A model program for the treatment of children with attachment disorders addresses a burgeoning problem that afflicts many of the most "at risk" young children and their families in our community. Attachment disorders disproportionately and severely incapacitate children who have had their original parental bonding disrupted ---frequently due to abuse, neglect, removal from the home or institutionalization. Among these children are some whose sensory processing abilities are also compromised.  They are frequently unable to manage themselves in their traditional environments sufficiently to attend to and engage in the psychotherapy necessary to address the attachment disorders.  We are eager to begin implementing a unique program that models an integrative approach to providing these children a path to healing and effective inclusion in their foster and adoptive homes and the related educational, religious and recreational communities.

Our unique therapeutic strategy provides for a licensed occupational therapist and a licensed psychotherapist to work together with a child and his or her primary caregiver once each week over 50 weeks in our large therapy "gym" containing suspended equipment such as tire swings and other tools for providing sensory integration therapy.  Each session will be individualized therapy, and will initially focus on interventions to enable the child to manage sufficient self-regulation so that the child is prepared to engage in emotional intervention for the balance of the session. Both therapists maintain their involvement in the session to facilitate optimum participation of the child and parent. This is not to be mistaken for a program of consecutive sessions of occupational therapy and psychotherapy, because the treatment of attachment disorders is integrated and not arbitrarily divided between "psycho-social" and "neuro-motor" behaviors.  Through the integration of these treatment modalities one enables the other to fulfill its remediate purpose. 

Then, periodically, without the child present, therapists and caregiver will "debrief" through review of videotape and discussion.  Post-treatment debriefings engage the parent, the occupational therapist and the psychotherapist in an integrated review of the past treatment session and planning for the upcoming session. Through participation in the treatment sessions and the debriefing, the parent becomes a part of the treatment team, contributing to the development of new strategies as well as learning new strategies and implementing these strategies throughout the week between sessions in the clinic.  At the end of the course of treatment, the objective is to see measurable improvement in behavior and other deficit areas that were identified during the evaluation phase. 

Most psychotherapeutic interventions either rely on a child's ability to modulate their responses to environmental and sensory input sufficiently to be present, attend to, and benefit from the intervention, or treat unwanted behavior as symptomatic of the psychological target of therapy. This model of therapy can better accommodate children unable to sufficiently regulate their responses and uses sensory integration strategies to create within the child a more regulated system that results in a sense of safety so that the child can more easily engage in the work of psychotherapy.   This is an essential ingredient in the treatment of children with attachment disorder as their continual hypervigilence creates a guardedness that makes them emotionally unavailable for treatment.

The demonstration of the efficacy of this proposed co-treatment is at the emerging center of some very significant shifts in the paradigms used to approach treating some of the most "at risk" children in our society. The implementation of this proposal will include the parent in the therapeutic team and render the family the essential fulcrum of successful treatment.  In an age where treatment has become synonymous with polypharmacy this proposal models a progressively integrative approach to the actual therapeutic interventions.

The lynchpin for advancement now is the development of written and videotaped narratives of good candidates for success.  This will require the Foundation to support pulling an occupational therapist and a psychotherapist out of the current "normal" clinic routine sufficiently to adequately engage in effectively demonstrating and documenting this new protocol.  It is that demonstration and documentation that will then become the locus for generalizing the model to other collaborations of occupational therapy and behavioral health clinicians, to other similar children and families, to clients presenting other or more involved co-morbidities, to other clinical settings (perhaps, for example, forensic court clinics, partial hospitalization programs, special education classrooms, etc.) and to more sustainable models of funding.  The underlying commitment of COTF is to ensure that the initiation and all future development of this protocol is evidence based and replicable.