Trauma Systems Therapy

Domain V · Systemic, relational, group & community · Glenn Saxe, B. Heidi Ellis, Julie Kaplow · 2000 · Boston, USA

What it is

TST was developed in the early 2000s at Boston Medical Center by Glenn Saxe and B. Heidi Ellis (with Julie Kaplow on the 2007 first edition). It now runs from the NYU Langone TST Training Center (Saxe, Adam Brown, Susan Hansen). It is both a clinical model and an organisational model: it tells…

Format

• Team and organisation. Every case has a multidisciplinary TST team: therapist, home-based clinician, psychiatrist or nurse prescriber, case manager or advocate (sometimes an advocacy attorney), and, in residential settings, direct care staff as full members, with weekly team meetings per case. The…
• Weekly consultation for the length of the contract, plus a TST book review and quizzes.

Who practises it, and how they are trained or regulated

• Pre-treatment (intake). CSA training material gives about 2 weeks each for Assessment, Treatment Planning and Treatment Engagement. TST-R allows up to one month for intake. Treatment does not start until engagement (Ready–Set–Go) is achieved.
• Assessment that sets the phase. The team rates two things: the child's emotional and behavioural regulation (how often survival states occur and how much they impair functioning, and whether they are dangerous) and the stability or safety of the social environment. The combination places the trauma system in one of three phases. The assessment is repeated at regular intervals, and the phase changes when the ratings…
• Total length. Sources differ: NCTSN 2024 gives 6–12 months if starting in SFT, otherwise usually 4–7 months; the Clearinghouse and CEBC give a typical 7–9 months. The model expects the child to reach BTT ideally; under time-limited child-welfare contracts, phase-based follow-up care is used. Psychopharmacology may be added in any phase, and a psychiatrist or psychiatric nurse practitioner is always on the team.…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• A plan with no social-environment arm.
• Goals imposed by adults rather than owned by the youth.
• Adults using the cue as a threat ("use your skill or else").
• Rating only the child. A calm child in a dangerous home is still an SFT case.
• A diagnosis or a vague label ("anger issues") in place of a cue→state→history link.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.