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 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, and developmental competencies. This model emphasizes the importance of understanding and intervening with the child-in-context, with a philosophy that systemic change leads to effective and sustainable outcomes. Unlike manualized treatment protocols, this framework acts as a guideline to inform treatment choices, while recognizing the need for individually tailored intervention as well as the important role of each practitioner's skill base.
Attachment, Self-Regulation, and Competency: a framework for intervention with complexly traumatized youth.
The goal of ARC is to address vulnerabilities created by exposure to overwhelming life circumstance that interfere with healthy development. ARC is based in phase-oriented treatment approaches; while recognizing the importance of processing traumatic memory and experience, ARC-focused intervention concentrates on the broader array of skills deficits seen in the complexly traumatized child and highlights the foundation needed for transforming traumatic experience. Through building skills, stabilizing internal distress, and strengthening the security of the caregiving system, interventions guided by this framework seek to provide children with generalizable tools that enhance resilient outcome.
For each of these three key areas, ARC provides guiding principles in which to ground assessment and intervention and a menu of sample activities to be used. This allows clinicians the flexibility to choose interventions based on the assessment of each particular child, within his or her own context. Specific approaches should be incorporated into the larger treatment plan, to address particular issues for each child.
“Attachment” describes the interactions between children and their caregivers that have a longstanding impact on the development of identity and personal agency, early working models of self and other, and the capacity to regulate emotions.2 Nurturing and consistent caregiving promotes skill development and a safety net for coping with difficult experiences. Secure attachment in childhood has been linked to numerous positive outcomes and is a significant predictor of resilience among high-risk populations.3 Conversely, impaired attachment has been linked to multiple negative outcomes, including psychopathology4,5 and altered peer relationships.6
The majority of maltreated children have insecure…