PLEASE READ!!!

2-4 pages  please look at attachment please read case study prior to completing paper. please use the template in the attachment to complete the paper by answering the questions . 

Provide a brief description of the intervention including:

USE THE TEMPLATE TO ANSWER THESE QUESTIONS!!!!

(1) to whom it can be applied
(2) under what circumstances it can be applied
(3) any limitations to the intervention that should be considered

Provide rationale for choosing the selected approach for the case study.
Include an explanation for why selecting that intervention will help your work with the selected case study client, and provide appropriate support.
Describe how the intervention can be used in future work when supporting the treatment approaches for clients.
Provide a link to the intervention within the body of the paper (or upload the PDF) so your instructor can easily identify and reference it. Ensure the link is active and accessible for review by your instructor. Note: If your selected intervention is not accessible, your submission will be returned to you.

                                                        please use this link for search !!!!!

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COU 680 Week Three Case Study: Deena

Deena is a three-year-old Caucasian female who was brought into therapy by her foster mother, Jamie,
as a result of extreme emotional outbursts and a struggle to connect. Deena was removed from her
birth mother’s care at 18 months of age as a result of extreme abuse and neglect, and has now moved
into her sixth foster home since entering foster care. She now lives with her foster mother, Jamie; foster
father, Jesse; and their biological son, Max, age seven.

Deena is presenting with an array of developmental, systemic, and relational deficits related to many of
her unmet needs. Of particular concern are the delays related to language acquisition.

History
Deena was born in rural Alabama. Her single, 18-year-old Caucasian mother raised Deena alone after
her boyfriend Lewis “hit the road” when he learned of the pregnancy. We know little about Deena’s first
year of life, but do know that the Department of Human Services (DHS) initiated an investigation just
after Deena’s first birthday. Although initial complaints of suspected abuse and neglect went
unsubstantiated, a trip to the emergency room (ER) ultimately resulted in a DHS decision to remove
Deena from her birth mother’s care. In the report it was disclosed that Deena’s birth mother had been
routinely using sedatives in place of babysitters. Whenever Deena’s birth mother wanted to go out with
friends, she administered sedatives to Deena, who would fall into a deep sleep while her mother “was
out partying.” One morning, however, Deena did not wake. Terrified, her mother rushed Deena to the
ER and revealed her strategy for “childcare.”

In accordance with state child protection laws, the physicians immediately notified DHS. This incident,
coupled with prior unsubstantiated abuse complaints, resulted in DHS immediately removing Deena
from the home and placing her into foster care. Rather than fighting this action, Deena’s birth mother
seemed relieved and did not contest the decision. Within six months, she voluntarily surrendered her
parental rights.

Deena arrived in her first foster home at 18 months of age and stayed less than a month. The first set of
foster parents described Deena as inconsolable, highly emotional, and so “out of control” that they felt
unequipped to provide adequate care for her. Over the course of the next 15 months, Deena would be
placed in—and soon removed from—four additional foster homes. It was not until she lived with Jamie
and Jesse that Deena experienced any consistency of care. Deena has now been with them for three
months.

Developmental Considerations
From a developmental perspective, Deena manifested some delays, which were unsurprising given her
life history. For example, in the context of psychosocial development, Deena struggled with the
development of trust in herself and others, and she also exhibited low tolerance for frustration.
Additionally, Deena displayed some cognitive delays, most clearly evident with regard to language
acquisition.

Relational Considerations
From a relational perspective, Deena’s early relationship with her primary caretaker had been
insufficient at best. Rather than offering the consistent and loving care and attention needed to build
strong attachments, Deena’s mother remained inconsistent, often inattentive, neglectful, and

sometimes abusive. When removed from her birth mother’s care, Deena was already at risk for
attachment-related difficulties.

Multicultural Considerations
Although they all identified as Caucasian, differences related to socioeconomic status may have
contributed to the difficulties early foster parents had in relating to Deena. The foster families
benefitted from the privilege afforded by a middle-class lifestyle and had no real understanding of the
impact of poverty on Deena’s birth mother. They had no real understanding of how poverty, both in
terms of financial and social capital, might contribute to a mother’s decision to choose inexpensive
sedatives purchased on the street over a human babysitter. This may have resulted in them villainizing
Deena’s birth mother and having great difficulty in responding to Deena’s emotional distress over her
separation from her mother.

Ultimately, Deena experienced foster care as a series of changes in caregivers that prevented her from
forming healthy or stable relationships.

