Topic: PTSD, Trauma, Grief & Loss, Child Abuse
Target Population: Adolescents, Early Childhood, Middle Childhood, Young Adults, Parents
Sector: Community-Based
This program is for children and youth who are 2 to 21 years old and have a history of complex stress and trauma exposure, and their caregivers.
Sensory Motor Arousal Regulation Treatment (SMART), a community-based program, is designed to address the functional impairments that youth experience as a result of traumatic experience through the use of a movement-based somatic regulation therapy.
A quasiexperimental pilot study in a small group of predominantly female participants who had been exposed to multiple forms of trauma found that those in the SMART intervention group experienced significant reductions from pre-treatment to post-treatment on a scale of internalizing behaviors, specifically somatic complaints and anxious/depressed behaviors, compared to participants in a treatment as usual group. The average length of time from pre-treatment assessment to post-treatment assessment was 9 months; however, the range was 6 to 12 months.
SMART is a trauma psychotherapy that intends to improve the participant’s behavioral and emotional regulatory abilities by shifting (up- or down-regulating) physiological arousal through engagement at the sensory motor level. This form of somatic regulation supports the processing of trauma and present-day challenges through the use of non-verbal and verbal strategies. Attachment-building occurs via participation of caregivers in learning new co-regulation strategies through sensory motor play and through parent coaching.
The SMART intervention consists of the following three main components:
This therapy can be used to treat somatic problems, emotional dysregulation, behavior disorders, and mood and anxiety disorders that are based in a history of trauma experience, and Post-Traumatic Stress Disorder and Complex PTSD. Delivery format is flexible, and the treatment can be implemented as individual therapy, caregiver-child therapy, parent psychoeducation, and parent coaching.
The first SMART room was opened in 2008, and was equipped with mats, crash cushions, physioballs, mini trampolines, and balance equipment. SMART has been adapted for use in outpatient clinics, early childhood settings, community-based in-home treatment, residential treatment, therapeutic day schools, and regular education settings. Therapists have been trained in Hong Kong, Norway, and throughout the USA.
This program is delivered by mental health professionals, including master’s or doctoral level therapists, counselors, or clinicians who have a background in trauma theory, child development, and child therapy. The training of these professionals consists of a 2-day intensive foundations training, with an optional 3rd day for special modules such as Working with the Caregiver, Application in Residential Treatment or Application for In-Home Therapy. Implementation is supported through a year-long SMART consultation with a SMART trainer. The implementation module is delivered in person or online with therapist groups and uses videotape of therapy sessions as the basis for learning the treatment application.
Considerations for implementing this program include hiring therapists who have a suitable educational background and ensuring they receive training (intensive 2-day foundations training plus consultation module), acquiring participant buy-in, locating space large enough to allow for movement and use crash mat, etc., and installing a videotaping system to assist with therapist training and supervision.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing SMART, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Length of treatment is flexible and varies based on the needs of individual participants and the nature of the setting. The treatment may be used to target regulation, or to provide a full trauma therapy.
The book, Transforming Trauma in Children and Adolescents: An Embodied Approach to Somatic Regulation, Trauma Processing and Attachment Building, is the publication which articulates the model, provides case studies, discusses adaptations to different settings, and describes how to create a SMART room. The cost is $18 for the ebook or $25 for the paperback. Please visit https://www.northatlanticbooks.com/shop/transforming-trauma-in-children-and-adolescents/ to learn more.
To move SMART to the Promising category on the Clearinghouse Continuum of Evidence, at least one evaluation should be performed demonstrating positive effects lasting at least one year from the beginning of the program or at least six months from program completion.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact SMARTmoves by mail 450 Lexington St., Suite 203, Newton, MA 02466, or visit https://smartmovespartners.com/contact-smartmoves/
https://smartmovespartners.com/smart-therapy-approach/; and Warner, Koomar, Lary, & Cook (2013).
Warner, E., Spinazzola, J., Westcott, A., Gunn, C., & Hodgdon, H. (2014). The body can change the score: Empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child & Adolescent Trauma, 7(4), 237-246. https://doi.org/10.1007/s40653-014-0030-z
Finn, H., Warner, E., Price, M., & Spinazzola, J. (2017). The boy who was hit in the face: Somatic regulation and processing of preverbal complex trauma. Journal of Child & Adolescent Trauma, 11(3), 277-288. https://doi.org/10.1007/s40653-017-0165-9
Warner, E., Cook, A., Westcott, A., & Koomar, J. (2014). Sensory Motor Arousal Regulation Treatment (SMART) Manual: A “bottom up” approach to treatment of complex trauma for children and adolescents, Version 2. (Version 2 ed.). Brookline, MA.: Trauma Center at JRI.
Warner, E., Koomar, J., Lary, B., & Cook, A. (2013). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence, 28(7), 729-738. https://doi.org/10.1007/s10896-013-9535-8
Warner, E., Westcott, A., Cook, A. & Finn, H. (2020) Transforming Trauma in Children and Adolescents: An Embodied Approach to Somatic Regulation, Trauma Processing and Attachment Building. Berkeley, CA.: North Atlantic Press.
