SFCR has been shown to be feasible and effective. In a sample of 185 families, with pre/post data on 103 families, SFCR was found to work in multiple types of sites with families who have experienced many types of severe adversity and trauma.

Data indicated that 50% of families taking part in the 15-week model are attending 11 or more sessions.

Children experience significant reductions in symptoms of PTSD and in behavior problems.

Parents experience significant reductions in symptoms of emotional distress and PTSD (new data).

Families gain skills in coping and stress reduction, and demonstrate healthier functioning.

SFCR’s effectiveness has been demonstrated through the collection of practice-based evidence. The model has not been tested under highly controlled conditions or compared to other treatments.

Your initial SFCR multi-family group will include a family meal, group activities about family traditions and family stories, and some time spent establishing group rituals. The group lasts about 2 hours and includes time participating together as a big group, time for each family to do some activities together, and time for “break out” groups such as parents, teens, school-age kids, and toddlers. During the first group, you will meet 4-5 other families who also want to learn and practice new skills.

A parenting class often focuses on teaching parents things to do with their children to improve child behavior and functioning. In SFCR, all family members will learn skills and make shifts in family relationships that will improve functioning for everyone in the family, such as decreased stress, improved communication, and increased use of positive coping skills.

“The kids like the idea that they have other children they can talk with and understand each other. Their feelings are accepted”

“We have talked more as a family since being in this group”

“Dinner used to be stressful and I dreaded it so much I would just turn on the TV and we ate while we watched. Now I enjoy dinner with my kids and we actually have fun!”

“I know now how it important it is to have fun with my family. We have all been through so much and I want to make sure we remember to have fun together.”

“The group brings families together and you get to know other families/positive people who are in similar situations. At the end of the group it made me feel like I have a larger family.”

“I feel like I met some extraordinary families that showed so much strength.”

“I really learned a lot of patience and I really enjoyed getting my child’s input on projects.”

“We loved coming to the group and wish it wouldn’t stop.”

“We get along better now. We learned about how to handle stress.”

“Something my family does differently now is we try to talk to each other instead of yelling.”

“It brought my heart joy listening to my grandson speak on his feelings. He has grown and is developing the right attitude and mind frame for a beginning of forgiveness and moving on.”

“It has truly been a blessing for us to be able to learn to understand each other on a deeper level and to utilize new ways to communicate and help each other grow to maximize our potential.”

Please contact Laurel Kiser or one of the SFCR stewards through the website to find out more about training in SFCR.

While the multi-family group models of SFCR have been around for many years, more recently the SFCR has been working on adaptations for SFCR including 1) with teen parents, 2) SFCR for parents led by parents (Peer to Peer), and 3) SFCR for individual family treatment.

Training for SFCR covers information about how trauma impacts family systems. Depending on role you play as a facilitator of SFCR, it is preferable that you have a background in trauma and family systems work, but it is not necessary as a precursor for training.

As mentioned about, the Peer to Peer model of SFCR is designed to be led by and for caregivers/parents. Often, parents are trained in this model after attending the SFCR multi-family group.

“SFCR is the only group I have ever led that had perfect attendance for the full 10 weeks!”

“This is the most profound therapeutic work I have done.”

Yes!

SFCR has been translated to Spanish by a team focused on cultural responsiveness. Not only were the materials translated, they were adapted to be culturally relevant to families of Latino and Hispanic origin.

In addition, SFCR Peer to Peer has been led in at least 5 other languages using patient navigators to lead and/or translate the groups.

The selection criteria for the group vary with the format.

For the 15-week trauma treatment model, exposure to a traumatic event and associated traumatic stress symptoms are a requirement for eligibility. More specifically, at least one member in the family, must have experienced multiple traumatic events which meet Criterion A for a DSM-IV PTSD diagnosis. In addition, the identified family member(s) must also meet criteria for a full or partial diagnosis of PTSD.

