---

---

“This second edition represents the growth of TST and its increased focus on the TST treatment team working within a much larger, multifaceted organizational system….The 10 years between the first and second edition of this book led to the creation of a more robust and encompassing treatment plan. This excellent book details the growth of TST and its expansion to include more than the population of traumatized children. Much was learned over those 10 years, and that learning is carefully laid out in a comprehensive, organized, and, to use the author’s expression, ‘real world’ manner. It is clear that Saxe, Ellis, and Brown have ‘walked the walk’ and have created an excellent, important, well thought out, and detailed text which can have a profound impact on both providers and those in need of services. The book can be a valuable tool for any student or trainee in social work, psychology, psychiatry, pediatrics, or law who wishes for a greater understanding of the fundamentals of traumatic stress and its proper and effective management….This book breathes a breath of fresh air into a very thorny issue and does provide hope by focusing on the system as a target of therapy as well as on individual therapy….It is highly recommended for anyone working in or with agencies and with challenging populations.”

—Child and Family Behavior Therapy


“This book would be extremely supportive to clinicians working in schools, homes, clinics, or the community….It is also extremely useful knowledge for any practitioner working with trauma, either in children or adults….The book is, effectively, a gold mine of information on trauma….The information is easy to access and well presented….An excellent resource….If you work in the field, I think you need this book on your shelf.”

—BACP Children and Young People


“The authors provide helpful advice on the treatment of childhood traumatic stress that can be used by clinicians, teachers, social service workers, lawyers, administrators, policy makers....Helps guide individuals in the treatment of children as well as in the coordination of services under a financially constrained system of care.”

—Journal of the American Academy of Child and Adolescent Psychiatry (on the first edition)


“An excellent resource for therapists who work with the children and families served by public mental health and child welfare systems. This is a practical treatment manual that incorporates all of the major techniques or practice elements used in proven trauma treatments....Saxe and colleagues have organized their book to be easily accessible for busy clinicians and other mental health workers who may find it difficult to tackle denser textbooks....I really like this book. I recommend it highly for clinicians working in children's mental health and for students in this field. In fact, I have been trying to find a way to buy copies for all of our state's contracted provider agencies, because I think they all could improve their practice by using at least some aspects of this approach. Although the book focuses on intensive outpatient treatment settings, the approach clearly could be applied in many of the other settings that make up our array of services, such as therapeutic group home or foster home programs.”

—PsycCRITIQUES (on the first edition)


“I recommend this book, as it provides the basic elements and components of the TST approach in a clear and integrated way and, as a textbook or manual, it is easy to read and follow.”

—Journal of Children's and Young People's Nursing (on the first edition)


“A valuable resource that strikes the balance well between just the right amount of jargon-free theory and maintaining its focus on practical issues. The book is friendly and easy to read....Here is a book that offers a model that moves theory to practice in order to help all of us who endeavour to treat, support, and care for traumatised children and adolescents.”

—Counselling Children and Young People (on the first edition)


“The authors of this text have done well in bridging a gap between theory and practice, while providing an easy-to-read text, which serves as a guidebook for effective treatment of traumatic stress in children and teens.”

—Family Journal (on the first edition)


“This is an excellent volume, particularly for the front-line provider interested in a manualized hands-on introduction to interventions with traumatized children, teens, and their families.”

—Archives of Pediatrics and Adolescent Medicine (on the first edition)


“A marvelous, practical, integrative guide for all those who work to help traumatized kids. Based on a thorough understanding of the underlying biological, social, and attachment issues, this book confronts the realities of children's and families' lives and the awesome obstacles that providers face. TST offers a comprehensive way to deliver effective services and reorganize often-broken systems of care. This approach not only will facilitate healing, but also will help prevent practitioner burnout and the wasteful use of resources. I love the energy behind this work!”

—Bessel A. van der Kolk, MD, Founder and President, Trauma Research Foundation, Boston, Massachusetts


“The second edition of this important book reflects the essence of what it takes to provide excellent trauma treatment. Everything in this volume makes complete sense, especially with regard to understanding and assessing the traumatized child's survival-in-the-moment states. Recommendations for planning treatment and integrating services are clear and concise. Readers will find this a valuable resource for developing comprehensive services for children and families exposed to traumatic life events.”