Diagnosis
Diagnostically, Deena is displaying symptoms consistent with reactive attachment disorder (RAD;
American Psychiatric Association [APA], 2013), which is etiologically related to the lack of consistency
and care in her early relationships (RAD Criterion D). Deena is also presenting with symptoms consistent
with a diagnosis of post-traumatic stress disorder (PTSD; APA, 2013).

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Washington, DC: Author.

CASE STUDY OF [TOPIC] 4

[Note: To complete this template, replace the bracketed text with your own content. Remove this note before you submit your paper.]

Intervention Paper: Case Study of [Topic]

[Your Name]

Running head: CASE STUDY OF [TOPIC] 1

Southern New Hampshire University

Description of Intervention

[Include in this section a brief overview of the intervention you have selected, based on how it was described in the article. Please do not copy and paste the description from the article—use your own words. Think of this like you are explaining it to your best friend. What does it do, how do you do it, and to whom would it apply? You also want to make sure you are looking for any limitations to the intervention noted in the article or important to consider. Most journal articles will have a limitations section or speak to any considerations you might want to think about before applying it. Others may not have this concretely stated, so you will need to do some analysis and consider to whom the intervention might not be applicable and why. A couple of limitations you are likely to see are that they are relatively new and untested or that they only apply to a specific group of people. Those are great things to consider when selecting an intervention and part of what I want you to get savvy at looking for.]

Rationale

[This section should center on why you have chosen this intervention for the case study. Why is it appropriate to the specific client? You want to use the details of the case study to help you justify the approach based on factors like diagnosis, culture, family dynamics, developmental influences, etc. Remember, the goal in any intervention is to choose one that will be most effective to the needs of the client. To that end, you will really want to consider and speak to the details of the case study and why they tie back to your chosen intervention in this section.]

Explanation of Support

[In this section you will speak to the actual application of the intervention to the case study client. What would it look like when applied to the client from the case study given the details of the article and the description above? This takes your rationale a step further and has you really think about what it would mean to put the case study client in the intervention. This step moves you from why it would be valuable (rationale) to how it would work.]

Future Applications

[This final section is designed to have you consider to whom or under what circumstances you might apply this intervention in the future. How might you use this tool in your toolbox to help you in future work? Can it apply to more than one type of issue or client? This is where you should consider expansion beyond the particular case study and speak to how you think you will use this intervention to help your future practice.]

References

[Include any references cited in your paper in full APA format. Don’t forget to include in-text citations as well.]

COU 680 Clarification of Intervention

Clarification of “Intervention” for Rubrics:

Throughout the course of this term, you will be asked to research and select empirically validated
counseling treatment interventions appropriate to the case studies you have been provided. Treatment
interventions are those cognitive, affective, behavioral, and systemic counseling strategies, techniques,
and methods that are specifically implemented in the context of a therapeutic relationship. They should
reflect the specific needs of the client and demonstrate clinical efficacy in addressing the targeted
concern. For the purposes of this course, you will need to find journal articles that specifically target
crisis and trauma interventions demonstrating clinical application to each specific case study. Select
interventions from journal articles published within the past five years to ensure use of the most up-to-
date resources.

For assistance, consider the following as an example of an appropriate and empirically validated
intervention article for working with clients who have suffered from domestic violence:

Binkley, E. (2013). Creative strategies for treating victims of domestic violence. Journal of Creativity in

Mental Health, 8(3), 305–313.

http://ezproxy.snhu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=90363425&site=eds-live&scope=site

Runninghead: CASE STUDY OF DEENA 1

Intervention Paper: Case Study of Deena

Student Name

Southern New Hampshire University

CASE STUDY OF DEENA 2

Description of Intervention

In “Treatment of Reactive Attachment Disorder in Young Children: Importance of

Understanding Emotional Dynamics,” author Lin Shi of the Marriage and Family Therapy

program at Northern Illinois University, DeKalb, Illinois, describes an attachment informed,

three-stage treatment program. “The essence of attachment informed therapy lies in the provision

of a safe haven and secure base, that is, the rebuilding of human connections” (Shi, 2014, p. 4).

