Real Life Heros (RLH) - Promising Futures

• Individual
• Dyadic

• In-person
• Virtual
• Hybrid

• Licensed/Certified Professional Led

• Domestic Violence
• Child Abuse 
• Sexual Abuse
• Community Violence
• Neglect 
• Family Separation
• Substance Abusing Caregiver 
• Grief/Bereavement 
• Refugee/Immigration
• Reunification
• Medical Trauma
• Homelessness
• Verbal/Emotional abuse
• Historical trauma
• Trafficking
• Other type of experience addressed – Developmental Trauma Disorder

• Somatic
• Arts based
• Dance/Theater based
• Talk-Based
• Experiential
• Play Based
• Culturally Grounded
• Other Engagement Methods – Use of ‘hero’s journey’, eliciting strengths in family and cultural heritage, use of ‘improv,’ music, and yoga

• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
• Intervention

• Less than 12 weeks
• Greater than 12 weeks

• School
• Home 
• Hospital-based
• Residential 
• Domestic Violence Shelter
• Correctional
• Homeless Shelter
• Family service agencies
• Foster Care 
• Mental Health Setting
• Community-based agency
• Other Settings – Refugee

Type of services provided:

RLH is a resiliency-focused treatment program that was developed to broaden the reach of evidence-supported trauma treatments and promote engagement and inclusion of children, adolescents and families with Complex Trauma. RLH provides counselors and therapists with ready-to-go tools including a life storybook, assessment guides, and multi-sensory creative arts, mindfulness, yoga and ‘improv’ activities to engage children and parents/caregivers in attachment-centered trauma treatment. RLH helps practitioners to reframe referrals based on pathologies and blame into a shared ‘journey,’ a ‘pathway’ to recovery focused on restoring (or building) emotionally supportive and enduring relationships and promoting development of self- and co-regulation skills for children and caregivers. The Real Life Heroes Life Storybook, 3^rd ed.,  engages children and caregivers with an emphasis on strengths in the child and the child’s family and cultural heritage. The Real Life Heroes Toolkit for Treatment of Traumatic Stress in Children and Families, 2^nd ed.,  provides a flexible phased-based approach to rebuild safety, hope, attachments, skills and resources that matches the best practice recommendations of the NCTSN for treatment of Complex Trauma. Creative arts and movement activities are utilized to develop skills including affect recognition, affect expression, emotional regulation, concentration, and mindfulness. Life Storybook pages help youths and caregivers to replace feelings of shame with pride and supportive relationships. Components include psychoeducation on traumatic stress for children, caregivers and other service providers, activities to foster attunement and trust with caring adults, development of skills for affect recognition and modulation, mindfulness, desensitization to triggers, trauma processing, and life story reintegration including a past, present and future that enhances resiliency and relationships.

Program setting:

RLH has been used successfully in a wide range of child welfare, behavioral health, and educational programs ranging from home-based services to outpatient clinics, foster care, residential treatment and hospital-based programs. RLH can be used with children and adolescents often excluded from trauma-focused treatments including children with suspected traumas that have not been acknowledged or validated, with children who have had frequent hospitalizations, and with children whose parents/caregivers are not able or willing to work in trauma-focused treatment. RLH can also be used in combination with other evidence-supported trauma treatments to engage children, adolescents and caregivers, develop self and co-regulation skills, and strengthen (or build) attachments.

Length of program/number of sessions:

Typically 6 to 18 months of weekly (60-90 minutes) therapy sessions; however, length is flexible and can be adapted for a wide range of programs and to match the needs and strengths of children and famiies.  Length of treatment is often linked to the capacity and willingness of safe caregivers to participate in trauma treatment. RLH can also be used to help search for caring adults and develop safe, emotionally supportive relationships for children.

Type(s) of trauma/concerns addressed:

Neglect, emotional, physical and sexual abuse, abandonment, losses, domestic violence, frequent hospitalizations, placements, disasters, terrorism, war. RLH was especially developed for treatment of Complex PTSD in children and caregivers.

Symptoms addressed:

Symptoms of Complex PTSD and Developmental Trauma including criteria for diagnosis of PTSD or Complex PTSD (ICD 11) and high risk behaviors that threaten the safety of children, families and communities.

