believed to be largely
unreported.
WHAT ARE THE EFFECTS OF DOMESTIC VIOLENCE ON CHILDREN?
Being exposed to domestic violence affects childrens emotional, developmental and
physical well-being. These children are more likely to be abused themselves, may be
caught in harms way during a violent episode and be inadvertently injured, may
experience behavioral problems related to anger, aggression, and oppositional
behaviors, and are more likely to experience depression and anxiety than other children.
They also tend to spend less time with their friends and are less likely to have a best
friend. At school, children exposed to domestic violence may present with elevated
rates of behavior problems, hyperactivity, social withdrawal and learning difficulties.
Many of these children develop symptoms of posttraumatic stress disorder (PTSD)

due to exposure to domestic violence. These symptoms include, but are not
limited to, distressing memories and/or nightmares of the violence; efforts to avoid
thoughts, feelings, or conversations that may remind them of the violence; diminished
interest in activities that were once pleasurable; social isolation; difficulty falling or
staying asleep; difficulty concentrating; and anger outbursts.
Children exposed to domestic violence are also at a higher risk of being exposed to
other forms of abuse. It is currently estimated that 50% of perpetrators who abuse their
spouses also abuse their children. These children have also been found to be at a higher
risk of being emotionally abused and sexually abused than other children.
Exposure to domestic violence may also cause other long-term effects such as an
increased risk of entering the juvenile justice system, attempting suicide, committing
sexual assault crimes, and abusing drugs and alcohol. There is also an increased risk of
becoming victims of abuse as adults and of developing distorted belief systems in regard
to relationships, personal responsibility, violence and aggression, and sex-role
expectations.
Every child responds to domestic violence exposure differently due to the influence of
such characteristics as age, length of time the abuse had occurred, frequency and
severity of the abuse, the childs relationship with the abuser, type of abuse, support
system available to the child, and the childs overall resiliency and vulnerability.
HOW COMMON IS DOMESTIC VIOLENCE?
Domestic violence occurs across all races, religions, ethnicities, and economic groups. It
is estimated that more than 1 million women are victims of domestic violence every
year, with a high percentage of these assaults being witnessed by one or more children.
In other words, more than 3 million American children are exposed to domestic violence
each year.
WHAT ARE SOME COMMON BEHAVIORAL SYMPTOMS OF A CHILD WHO HAS BEEN
EXPOSED TO DOMESTIC VIOLENCE?
Bullying, physical aggressiveness, and insulting behavior toward peers.
Withdrawal from peers and social contacts, and overall poor peer relationships.
Difficulty separating, especially from the battered caregiver.
Oppositional and defiant behaviors with authority figures, especially with the
battered caregiver.
Increased verbal aggressiveness/talking back.
Bed-wetting, daytime accidents, baby talk, or other regressive behaviors.
Difficulty focusing and learning while at school.
Loss of appetite or changes in eating patterns.
Failure to thrive in infants.
Nightmares, insomnia, or other sleep problems.
Increased violent behavior toward siblings and peers.
Running away from home.
Role reversal: taking on caregiver role.
WHAT ARE SOME BEHAVIORAL SYMPTOMS IN PRETEENS AND TEENAGERS WHO HAVE
BEEN EXPOSED TO DOMESTIC VIOLENCE?
Physically, verbally, or sexually abusing their dating partners.
Being victimized physically, verbally, or sexually by their dating partners.
Violence toward the battered caregiver/imitating words and behaviors of the
abuser.
Acting as the battered caregivers protector.
Drug and/or alcohol abuse.
Poor peer relationships and choices.
WHAT ARE SOME EMOTIONAL SYMPTOMS OF EXPOSURE TO DOMESTIC VIOLENCE?
Increased nervousness, anxiety, and fear.

Depressed mood and suicidal thoughts.
Insecurity.
Feeling responsible for protecting the battered caregiver and siblings.
Excessive worry about the safety of others.
Embarrassment (not wanting peers to be aware of family violence).
Resentment toward the battered caregiver and siblings.
Fear of day-to-day arguments.
Fantasies of standing up to, or hurting, the abuser.
Confusion regarding loyalty to both the abusive and abused caregiver.
WHO PERPETRATES DOMESTIC VIOLENCE?

A perpetrator or batterer is a person who exercises a pattern of coercive control in a
partner relationship, with one or more acts of intimidating physical violence, sexual
assault, or threatening physical violence. This pattern may be manifested in the form of
psychological control, economic control, sexual coercion, or primarily through physical
violence. Although there are batterers in both sexes, most are male. Even though the
batterer may be violent only toward his (or her) partner, he (or she) is also the person
responsible for exposing the child to the violence. Battering is not due to impulse
control problems, drinking problems, or anger management problems. It is a problem
of intentional, repeated coercive controlling behavior that one partner exerts over the
other in an intimate relationship. For this reason, anger management, Alcoholics
Anonymous, or couple therapy are not the appropriate treatments to stop domestic
violence.
HOW CAN I HELP MY CHILD?
Tell him/her that abusive behavior is wrong.
Reassure your child that none of the violent episodes were in any way his/her
fault.
Remind your child how much you love him/her.
Develop a safety plan to prepare for crisis situations.
Encourage your child to talk about his/her feelings.
Prepare to get extra help for your childs schooling.
Seek help from a mental health professional.
This information comes from the book, Treating Trauma and Traumatic Grief. This book has been purchased
for or by you and therefore is reprinted here for you to use for your own personal use. It cannot be
reproduced for other reasons.
DOMESTIC VIOLENCE INFORMATION FOR CHILDREN