—Anthony P. Mannarino, PhD, Department of Psychiatry, Allegheny General Hospital and Drexel University College of Medicine


“Building on the strengths of their first edition, the authors have incorporated innovations from successful adopters of TST. This treatment model tackles multiple real-world challenges to thoroughly assess traumatized children and their families and social environments. Interventions targeting both the impact of trauma and the barriers to care in the environment take into consideration key principles of neurobiology, child development, and family systems, as well as the evidence base for treating child traumatic stress. The book includes a full set of therapeutic activities and reproducible assessment tools and worksheets. The new chapter on organizational planning and implementation facilitates adoption of this unique model of integrated care.”

—Lisa Amaya-Jackson, MD, MPH, UCLA-Duke National Center for Child Traumatic Stress, Duke University School of Medicine

---

Table of Contents

1. Introduction to TST

I. Foundations

2. Survival Circuits

3. The Regulation of Survival-in-the-Moment States

4. The Social Environment and the Services System

5. Safety Signals

II. Getting Started

6. Ten Treatment Principles

7. The Treatment Team

8. Organizing Your Program

III. Doing TST

9. Assessment

10. Treatment Planning

11. Ready–Set–Go

12. Safety-Focused Treatment

13. Regulation-Focused Treatment

14. Beyond Trauma Treatment

15. Psychopharmacology

IV. Improving TST

16. Democratizing TST

17. Extending TST Beyond Trauma

18. Conclusions

---

About the Authors

Glenn N. Saxe, MD, is the Arnold Simon Professor and Chair of the Department of Child and Adolescent Psychiatry at New York University (NYU) School of Medicine and Director of the NYU Child Study Center. Dr. Saxe is a physician-scientist with a focus on the psychiatric consequences of traumatic events in children and on factors that contribute to children’s risk and resilience in the face of adversity. He is the principal developer of trauma systems therapy (TST), which is currently used to guide clinical care in 14 states. He is also Director of the Center for Coordinated Trauma Services in Child Welfare, a National Child Traumatic Stress Network academic center funded to improve trauma services for the nation’s child welfare systems.

• Author's website

B. Heidi Ellis, PhD, is Assistant Professor of Psychiatry at Harvard Medical School and Boston Children's Hospital. She is also Director of the Refugee Trauma and Resilience Center at Boston Children's Hospital, a partner in the National Child Traumatic Stress Network. Dr. Ellis's primary focus is understanding how trauma and sociocultural contexts affect the mental health and development of youth, and translating this understanding into mental health and/or violence prevention intervention programs. She is the codeveloper of TST and oversees the adaptation and implementation of the model with refugee youth.

Adam D. Brown, PsyD, is Clinical Assistant Professor in the Department of Child and Adolescent Psychiatry at NYU School of Medicine. He is also the clinical coordinator of the trauma service at the NYU Child Study Center. At NYU, he directs training, consultation, and technical assistance in TST. Dr. Brown has overseen programs for youth in inpatient, day treatment, and residential settings, and has extensive training and expertise in the area of assessing and treating interpersonal trauma in children and adolescents. He has a focused interest in the complex interplay between traumatized youth and families, the people who provide care to these youth and families, and the systems that contain this care.

---

Contributors

Glenn N. Saxe, MD, Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York

B. Heidi Ellis, PhD, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts

Adam D. Brown, PsyD, Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York

For Promoting Successful Transition to Adulthood for Students with Disabilities:

Robert L. Morgan, PhD, Department of Special Education and Rehabilitation, Utah State University, Logan, Utah

Tim Riesen, PhD, Department of Special Education and Rehabilitation, Utah State University, Logan, Utah

---

Audience

Mental health professionals working with 6- to 18-year-olds, including child and adolescent clinical psychologists, psychiatrists, social workers, and counselors.

---

Course Use

May serve as a supplemental text in graduate-level courses.

---

Previous editions published by Guilford:

First Edition, © 2006
ISBN: 9781606233498

---

New to this edition:

• Restructured to reflect significant conceptual and clinical advances.
• Even more clinician friendly: increased emphasis on practical aspects of assessment and treatment.
• Chapter on organizational planning.
• Chapters on TST innovations, including applications for diverse trauma populations and for problems other than trauma.
• More reproducible clinical tools—now downloadable.