This intervention consisted of key elements as follows: the therapist working on the emotional

challenges rather than starting with behavioral; a commitment to a challenging, tiring, emotional

16 session program by the therapist; a committed, involved parent; access to funding, reduced

rates; and the three stages approach. The first stage is creating a “safe haven” space, in this case

study, a play therapy room, where the therapist and the child worked on attachment for sessions

one to three. Expected setbacks occurred in between sessions and at sessions as the child

absorbed the new surroundings, people, connections and began working on emotions. In the

second stage, the purpose is to facilitate mother-child attachment interaction, through the play

and guided by the therapist; this is for sessions 4 through 9. In between sessions, the foster

mother ensured she spent 10 minutes daily of one-on-one time with “Tom,” the 4-year-old boy in

her care. In the third stage, the purpose is to strengthen the mother-child attachment interaction

for sessions 10 through 16. The primary role is turned over to the mother.

Limitations or considerations to use of this intervention are as follows. “The most critical

pieces …were a committed therapist and parental figure, and a relatively stable living

environment” (Shi, 2014, p. 12). So, the committed, attachment-focused therapist is key, as is

the therapist’s own self-care due to the complexity and the emotional nature of the work, where

setbacks are to be expected, but are part of the child’s growth curve, too. The parent’s intimate

CASE STUDY OF DEENA 3

involvement and the parent’s own mental health, availability, secure sense of intimacy and

attachment are key. The ability to fund 16 sessions is a potential limitation. The last limitation is

where the foster child is in the foster system. If he/she is likely to be moved soon, that presents

another attachment “failure” on the system’s part, so this therapy would not be introduced then.

The child can become retraumatized and the chances of finishing the 16 sessions, with the

requisite parental support are slim.

Rationale

This intervention would be appropriate for Deena for the following reasons. She has been

diagnosed with RAD and PTSD, resulting from her first 18 months with her family of origin,

where neglect and abuse were constant. One example was her mother who used sedatives for

Deena as her babysitter. Another is how easily she gave up Deena, not arguing the decision for

Deena to be moved to foster care. Deena exhibits some key behaviors which the young boy did

in the case study: low frustration tolerance, language issues, low trust in herself, significant trust

issues with others, a struggle to connect, and emotional outbursts. When in treatment, Deena

would have a caring environment with parents who would likely be involved in treatment and do

the in between session work. Also, she finally seems to be in a foster family which is more

similar culturally and economically, a family who seems to want to work with her. She has

experienced “consistency of care” with this family and has been with them longer than any other

foster family. This is as opposed to the six other foster homes she has been in for short durations

in her 3 years of age, with the first 18 months in her own family of origin. Her therapist would

need to be committed, have good self-care, work from an attachment versus behavioral

perspective and know play therapy.

CASE STUDY OF DEENA 4

Explanation of Support

We would need a play therapy space, a “safe haven” we could create. We would need a

variety of toys, so Deena could choose what we played with as we got to know each other and

got closer over time. I would also need to be a therapist with some play therapy experience,

though the key is that I really understand attachment theory. This is so that I would have the

experience, patience, emotional tolerance and instincts to know when to move towards or away

from Deena, physically and emotionally. In the case study, only one parent was involved, the

mother; I’m not sure if that was by choice (e.g., mother as primary attachment figure) or not. In

Deena’s case, we have a mother, father and a young son. I would start with the mother since that

is what Erikson’s theory of development stages would say as well as attachment theories. The

mother and I would need to talk about her own family to ensure there were no significant family

attachment issues, and I would want to be aware of mental health conditions she might have, as

we partner together. I also would want to work with the father and the son on how to “be” with

Deena when she was at home, so to educate them on how to support the efforts and not

unintentionally sabotage the good work of the mother and the therapist. At some point, if Deena

could handle it, I would attempt to have all of her family in the therapy room together, which is

how it would be once she went home after therapy was done. I would set up a less frequent

schedule to maintain their progress as an aftercare program and to show Deena that attachments

can last, such as hers and mine.

Future Applications

I could see using this approach not only for young children with attachment disorders, but

for people of any age with trauma, or people with any language or verbal issues. The play seems

CASE STUDY OF DEENA 5

to be almost a diversion, to lower the frustration level with fun things to do. It allows the child to

relax and be more open to connecting, over time of course. I’ve read about wilderness programs

for adolescents, or therapy while walking because of the diverted focus, which allows people to

open up; plus, with nature, we know being outside is clearing and creative for the brain. I could

also see this type of treatment being handled in a residential center for adolescents, not a hospital

which sometimes would not be perceived as a “safe haven,” but a private center in the mountains

for example. The key part of this is that the therapist approaches the treatment not with a

behavioral lens, but with attachment disorder as the lens. I suppose that would be like a client

with PTSD not reliving the trauma during treatment but learning a safe way to talk about it, with

an adult version of play and creative therapy (art, nature, music, walking, painting, etc.).