WHAT DOES DOMESTIC VIOLENCE MEAN?
Domestic violence means that one adult family member is hurting another family
member. This hurt can occur when an adult pushes, shoves, hits, slaps, punches, or
uses objects to hurt another family member. The hurting can also occur through name
calling, not allowing someone to do what he/she wants, making a person do things that
he/she doesnt want to, and by threatening to push hit, slap, or even kill the person.
This can all seem very scary, but the most important thing to remember is that when
adults fight, it is never the childs fault. Children cannot stop the fighting between the
adults in their home, no matter how good they are.
ARE THERE A LOT OF KIDS WHO WITNESS DOMESTIC VIOLENCE IN THEIR HOMES?
Yes. More than 3 million kids see this violence in their homes every year. This means
that there are lots of children who see and hear adult family members hurting one
another.
WHAT CAN KIDS DO TO HELP THEMSELVES WHEN THEY WITNESS THIS KIND OF
VIOLENCE IN THEIR HOMES?
1. When there is no fighting, they can talk to their caregivers about how it feels
when one caregiver hurts another.
2. Plan with their caregivers to have a safe house or place where they can go
when their caregivers are fighting.
3. Come up with a safety plan with the battered caregiver in case of emergencies.
4. Talk to a grandparent, aunt or uncle, a grown-up friend, a friends parents, or a
family helper about how they feel when their parents fight.
5. Draw pictures of what they are feeling.
6. Do things that make them happy, such as reading favorite books, playing board
games or video games, watching TV shows, and talking to friends on the phone
(or visiting them).
7. Remember that they are not the reason one caregiver is abusing the other.
WHAT CAN KIDS DO IF THEY ARE FEELING UNHAPPY OR SCARED, EVEN IF THEY NO
LONGER LIVE WITH THE PERSON WHO WAS VIOLENT TO THEIR ABUSED CAREGIVER?
1. Talk to the abused caregiver or other trusted adult about how it feels when
they saw or heard the violence in their home.
2. Talk to the abused caregiver or other trusted adult about what it feels like now
that things are different, even if the feelings are confusing.
3. Talk to a family helper about all of these confusing feelings.
4. Do things to help them feel happy, such as drawing, reading, coloring, playing
board games, playing video games, watching TV, playing sports, and spending
time with family and friends.
5. Remember that no matter what happened between their caregivers, it was not
their fault.
CHILD PHYSICAL ABUSE INFORMATION FOR CAREGIVERS

WHAT IS CHILD PHYSICAL ABUSE?
The National Center on Child Abuse and Neglect defines child physical abuse as the
physical injury of a child by a person responsible for the childs welfare. The most
common ways children experience physical abuse are by being beaten, being burned,
being thrown, and being shaken. But the number of ways children are injured by adults
is unlimited. It can involve things like being locked in a cage or being forced to eat feces.
WHAT ARE THE EFFECTS OF CHILD PHYSICAL ABUSE?

Many studies have attempted to understand the effects of child physical abuse on
children. The most consistent finding is that children who experience physical abuse are
at risk of becoming aggressive toward others and developing conduct problems.
Children who have experienced physical abuse are more likely to have problems taking
the perspective of another child (empathy), are more likely than other children to see
hostile intent in other peoples actions, and have a harder time developing alternatives
to fighting. Children who have experienced physical abuse are also of greater risk of
developing problems like anxiety or depression. Some of these children may develop
problems in behavior and in feelings.
HOW COMMON IS CHILD PHYSICAL ABUSE?

Estimates of child physical abuse range from 1.5 kids per 1000 to 2.5 kids per 1000 being
physically abused each year. This may sound like a small number, but it translates to
millions of children who experience physical abuse in their lifetimes.
WHO PHYSICALLY ABUSES CHILDREN?

It is not possible to predict who is going to physically abuse a child because the causes of
child physical abuse are many. Children who grow up in families where there is a lot of
stress, substance abuse, psychiatric problems and other forms of violence are at risk of
being physically abused. We know that homes where a parent is being abused by a
domestic partner are particularly risky places for children to also be abused. When there
is physical abuse going on in a home, there are often other problems. People who
physically abuse children are often not skilled at nurturing, loving and stimulating.
Parents who abuse children may be poor at understanding a childs intentions. For
example, they may assume children wet the bed, cry or ask for attention because they
are trying to annoy the adult. Other parents who maltreat may have misguided views of
what is helpful to the child, assuming that physical abuse will teach a child a lesson. The
lesson it often teaches is to be afraid of adults.
HOW CAN I HELP MY CHILD WHO HAS BEEN PHYSICALLY ABUSED?
Tell him/her that abusive behavior is wrong.

Reassure your child that none of the physical abuse was in any way his/her fault.
Remind your child how much you love him/her.
Develop a safety plan to keep your child away from adults who have been abusive
or when these adults are at greater risk of abusing your child.
Encourage your child to talk about his/her feelings.
Prepare to get extra help for your childs schooling.

Seek help from a mental health professional.
CHILD PHYSICAL ABUSE INFORMATION FOR CHILDREN

WHAT DOES PHYSICAL ABUSE MEAN?
Physical abuse means that an adult who is supposed to care for and protect a child
injures that child by beating the child, burning the child, throwing the child, shaking the
child or hurting them in some other way.
ARE THERE A LOT OF KIDS WHO ARE PHYSICALLY ABUSED?
Yes. Hundreds of thousands of children are physically abused each year.
WHAT CAN KIDS WHO LIVE WITH PEOPLE WHO ABUSE THEM DO?
1. They can talk to an adult that they trust and who doesnt hurt children
about what has happened to them and how they feel.
2. Call 911 if they are in danger.
3. Plan with their caregivers to have a safe house or place they can go when
someone in their home is angry and may want to hurt a child.
4. Draw pictures of what they are feeling.
5. Do things that make them happy, such as reading favorite books, playing
board games or video games, watching TV shows, and talking to friends on
the phone (or visiting them).
6. Remember that they are not the reason that they have been hurt.
WHAT CAN KIDS DO IF THEY ARE FEELING UNHAPPY OR SCARED, EVEN IF THEY NO
LONGER LIVE WITH THE PERSON WHO ABUSED THEM?
1. Talk to a trusted adult about how it felt to live in a place that was unsafe.
2. Talk to a trusted adult about what it feels like now that things are different,
even if the feelings are confusing.
3. Talk to a family helper about all of these confusing feelings.
4. Do things to help them feel happy, such as drawing, reading, coloring, playing
board games, playing video games, watching TV, playing sports, and spending
time with family and friends.
5. Remember that no matter what happened between their caregivers, it was not
their fault.
CHILD SEXUAL ABUSE INFORMATION FOR CAREGIVERS

