Trauma-specific therapies  

What is it?

Trauma occurs when an event or set of circumstances causes physical or emotional harm which leads to lasting adverse effects on health and wellbeing. Research suggests a link between experiencing trauma and increased risk of involvement in crime and violence. 

Trauma-specific therapies, also known as trauma-focused interventions, aim to support children to recover from trauma. They typically involve forms of psychological therapy where a therapist provides support to individuals or small groups. They can work with children who have experienced trauma but have not been involved with the criminal justice system, or with children who are already in the system. These therapies are distinct from trauma-informed practice or trauma-informed training, which seek to improve practitioners’ understanding of and approach to trauma within day-to-day services such as policing or education. We have a separate Toolkit strand for trauma-informed training and service redesign.  

A range of different therapies are included in this summary:   

• Trauma-focused Cognitive Behavioural Therapy (TF-CBT), which aims to modify thoughts, behaviours, and emotions. 
• Cognitive Processing Therapy (CPT), a specific form of CBT that focuses on modifying unhelpful and faulty beliefs related to a traumatic event.  
• Various other psychotherapies, such as humanistic therapy, psychodynamic therapy and safety seeking therapy.  
• Eye Movement Desensitisation and Reprocessing (EMDR), which aims to reduce the vividness and the emotional response associated with memories of trauma.    

A range of different practical activities were used by the interventions above. Therapists might work with children to develop coping skills, make sense of traumatic experiences, set personal goals, and plan for the future.   

Theories suggest that trauma-specific therapies can support children and young people to cope with trauma and adverse childhood experiences (ACEs). This could disrupt the link between trauma and negative behaviours that are associated with later involvement in crime and violence.  

Is it effective?

On average, trauma-specific therapies are likely to have a high impact on preventing crime and violence for children and young people at-risk of involvement in the criminal justice system.  

Our estimate is based on only four studies which suggest on average trauma-specific therapies reduced crime and violence for children and young people at-risk of involvement by 45%.  

Findings from 19 studies suggest that trauma-specific therapies also had a high impact on externalising behaviours, such as aggression.  

It is important to note the effect may vary depending upon the characteristics of children and young people supported. Six studies assessed impacts on offending, of which four focused on children and young people at-risk of involvement in crime and violence, and two focused on children and young people already involved in the justice system. The latter two studies did not find that trauma-specific therapies were effective for children and young people already involved in the justice system. However, the very low number of studies means we have very low confidence in these findings.  

How secure is the evidence?

We have very low confidence in our estimate of the average impact on violent crime. 

Our confidence is very low because the estimate is based on only four studies and there is a lot of variation in the impacts they found. Some studies suggested that the impact was higher and others suggested it was lower. Studies have generally used very small sample sizes, typically between 21 and 30 children. 

Most studies were conducted in the USA and the review didn’t find any studies from the UK or Ireland.  

How can you implement it well?

The review suggests that programmes that include techniques to change the way we think may have a larger effect for children and young people at-risk of involvement with the criminal justice system. This involves: 

• Becoming aware of the thoughts we regularly have  
• Evaluating our thoughts and deciding what could be changed  
• Replacing unhelpful or unhealthy thoughts with more rational thoughts.  

Programmes that include ‘trauma narrative therapy’ may have a larger effect for children and young people at-risk of involvement with the criminal justice system compared to those that don’t include it. This type of therapy involves creating a chronological narrative of the person’s life story, remembering and talking through traumatic experiences and related thoughts and feelings. This gives opportunity to re-evaluate and reconstruct memories, modify fear reactions and develop healthy processing of memories.  

What programmes are available?

Below is a list of programmes found in the Early Intervention Foundation’s (EIF) Guidebook. The Guidebook summarises the research on programmes that aim to improve outcomes for children and young people.

How much does it cost?

On average, the cost of trauma-specific therapies is likely to be moderate.  

Most interventions for trauma consist of therapies which require a trained therapist and intensive and specialised support. A review of costs of trauma-specific therapies found that costs varied between around £500 and £1,500 for the various therapies used.  

Topic summary

• Trauma-specific therapies are targeted interventions which aim to support individual recovery from trauma. 
• Trauma-specific therapies on average have a high impact for children and young people at-risk of offending, although this is based on very weak evidence.  
• Further insights could be gained through evaluations of trauma-specific interventions conducted in the UK.  
• YEF have funded a pilot study of ASSIST Trauma Care, a project that employs experienced therapists trained to work with Post Traumatic Stress Disorder (PTSD) and the after-effects of trauma in line with current evidence-based practices.  Find out who we fund.

Take away messages

• Invest in clinically-led provision of therapies for children with identified trauma who are at-risk or already involved in violence.   
• Fund therapeutic services that incorporate cognitive restructuring techniques, such as Cognitive Behavioural Therapy, Trauma-focused Cognitive Behavioural Therapy, and Cognitive Processing Therapy.  
• Ensure referrals and needs assessments take place quickly.  
• Put strategies in place to reach children from racially minoritised communities and to keep them engaged throughout the intervention.  

External links

Adverse childhood experiences: What we know, what we don’t know, and what should happen next 

EIF report about what we know about the impacts of trauma and the types of interventions used to treat trauma.

What have ACEs got to do with justice? 

A research report by the Scottish Government outlining the relationship between ACEs and future outcomes. 

Recognizing and Treating Child Traumatic Stress  

Information sheet about the signs of traumatic stress, its impact on children, treatment options, and how families and caregivers can help. 

Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder 

This review of cost-effectiveness includes a table of average costs of various trauma-focused interventions delivered in the UK.  

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