Education level of providers:

Psychologists and social workers with Master’s level degrees and above.

Additional information:

Activities and tools drawn on a child’s and families’ strengths, community resources, cultural heritage and stories of overcoming adversity, faith, ties to religious organizations, and spirituality.

The RLH model assists therapists and family members to recover and increase family and cultural strengths and promote safety planning, affect management, social skill building, attachments, and trauma processing.

Unique/Innovative Characteristics:

Real Life Heroes® is a relationship-focused treatment that counters the effects of interpersonal traumas and works to increase children’s attachments with caregivers and pride in their abilities, family and cultural heritage as an ‘antidote to shame’ (Herman, 2011). RLH focuses on ‘Relational Healing for Relational Traumas’.

The RLH format includes an activity-based workbook and session rituals which provide an easy-to-learn and transferable structure that allows children and caregivers to continue trauma treatment if they move between programs or practitioners and includes primary roles for residential counselors, parents, resource parents, mentors, and other caring adults.

The RLH Toolkit integrates core components of treatment for Complex PTSD (Relationships, Emotional Self and Co-regulation, Action Cycles, and Life Story Integration) from referral and assessment through service planning, treatment sessions, treatment reviews, three-month outcome evaluations, and discharge from group care with fidelity tools to support supervisors.

RLH provides ‘ready-to-go’ tools for hard-pressed practitioners including step by step guides for developing self and co-regulation with slow breathing, yoga, movement, improv, and storytelling activities that promote child-caregiver attunement and trust.

The model guides flexible adaptation of tools to engage a wide range of families and adjust for changes in a child and caregiver’s stability to maintain safety and progress in treatment.

RLH can be used with children often excluded from trauma-focused treatments including children with suspected traumas that have not been acknowledged or validated, with children who have had frequent hospitalizations, and with children whose caregivers are not able or willing to work in trauma-focused treatment.

Date Added/Updated:

08/12/2022

• 6-12 (Childhood)
• 13-17 (Adolescent)
• 18-25 years (Young Adult)

• English
• Other Population Language – Chinese

• 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
• Parent who uses Violence
• Survivor parent
• Community
• Foster/Adoptive Parents
• Other Client/audience – Students and Their Families

Age range of children served:

6 to 12 years old plus adolescents (13-19 years old) with delays in social, emotional and/or cognitive functioning including youths and young adults with intellectual deficits.

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

Yes

Ethnic/racial and other groups served:

RLH was pilot testedwith youths and families with diverse ethnic/racial heritage. RLH tools bring out strengths in each child and family’s cultural heritage as well as addressing multi-generational experiences of oppression and racism.

Specific cultural adaptations:

The Real Life Heroes Toolkit for Treatment of Children and Families with Traumatic Stress, 2^nd ed.,  provides strategies to integrate family and cultural heritage into life story work from initial assessments and service planning through the conclusion of treatment. Activities and tools engage strengths of the child’s family, community resources and cultural heritage including stories of overcoming adversity, ties to religious organizations and spirituality. Guidelines are also provided to help therapists adapt the model for use with adolescents, preschool children, children with intellectual deficits and developmental disabilities and families with adopted children.

Languages that service/resource is available:

English, Chinese

Goals of the program/services:

• Increased child and caregiver well-being
• Increased child developmental abilities
• Decreased high-risk behaviors including self-abuse, suicide attempts and aggression to others
• Decreased number and length of temporary placements
• Decreased number of psychiatric hospitalizations

Treatment goals include:

• Increased psychological, physical and emotional safety for children and caregivers
• Rebuilding/building emotionally supportive relationships with caregivers committed to nurturing, guiding and protecting children
• Self- and co-regulation development for children and caregivers
• Trauma memory reintegration matched to child and caregivers capacity
• Development of a positive self-identity for children linked to their family and cultural heritage
• Prevention and management of disruptions of important relationships

Has there been any evaluation?