CASE STUDY OF DEENA 6

References

Shi, L. M. (2014). Treatment of reactive attachment disorder in young children: Importance of

understanding emotional dynamics. The American Journal of Family Therapy, 42, 1-13.

doi:10.1080/01926187.2013.763513

trauma and loss in children

Healing Trauma, B i l i i Resilience:
SITCAP in Actiijf
William Steele and Caelan Kubaíñ

www.reclaimingjqurnaLcom

Wf

Trauma and loss are not seen as diagnostic
disorders but as painful experiences with
which the child is struggling to cope.
Interventions involve children in their
own healing so that they feel safe and
empowered—no longer victims but
survivors and thrivers.

Since 1990, the National Institute for Trauma andLoss in Children (TLC) has pioneered strength-
based, resilience-focused
interventions with
young people. Instead
of being a detached di-
agnostician, the helping
adult becomes a witness
seeking to understand
the deeply painful expe-
riences of traumatized
children. How traumatized youth interpret them-
selves, their interactions with others, and their en-
vironment guide treatment. The collective voices of
traumatized youth have repeatedly said:

If you don’t think what I think…feel what I feel…
experience what I experience…see what I see
when I look at myself, others, and the world
around me…how can you possibly know what is
best for me?

Childhood trauma is marked by an overwhelm-
ing sense of terror and powerlessness. Loss of lov-
ing relationships is yet another type of trauma
that produces the pain of sadness and grief. The
resulting symptoms only reflect the neurological,
biological, and emotional coping systems mobi-
lized in the struggle to survive. These young peo-
ple need new strategies for moving beyond past
trauma, regulating emotions, and coping with
future challenges.

Neuroscience confirms that trauma is experienced
in the deep affective and survival areas of the brain
where there are only sensations, emotionally con-
ditioned memories, and visual images. These de-
fine how traumatized youth view themselves and
the terrifying world around them. Reason, lan-
guage, and logic needed to make sense of past ex-
periences are upper brain cognitive functions that
are difficult to access in trauma (Levine & Kline,
2008; Perry, 2009; van der Kolk, 2006). This ex-
plains the limitation of traditional talk therapy or
narrowly cognitive interventions. Therefore TLC’s
Structured Sensory Interventions for Traumatized

Children, Adolescents, and Parents (SITCAP) starts
with the subjective experience of youth which
drives their behavior.

SITCAP provides the opportunity to safely revisit and
rework past trauma, beginning with sensory memo-
ries which youth have experienced and stored. Trau-
ma-related symptoms can be reduced and resilience
strengthened to support posttraumatic growth as
youth engage in SITCAP (Steele & Kuban, 2013). The
process is designed to support safety, emotional regula-

tion, and empowerment.

Curiosity by the adult allows
youth to take the lead and set

the pace of intervention,
which is empowering.

Every SITCAP session is
structured to begin and
end with safe activities
such as guided imagery
or breathing techniques
that engage youth in
self-regulation practice.
Trauma-focused ques-

tions are open ended and tied to the non-language,
sensory-based activities used to address common
themes of trauma such as worry, fear, hurt, and an-
ger. These questions are designed to keep the prac-
titioner in the role of a curious witness rather than
the “all-knowing” therapist.

Curiosity of the adult also allows youth to take the
lead and set the pace of intervention, which is em-
powering. They are giving permission to say “yes”
or “no” to whatever they are asked to talk about and
discover that saying “no” is honored. This genuine
interest is essential to allow the youth to experi-
ence the intervention as safe and the practitioner
as trustworthy. Their safety remains the primary
focus. The SITCAP process helps youth identify the
ways their body responds to stress. Young people
recognize how posttraumatic memories can be ac-
tivated by current events and learn to “resource”
their body to regulate their reactions.