WHAT IS CHILD SEXUAL ABUSE?
Child sexual abuse is often defined as contacts or interactions between a child and an
adult in which the child is used for the sexual gratification of the offender or another
person. Sexual abuse may also be committed by a person under the age of 18 when the
person is either significantly older than the child or is in a position of power or control
over that child. Most often, sexual abuse involves some direct physical contacte.g.,
sexualized touching and/or kissing; fondling; rubbing, and/or fondling, rubbing, and/or
penetration of the vagina or anus with the fingers; oral sex; and simulated intercourse
or penile penetration of the vagina or anus. Some sex offenders gratify themselves by
exhibiting their genitals to a child or by observing or filming a child removing his or her
own clothes.
Children are often engaged in these sexually abusive activities by playful coaxing (e.g.,
This will be our special secret) or bribed with offers of money, candy, and favors.
Sometimes they are bullied or threatened. On some less frequent occasions, physical
force or violence may be used. It is important to remember that whether or not the
child is actually hurt, whether or not the child objects, and whether or not the child
likes it, such sexual engagement by an adult or a coercive older child is considered to be
child sexual abuse.
WHAT ARE THE CONSEQUENCES WHEN CHILDREN EXPERIENCE SEXUAL ABUSE?
Children who have endured sexual abuse may experience a wide range of emotional
and/or behavioral reactions to the abuse. The nature and severity of these difficulties
may depend upon the age of the child, the identity of the offender, the circumstances of
the abuse, and the familys reaction to the childs disclosure. Children may exhibit
symptoms indicative of anxiety and distress, such as wetting the bed, withdrawn or
acting-out behavior, nightmares, difficulty in school, and running away. These
difficulties are similar to the problems exhibited by children who have experienced any
kind of trauma. Children may also exhibit symptoms that are more specific to sexual
abuse, such as repetitive sexual talk and play, age-inappropriate sexual behavior and
fears of specific situations or people that remind them of the abuse. Additionally, some
children do not exhibit any apparent difficulties as a result of their traumatic experience.
Once the abuse has been disclosed and stopped, some children return to relatively
normal behavior and emotions. The support and protection of people close to them are
very important in helping them get back to normal. However, some children have
symptoms that persist long after the abuse itself has ended. In fact, a significant
number of children who have experienced sexual abuse exhibit posttraumatic stress
symptoms. Therefore, it is important for a child who has experienced sexual abuse to
receive a psychological evaluation and, if necessary, treatment.
WHAT KIND OF TREATMENT IS AVAILABLE FOR CHILDREN WHO HAVE EXPERIENCED
SEXUAL ABUSE?
Many therapy formats have been used to help children overcome the effects of sexual
abuse. These include individual, family and group therapy formats. The therapy
techniques used have been derived from a wide range of psychological theories,
including psychodynamic, behavioral, cognitive, insight-oriented, structural and
strategic theories of family therapy. There has been only limited research regarding the
effectiveness of these varying approaches in assisting children to deal with the
difficulties they experience as a result of sexual abuse. However, there is considerable
research indicating that cognitive-behavioral therapy, applied in both individual and
group settings, effectively decreases the problems experienced in the aftermath of
sexual abuse.
Cognitive-behavioral interventions have been successful in helping children who have
been sexually abused as well as their non-offending caregivers. The cognitivebehavioral therapist may help non-offending caregivers cope with their own thoughts
and feelings about their childs abuse. At the same time, they teach caregiver skills
that help caregivers respond more effectively to their childrens disclosures and
abuse-related difficulties. Cognitive-behavioral interventions are individually
tailored to target the particular childs difficulties and include educational, coping
skills, and processing exercises. Processing exercises encourage children to
confront memories, thoughts, and everyday reminders (e.g., bathrooms, sleeping

alone, undressing, showering) of the abuse in a graduated fashion over time.
Discussion, doll play, drawing, reading, writing, poetry, singing, etc., may be used in the
process. By reducing the anxiety associated with abuse-related discussion, these
therapy activities help children who have experienced sexual abuse to express their
thoughts and feelings more openly, thereby enhancing their understanding and
emotional processing of the abusive experience(s).
Finally, it is important for caregivers to know that the research in the field of child sexual
abuse has repeatedly demonstrated that the most important factor influencing
childrens psychological adjustment following sexual abuse is the degree of support they
receive from caregivers and other adults. With strong emotional support from caring
adults and effective medical and mental health intervention, children who have
experienced sexual abuse can look forward to healthy, satisfying and fulfilling futures.
WHO IS SEXUALLY ABUSED?
Child sexual abuse cuts across all social classes and racial and religious groups. Both
boys and girls are victimized, and it is not a very rare occurrence. Our best estimates
suggest that, by the age of 18, one of every four females and one of every seven males
have been subjected to some form of sexual abuse.
WHO SEXUALLY ABUSES CHILDREN?
Although a small percentage of sex offenders are women, the majority are male. Sex
offenders are generally not dirty old men or strangers lurking in alleys. They usually
are not obviously mentally ill or retarded. In fact, sex offenders are often well known
and trusted by the children they abuse. Offenders are often family members (e.g.,
cousin, uncle, parent, stepparent, grandparent) or individuals who are unrelated but
well known to the child (e.g., a neighbor, coach, babysitter). There is no clear cut
description or profile for a sex offender, and there is no way to recognize a potential
abuser. For this reason, it is often hard to believe that a trusted individual would be
capable of sexually abusing children.
Some offenders have been sexually abused themselves as children. Others have
suffered other forms of abuse and neglect in childhood. Some may be unable to
function sexually with adult partners and may have many different encounters with
children. Others are able to maintain sexual relationships with adults, but may turn to
children for gratification during times of stress. A small percentage of offenders sexually
abuse children while the offender is under the influence of drugs or alcohol.
WHY DOES SEXUAL ABUSE OCCUR?
Although the question as to why sexual abuse occurs is frequently asked by children and
their caretakers, there is no simple answer. The main point to remember is that children
and adolescents who have experienced sexual abuse and their non-offending caregivers
are not to blame. The responsibility for sexual abuse rests squarely on the shoulders of
the sex offender, regardless of the problems which may have contributed to his/her
abusive behavior.
Our society is generally uncomfortable with sexuality and has made limited efforts to
prevent child sexual abuse; these attitudes may also be responsible for keeping the
problem hidden for so long. For this reason, it is essential that we communicate our
concerns about child sexual abuse clearly and openly. As a society, we must become
more aware of the seriousness and prevalence of the problem, and we must increase
our present efforts to address this problem worldwide.
WHY DO NOT CHILDREN TELL US WHATS HAPPENING?
Child sexual abuse is, by its very nature, secretive. It almost always occurs when a child
is alone with an offender. In order for the sexual activity to continue, offenders rely on
the children to keep the secret. There may be direct threats of physical harm to the
children and/or to their pets, family members, etc., if they tell. Often children are led to
believe that the abuse is their own fault and that they will be blamed, rejected or
disbelieved if they tell. They feel embarrassed, ashamed, and fearful about the abuse as
well as the secrecy. In fact, many children who have experienced sexual abuse grow
to adulthood without ever telling anyone because they fear rejection, punishment,
or retaliation.
WHEN SHOULD YOU SUSPECT CHILD SEXUAL ABUSE?
Because of the secretive nature and wide range of behavioral reactions of children,
child sexual abuse is a difficult problem to detect. Children who have been
sexually abused, however, are most often identified as a result of their own
accidental or purposeful disclosures. Some children accidentally reveal their abuse by