Yes

Key evaluation results:

In a one-group, pretest-posttest study (Kagan, et al, 2008), 41 children (ages 8 to 15 years old) received the RLH intervention. The children were involved in child welfare and behavioral health programs and were primarily from low, socioeconomic and mixed urban-rural backgrounds and had severe trauma histories. From baseline to four months, children demonstrated significant reductions in child self-reports of trauma symptoms and reduced problem behaviors reported on caregiver checklists. At twelve month follow-ups, there was a significant reduction of child trauma symptoms reported by parents and increased security/attachment over time.

In a study with 119 children with experiences of multiple traumas and significant levels of traumatic stress in 7 child and family child welfare and behavioral health programs (Kagan et al, 2014), children receiving RLH demonstrated statistically significant decreases from baseline to 6 months in child behavior problems on the CBCL (Internalizing and Total Behavior), the Anger subscale of the TSCC, the UCLA PTSD Index-Parent Version (Reexperiencing, Avoidance, Hyperarousal, and Total Symptoms), and the UCLA PTSD Index-Child Version (Avoidance and Total Symptoms). Significant reductions were also found with repeated measures at 3-month assessments from baseline to 9 months on the CBCL, the UCLA Parent and Child Versions, and the PTSD subscale of the TSCC. Children receiving RLH did not have placements or psychiatric hospitalizations, a positive, but not significant trend, compared with trauma-informed “treatment as usual” provided by RLH-trained practitioners in the same programs.

Is there an evaluation currently in progress or planned?

Yes

Publications about the program:

Ford, J., Blaustein, M., Habib, M., & Kagan, R. (2013). Developmental Trauma Therapy Models. In J. D. Ford & C. A. Courtois (Ed.) Treating complex traumatic stress disorders in children and adolescents; Scientific foundations and therapeutic models. New York: Guilford Press.

Kagan, R. (2017). Real Life Heroes Toolkit for Treating Traumatic Stress in Children and Families. 2nd ed., New York, NY: Routledge.

Kagan, R. (2017). Real Life Heroes Life Storybook, 3rd Ed. New York, NY: Routledge

Kagan, R. (2009). Transforming Troubled Children into Tomorrow’s Heroes. Chapter in Brom, D., Pat-Horenczyk, R. & Ford , J. (Eds.) Treating traumatized children: Risk, resilience and recovery. New York: Routledge

Kagan R, Douglas AN, Hornik J, Kratz SL. (2008). Real Life Heroes pilot study: Evaluation of a treatment model for children with traumatic stress. Journal of Child and Adolescent Trauma, 1(1): 5-22.

Kagan, R, Henry J, Richardson M, Trinkle J, LaFrenier, A. (2014). Evaluation of Real Life Heroes treatment for children with complex PTSD. Psychological Trauma: Theory, Research, Practice and Policy, 6(5):588-596.

Kagan, R. & Spinazzola, J. (2013). Real Life Heroes in Residential Treatment; Implementation of Trauma and Attachment-Focused Treatment for Children and Adolescents with Complex PTSD. Journal of Family Violence. Volume 28 (7), 705-715.

Rated/Reviewed by Evidence Based Registries:

The National Traumatic Stress Network Treatments and Practices, Trauma Interventions
SAMHSA’s National Evidence Based Practice Resource Center 
California Evidence-Based Clearinghouse for Child Welfare

• English
• Chinese

• Yes

Training manuals/protocols:

Kagan, R. (2017). Real Life Heroes Toolkit for Treating Traumatic Stress in Children and Families. 2nd ed., New York, NY: Routledge.

Kagan, R. (2017). Real Life Heroes Life Storybook, 3rd Ed. New York, NY: Routledge

Publications for promoting trauma-informed schools and for use in counseling:

Kagan, R. (2021). The Hero’s Mask. London: Routledge Press.

Kagan, R. (2021). Helping Children with Traumatic Stress; The Hero’s Mask Guidebook for Parents, Educators, Counselors and Therapists.  London: Routledge Press.

Availability of Training:

Yes, Primarily online training programs.   An On-Demand training program is scheduled for completion by 10/1/22 and can be coupled with small group consultation to adapt the model for specific programs.

Richard Kagan
richardkagan7@gmail.com

Richard Kagan, PhD
Director, Training Programs on Traumatic Stress, Columbia, SC
richardkagan7@gmail.com
www.reallifeheroes.net