SITCAP in Action
As is shown in the following two case examples,
SITCAP uses drawing as a primary therapeutic ac-
tivity. More than words, drawing allows children
to access and externalize the sensations, memo-
ries, and iconic images shaped by trauma. Draw-
ing activities can focus on the primary themes of
trauma—terror, worry, hurt, anger, revenge, guilt,
shame, and powerlessness. The drawing process it-
self yields far more information than only asking
youth to talk about their experiences. Drawing also
enables young people to create new images of self
that are strength-based and resilience-focused.

winter 2014 volume 22, number 4 I 19

Erica, a i6-year-old, was exposed to multiple sexual
assaults in her home. She was asked to draw a pic-
ture to tell a story about what happened to her. She
drew a picture of her abuser and the room where the
abuse took place several times a week. At the bottom
of her paper, she drew a box and identified this as
the “Dance Area.” This was not only the room where
she was repeatedly abused, but also the room where
she would come and dance for hours. She turned her
place of terror into a place of safety. There she could
engage in a self-regulating activity that buffered the
fear she felt every night when it was time to go to bed.
This was significant Information that had not been
discussed previously but was only revealed through
her drawing. Music and dance became the resources
of resilience and self-regulation that were integrated
into her treatment plan. Erica’s story demonstrates
that we can help youth trapped by traumatic memo-
ries to create a safe refuge where they can begin to
regulate the constant worry of being traumatized
(Steele & Kuban, 2013).

Being empowered to
participate in their own heaiing
gives young peopie a renewed
sense of seif-controi, safety,

and purpose.

Michelle is a 17-year-old with a history of abuse, ne-
glect, sexual assault, and rape. The adult expressed
curiosity by asking this trauma-specific question:
“Of all that has happened that brought you here to-
day, what was the worst part for you?” Michelle was
encouraged to tell her story by drawing a picture.
She described her worst experience as, “the rape,
but not the rape itself…I am an outgoing, strong
girl. I was the only girl on our school football team
my sophomore year—I am tough! Every day I look
back on the situation and just hate myself for let-
ting the rape happen.” Providing Michelle with
an opportunity to tell her story through drawing
was a turning point. In spite of months of “talk-
ing through” her rape with a very caring aunt and
good friends, it was visual images and trauma-
specific questions that led to a shift in her view
of herself. Michelle looked up from her paper and
exclaimed, “I did do everything I could to try to
stop the rape from happening. It wasn’t my fault.”
The visual representation allowed Michelle to see
that she did everything she could do to escape that
situation. There was no longer a need to dwell on
feelings of guilt.

SITCAP’s healing value is supported by research and
practice history in varied settings with youth who
have experienced a wide range of trauma-inducing
situations.’ Young people move from trauma to
resilience as they reframe their thinking from the
role of victim to survivor. The SITCAP model uses
the traumatized youth’s own experiences to guide
treatment. Trusting bonds and repetitive safe and
structured activities provide new opportunities
for youth to view themselves and their world with
hope and resolve. Being empowered to participate
in their own healing gives young people a renewed
sense of self-control, safety, and purpose.

William Steele, MSW, PsyD, founded the National
Institute for Trauma and Loss in Children (TLC) in 1990,
and developed the SITCAP model He trains profession-
als to treat childhood trauma not as a deficit-focused di-
agnosis, but a series of sensory experiences experienced
by traumatized children regardless of their culture. He
can be contacted at steelew@starr.org

Caelan Kuban, LMSW, PsyD, is Director of The
National Institute for Trauma and Loss in Children
(TLC), a program of the Starr Global Learning Net-
work. She trains professionals nationwide and is a
Certified Trauma Consultant-Supervisor providing
trauma assessment and short-term intervention uti-
lizing evidence-based practices including the SITCAP
model. E-maii ckuban@tlcinst.org

References

Levine, P., & Kline, M. (2008). Trauma-proofing your kids: A
parents’ guide for instilling confidence, joy, and resilience.
Berkeley, CA: North Atlantic Books.

Perry, B. (2009). Examining child maltreatment through a
neurodevelopmental lens: Clinical applications of the
neurosequential model of therapeutics. Journal of Loss
and Trauma, 14(4), 240-255.

Steele, W., & Kuban, C. (2013). Working with grieving and trau-
matized children and adolescents: Discovering what mat-
ters most through evidence-based, sensory interventions.
Hoboken, NJ: John Wiley & Sons.

van der Kolk, B. (2006). Clinical implications of neurosci-
ence research in PTSD. Annals of the New York Academy
of Sciences, i, 1-17.

(Endnotes)

I Further information on research supporting SITCAP pro-
grams is listed on the California Evidence-Based Clearing-
house and the Substance Abuse Mental Health Services
Agency (SAMHSA) National Registry of Evidence-Based Pro-
grams and Practices (NREPP).

20 I reclaiming children and youth www.reclaimingjournal.com

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