1. Running head: STRENGTHENING FAMILY COPING RESOURCES 1
Strengthening Family Coping Resources:
A Promising Group Intervention for Children & Families Exposed to Trauma
Student ID: 00207923
University of Maryland
School of Social Work

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Strengthening Family Coping Resources:
A Promising Group Intervention for Families Exposed to Trauma
Recent unrest in Baltimore City has once again shed light on the penetrating poverty and
violence that many cities in the United States must contend with. Amid coverage of the
Baltimore riots and Black Lives Matter movement, media outlets in America are reflecting how
the public is taking an unflinching look at how these issues disproportionately affect minority
populations. With Baltimore City’s black population at 63%, the legacy of racism and structural
inequality is an inescapable fact, as many black communities here have become isolated from the
mainstream amidst their struggle for survival (U.S. Census Bureau, 2015).
Indeed, the public is warming up to the idea, long held by behavioral health advocates,
that these issues are not availed by a criminal justice approach. While it is true that there are real
victims to the violence that occurs within these communities, status quo approaches have proven
ineffective. Behavioral health advocates have been successful in drawing attention to the
ecosystems that produce serious social problems such as crime, drug abuse, and the maltreatment
of children. The proliferated concept of psychological trauma has greatly altered public discourse
about these social problems.
Although encountering stress is a part of daily living, trauma occurs when individuals
experience events that overwhelm their ability to cope, often causing psychiatric symptoms
(National Child Traumatic Stress Network1
). There are many types of trauma, such as natural
disasters, community violence, medical trauma, and abuse. Interfamilial abuse (such as domestic
violence, incest, physical abuse, and neglect) and community violence are often chronic which

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can lead to complex trauma. The term complex trauma both indentifies individuals who have
experienced multiple traumas and describes the symptoms that can accompany this exposure.
While inter-familial abuse happens across race and class lines, impoverished inner-city residents
suffer more from the effects of complex trauma because they are more vulnerable to long-term
violence. And within the communities most affected by complex trauma, children are, of course,
the most impacted. While these individuals can also suffer from PTSD, the consequences of
complex trauma are often more insidious and can include disrupted attachment, a foreshortened
sense of the future, and self-harming behavior (National Child Traumatic Stress Network2
).
One of the most well known studies on psychological trauma is the famous “ACE”
(Adverse Childhood Experiences) study, in which a physician at Kaiser Permanente established a
relationship between childhood trauma and a battery of negative health outcomes in adults
(Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, & Marks, 1998). However, the
“ACE” study drew from a population of individuals in California who were not impoverished.
Subsequent research has confirmed that poor, inner-city populations are much more likely to be
exposed to trauma than people of higher socioeconomic statuses. In fact, it is estimated that 70 –
100% of children living in impoverished urban communities are exposed to trauma (Dempsey et
al., 2000, qtd. in Kiser & Black, 2005).
While these strides in knowledge are important, trauma-informed research and treatment
has been limited by a focus on individuals (Kiser, Backer, Winkles, & Medoff, 2015). This trend
persists despite mounting evidence implicating family processes in both the development of and
recovery from child psychopathology in the wake of trauma. More specifically, research has
shown that individual trauma exposures affect all family members and that family functioning

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can often predict child recovery from PTSD (Kiser & Black, 2005; Kiser, Medoff, & Black,
20101
).
While the connection between individual trauma experiences and family functioning may
be obvious, it is important to appreciate the complexity with which trauma affects families on a
systems-level. Weakened parental functioning has been associated with both chronic community
stress and the presence of PTSD in family members (Ceballo & McLoyd, 2002; Kiser & Black,
2005). Parents who are suffering from trauma-related stress or PTSD have been found to exhibit
“negative parenting characteristics” such as withdrawal, reactivity, and harshness (Kiser &
Black, 2005). More specifically, mothers in poor, urban environments are prone to “use physical
punishment, give commands without explanations, and provide less support and verbal rewards”
than mothers in other milieus (McLoyd, 1990, qtd. in Ceballo & McLoyd, 2002).
The affect of one family member’s PTSD on other members has been coined “relational
PTSD” and is most evident in the parent-child dyad (Scheeringa & Zeanna, 2001, qtd. in Kiser &
Black, 2005). In fact, caregivers suffering from PTSD, and more specifically hyper-arousal
symptoms, often exhibit irritable, punitive, and sometimes physically abusive parenting styles.
By contrast, parents with avoidant PTSD symptoms have been found to be lacking in nurturance,
warmth, and often cannot appropriately respond to a child’s fears (Scheeringa & Zeanna, 2001,
qtd. in Kiser & Black, 2005). If parents are unable to protect their children or soothe them,
children may “internalize consistent failure of caregivers to provide protection” and therefore,
develop “working models of mistrust” (Ackerman et al., 1999, qtd. in Kiser, Medoff, & Black,
2010, p. 2).
In addition to compromised parental functioning, the presence of PTSD in a caregiver is
also associated with “higher rates of interpersonal violence, and separation/divorce” (Calhoun &

