Assessment and treatment planning

Quick reference

Begin with the child’s concerns, the caregiver’s concerns, and what each hopes will change. Establish whether trauma exposure and associated difficulties make TF-CBT an appropriate treatment focus. Exposure alone does not establish a diagnosis or treatment need. A full PTSD diagnosis is not required; assess significant symptoms related to a remembered trauma and their impact, alongside possible needs for other treatments. This reference supports trained clinicians; it does not replace assessment training, consultation, or a diagnostic evaluation.

• Explain privacy, its limits, and how information will be shared before asking for sensitive details.
• Assess immediate safety and ongoing threats separately from distress triggered by reminders of past events.
• Combine developmentally appropriate interviews, validated measures, and information about everyday functioning.
• Identify a supportive caregiver and practical barriers to participation; do not assume a biological parent is safe or available.

Child and caregiver work

Meet separately when appropriate so each can describe concerns without pressure to agree. Ask about sleep, school, relationships, avoidance, mood, behavior, bodily distress, and coping. Clarify what happened sufficiently to inform treatment without requesting a detailed narrative at intake. Explain why questions are being asked and allow the child to say when language is confusing.

Explore caregiver strengths, stress, beliefs about the trauma, and capacity to support practice. An appropriate caregiver may be a foster caregiver, relative, or another stable adult. If the usual caregiver caused harm or cannot participate safely, consult about an alternative and document the participation plan. Caregiver involvement should support the child rather than expose disclosures to retaliation.

Select measures suited to age, language, and presenting concerns, following their administration guidance. Consider suicide or self-harm risk, substance use, dissociation, developmental needs, and other conditions when relevant. Respond to urgent risk through local clinical procedures. Coordinate necessary services with consent and applicable reporting duties.

Phase structure and pacing

Organize the plan around three phases: stabilization, trauma narration and processing, and integration and consolidation. The PRACTICE components normally follow their established order. Flexibility within stabilization skills and earlier safety work can be appropriate; in-vivo mastery is included when clinically indicated. Repeating a skill does not turn the model into an interchangeable menu.

Consider the balance of time as well as readiness. Typical treatment gives the three phases roughly similar shares. Complex trauma may require about half the treatment for stabilization, with the other half shared between narration/processing and integration/consolidation. These are planning guides, not a fixed session calendar. Revisit the balance in consultation while monitoring safety, engagement, symptoms, and functioning.

Example language

Original examples for adaptation; not published protocol scripts.

To the child: “We can start with what is hardest in your day. You do not need to tell every detail today. What would you like to be easier?”

To a caregiver: “Your view helps us understand the whole picture. I also want to hear the child’s view separately. Where do you see strengths, and where is support hardest to provide?”

To discuss goals: “Instead of only saying ‘less anxious,’ could we track something that matters to you, such as returning to a school activity or sleeping with fewer interruptions?”

Developmental considerations

Use play, drawings, visual choices, or concrete examples to support communication without treating them as diagnostic proof. Adolescents may prioritize privacy and independence; agree on what caregiver updates will include. Check language access and literacy rather than equating limited verbal answers with avoidance. Adapt presentation while preserving the treatment’s core work.

Common challenges

Different reports are useful information, not a contest over who is correct. Clarify settings and timing. If safety is unstable, address protection and coordinate support while revisiting whether planned trauma work is appropriate. If engagement is limited, explore transport, scheduling, cultural concerns, and prior treatment experiences before labeling the family resistant.

Between sessions

Choose one feasible observation task, such as noting sleep interruptions or a situation the child avoids. Do not assign independent trauma retelling. At review, compare symptoms and functioning with baseline, ask both participants about benefit and burden, and update shared goals. Components recur and pacing varies; assessment continues throughout treatment rather than ending after intake.