When to Seek Out Professional Help After a Traumatic Event

In the wake of catastrophic violence, the days, weeks, and months that follow can be very stressful on children.  It should be expected that anxiety, fear, and worry are common reactions to the trauma a child has experienced.  Children may also demonstrate changes in behavior, including activity level, concentration, irritability, sadness and withdrawal, and sleep and appetite. Schoolwork may be affected.  As well, children may become hyper-focused on the traumatic event, experience intense reactions to reminders of the event, and/or extend significant effort to avoid people, places, and things that reminders of the event.  Short-term distress or behavioral change after a traumatic event is almost universal. 

When to seek formal treatment.  In time, with the support of family, friends, and caregivers, most children will recover and return to normal routines.   How long it takes a child to return to prior levels of functioning can depend on many things, such as what happened to the child and their family during and after the event, developmental age, ongoing life stressors, and past traumatic experiences. 

After four to six weeks, if the child is still experiencing significant distress it may be time to seek assistance from a mental health professional, preferably a trauma specialist.  In making the decision to seek out trauma therapy for your child, some warning signs to look for include:

• Poor or diminished school functioning
• Difficulty with focus and concentration
• Nightmares or unwanted, intrusive flashbacks and memories of the event
• Physical complaints such as headaches and stomachaches
• Trouble eating and sleeping
• Reduced interest or disinterest in friends or previously enjoyable activities
• Hyper-vigilance, jumpiness, or overly restless
• Active avoidance of thinking about or talking about the trauma
• Active avoidance of people, places, and things that remind them of the event
• Consistent irritability, fear, or guilt about the event

Trauma therapy.  If a family decides to reach out to a trauma therapist, there are a multiple types of and approaches to trauma therapy.  The theoretical foundations and specific techniques may vary but the common goals of trauma therapy are to allow the child and family to develop a healthy understanding and perspective about the traumatic event, to reduce or eliminate trauma-related symptoms, and return to normal daily functioning.  The needs of the child and family should determine which approach to trauma treatment is most appropriate. 

Trauma treatment for young children.  The Matilda Theiss Early Childhood Trauma Treatment Center (ECTTC) at the University of Pittsburgh and UPMC Western Psychiatric Hospital provides evidence-based, culturally-sensitive, early childhood trauma services for young children and families in the larger Pittsburgh region.  The program is a treatment center within the National Child Traumatic Stress Network (NCTSN), federally funded through the Substance Abuse and Mental Health Services Administration, Department of Health and Human Services (SAMHSA; SM61119).  Since the NCTSN grant was awarded to the University of Pittsburgh in 2012, the program has served more than 200 children and families who have experienced significant trauma.

The ECTTC places a special emphasis on improving service access for specific underserved groups in our region that are greatly affected by trauma, including: young children and families impacted by community violence, intimate partner violence, parental addiction and those involved in the child welfare system. Our treatment philosophy at the ECTTC is that young children are best treated within the context of their families and communities.   We utilize interventions focused on building more secure caregiver-child relationships that may have been negatively impacted by traumatic stress. Both caregiver and child are active participants in treatment and meet together with a trauma therapist who engages the dyad in treatment largely through the use of play.  Our trauma treatment is available across a range of programs that include outpatient and intensive outpatient therapy, day treatment for young children, mobile therapy, and school-based services.

One of the primary evidence-based trauma treatments offered by ECTTC is Child-Parent Psychotherapy (CPP).  This treatment is designed to address behavioral health problems, attachment disruptions, and stress reactions resulting from trauma by strengthening the parent-child relationship so that both the child and the caregiver can heal from the traumatic experience.  That strong relationship then becomes a vehicle for restoring the child’s typical cognitive, emotional, behavioral, and social functioning.   

Behavioral health outcomes.  The CPP treatment provided by the ECTTC is clearly demonstrating success in the treating trauma in young children. Within six-months of CPP treatment at the ECTTC, reductions in anxiety, post-traumatic stress, and dissociation were observed with small to moderate effect sizes (Schreiber, 2017) utilizing parent ratings on the Trauma Symptom Checklist for Young Children (Briere, 2005).  Results from this rigorous program evaluation indicate that these services are resulting in significant and positive outcomes for the young children and families.

Briere, J (2005). Trauma Symptom Checklist for Young Children (TSCYC): Professional Manual.
Schreiber, J (2017). Final Evaluation Report 2012-2016, Early Childhood Mental Health Trauma
Treatment Center (ECMH-TTC): Grant ID: SM61119.  Pittsburgh, PA: Author.

Kimberly Blair is an Associate Professor in the Unviersity of Pittsburgh Department of Psychiatry and the Program Director of the Early Childhood Trauma Treatment Center, as well as the Director of the Matilda Theiss Early Childhood Behavior Health Center. Blair has dedicated her career to providing quality care, enhancing access to care, and promoting evidence-based treatments in clinical services. Under her leadership, the Matilda Theiss programs have thrived. This state-of-the-art treatment center provides early childhood mental health services to young children with psychiatric disorders and to those children who are at high risk of developing psychiatric or developmental difficulties.