Violence Prevention: Psychological Harm from Traumatic Events Among Children and Adolescents – Play Therapy – Inactive
The reviews and findings listed on this page are inactive. Inactive reviews and findings are not scheduled for an update at this time, though they may be updated in the future. Findings become inactive when reviewed interventions are no longer commonly used, when other organizations begin systematically reviewing the interventions, or as a result of conflicting priorities within a topic area.
Summary of CPSTF Finding
The CPSTF has related findings for the following types of therapies:
- Art therapy (insufficient evidence)
- Pharmacological therapy (insufficient evidence)
- Psychodynamic therapy (insufficient evidence)
- Psychological debriefing (insufficient evidence)
Intervention
A traumatic event is one in which a person experiences or witnesses actual or threatened death or serious injury, or a threat to the physical integrity of self or others. Trauma may take the form of single or repeated events that are natural or human-made (e.g., tsunami or bombing) and intentional or unintentional (e.g., rape versus car crashes or severe illness). Traumatic exposures may have only temporary effects or result in no apparent harm. However, traumatic exposures may result in psychological harm and lead to long term health consequences.
CPSTF Finding and Rationale Statement
About The Systematic Review
Context
Summary of Results
Two studies were included in the systematic review.
- All of the effect sizes reported were in the desirable direction across all of the studies and outcomes.
Summary of Economic Evidence
Applicability
Evidence Gaps
The following outlines evidence gaps from these reviews on reducing psychological harms from traumatic events: Individual CBT; Group CBT; Play Therapy; Art Therapy; Psychodynamic Therapy; Pharmacological Therapy; Psychological Debriefing.
- Identification of robust predictors of transient and enduring symptoms following traumatic events would allow for better screening of exposed children and adolescents and more efficient allocation of treatment resources.
- The optimal timing of cognitive behavioral therapy (CBT) intervention following the exposure and the onset of symptoms is important to assess.
- It would be useful to stratify the outcomes of CBT treatment by the severity of patient PTSD symptoms and history. For example, it would be useful to know whether children and adolescents with multiple traumatic exposures require more intensive or longer treatment.
- One study with long term follow-up indicates that it may take a year after the end of the intervention for benefits to appear. This outcome should be replicated. If confirmed, it suggests that follow-up periods of less than one year are not adequate and may erroneously indicate intervention ineffectiveness.
- The cost effectiveness and differential cost effectiveness of individual and group CBT among children and adolescents should be explored.
- The effectiveness of individual and group CBT among minority populations, especially in communities in which violence is prevalent, should be further explored.
- Adaptations of CBT involving the recruitment, training, deployment, and supervision of nonprofessionals should be evaluated, and their applicability to low-income countries should also be explored.
Furthermore, the finding of insufficient evidence to determine the effectiveness of several of the interventions reviewed highlights the need for additional well-controlled studies of these interventions. Because CBT has been found to be an effective intervention, and because research funds are limited, it would be useful to adopt CBT as a comparison in future evaluations. Because of harms reported for psychological debriefing among adults, caution should be taken in research on this intervention with children and adolescents.
Study Characteristics
- There were substantial differences between the included studies in terms of index exposure and play-therapy implementation.
- One study assessed the effectiveness of a program for children exposed to an earthquake in Taiwan; the other study assessed a program for children exposed to domestic violence who were living in women’s and homeless shelters.
Publications
Task Force on Community Services. Recommendations to reduce psychological harm from traumatic events among children and adolescents. American Journal of Preventive Medicine 2008;35(3):314-6.
Analytic Framework
Effectiveness Review
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
Summary Evidence Table
Effectiveness Review
Summary Evidence Table
Contains evidence from reviews of individual CBT; group CBT; play therapy; art therapy; psychodynamic therapy; pharmacological therapy; psychological debriefing
Included Studies
Effectiveness Review
Kot S, Landreth GL, Giordano M. Intensive child-centered play therapy with child witnesses of domestic violence. Int J Play Therapy 1998;7:17 36.