The selection criteria for the high-risk model are less stringent. It is common for families who participate in this model to have experienced traumatic events or live in environments where the risk for exposure to trauma is high. Additionally, traumatic stress symptoms may be present at a subclinical level.

The workshop model is typically offered by organizations serving families at high-risk for trauma exposure. These organizations typically either select or recruit families to participate in the workshop by advertising the workshops and inviting any interested family to drop in and participate.

Since the social support is theorized as a healing resource in the model, the number of families attending is important to consider. Most agencies start with 5-6 families. If a family has to miss a session or drops out, there are still enough families in attendance to make connections. Of course, availability of facilitators and space are considerations.

Issues of family engagement and retention are critical to intervention effectiveness for the targeted families for two reasons: a) previous trauma treatment research with children and their families demonstrate that the symptoms of the disorder (isolation, mistrust) may impede the establishment of therapeutic alliances; and b) families living in traumatic contexts may have cultural, logistical, and financial issues that impede engagement. Therefore, significant efforts are made to identify and minimize barriers to recruitment and to encourage attendance and participation. SFCR is highly structured and manualized. Even so, it is critical to establish rapport and a good working relationship with each family. This requires clinical skills and an investment in engaging each family in the treatment process.

SFCR has several specific strategies built in to help increase engagement. These include providing a meal at each session, fun activities, and reminder phone calls and postcards from facilitators to encourage ongoing participation. Individual sites may offer additional incentives, as available, such as transportation to/from sessions and providing a door prize to at least one family at each session.

An important part of the intervention and engagement in SFCR is the formation of a community among group members. In the first session, families work together to determine their opening and closing rituals, providing them ownership over their group. Over the course of SFCR, families are asked to share stories and other activities with the group (although they are never asked to share any information about their traumas with the group). These group activities allow the relationships between families to grow. Breakout groups divided by age also help with group cohesion. The parent breakout group is often critical to the families’ engagement in the treatment process. Parents often form a close bond that seems to be an important factor in their level of engagement. Additionally, the youth are given a chance to spend time with other kids their age and do a fun activity together. Also, in session 6, a family buddy system or phone tree is established so families can contact one another outside of sessions. This serves to both support participation in group and group cohesion among members.

The time of day can be determined by your site, depending on staff availability, space availability, and when families are most likely to attend. Our groups have previously been conducted in the morning, after school, and early evening hours. Most commonly at our clinic, the full trauma model is run in the early evening and a family dinner is served. The morning and early afternoon groups have primarily been used with the workshop model.

After each session, each facilitator completes a treatment adherence measure. The adherence measure uses a yes/no question format. The measure includes 16 items indicating both actions and procedures, as specified in the treatment manual, which a clinician should and should not be doing during each session.

Videotaping can be used, at the discretion of each site, to aid in ensuring fidelity. However, videotaping is not a requirement for measuring treatment fidelity.

SFCR Multi-family groups are conducted using facilitator teams. SFCR facilitator teams usually comprise experienced clinicians along with students or other support staff.

Generally, to implement SFCR, clinical facilitators should be trained in developmental psychopathology, and be experienced in assessing and treating a wide range of different child, adolescent, and adult mental health disorders within the context of the family. Additionally, clinical facilitators should have prior training and supervision in providing a variety of treatment approaches to children and their families, both individually and in groups, including: family systems, parent-child interaction, cognitive-behavioral, and play therapies. Clinical facilitators should also have experience in the provision of trauma-focused treatment with children and their families.

SFCR provides a wonderful training opportunity for students from a variety of mental health disciplines. Students who serve as part of a SFCR facilitator team have the opportunity to observe the clinical facilitators work with a variety of families in a variety of clinical modalities (multi-family, family, and small group) and also participate in leading various group activities under close supervision.

Additional facilitators can be members of the organization or community in which the group is taking place and bring an understanding of that community’s culture and value system.

