Refugee Trauma and Resilience Center | Prevention and Intervention

Trauma Systems Therapy (TST)

Trauma Systems Therapy (TST; Saxe, Ellis, & Kaplow, 2006) is a comprehensive method for treating traumatic stress in children and adolescents that adds to individually-based approaches by specifically addressing social environmental/system-of-care factors that are believed to be driving a child’s traumatic stress problems. TST conceptualizes child traumatic stress as the interface between two conceptual axes: 1) the degree of emotional and behavioral dysregulation when a child is triggered by overt and subtle reminders of a trauma and 2) the capacity of the child’s social-ecological environment/system-of-care to protect the child from these reminders, or help the child to regulate emotions in the face of such reminders. TST is both a way of organizing services as well as a set of specific clinical interventions. 

TST Phase Assessment Grid 

This phase-based treatment recommends various treatment modules depending on the degree of emotional dysregulation and the stability of the social environment. Treatment proceeds in phases depending on the child’s degree of emotional/behavioral regulation and environmental stability. Children move from one phase to the next based on improvements in the stability of the social environment and/or emotional regulation. TST includes plans and procedures for engaging all service providers, specific treatment planning forms that can cross systems of care, and legal consultation when needed to help a family access needed services related to recovery from traumatic stress. Specific intervention modalities that are contained within TST are home-based care, legal advocacy, skill-based psychotherapy, and psychopharmacology.

A full description of TST is offered in our book: Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach(Saxe, Ellis, & Kaplow, 2006).

TST adapted for Refugees (TST-R)

Many refugee youth and their families experienced war and violence prior to resettlement and continue to face ongoing acculturative and resettlement stress. Some experience problems related to trauma and stress; however, cultural and practical barriers have led to very few of them receiving appropriate care. TST-R diminishes these barriers to care through implementing an adaptation of Trauma Systems Therapy (TST).

TST-R consists of three components of prevention and intervention: 1) parent outreach focused on anti-stigma and psycho-education, 2) skills-based groups for youth and 3) direct intervention for youth using an empirically-supported model of treatment, Trauma Systems Therapy.

Partners in Disseminating TST-R

TST-R is being adapted for, and implemented with, various refugee communities. We partner with academic institutions, public schools and community mental health agencies and provide technical assistance to these sites regarding the development, implementation and evaluation of TST-R. Our past and current partners include:

1) Project SHIFA Boston

Project SHIFA (Supporting the Health of Immigrant Families and Adolescents) was developed to provide culturally appropriate school-based mental health care for Somali youth and their families in the Boston area. Somalis are one of the largest groups of refugees resettled in Massachusetts and across the United States.

The implementation of Project SHIFA started in the Boston area in the Lilla G. Frederick (LGF) Pilot Middle School in Dorchester in 2007 in partnership with the Refugee and Immigrant Assistance Center and the Boston University School of Social Work. Project SHIFA continued as part of the Boston Children’s Hospital Neighborhood Partnership (CHNP) through 2012.

Through a generous grant from the Marigold Charitable Trust, Project SHIFA Boston and RTRC staff continue to provide psychosocial supports for young Somali children (0-11) in the Boston area. With support from Marigold Charitable Trust we are able to expand our services to Somali students of elementary-school age. Given the nearly ubiquitous trauma history for Somali refugee families, and the significant acculturative stress of relocating in the U.S., this represents a particularly important group for early intervention/prevention. Through this program we serve younger siblings of children currently enrolled in our program, as well as young children attending any Boston Public elementary-school who are referred to our program in crisis. Children receive family outreach and family-based prevention work and teacher consultation to help ensure the children's teachers understand culture, trauma, and how best to support the children's success at school.

2)  Project SHIFA Maine, Lewiston/Auburn, ME is currently being implemented with Somali youth. The implementation of Project SHIFA Maine was initiated in 2011 through the work being conducted as part of a Safe Schools Healthy Students grant to Lewiston/Auburn schools.  Partners in Maine include Spurwink Clinical Services, United Somali Women of Maine, Auburn Public Schools and Lewiston Public Schools.

3) West Springfield, MA began implementing TST-R with Bhutanese youth in September 2013. Partners in West Springfield include Behavioral Health Network and West Springfield Public Schools.

4) Louisville, KY (Kent School of Social Work, NCTSN Cat III Center) began implementing TST with Somali youth in the spring of 2013, with plans to expand to other refugee groups over the next few years.