The Tern Program: Development and Multi-site Evaluation of a Person-Centred, Trauma Informed Psychotherapy Protocol for Young People with Histories of Childhood Trauma

The Tern Program is a semi-structured, multi-component psychosocial intervention designed to address the features of Complex PTSD as defined by the ICD-11. The four major components of the program include: psychotherapy, a psychoeducation group, Limited Case Management, and Therapist Supports. The Psychotherapy: This is an evidence-based psychotherapeutic model drawing from the current knowledge base. Intervention components include psychoeducation, cognitive therapy, somatic and affect regulation skills, behavioural activation, narrative and imaginal exposure, psychodynamic techniques, and supportive techniques such as problem-solving and coaching. This psychotherapy is semi-structured, with intervention components being delivered to greater or lesser extent as required by the patient. The psychotherapy is long-term (to a maximum of 24 months) in order to accommodate anticipated issues of engagement, ongoing or repeat traumatisation, and lapses in recovery (e.g. hospitalisation). Length of individual psychotherapy sessions will range from 50 - 90 minutes dependent on individual need. The psychotherapy is broadly defined as including four distinct phases of care, with differing treatment components within each phase. These may loosely be described as follows: Phase 1 - Safety and Coordination of Care (focus on engagement, assessment and environmental safety) Phase 2 - Stabilisation (primary focus is on individual treatment and development of insight and coping skills) Phase 3 - Processing (provision of exposure therapy to those requiring it) Phase 4 - Identity and Independence (discharge phase focusing on occupational success, maintenance of recovery and consolidation of identity) The psychotherapy will be delivered in weekly individual, one-on-one sessions for 24 months as required by individual participant needs. The treatment program will be individualised to each participant, which is required to be presented at a fortnightly case review. The individualised treatment plan must be presented after at least five sessions of intervention to allow sufficient assessment and treatment planning to have been completed. The treating therapist is then required to provide a minimum of one update on treatment planning after every 10 sessions of treatment (coinciding with the required assessment timepoints). Psychoeducational Group: Participants in the program are invited to join a structured, five-week group program focused on providing education and coping skills regarding the biological and psychological impacts of trauma. This group may be completed prior to commencing individual psychotherapy or during the individual psychotherapy component. Limited Case Management: This component refers to non-traditional psychotherapy tasks aimed at advocacy and improving the patient's environmental circumstances. This may include care-coordination, referral writing, stake-holder meetings, parent/family sessions, or advocacy within work or school settings. Therapist Supports: In recognising the inherent challenges in working long-term with complex/severe mental health presentations, specific attention is provided to supporting the therapists delivering the Tern Program. Therapists received fortnightly two-hour group reflective supervision and access to regular training time and resources. As the Tern Program is a new protocol, fidelity will be measured during the research project. Therapists will be required to record which treatment component they have delivered on a fidelity checklist for every session a patient receives. Fidelity will also be monitored through an assessment at the conclusion of a therapist's orientation to the program, and continually through the group supervision process. Additionally, as the Tern Program is an active clinical service, participants will continue to receive services before and after the data collection period has ceased. If a participant continues to require treatment after the data collection timeframe, they will continue to receive it, though they will no longer be providing data to the project at that time. Participants will continue to be enrolled into the project until the final three months of data collection, so as to allow a minimum of two time points of data. No new participants will be invited to the research project past that point.