Zilberstein Karen
A Home Within, 8 Trumbull Rd #205, Northampton, MA 01060 USA.
J Child Adolesc Trauma. 2021 Oct 23;15(2):487-500. doi: 10.1007/s40653-021-00416-3. eCollection 2022 Jun.
Evidenced based trauma treatments benefit children, but they rarely suffice for youth with multiple and complex comorbidities. After the completion of standard treatments, many children continue to show residual social, behavioral, and emotional difficulties. Part of the difficulty is that while the literature on trauma describes numerous facets that contribute to the severity, expression, and outcomes of trauma exposure, clinical assessments and interventions do not sufficiently reflect that literature. Clinicians thus have little guidance on how to integrate the intricacies of client's circumstances into a trauma-informed framework. To expand the scope and efficacy of treatments and guide clinicians in selecting appropriate interventions, this paper explores factors associated with pretreatment traumatic responses and proposes an integrative treatment model that includes the trauma experience, itself, combined with pre- and post-trauma factors that are both internal and external to the child and family. Pre-trauma experiences influence the severity of traumatic responses, while post-trauma factors impact a person's ability to cope and recover. Both are important targets for direct intervention.
循证创伤治疗对儿童有益，但对于患有多种复杂共病的青少年来说，这些治疗往往并不足够。在完成标准治疗后，许多儿童仍表现出残留的社交、行为和情绪问题。部分困难在于，虽然关于创伤的文献描述了许多导致创伤暴露的严重程度、表现及结果的方面，但临床评估和干预措施并未充分反映该文献内容。因此，临床医生在如何将患者情况的复杂性纳入创伤知情框架方面几乎没有指导。为了扩大治疗的范围和效果，并指导临床医生选择合适的干预措施，本文探讨了与创伤前反应相关的因素，并提出了一种综合治疗模型，该模型包括创伤经历本身，以及儿童和家庭内部及外部的创伤前和创伤后因素。创伤前经历会影响创伤反应的严重程度，而创伤后因素则会影响一个人的应对和恢复能力。两者都是直接干预的重要目标。