More specifically, the facilitators are required to maintain a focus on specific issues related to constructive family coping. They attend each session with a positive attitude and high expectations. They make the children, the caregivers, and the families as a group feel that this time is special. They encourage each group to form a network and make positive use of all of the people resources available during each session. When events happen to threaten the continuity or cohesion of the session, the facilitators model flexible problem-solving skills and conflict resolution, yet manage to ensure that the session proceeds and the goals for the session are accomplished. Finally, they encourage a high level of participation from each person attending regardless of their age, stage of development, or abilities.

In addition, facilitators must be sensitive to the needs of trauma victims. They are aware of the physiological and emotional reactions that are triggered by reminders of traumatic events and work to identify these triggers and help participants regulate their expressions of distress. Facilitators are also keenly aware of the contagious nature of traumatic distress so pay careful attention to group processes. Finally, facilitators realize that trauma treatment is difficult and make efforts to work through their own reactions to the trauma pain that is experienced within the group.

Yes, in the MFG version SFCR is quite resource intensive as are the needs of the families participating. The next group of FAQs breaks down the resources needed so that agencies can plan accordingly.

The minimum number of clinical facilitators required for the trauma-specific and high-risk models are based on two factors: the total number and size of families enrolled and the number and size of age-based breakout groups.

For the trauma treatment version, at least one clinical facilitator must be present for each family enrolled in the group to cover the family-based breakout groups (co-constructing a family narrative). For these family narrative sessions it is important that each  facilitator is skilled and comfortable in conducting trauma-focused family therapy. If meeting this requirement is a challenge due to staff restrictions, there are some possible ways to alter the group schedule to accommodate fewer experienced clinical facilitators. Such modifications are addressed on a site-by-site basis.

At least one facilitator must be present to cover each age-based breakout group. Possible  groups outlined in the SFCR manual include: parents, adolescents, older children, younger children, and babies and toddlers. However, there are several considerations which may alter the number of facilitators required. First, not all groups will have children to fill each age-based breakout group. For example, there may not be any adolescents enrolled so a facilitator is not required to staff this group. Second, some sites recruit families with children of specific ages to limit the number of breakout groups (either to due to space or staff limitations). For example, one site did not recruit families with babies or toddlers because they were unable to staff this breakout group.

Finally, some breakout groups may need more than one facilitator to manage the group appropriately. This may be due to the age of the children, the number of children included in the group, and/or behavior concerns. Traditionally, breakout groups benefit from additional staff if there are several babies, toddlers, or young children, or if there is a child who has difficulty managing his/her behavior and may be disruptive to the other members of the group.

For the workshop model, approximately 2-3 facilitators are required given a group size of 4-5 families.

Preparation for the group involves several components: initial preparations prior to session one, meal preparations, and preparing for each session on a week-to-week basis. The initial prep, especially if it is the first time a site is running the group, can be fairly time-intensive. The preparation includes ordering or shopping for all group materials, recruiting families, preparing the weekly materials, and organizing the facilitator team and other logistics (such as space, food, etc). However, many of these tasks can be divided among several individuals and are started 4-8 weeks prior to the group start date, decreasing the burden on one person’s schedule.

The extent of the mealtime preparations depends on what type of meal your site is able to implement, how the delivery of the food is arranged, and how you plan to serve the food (see below for more information). Weekly tasks may include ordering the food, picking up the food or arranging to meet a delivery person, setting up the room for mealtime (i.e., setting up the buffet, setting the tables), and cleaning up after the meal.

Lastly, the week-to-week preparation for sessions includes two main tasks: meeting as a group for supervision and planning purposes, and preparing the materials for the impending session. Typically, groups meet for 30 minutes to an hour to discuss the previous group, debrief and problem solve any difficulties that were not handled in session. The team also plans for the next session, including assigning various roles, as needed, and plans for any clinical concerns (i.e., how the team will handle a disruptive child). The material preparations are typically assigned to one or two individuals for the duration of the group. These tasks include printing/copying all handouts and gathering materials for each of the planned activities. The amount of time to complete these tasks varies based on the individual’s experience with the group materials and the nature of the activities planned for that session. Typically, these tasks can take anywhere from 10 minutes to 45 minutes.

