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Ms. Kinniburgh is director of child services, Dr. Blaustein is director of training and services, and Dr. Spinazzola is executive director, The Trauma Center at Justice Resource Institute, Brookline, MA. Dr. van der Kolk is professor of psychiatry, Boston University Medical School, Boston; clinical director, The Trauma Center; and co-director, National Child Traumatic Stress Network.
The authors have no industry relationships to disclose.
The development of the framework presented in this paper was funded in part by the National Child Traumatic Stress Network initiative administered by the Substance Abuse and Mental Health Services Administration (SAMSHA).
Children who suffer from complex trauma have been exposed to an environment marked by multiple and chronic stressors, frequently within a caregiving system that is intended to be the child's primary source of safety and stability. The cumulative influence of these experiences is seen on immediate and long-term behavioral, functional, and mental health outcomes. There is growing consensus that early-onset and chronic trauma result in an array of vulnerabilities across many different domains of functioning: cognitive, affective, behavioral, physiological, relational, and self-attributional. While, in the course of development, most children have the chance to invest their energies in developing various competencies, complexly traumatized children must focus on survival.
These children need a flexible model of intervention that is embedded in a developmental and social context and that can address a continuum of trauma exposures, including ongoing exposure. This model must draw from established knowledge bases about effective treatment while accounting for the skills of clinical practitioners and the needs of individual children.
Consensus from experts suggests that effective treatment of complex trauma in youth should address six central goals: safety, self-regulation, self-reflective information processing, traumatic experience integration, relational engagement or attachment, and positive affect enhancement (Cook et al., see page 390, and van der Kolk, see page 401). 1 Further, there is a need to recognize contextual variables, including developmental competencies and deficits, familial strengths and vulnerabilities, and external and internal resources and needs.
The ARC Framework
The Attachment, Self-Regulation, and Competency (ARC) model provides a component-based framework for intervention ( Figure , see page 426). The framework is grounded in theory and empirical knowledge about the effects of trauma, recognizing the core effects of trauma exposure on attachment, self-regulation,...