exhibiting adult-like sexual behaviors or by sharing sexual knowledge that is beyond
their years. Some children may make a vague disclosure or tell a friend who then tells
an adult. Caregivers should be aware of sudden changes in behavior: nightmares,
withdrawal, avoidance of particular persons, places, or things, unusual aggressiveness,
jumpiness, and/or inappropriate sexual behavior. These behaviors may suggest the
presence of a wide range of possible traumatic difficulties that need to be explored.
Childrens reactions to the person who abuses them are quite varied. One cannot
determine if sexual abuse is occurring by observing the child and alleged offender
together. Some children are fearful and/or avoid their offenders; others talk very
negatively about the offender but behave positively to him/her. Still others remain very
attached and loving to an offending parent or caretaker. Whether they are positive,
negative, or ambivalent, the childs feelings toward the offender should be accepted.
Children need to know that none of their feelings are wrong.
Teaching your child personal safety skills and maintaining open lines of communication
within the family may increase the likelihood that your child would disclose sexual abuse
and/or other traumatic childhood experiences, if experienced.
HOW CAN YOU REDUCE A CHILDS RISK OF SEXUAL VICTIMIZATION?
In general, it is important to maintain open lines of communication with children.
Specifically, children should receive age-appropriate sex education as well as
information about sexual abuse. Just as we teach our children about fire prevention, we
also need to teach them about child sexual abuse. Children should be taught, in a
matter-of-fact way, that their bodies belong to them and that they have the right to say
no to a not OK touch. They need to be taught that they can tell an adult about any
touching that makes them feel uncomfortable or that they think is not OK. In
addition, children and adolescents can be taught how to make safe decisions about
where they go and what they do when there is no parental or adult supervision.
It is important to remember, however, that it may be extremely difficult for a child or an
adolescent to stop, or tell about, sexual abuse. Therefore, a child or adolescent should
never be blamed for not stopping the abuse from happening or for waiting a while
before telling about it. Many children never tell, and most children do not tell the right
way.
HOW SHOULD YOU RESPOND IF YOU SUSPECT CHILD SEXUAL ABUSE?
It is natural for caregivers to feel quite distressed upon discovering that their child may
have been sexually abused. However, the most important action to take as a caregiver
is to try to remain calm. Children, including adolescents, are very sensitive to caregiver
emotional reactions, and if they see or feel how upset or angry you are, they may be
very frightened and clam up. You want to convey to your child that it is good that
he/she has told you. If you cannot question your child calmly by yourself, it is better to
wait for help from a professional. Be careful not to say anything that sounds like you
blame him/her, and be sure to emphasize that the abuse is not his or her fault. Some
children report that the sexual contact felt good. This does not mean that the child is, in
any way, to blame or that the child should feel guilty for having enjoyed the sexual
interaction and/or the offenders attention. Sometimes children who have been
victimized may even initiate sexual behavior with other adults. However, it is always
the adults responsibility to set appropriate limits.
Do not encourage your child to forget about it and shut off the conversation. On the
other hand, it is not helpful to push the child beyond what he/she is ready to say. Just
be open to whatever your child can tell you and to any questions he/she may ask. Try to
understand that the child may have mixed feelings about the offender and what has
happened. Although you may feel like keeping your child at your side continually for
protection, it is important that you not be overly restrictive and that you help your
family return to as normal a routine as possible. It is also important not to be afraid to
show your child your normal expressions of affection and physical closeness.
Sometimes this is difficult, especially for non-abusive fathers. But you do not want to
give the child the impression that your feelings about him/her have changed
because of what has happened.
Children who may have been sexually abused should undergo a specialized
physical examination that includes the genital area. Although children may feel
hurt by the sexual abuse, their bodies usually remain unchanged. Well-trained
physicians can reassure children that their bodies are OK.
WHERE SHOULD YOU GO FOR HELP?

Anyone who suspects that a child has been sexually abused should contact the
child protection agency in his/her state. Most states have a 24-hour toll-free
number for this purpose. (Here is a link to the Child Welfare Information
Gateways website, which lists child abuse reporting numbers by state:
http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=1111172). You may remain anonymous, but the caseworker will ask you important
questions about the child, the possible offender, and the circumstances. The
agency will most likely investigate the sexual abuse allegations and provide
guidance and help to the child and family.
CHILD SEXUAL ABUSE INFORMATION FOR CHILDREN

WHAT IS CHILD SEXUAL ABUSE?
Child sexual abuse occurs when an adult or older child touches or rubs and childs
private parts (penis, testicles, vagina, bottom, breasts), or when an adult or older child
asks a child to touch the other persons private parts. This kind of touching is not OK.
The person who does this is called a sex offender. The offender might make the child do
these things and be rough, or he/she might pretend it is a game or even give the child a
reward to do it. The offender could be someone known to the childa relative, a family
friend, a teenager, or another child. Still, it is not OK even if the person tries to make it
fun, and the child thinks it is fun.
WHO IS SEXUALLY ABUSED?
Sexual abuse happens to a lot of children. It can happen to boys and girls of all ages,
religions and races. Some children who have been sexually abused are rich, some are
poor, and they are all from different neighborhoods. By the age of 18, one of every four
girls and one of every seven boys may have experienced sexual abuse.
WHO SEXUALLY ABUSES CHILDREN?
Some people sexually abuse children, but many more people only touch children with
not OK touches. Most sex offenders are men, though some are women. Children
cannot tell by the way these people look, dress, or act that they are offenders. Most of
the time, the offender is not a stranger but someone whom the child knows very well.
The offender could be a family member (such as a cousin, uncle, parent, or grandparent)
or someone who is well known to the child (such as a coach, babysitter, or neighbor).
WHY DONT CHILDREN TELL?