Shen Y. Short-term group play therapy with Chinese earthquake victims: effects on anxiety, depression, and adjustment. Int J Play Therapy 2002;11:43 63.
Smith N, Landreth G. Intensive filial therapy with child witnesses of domestic violence: a comparison with individual and sibling group play therapy. Int J Play Therapy 2003;12:67 88.
Tyndall-Lind A, Landreth GL, Giordano MA. Intensive group play therapy with child witnesses of domestic violence. Int J Play Therapy 2001;10:53 83.
Search Strategies
Effectiveness Review
Electronic searches for literature were conducted in the MEDLINE; EMBASE; ERIC; NTIS (National Technical Information Service); PsycINFO; Social Sciences Abstracts; and NCJRS (National Criminal Justice Reference Service) databases for all dates up to March 2007. Search terms included the generic and specific terms for treatments, different forms of trauma, and terms such as evaluate, effective, and outcome. Also reviewed were the references listed in all retrieved articles; researchers also consulted with experts on the systematic review development team and elsewhere for additional studies. Studies published as journal articles, government reports, books, and book chapters were considered.
- (THERAPY OR THERAPIES OR COUNSELING OR DEBRIEFING OR (CRITICAL()INCIDENT(2W)MANAGEMENT) OR SCREENING OR INTERVENTION? OR CISD OR CISM)/TI,AB
- (CHILD? OR TODDLER? OR YOUTH? OR ADOLESCENT? OR INFANT? OR BABY OR BABIES OR PEDIATRIC? OR TEEN OR TEENS OR TEENAGER?)/TI,AB
- (VIOLENCE OR VIOLENT OR DISASTER? OR FIRE OR CHILD()ABUSE? OR SEXUAL()ABUSE? OR RAPE OR WAR OR TRAUMA? OR TERRORIST OR TERRORISM OR CRISES OR CRISIS OR PTSD OR POST()TRAUMATIC OR POSTTRAUMATIC OR POST-TRAUMATIC OR DROWNING OR BOMBING …
- (EVALUAT? OR EFFICACY OR EFFECTIVE? OR ASSESSMENT? OR OUTCOME?)/TI,AB
- S1(20N)S2
- S1(20N)S3
- S1(20N)S4
- S5 AND S6 AND S7
- (ADULT? OR BLOOD OR XRAY? OR X-RAY? OR BRAIN()INJUR? OR PERSONNEL OR MANPOWER OR CRANIOCEREBRAL OR HEAD()TRAUMA OR ASTHMA OR BRONCHODILATOR OR KIDNEY? OR LUNG? OR CRIMINOLOGY OR COUPLE?()THERAPY OR CHILD()ABUSE()PREVENTION)/DE
- 10 S8 NOT S9
- (ADULT? OR BLOOD OR XRAY? OR X-RAY? OR BRAIN()INJUR? OR PERSONNEL OR MANPOWER OR CRANIOCEREBRAL OR HEAD()TRAUMA OR ASTHMA OR BRONCHODILATOR OR KIDNEY? OR LUNG? OR CRIMINOLOGY OR COUPLE?()THERAPY OR CHILD()ABUSE()PREVENTION OR SURGER? …
- S8 NOT S11
- (RISK? OR SCREEN?)/TI
- S12 NOT S13
- RD (unique items)
- (ADULT? OR WOMAN OR WOMEN)/TI
- S15 NOT S16
- (CHILD? OR TODDLER? OR YOUTH? OR ADOLESCENT? OR INFANT? OR BABY OR BABIES OR PEDIATRIC? OR TEEN OR TEENS OR TEENAGER?)/TI
- S17 AND S18
- (VIOLENCE OR VIOLENT OR DISASTER? OR FIRE OR CHILD()ABUSE? OR SEXUAL()ABUSE? OR RAPE OR WAR OR TRAUMA? OR TERRORIST OR TERRORISM OR CRISES OR CRISIS OR PTSD OR POST()TRAUMATIC OR POSTTRAUMATIC OR POST-TRAUMATIC OR DROWNING OR BOMBING …
- S19 AND S20