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Wampler, 2002, qtd. in Kiser & Black, 2005). All of these factors can increase the risk of further
victimization among family members. Sibling relationships are also affected by the experience of
trauma and PTSD in caregivers. When caregivers exhibit harsh parenting styles as a result of
trauma exposure, this can increase “sibling aggression and self-protective behavior” or
conversely, promote nurturance among siblings (Brody et al., 2003; Stocker & Youngblade,
1999; Brody, 1998; qtd. in Kiser & Black, 2005, p. 734).
However, this “top-down” flow of caregiver stress onto children is just one way that
family systems are affected by trauma. A child’s reaction to a traumatic event can cause a ripple
effect throughout the family system. For instance, complex trauma and PTSD symptoms in
children (such as play re-enactment, emotional dysregulation, and sexualized behavior) can be
disturbing to parents, which can create a multiplicity of effects, such as interrupted routines,
parental withdrawal and rejection, and parental anxiety (Kiser & Black, 2005). However, when
children exhibit resiliency after trauma, this can create a sense of hope and cohesion in the
family system, resulting in post-traumatic growth (Tedeschi, Park, and Calhoun, 1998, qtd. in
Kiser & Black, 2005).
While many families can “re-coup” after single-event traumas, families with limited
resources can be seriously affected by complex trauma exposure. Although there are a variety of
family responses to these conditions, two are most common. Some caregivers respond to chronic
stress and crisis by creating structures in which a punitive and hyper-vigilant parenting style
attempts to create order and protect children from unsafe community elements (Kiser and Black,
2005). Within these families, the trauma exposure is often community-based and not familial
although punitive parenting can lead to child abuse. Alternately, some families respond to
chronic trauma by becoming complacent with or stuck in chaotic family systems that often

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become their own engines of trauma. The chaos of these systems is characterized by undefined
boundaries, lack of routine, and an absence of hierarchy or leadership (Kiser and Black, 2005).
Often, the beginning of this chaos can be traced back to when family members attempted to
adjust and cope with early trauma or stress. Over time, when members do not abandon coping
strategies that are maladaptive (such as abusing alcohol, emotional withdraw, or violence) these
problems become entrenched (Center for Child & Family Stress, lecture, 2015). Like a snowball
effect, the more stress and trauma that occur (either from within or without), the more family
members cling to their maladaptive coping strategies, making family change seem threatening
and difficult.
Research has also drawn attention to how family structures alone can sustain dysfunction.
A study by Howes, Cicchetti, Toth, & Rogosch (2000) observed non-maltreating and maltreating
families, both from low-socioeconomic status, as they completed a structured task in their home.
After video tapes were coded by blind research assistants, the families who had experienced
inter-familial sexual abuse were identified as “struggling with displays of angry feelings, as more
chaotic and less organized around family roles, and as less adaptive and flexible in their
treatment of one another” (Howes et al., 2000, p. 104). The researchers interpreted these results
as being indicative of the unique strains that are introduced into a family experiencing sexual
abuse. Other family system traits associated with child maltreatment are rigid external
boundaries and social isolation (Gabarino & Sherman, 1980, qtd. in Ceballo & McLoyd, 2002).
However, as much as family structure can invite and perpetuate trauma, it can also
prevent or ameliorate it. In fact, changes in family functioning after trauma can predict the
development of post-traumatic symptoms and psychopathology more than “event-related
variables” (Pfefferbaum, 1997, qtd. in Kiser & Black, 2005, p. 716). Indeed, less than 20% of

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children who experience traumas develop PTSD, which further indicates the power of families to
help their children to recover (American Psychiatric Association, 1994, qtd. in Kiser, Medoff, &
Black, 2010). In a study by Kiser, Medoff, and Black (2010), children exposed to trauma had
less internalizing and externalizing behaviors if their families had regular routines and rituals.
The ability of families to create a predictable and stable environment is critical in helping
children recover from trauma (Kiser, Medoff, & Black, 2010). Another protective feature found
in trauma-exposed families is sociality. Mothers in stressful urban communities who engage in
frequent social exchanges have been found to be more nurturing, consistent, and less punitive
(McLoyd 1990; Weinraub & Wolf, 1983, qtd. in Ceballo & McLoyd, 2002). The large kinship
networks characteristic of African American families can therefore serve as a protective factor
for children and families (Ceballo & McLoyd, 2002).
Despite this wealth of convincing research, the behavioral health field is just now
beginning to develop interventions that treat whole families affected by complex trauma and
PTSD. Although Trauma - Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-
based treatment for trauma-exposed children and their caregivers, this modality does “not
address the systemic effects of traumatic distress on families” and therefore has raised “questions
as to its applicability” (Kiser, Donahue, Hodgkinson, Medoff, and Black, 2010, p. 2). However, a
new model called Strengthening Family Coping Resources (SFCR) has been specifically
designed for this population. Developed by University of Maryland’s Dr. Laurel Kiser, SFCR
uses a “family systems framework” to promote “recovery from trauma for multiple family
subsystems” (Kiser et al., 20102
; National Child Traumatic Stress Network3
). SFCR uses a
“workshop model” to teach families how to build stability and support through the development
of “routines, rituals, and traditions” that aim to increase a family’s “protective function” and