The cost for the supplies is outlined in the last two pages of the SFCR manual. For the full 15-week version, the cost for supplies is currently around $1800. These supplies are predominantly reusable, and will be a one-time cost. However, there will also be an ongoing cost related to food, which depends on the size of the group and the type of meal provided. For the high risk version, several of the supplies used in the full version are not needed. These are indicated on the order form with an asterisk and decrease the cost by approximately $250. The meal component is also included in this version, but only requires 10 weeks of food costs. The materials needed for the workshop model vary by the materials available at each site. A projected list of supplies and possible cost can be provided upon request.

The meal component usually consists of a dinner, which can be served and consumed within the 30-minute time frame allotted to the family meal. At our center, the dinners typically include kid-friendly meals that change from week-to-week. Meals have included spaghetti, chicken fingers and French fries, grilled cheese and soup, hamburgers, pizza, etc. Meals may either be served family style, in which there is a portion large enough for the entire family set at the center of each family’s table, or as a buffet. Typically, the manner of serving the meal is based on the availability of space at each individual site.

Several groups have served breakfast or an afternoon snack instead of dinner. The type of meal served is influenced by the time of day during which you will be running the group and at times, the model of the group being used. The workshop version tends to be most flexible in terms of scheduling, and often lends itself to being run at various times during the day. Therefore, in our experiences, the workshop version has served the greatest variety of meals.

The type of the meal you are able to serve and the cost will likely be determined by the options available to your institution. For example, at our clinic, we have an arrangement with a local restaurant for a set cost per person, providing we select the meals from a limited menu.

To implement the full trauma or high-risk versions of SFCR, a large group room is required that can accommodate all of the families who are members of the group, the facilitators, and serving a family meal.

In addition, several smaller rooms are required for the breakout groups. The number of “breakout” rooms required depends on the number of breakout groups within each group and/or the total number of families enrolled. For the age-based breakout groups, each group requires their own space to complete their activities with a facilitator. The maximum number of breakout groups is 5; parents, adolescents, older children, younger children, babies & toddlers. For the family-based breakout groups, each family requires their own space to complete their activities. The number of rooms required depends on the number of families recruited and enrolled. A typical therapy office is usually large enough to accommodate the breakout groups, although it depends on the number of participants in each group.

It is important to note that at many sites, the space requirements are strongly considered when recruiting for the group. If space limitations are present, facilitators will only recruit and enroll the number and size of families they are able to accommodate with the space they have available. Additionally, if needed, several sites have limited their recruitment to families with children in specific age ranges to limit the number of breakout groups.

Implementation for SFCR consists of a pre-implementation planning phase followed by formal training and ongoing consultation. Training includes didactics covering constructive family coping, family traumatic stress, and intervention content delivered as a 2-day workshop. All intervention methods and materials are presented in detail, including discussion of each session, rehearsal through role-plays, and hands-on practice of several activities. Ongoing consultation consists of weekly calls with the facilitator team through one 15-week group and bi-weekly calls through the second 15-week group. Consultation is typically conducted via conference calls pre-arranged at a regular weekly time that is convenient for both Dr. Kiser or a trained trainer and the facilitator team.

Costs vary depending on the version of SFCR being used and the number of teams being trained. The initial training can be held locally at your site, although the overall cost will increase to include travel expenses.

A Booster training has been developed that offers a 1-day experience for facilitators who are joining established SFCR facilitator teams. This training is also an excellent opportunity to prevent drift from fidelity.

An advanced half-day training is available for agencies conducting the 15-week treatment model. This training focuses on facilitating family trauma narrative work.