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Integrative Treatment of Complex Trauma for Adolescents (ITCT-A)


Delivery Approach:
  • Individual
  • Group
  • Individual & Group
  • Dyadic
Delivery Format:
  • In-Person
  • Virtual
  • Hybrid
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Substance Abusing Caregiver 
  • Natural Disasters 
  • Grief/Bereavement 
  • Refugee/Immigration
  • Reunification
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Historical trauma
  • Homophobia/Transphobia
  • Trafficking
Engagement Methods:
  • Talk-based
  • Experiential
  • Play-based
  • Arts-based
Level of Intervention:
  • Tertiary Prevention
  • Intervention
  • Greater than 12 weeks
  • School
  • Home 
  • Hospital-based
  • Residential 
  • Correctional
  • Homeless Shelter
  • Family service agencies
  • Health Services 
  • Foster Care 
  • Mental Health Setting
Program Details:
Type of services provided:

ITCT-A is an assessment-driven, multicomponent and flexible treatment for multi-traumatized adolescents based on individualized, periodic assessment of the client’s needs and stressors. ITCT-A is based on developmentally appropriate, culturally adapted approaches that can be applied in multiple settings. Treatment modalities include relational/attachment-oriented, cognitive therapy, exposure therapy, mindfulness skills development, affect regulation training, trigger management, social advocacy, identity development, and psychoeducation in individual and group therapy with collateral and family therapy approaches integrated into treatment.

Continuous monitoring of treatment effects over time, using the Assessment-Treatment Flowchart (ATF-A), is a core element of ITCT-A. In addition to evaluating an adolescent’s symptomology, the ATF-A assesses socioeconomic status, culture, ongoing level of support systems and coping skills, family and caretaker relationships, attachment issues and functional self-capacities. A client’s social and physical environment is considered as well as the presence of new stressors, changes in family financial and housing status, potential danger from revictimization and exposure to community violence.

Program setting:

Outpatient clinic, school, inpatient, residential, juvenile justice system; involves collaboration with multiple community agencies

Length of program/number of sessions:

16-36 sessions

Type(s) of trauma/concerns addressed:

Complex trauma, physical abuse, sexual abuse, emotional abuse and neglect, community violence, domestic violence, medical trauma, traumatic loss, parental substance abuse

Symptoms addressed:

Symptoms associated with complex trauma including attachment disturbance, chronic negative relational schema, behavioral and affect dysregulation, interpersonal difficulties, identity-related issues and substance abuse

Education level of providers:


Additional information:


Unique/Innovative Characteristics:

ITCT-A was developed as a specialized intervention to address the specific and often complex social and psychological issues of children and youth that have experienced early-onset, repeated trauma.
ITCT-A focuses on social and cultural issues and working with children/youth in socially marginalized populations.

The treatment manual, assessment tool and other resources can be downloaded from the program’s website.

Date Added/Updated:


Population Served

  • 6-12 years (Childhood)
  • 13-17 (Adolescent)
  • 18-25 (Young Adult)
  • 25 & Up (Adult)
Population Language:
  • English
  • Spanish
Ethnic Racial Group:
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Indigenous People – American Indian/Native American, Alaskan Native
  • Native Hawaiian or other Pacific Islander
  • White
  • Child and Non-abusive Parent/Caregiver
  • Child
  • Family
  • Grandparents
  • Survivor parent
  • Foster/Adoptive Parents
Population Adaptations:
Age range of children served:

12 to 21 years of age

Are parent/adult caregiver(s) included in intervention?


Ethnic/racial and other groups served:

Developed to be responsive and sensitive to cultural differences as well as the effects of poverty and social marginalization. Used widely by programs serving diverse clientele including Hispanic-Americans, African-Americans, Caucasian Americans, Asian Americans and unaccompanied minors from Mexico and Central America. ITCT-A has been used with homeless youth, unaccompanied immigrant minors and youth exploited by the sex industry. This treatment, which stresses cultural sensitivity and adaptations, has been tailored for socioeconomic status, race, ethnicity, LBGT and rural/urban youth.

Specific cultural adaptations:

Adapted for Spanish speakers

Languages that service/resource is available:

English; adapted for Spanish-speaking clients and ITCT-A tools are available in Spanish


Goals of the program/services:

Provide effective intervention for socially marginalized children and adolescents suffering from the effects of repeated interpersonal traumas


Evaluation Studies:
Has there been any evaluation?


Key evaluation results:

In a one-group, pretest-posttest study, children and youth (ages 8 to 17 years old) living in an economically deprived environment received ITCT-A over a period of 3 to 8 months. At the end of the intervention, compared to pretest scores, there were significant reductions in anxiety, depression, posttraumatic stress, anger, dissociation and sexual concerns as a function of time in treatment.

Is there an evaluation currently in progress or planned?

None indicated at this time.

Publications about the program:

Lanktree CB, Briere J, Godbout N, Hodges M, Chen K, Trimm L, Adams B, Maida A, Freed W. Treating multitraumatized, socially marginalized children: Results of a naturalistic treatment outcome study. Journal of Aggression, Maltreatment & Trauma. 2012; 21:813-828.

Rated/Reviewed by Evidence Based Registries:

California Evidence-Based Clearinghouse for Child Welfare
National Child Traumatic Stress Network Empirically Supportive Treatments and Promising Practices

Training & Resources

Training Language
  • English
Training Available:
  • Yes
Training Details:
Training manuals/protocols:

Briere J & Lanktree CB. Integrative treatment of complex trauma for adolescents (ITCT-A): A guide for the treatment of multiply-traumatized youth., 2nd Edition. Los, Angeles, CA. Public access at:

Training Contact:

Not specified

Program Contact

Cheryl Lanktree
(213) 701-1149

John Briere PhD
Karianne Chen, MS, MFT
(310) 370-9208