Sometimes the offender tells the child to keep the not OK touching a secret. The
offender may use tricks to keep the child from telling. The person may say that it is the
childs fault or that the child or his/her family will get hurt if the child tells. These are all
tricks. Sometimes children just keep it a secret because they feel ashamed,
embarrassed, or scared. For those reasons, many children do not tell about sexual
abuse or they take a little while to gain the courage to tell. It helps the children to keep
telling adults until they find an adult who will help them to stop the sexual abuse.
WHY DOES SEXUAL ABUSE HAPPEN?
There are a lot of different reasons, just like there are lots of different offenders. But it
is very hard to know the reason why it happens to any child. We do know this much: No
child is responsible for what an adult does.
HOW CAN YOU TELL THAT A CHILD HAS BEEN SEXUALLY ABUSED?
You cannot tell by looking at a child that he/she has been sexually abused. Sometimes
you can tell by the way the child is acting that something is bothering him/her, but you
do not know what it is. That is why it is so important for children to tell somebody when
they experience a not OK or confusing touch.
HOW DO CHILDREN FEEL WHEN THEY HAVE BEEN SEXUALLY ABUSED?
Children may have all kinds of feelings in response to sexual abuse. The sexual touching
may feel good to some children, and they may still like the person who did it. But some
children have other feelings; they are very angry at the person who did the abuse or are
scared of him/her. Other children might feel guilty about what happened. Any of these
feelings are OK. Sometimes when people have these feelings, the feelings affect the
way they behave. A child who is afraid may not want to sleep alone or be left alone.
Sometimes children get into more arguments, and some may just feel sad and want to
be alone. Some children feel upset for a long time after the abuse has ended but often
feel better with the help of counseling. If children are having a hard time with these
feelings, talking with a counselor or caregiver can help them feel better.
HOW CAN CHILDREN RESPOND TO CHILD SEXUAL ABUSE?

All children need to know that their body belongs to them. If you feel uncomfortable in
the way you are being touched, you can tell the person NO! Saying NO! can
sometimes be hard to do, especially if you are scared, shy or embarrassed. But the next
and most important thing to do is GO TELLalthough this can also be hard to do, it is
important to tell an adult (such as a caregiver, other family member, or a teacher) about
what happened. It is important to keep telling until someone listens and helps.
Remember the steps: NO-GO-TELL!
It is great to talk to a counselor or a caregiver. It helps to talk about sexual abuse, even
though it can be hard. Talking, writing, and even singing and drawing can help children
who have been sexually abused feel better after awhile.
It is important to tell adults about child sexual abuse so that they can get help. There is
a special agency in every state that is available to help children who have experienced
abuse.
DIAPHRAGMATIC or BELLY BREATHING
Sit or lie comfortably.

Put one hand on your chest and one hand on your diaphragm or belly.
Breathe from the belly, not the chest.
Breathe in through your nose.
Breathe out through your pursed lips.
Notice your belly expand like a balloon as you inhale and deflate as you exhale.
Try to breathe in and out smoothly.
Breathe at a comfortable rate (usually about 8-12 breaths per minute).
Inhale a normal amount of air, not huge breaths.
Count 1 as you inhale and think relax as you exhale. Count up to 10 on your
inhalations and then start back at 1.
Practice for about 5-10 minutes.
Practice belly breathing during a relatively calm time. Once you feel comfortable with
belly breathing, you can also use it to feel better when you are worried or afraid.
RELAXATION SCRIPT FOR CHILDREN

[NOTE: These exercises can be done seated OR lying down.]
Introduction
Today we are going to do some special kinds of exercises called relaxation exercises.
These exercises help you learn how to relax when you are feeling uptight and help you
get rid of those butterflies-in-your-stomach kinds of feelings.
In order for you to get the best feelings from these exercises, there are some rules you
must follow. First, you must do exactly what I say, even if it seems kind of silly. Second,
you must try hard to do what I say. Third, you must pay attention to your body.
Throughout these exercises, pay attention to how your muscles feel when they are tight
and when they are loose and relaxed. And fourth, you must practice. The more you
practice the more relaxed you can get.
Are you ready to begin? Okay. First, get comfortable as you can in your chair. Sit back,
get both feet on the floor, and just let your arms hang loose. Thats fine. Now, close
your eyes and do not open them until I say so. Remember to follow my instructions
very carefully, try hard, and pay attention to your body. Here we go.
Hands and Arms
Pretend you have a whole lemon in your left hand. Now squeeze it hard. Try to
squeeze all the juice out. Feel the tightness in your hand and arm as you squeeze. Now
drop the lemon. Notice how your muscles feel when they are relaxed. Take another
lemon and squeeze it. Try to squeeze this one harder then you did the first one. Thats
right. Really hard. Now drop your lemon and relax. See how much better your hand
and arm feel when they are relaxed. Once again, take a lemon in your left hand and
squeeze all the juice out. Do not leave a single drop. Squeeze hard. Good. Now relax
and let the lemon fall from your hand.
[REPEAT THE PROCESS FOR THE RIGHT HAND AND ARM.]