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reduce trauma symptoms (National Child Traumatic Stress Network3
, Kiser et al., 20102
, p. 3).
Building coping resources through strengthening family functioning is an intervention that has
been indicated by the “family trauma treatment literature” but rarely operationalized into an
applicable treatment (National Child Traumatic Stress Network3
). While SFCR focuses on
routines and traditions, the manual is not “content specific” and therefore allows for a broad
interpretation of these cultural concepts (National Child Traumatic Stress Network3
). In addition
to helping families create stability and a sense of safety, SFCR also “empowers parents to lead
their families” and builds a family’s storytelling capacities (Kiser et al., 2015, p. 51). Families
are guided through storytelling activities throughout the model and this narrative practice
culminates with the family authoring their own trauma narrative.
SFCR meets for two hours a week, for 15 consecutive weeks. Each SFCR session begins
with a meal and each family dines together at their own designated table. This table serves as the
family’s symbolic home and the table will have their family name on it, along with a modest
centerpiece. Not only does the provision of food encourage group retention, it also allows for the
families to experience the benefit of routine family meals. Families will do most activities
together at their family table, unless they are separated into breakout activity groups with SFCR
participants of a similar age. These breakout activities address the unique developmental
capacities, roles, and responsibilities of different family members. In addition to these features,
SFCR facilitators encourage the group to create opening and closing rituals, since “forming a
community” is an important therapeutic goal of SFCR (Kiser, 2006, p. 38). Some of these rituals
have included “greeting each family when they arrive [and] a snack/meal-time blessing” (Kiser,
2006, p. 34). To view a video on the routines and rituals component of SFCR, please visit:
https://www.youtube.com/watch?v=rkk-PJixZes (Kiser, 2014). To summarize, each SFCR

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session includes skill-building focused on each individual family, “network building” among
participants, and role-specific skill-building during breakout groups, such as parenting and child-
specific coaching (Kiser, 2006, p. 34).
Recruitment for SFCR is recommended for families who have experienced complex
trauma and have members with PTSD, specifically children. SFCR’s full 15-week model is
recommended for only 6 families and there must be enough clinicians to work individually with
each family. SFCR also offers a 10-week model in which families do not complete the last
module, which focuses on developing the family’s trauma narrative. This model, which has more
of a prevention focus, is more appropriate for families who are at high risk for trauma exposure
but do not have PTSD. SFCR promotes a fluid concept of family, since families are encouraged
to invite anyone they consider to be a member. In fact, the manual merely recommends
recruiting families in which a care-giving system has been present for 6 months and can continue
to be present for another 6 months. Also of note, there are no age restrictions regarding child
participants. In addition to the provision of meals, this is another feature that makes SFCR truly
holistic and family-friendly. Featured below is a breakdown of SFCR’s 15-week format:
Module Name & Description of Goals Session Names
Module 1: Rituals and Routine
“Introduces the families to
the concept of family ritual, routine, and
storytelling (Kiser, 2006, p. 34).”
Pre-session: Evaluating Trauma and Family Functioning
Session 1: Telling Family Stories
Session 2: Ritual Family Tree
Session 3: Family Diary
Module 2: Using Rituals to Cope
“Focuses on using constructive family coping resources
when families are dealing with stress (Kiser, 2006,
p. 34).”
Session 4: Feeling Safe I
Session 5: Feeling Safe II
Session 6: People Resources
Session 7: Life Choices
Session 8: Spirituality & Family Values

