How the Village for Families & Children is using Eye Movement Desensitization and Reprocessing (EMDR) Therapy Initiation, Evaluation, Current Use
Why and how did The Village for Families & Children add EMDR to the treatment methods its clinicians employ to help children and adolescents affected by trauma?
The Village for Families & Children uses a number of therapy models to treat children who have experienced trauma: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); play-based Cognitive Behavioral Therapy, Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems (MATCH-ADTCP), Child Parent Psychotherapy (CPP) and the Attachment, Regulation and Competency (ARC) Framework which includes clinical intervention for both the child and his family/caregiver support network. While therapists can be trained in multiple models, The Village encourages its therapists to receive a strong grounding in a model before receiving training and certification in additional models.
While it’s generally available among private practitioners, EMDR has been under-recognized and underutilized in community mental health, the source of behavioral health care for the majority of Medicaid-eligible children. As a result, too many of Connecticut’s most vulnerable residents have limited access to this effective treatment.
Recognizing these disparities, in 2012, The Village for Families & Children received a four-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand evidence-based treatment options, including EMDR, in its urban multi-site outpatient behavioral health clinics.
This grant focused on children who screened positively for trauma upon intake and who The Village’s clinical team believed could benefit from trauma treatment. Cases were triaged by clinical managers to determine how EMDR Therapy would benefit clients in comparison to other evidence-based models.
How did The Village begin to integrate EMDR into its therapy options?
Drawing upon The Village’s success in using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with children of highly mobile families who were unable or unwilling to talk about the traumatic events they experienced, the organization decided to include EMDR in its therapy options because it offered
- Shorter duration of treatment to observe progress
- Less focus on verbal processing of the trauma – important for children who are unwilling or unable to talk about their experience
- The ability to use EMDR in conjunction with other therapies
- The option to treat children where there is no parental involvement, e.g., for children who have been temporarily removed from their families and/or are awaiting foster or adoptive homes
In partnership with Trauma Recovery EMDR Humanitarian Assistance Programs (EMDR-HAP) – which has provided training to clinicians at more than 100 community-based, faith-based, education and healthcare organizations in Connecticut – The Village trained eight clinicians in Advanced EMDR seminars to support the work of others, and 75 clinicians in Basic EMDR Part I and II, with 10 hours of consultation practice.
Associate Vice President for Intensive Treatment Jennifer Lusa, LCSW, Ph.D., oversees The Village’s EMDR therapy and provides bi-monthly consultation to all EMDR-trained clinicians at The Village to ensure adherence to EMDR protocols.
How did The Village choose the children who would be part of the EMDR evaluation?
The Village chose child and adolescent clients for EMDR from all new intakes who
- Had been exposed to at least one traumatic event and/or had prolonged traumatic stress
- Reported symptoms of traumatic stress, behavioral problems, and/or impaired functioning that constituted a diagnosable disorder
With oversight from Yale University’s Institutional Review Board, clinicians at The Village offered EMDR to children they felt would be most appropriate for this method. Those who agreed provided consent to participate in the EMDR evaluation. Clinical staff at The Village measured each child’s status during intake and, for children still receiving services, six months after intake.
Two hundred seventy-eight children from 6-18 years old (average age 12.9 years) received EMDR services between October 2012 and October 2016. Girls made up 49.7 percent of the children treated; 65 percent were Hispanic/Latino; 28.7 percent were Black/African American, 15 percent were White, 7 percent were more than one race and 1 percent were Asian.
The children received EMDR in conjunction with regular talk and/or supportive therapy. Children and youth who received EMDR at the Village were in treatment an average of 48 weeks and received a total of 33 treatment sessions, 10 of which were EMDR sessions. Non-EMDR treatment sessions included individual counseling, family therapy, art therapy and group therapy.
What kinds of trauma did children in The Village’s EMDR evaluation experience?
More than 70 percent of the children receiving EMDR during the evaluation period had experienced five or more traumatic events. Most common sources of trauma were knowing someone who died, being separated from a parent or caregiver, witnessing people physically fighting or threatening harm, seeing a family member get arrested or in jail, being physically hurt or threatened, knowing someone who was badly sick, injured or near death, seen or heard someone using a weapon, watched people using drugs, been in or seen a very bad accident and been attacked by a dog or other animal.
What were the outcomes of The Village’s five-year EMDR evaluation?
Using several national standards to measure demographics, perceptions of care, exposure to trauma and effect on the child’s problem behaviors, the team found significant reductions in the children’s internalizing, externalizing and total behaviors related to the trauma(s) she or he had experienced.
Why are these results significant?
This study showed that EMDR is an effective method for helping children and adolescents of color in poor urban communities deal with past traumatic events. The method’s bilateral stimulation, resourcing and skill-building tools help ‘unlock’ the bad memory, allowing children to process it healthily. As a result, they gain resiliency to deal with troubling situations in the future, as well as deal with stressful situations in their day-to-day life.
Given the positive results of the EMDR evaluation, how is The Village broadening its clinicians’ use of EMDR to help children and adolescents process and manage the traumatic experiences they have suffered?
The Village has begun to incorporate EMDR into several programs including its Enhanced Care Clinic. The organization is also implementing the practice into several of its adolescent programs: home-based Intensive Community Program (ICP), Short-term Family Integrated Treatment (S-FIT), Alison Gill Lodge therapeutic group home for teen girls and Rapid Response programs.
Funded by a grant from the Connecticut Health Foundation.