Arms and Shoulders
Pretend you are a furry, lazy cat. You want to stretch. Stretch your arms out in front of
you. Raise them high over your head. Way back. Feel the pull in your shoulders.
Stretch higher. Now just let your arms drop back to your side. Okay, kitten, lets stretch
again. Stretch your arms out in front of you. Raise them over your head. Pull them
back, way back. Pull hard. Now let them drop quickly. Good. Notice how your
shoulders feel more relaxed. This time lets have a great big stretch. Try to touch the
ceiling. Stretch your arms way out in front of you. Raise them way up high over your
head. Push them way, way back. Notice the tension and pull in your arms and
shoulders. Hold tight, now. Great. Let them drop very quickly and feel how good it is to
be relaxed. It feels good and warm and lazy.
Shoulder and Neck
Now pretend you are a turtle. You are sitting out on a rock by a nice, peaceful pond,
just relaxing in the warm sun. It feels nice and warm and safe here. Oh-oh! You sense
danger. Pull your head into your house. Try to pull your shoulders up to your ears and
push your head down into your shoulders. Hold in tight. It is not easy to be a turtle in a
shell. The danger is past now. You can come out into the warm sunshine and, once
again, you can relax and feel the warm sunshine. Watch out now! More danger. Hurry,
pull your head back into your house and hold it tight. You have to be closed in tight to
protect yourself. Okay, you can relax now. Bring your head out and let your shoulder
relax. Notice how much better it feels to be relaxed than all tight. One more time now.
Danger! Pull your head in. Push your shoulders way up to your ears and hold tight. Do
not let even a tiny piece of your head show outside your shell. Hold it. Feel the
tenseness in your neck and shoulders. Okay. You can come out now. It is safe again.
Relax and feel comfortable in your safety. Theres no more danger. Nothing to worry
about. Nothing to be afraid of. You feel good.
Jaw
You have a giant jawbreaker bubble gum in your mouth. It is very hard to chew. Bite
down on it. Hard! Let your neck muscles help you. Now relax. Just let your jaw hang
loose. Notice how good it feels just to let your jaw drop. Okay, lets tackle that
jawbreaker again now. Bite down. Hard! Try to squeeze it out between your teeth.
Thats good. You are really tearing that gum up. Now relax again. Just let your jaw drop
off your face. It feels so good just to let go and not have to fight that bubble gum.
Okay, one more time. We are really going to tear it up this time. Bite down. Hard as
you can. Harder. Oh, you are really working hard. Good. Now relax. Try to relax your
whole body. Youve beaten the bubble gum. Let yourself go as loose as you can.
Face and Nose
Here comes a pesky old fly. He has landed on your nose. Try to get him off without
using your hands. Thats right, wrinkle up your nose. Make as many wrinkles in your
nose as you can. Scrunch up your nose real hard. Good. Youve chased him away. Now
you can relax your nose. Oops, here he comes back again. Right back in the middle of
your nose. Wrinkle up your nose again. Shoo him off. Wrinkle it up hard. Hold it just as
tight as you can. Okay, he flew away. You can relax your face. Notice that when you
scrunch up your nose that your cheeks and your mouth and your forehead and your
eyes all help you, and they get tight too. So when you relax your nose, your whole face
relaxes too, and that feels good. Oh-oh. This time that old fly has come back, but this
time hes on your forehead. Make lots of wrinkles. Try to catch him between all those
wrinkles. Hold it tight now. Okay, you can let go. Hes gone for good. Now you can just
relax. Let your face go smooth, no wrinkles anywhere. Your face feels nice and smooth
and relaxed.
Stomach
Hey! Here comes a cute baby elephant. But hes not watching where hes going. He
doesnt see you lying there in the grass, and hes about to step on your stomach. Do not
move. You do not have time to get out of the way. Just get ready for him. Make your
stomach very hard. Tighten up your stomach muscles real tight. Hold it. It looks lie he
is going the other way. You can relax now. Let your stomach go soft. Let it be as
relaxed as you can. That feels so much better. Oops, hes coming this way again. Get
ready. Tighten up your stomach. Real hard. If he steps on you when your stomach is
hard, it wont hurt. Make your stomach into a rock. Okay, hes moving away again. You
can relax now. Kind of settle down, get comfortable, and relax. Notice the difference
between a tight stomach and a relaxed one. Thats how we want it to feel nice and
loose and relaxed. You wont believe this, but this time hes really coming your way and
no turning around. Hes headed straight for you. Tighten up. Tighten hard. Here he
comes. This is really it. Youve got to hold on tight. Hes stepping on you. Hes stepped
over you. Now hes gone for good. You can relax completely. You are safe/ Everything
is okay, and you can feel nice and relaxed.
This time imagine that you want to squeeze through a narrow fence and the boards
have splinters on them. Youll have to make yourself very skinny if you are going to
make it through. Suck your stomach in. Try to squeeze it up against your backbone. Try
to be as skinny as you can. Youve got to get through. Now relax. You do not have to
be skinny now. Just relax and feel your stomach being warm and loose. Okay, lets try
to get through that fence now. Squeeze up your stomach. Make it touch your
backbone. Get it real small and tight. Get as skinny as you can. Hold tight, now. Youve
got to squeeze through. You got through that skinny little fence and no splinters. You
can relax now. Settle back and let your stomach come back out where it belongs. You
can feel really good now. Youve done fine.
Legs and Feet
Now pretend that you are standing barefooted in a big, fat mud puddle. Squish your
toes down deep into the mud. Try to get your feet down to the bottom of the mud
puddle. Youll probably need your legs to help you push. Push down, spread your toes
apart, and feel the mud squish up between your toes. Now step out of the mud puddle.
Relax your feet. Let your toes go lose and feel how nice that is. It feels good to be
relaxed. Back into the mud puddle. Squish your toes down. Let your leg muscles help
push your feet down. Push your feet. Hard. Try to squeeze the mud puddle dry. Okay.
Come back out now. Relax your feet, relax your legs, relax your toes. It feels so good to
be relaxed. No tenseness anywhere. You feel kind of warm and tingly.
Conclusion
Stay as relaxed as you can. Let your whole body go limp and feel all your muscles
relaxed. In a few minutes I will ask you to open your eyes, and that will be the end of
this session. As you go through the day, remember how good it feels to be relaxed.
Sometimes you have to make yourself tighter before you can be relaxed, just as we did
in these exercises. Practice these exercises every day to get more and more relaxed. A
good time to practice is at night, after you have gone to bed and the lights are out and
you wont be disturbed. It will help you get to sleep. Then, when you are a really good
relaxer, you can help yourself relax at school. Just remember the elephant, or the
jawbreaker, or the mud puddle, and you can do our exercises and nobody will know.
Today is a good day. Youve worked hard in here, and it feels good to work hard. Very
slowly, now, open your eyes and wiggle your muscles around a little. Very good. Youve
done a good job. You are going to be a super relaxer.
RELAXATION SCRIPT FOR ADOLESCENTS AND ADULTS