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Session 9: Things Get in the Way
Module 3: Trauma Resolution & Consolidation
“Focuses on helping families deal with specific
traumatic events, reconnect, move beyond
the trauma, and protect family members from
further exposure (Kiser, 2006, p. 34).”
Session 10: Telling About What Happened
Session 11: When Bad Things Happen I
Session 12: When Bad Things Happen II
Session 13: Marking the Trauma
Session 14: Good Things Happen Too!
Session 15: Celebration
Post Session: Re-evaluating Trauma and Family
Functioning
Although a new intervention, the efficacy of SFCR in building family cohesion and
reducing trauma symptoms has been suggested by two studies. A pilot study of SFCR’s
“feasibility,” conducted at the University of Maryland, demonstrated that the intervention
reduced PTSD symptoms in children, was meaningful to families, and could be reproduced with
fidelity (Kiser et al., 20102
). Since this study, SFCR has been implemented at 13 different sites.
A recently published article summarized a “practice-based, pretest-posttest longitudinal study”
that sought to determine whether SFCR would be associated with decreased trauma symptoms
and improved family functioning (Kiser et al., 2015, p. 50). In total, 39 rounds of SFCR were
conducted at 13 different sites, with a total of 185 participating families. Of note, 72.72 % of the
participants were African American, 21.9% were Hispanic, and more than half of the families
(60.42%) had an income below $20,000. The study measured reductions in PTSD symptoms
through child measures such as the UCLA PTSD Reaction Index. Similarly, family functioning
was gauged by measures like the Family Assessment Device-12 (FAD-12) and the Parenting
Stress Index – Short Form (PSI-SF). Although this study lacked a control group, the results

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suggest that SFCR “may have a significant positive impact on child symptoms and family
functioning” (Kiser et al., 2015, p. 55).
In conclusion, SFCR is a promising and creative intervention that does more than just pay
lip service to family and community ecologies. SFCR not only addresses the systemic aspects of
family dysfunction and trauma, it brings the critical component of peer support and community
directly into the clinical environment. Although substance abuse and recovery communities have
formally integrated peer support networks into many aspects of rehabilitation, the behavioral
health field has been reluctant to take community and peer support seriously. Hopefully, SFCR
will motivate others in the field of behavioral health to take creative, community-inspired
approaches to service delivery. In addition, although SFCR is highly manualized and therefore
requires leadership from facilitators, the primacy of communalism and shared experience
overshadow the typical hierarchical relationship between client and clinician. In this way, SFCR
is a truly collaborative and hopeful trauma intervention for families.

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References
Ceballo, R. & McLoyd, V. C. (2002). Social support and parenting in poor, dangerous
neighborhoods. Child Development, 73(4), 1310-1321.
Felitti V.J., Anda R.F., Nordenberg D., Williamson D.F., Spitz A.M., Edwards V., Koss
M.P., Marks J.S. (1998). Relationship of childhood abuse and household dysfunction to
many of the leading causes of death in adults: The adverse childhood experiences (ACE)
study. American Journal of Preventive Medicine, 14(4), 245-258.
Howes, P. W., Cicchetti D., Toth, S. L., & Rogosch, F. A. (2000). Affective, organizational, and
relational characteristics of maltreating families: A systems perspective. Journal of
Family Psychology, 14(1), 95-110. doi: 10.1037//0893-3200.14.1.95
Kiser, L. J., & Black, M. (2005). Family processes in the midst of urban poverty: What does
the trauma literature tell us? Aggression and Violent Behavior, 10, 715-750.
Kiser, L. J., Medoff, D., & Black, M. M. (2010). The role of family processes in childhood
traumatic stress reactions for youths living in urban poverty. Traumatology, 16, 33-42.
[PubMed: 21132049]
Kiser, L. J., Donohue, A., Hodgkinson, S., Medoff, D., & Black, M. M. (2010). Strengthening
family coping resources: The feasibility of a multifamily group intervention for
families exposed to trauma. Journal of Traumatic Stress, 23(6), 802-806. doi:
10.1002/jts.20587
Kiser, L. J., Backer, P. M., Winkles, J., & Medoff, D. (2015). Strengthening family coping
resources (SFCR): Practice-based evidence for a promising trauma intervention. Couple
and Family Psychology: Research and Practice 4(1), 49-59.
Kiser, L. J. (2006). Strengthening family coping resources: Multifamily group for families
affected by trauma. Unpublished manual.
National Child Traumatic Stress Network1
(NCTSN) (n.d.). What is Child Traumatic Stress?
Retrieved from http://www.nctsn.org/resources/audiences/parents-caregivers/what-is-cts
National Child Traumatic Stress Network2
(NCTSN) (n.d.). Complex Trauma. Retrieved from
http://www.nctsn.org/trauma-types/complex-trauma
National Child Traumatic Stress Network3
(NCTSN) (n.d.). Promising practice fact sheet:
Strengthening family coping resources. Retrieved from: http:// www.nctsnet.org/
nctsn_assets/pdfs/SFCR_PromisingPracticeFactSheet.pdf
U.S. Census Bureau. State and County Quick Facts. Retrdieved from
http://quickfacts.census.gov/qfd/states/24/24510.html