Go ahead and settle back so you feel comfortable. Let all your muscles go loose
and heavy. Close your eyes and take three deep, slow breaths. As you breathe in
slowly, concentrate on the air as it fills your lungs, and as you breathe out slowly,
notice your breath rushing out through your nose and mouth. Breathe in slowly,
thinking about the feeling of air passing in [PAUSE] and out of your body [PAUSE
10 SECONDS].
Now, I want you to clench your right fist as tight as you can, and hold it while I
count down from five . . . pay attention to the tight feeling in your fist as I begin to
count . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . relax your fist and notice the feelings of
warmth and relaxation that flow through your fingers into your arm . . . pay
attention to the feeling of relaxation that fills your arm . . . [PAUSE 10 SECONDS].
Now, clench your left hand into a fist and hold it while I count down from five . . .
pay attention to the tight feeling in your arm. . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . .release
your fist and notice how the tight feeling leaves your arm and is replaced by the
warm heavy feeling of relaxation [PAUSE 10 SECONDS]. Now hunch your
shoulders so they press against your head and neck, and pay attention to the tight
feeling this causes as I count down from five -- . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . As
you relax your shoulders, pay attention to the warm soothing feelings of relaxation
that run down your head, neck, and shoulders . . . [PAUSE 10 SECONDS]. Hunch
your shoulders again, paying attention to the tight feeling this creates as I count
down from five -- . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . As you relax your shoulders again,
notice the feelings of relaxation that flow down your neck and through your body .
. . [PAUSE 10 SECONDS]. Now I want you to scrunch up your face like you bit
something really sour like a lemon, wrinkle up your forehead, and hold it while I
count down from five . . . pay attention to the tightness in your forehead while I
count down from five -- . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . relax your forehead again,
smoothing out all the wrinkles. Notice how smooth and relaxed you feel [PAUSE
10 SECONDS]. Now clench your jaws, bite your teeth together and hold it while I
count down . . . 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . relax [PAUSE 10 SECONDS]. Let your
lips open a little bit and breathe deeply. Notice the warm heavy feelings of
relaxation in your body. Now, I want you to tighten up your whole body, from
your scrunched up face, to your hunched up shoulders, your tight fists and arms,
your stiff back and tight stomach, to your tight legs and curled up toes. Make your
whole body tense and stiff as a board and hold it while I count down from five -- . .
. 5 . . . 4 . . . 3 . . . 2 . . . 1 . . . let go and relax [PAUSE 10 SECONDS]. Just relax and
feel how warm and heavy your whole body feels. Relax.
Now, with your eyes still closed, I want you to imagine [INSERT HIS/HER SPECIAL
PLACE].
[CONTINUE DESCRIBING THE SPECIAL PLACE, STRESSING SENSORY DETAIL -THE WARMTH OR COOLNESS OF THE AIR, THE SOFT SOUNDS IN THE
BACKGROUND, ETC. PAUSE BETWEEN IMAGES TO LET THE CLIENT
REMEMBER AND FEEL. YOU CAN INCLUDE PEOPLE AS A CHOICE -- THERE
MAY BE SOMEONE SPECIAL WITH YOU SHARING THIS NICE PLACE, A FRIEND
OR SOMEONE IN YOUR FAMILY. REMEMBER HOW GOOD IT FELT TO BE
TOGETHER, AS APPROPRIATE].
Now it is time to leave your special place and come back to this room. We are
going to take five imaginary steps, each step moving father away from [INSERT
SPECIAL PLACE] and closer to this room. Ill count each step out loud for you . . . 1 .
. . you are stepping away from your special place . . . 2 . . . youve moved away a
little farther from [SPECIAL PLACE] . . . 3 . . . you are halfway back to this room . . .
4 . . . you are almost here, just one small step away . . . 5 . . . and you are back.
When you feel ready, go ahead and open your eyes.
[WHEN THE CLIENT HAS OPENED HIS/HER EYES, ASK IF S/HE WOULD LIKE TO
SHARE HIS/HER EXPERIENCE - WHAT THE CLIENT REMEMBERED, HOW S/HE FELT,
HOW S/HE FEELS NOW. ASK WHAT IT WAS LIKE TO TENSE AND RELAX DIFFERENT
MUSCLES. REMIND AGAIN THAT RELAXATION TAKES PRACTICE.]

Affective Modulation: 25 Ways to Feel Better
Right Now
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Stop whatever you are doing, close your eyes, and take 10 slow, deep
breaths.
Visualize your safe place.
Go to a quiet room and read a good book.
Meditate or focus on your special relaxation phrase.
Listen to your favorite music.
Sing out loud.
Dance.
Play.
Listen to, watch, or read something funny.
Go outside and take a walk in a safe area.
Run in place for 5 minutes.
Call a friend.
Talk to a caregiver or other adult who understands and listens.
Write in your journal.
Volunteer.
Tell yourself that things will get better.
Take a warm bath.
Make something with your handsknit, sew, crochet, woodwork, etc.
Tell yourself five good things about yourself.
Draw, color or paint.
Talk about your feelings with someone you trust.
Tell someone you love him or her.
Play with your pet.
Do something to help someone else.
What else helps you feel better?
PROBLEM-SOLVING STEPS
Problem solving involves several steps that can be summarized as follows:
State, or describe, the problem.

Think of, or identify, possible solutions to the problem. Try to
think of as many as you can, without judging them as good or
bad.
Evaluate, or consider, the likely outcomes of each possible

solution. What good or bad might happen if you chose that
solution?
Pick the solution most likely to help and try it out.

See how your choice worked. If it worked, great! If it didnt work
out as you hoped, try to figure out what went wrong. Go back
and pick another solution to try to solve the problem.
Cognitive Triangle
________________________________________
________________________________________
________________________________________
Thinking
What Happened
________________________
_____
Feeling
Doing
____________________________
___________________________
____________________________
___________________________
____________________________
___________________________
________________________
_________________
Example of the Cognitive Model in Action

Event
I step in dog poop on my

way to school
Thinking
Feeling
Doing
Ive heard this stuff

carries disease - I
bet I could catch
something.
Nervous or
Anxious
Go back inside, wash

vigorously, and change shoes.
This kind of thing

always happens to
me - Im such a
loser.
Unhappy or
Depressed
Go to school expecting a bad

day maybe not even wipe
off the poop.
Ive told that guy a

hundred times to
keep his dog in his
own lawn!
Angry or
Irritated
Go next door and scream at

neighbor.
At least I wasnt
wearing sandals.
Relieved or
Indifferent
Wipe off the poop and go to

school.
BLUE
UNHELPFUL thinking makes us feel bad, or
BLUE.
REALISTIC thinking makes us feel BETTER.
Types of UNHELPFUL thinking to look out for:
B . . . Blaming myself
L . . . Looking for the bad news
U . . . Unhappy guessing
E . . . Exaggerating Imagining a disaster
4 STRATEGIES FOR DISPUTING UNHELPFUL

THOUGHTS
When we feel upset about something, we tend to be thinking unhelpful thoughts. We
can ask ourselves 4 main questions in order to (a) evaluate whether these thoughts are
realistic or helpful to us, and (b) come up with more realistic or helpful thoughts.
1. Evidence?
What is the evidence for this thought or belief?
Are your judgments based on how you feel rather than what you are doing or have done
(rather than the evidence)?
Are you confusing a low probability event with a high probability event?
Are you underestimating what you can do to deal with the situation?
2. Alternatives?
Is there any alternative way of looking at the situation?
How would someone else think about the situation?
Are you overestimating how much control and responsibility you have in this situation?
3. Implications?
What are the consequences of you thinking this way?
What would be the worst thing that could happen?
If this is true, so what? What does it mean?
What are the real and probable consequences of the situation?
4. Usefulness?
Is it useful for you to think this way?
What are the advantages of holding on to this belief?

What are the disadvantages of holding on to this belief?
Are you setting yourself up for an unrealistic standard?
Situation that made me feel bad

PRACTICING THE COGNITIVE TRIANGLE
Thinking
Feeling
Doing
During the coming week, whenever you feel upset about something, write
down the situation and how it makes you feel. Then track back to what your
thought was about the situation that made you think that way. Ask yourself
whether that thought is (1) accurate and (2) helpful. Come up with alternative
thoughts in this situation and write down how they make you feel and whether
they are accurate and helpful. To identify new, more helpful thoughts, think
about what you would say to a good friend in a similar situation if he/she
shared the distressing thought(s).
Situation:__________________________________________________
Thought:___________________________________________________
Feeling:____________________________________________________
New thought:________________________________________________
New feeling:_________________________________________________
New Behavior:_______________________________________________
Cognitive Triangle: Challenging Your Thinking Mistakes

Thinking
Event
Feeling
EVENT
Something Happens
Doing
THOUGHTS
I tell myself something
FEELINGS
I feel something
BEHAVIORS
I do something
________________________
_________________
Are my thoughts accurate?

_____________________________________________________________________________
Are my thoughts helpful?
_____________________________________________________________________________
Am I falling into a Thinking Mistake trap (If so, which one)?
_____________________________________________________________________________
What could I say to myself that would be more accurate, positive, or helpful?
_____________________________________________________________________________
How would I feel if I told myself this?
_____________________________________________________________________________
HELPFUL HINTS FOR THE TRAUMA NARRATIVE

1. Introduce the child and caregiver to the theory behind TF-CBT and the trauma
narrative (e.g., cleaning a wound, taking out a splinter).
2. Prepare the child for the trauma narrative by talking about upsetting aspects of the
traumatic event(s) a little bit at a time so that talking about it becomes less painful,
frightening, and overwhelming over time.
3. Have the child write a chapter about a positive experience s/he has experienced.
This will allow the child to practice creating a narrative, so s/he will be better
prepared to create a trauma-related narrative. This also helps the therapist
differentiate between the child showing trauma-related avoidance versus having
limited ability to express experiences verbally or in writing.
4. Introduce the trauma narrative by reading a book about another childs experience
with similar traumatic events (e.g., Please Tell, A Place for Starr).
5. Suggest that children start their trauma narrative with non-traumatic information,
such as with whom they live and where they go to school. They can then be
encouraged to describe the specific context leading up to the traumatic experience.
6. Help the child develop the trauma narrative:
a) The child can create a book that tells the story of the traumatic event(s).
b) The child can create a life narrative instead of just a trauma narrative.
c) The child can verbally describe the traumatic event(s). The therapist can suggest that
the child write down what he/she has described afterwards. Alternatively, the
therapist can act as a recorder while the child talks.
d) The child can start by providing just one or a few details of the event. The therapist
can then ask questions such as what s/he was doing at the time the incident
occurred, what happened next, and so on.
e) The therapist should provide a lot of praise and encouragement for the childs
efforts.
f) It is best not to interrupt the child in the flow of his/her narrative to ask about
his/her thoughts and feelings regarding the event since this may make it more
difficult for him/her to keep focused on the event. Instead, let him/her first describe
his/her perception of the event, and then return to the beginning to clarify things or
to ask about his/her feelings and thoughts.
7. Once the child has written a full narrative of his/her memories, thoughts and feelings
about the traumatic event, the therapist should employ cognitive-processing
techniques to explore and correct cognitive distortions and errors.
8. Prepare the child and caregiver(s) to share the childs trauma narrative with the
childs caregiver(s). The narrative is shared with the caregiver only after considerable
preparation is provided for the caregiver in parent sessions, and only when the
caregiver is capable of providing a supportive response to the client (e.g., if a
caregiver does not believe the abuse occurred it may not be a good idea to share the
narrative with them).
FEAR THERMOMETER
or
SUDS (Subjective Units of Distress Scale)
SUDS helps clients to tell you in a number how distressed they are. You can have
the child make his or her own thermometer with descriptive words for each
number, or use this one:
10
9
8
7
6
5
4
3
2
1
0
Very very upset

Pretty upset
Sort of upset
Still OK
Very calm

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TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY

INTRODUCTION TO THE TF-CBT TOOLKIT

TF-CBT Emailed Tips

Website of TF-CBT Resources

The Missouri Therapy Network has also developed a website repository of

YOUR NEXT STEPS:

Kristin Hawley, Ph.D.

TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY

Assessment and Treatment Planning with TF-CBT

Psychoeducation about trauma

How stress and PTSD affect our bodies

Cognitive coping and processing

Four strategies for disputing unhelpful/unhealthy thoughts

In vivo mastery of trauma reminders

Conjoint child-parent sessions

Enhancing future safety and development

TF-CBT Memory Jogger

CRAFTS I: Core Values

Respect for individual, family, religious, community, and

Adaptability is crucial to the success of TF-CBT.

must be creative and flexible in implementing the core

A primary focus of TF-CBT is improving

caregiver-child interactions, communication, and

Therapeutic relationships are central to TF-CBT.

and maintaining a trusting, accepting, empathic

Self-efficacy including self-regulation of affect, behavior, and

In vivo mastery of trauma

Domains for Assessment and Treatment Planning with

Relationship problems: Difficulties getting along with peers; poor problem-solving or

Family problems: Caregiver skill deficits; poor caregiver-child communication;

Traumatic behavior problems: Avoidance of trauma reminders; trauma-related,

Somatic problems: Sleep difficulties; physiological hyperarousal and hypervigilance

TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY

UCLA PTSD INDEX FOR DSM IV (Revision 1)

Instructions for Administration:

Questions with reference to a generic

Suggested alternative wording for

When something reminds me of what happened, I

When something reminds me of the shooting, I

I have upsetting thoughts, pictures, or sounds of

I have upsetting thoughts, pictures, or sounds of

I have dreams about what happened or other bad

I have dreams about the shooting or other bad

I feel like I am back at the time when the bad thing

I feel like I am back at the time when the

I try not to talk about, think about, or have feelings

I try not to talk about, think about, or have

I think that some part of what happened is my fault.

I think that some part of what happened during

I have trouble remembering important parts of what

I have trouble remembering important parts of

I try to stay away from people, places, or things that

I try to stay away from people, places, or things

When something reminds me of what happened, I

When something reminds me of the shooting, I

I am afraid that the bad thing will happen again.

I am afraid that the shooting will happen again.

Scoring, Interpretation, and Psychometric Properties:

UCLA PTSD INDEX FOR

Name ________________________________ Age _______

Name __________________________ Age _

Child's Name __________________________ Age _ Sex (Circle): Girl Boy