Optimal functioning can be negatively impacted when families experience chronic exposure to trauma(s) and environmental stressors. This is especially evident when families live in environments which contain frequent threats interspersed with circumscribed traumatic events (DSM-IV Criterion A) (Kaysen, Resick, & Wise, 2003).

One example of a traumatic context, as illustrated in Figure 1, is urban poverty. Families living in urban poverty often contend with exposure to multiple traumas and experience their environments as containing multiple dangers and traumatic reminders. Families report frequent exposure to illegal drug activities, community violence, safety concerns such as house fires, rat infestations, difficulty finding a safe way to get children to and from school, along with multiple daily hassles associated with inadequate access to resources and opportunities.

The FITT Model:
The Systemic Impact of Traumatic Context The traumatic context of urban poverty has pervasive systemic effects that slowly erode parent and family functioning. Contextual risks affect everyone involved, but the effects on children are exaggerated through detrimental influences on parental well-being and family functioning. Specifically, there is evidence for the following (Kiser, 2006):

1. Persons living in urban poverty share increased risk for exposure to daily hassles and strains related to meager resources, crowded conditions, etc., in addition to traumas;
2.  The challenges associated with hardship conditions and exposure to traumas negatively affect individual functioning (child and adult) by increasing distress;
3. Increased parental distress attenuates positive parenting and, in turn, negatively influences family functioning; and
4. Parental and family functioning are associated with child outcomes by increasing or reducing risk for development of emotional and/or behavior problems.

The FITT Model recognizes and aims to ameliorate the impact of traumatic events and contextual stressors on every member of the family, on family relationships, and on the family as a whole. The FITT Model is multi-layered including: a) explication of the context of chronic trauma/high stress and the multiple pathways through which this context might affect families, b) strategies for identifying and assessing the risk/protective factors and current functioning of family systems, and c) a structured approach for choosing and staging multi-modal, empirically sound treatments targeting the complex needs of traumatized families.

In the model (as illustrated in Figure 2), the

solid lines

represent the

effects

of exposure to chronic trauma directly on

individual family members

. Individual family members form dyadic subsystems such as adult intimate partnerships, parent-child, and sibling relationships. The

dotted lines

represent the multiple pathways among chronic trauma and

dyadic family subsystems

. The

dashed lines

represent the pathways through which chronic trauma influences

family processes

and the

bold, dashed line a direct causal relationship

.

The FITT Model indicates trauma specific, help seeking pathways to treatments that reduce PTSD symptoms, promote safety and recovery for all family members. This model provides the framework for an ecological family systems intervention approach that aims to tackle obstacles that derail families’ efforts to attain safety and stability by putting families in the “driver’s seat” as they plot a course to address their unique needs. Recognizing that families interact with mental health care services at various stages of readiness, the FITT model infuses trauma-specific family engagement and casework strategies into all levels of the model to aid families in negotiating trauma-related barriers and complex systems to reduce the impact of daily hassles, system demands, and social/public incivilities. By anchoring this approach in family- and trauma-informed principles (see Tables 1 and 2), the FITT Center hopes to increase access to trauma-informed, family systems treatment. The cornerstone of this multi-modality family treatment approach is supporting families’ efficacy by partnering to accomplish assessment, psychoeducation, and treatment planning that leads to family-informed choice of effective trauma-informed care. In the FITT Model, as illustrated in Figure 3, the italicized items are available trauma-focused treatments that target impacts on specific family subsystems, the bolded items are interventions that the FITT Center will bring to the field. To learn more about how trauma impacts each level of the family system as well as available assessments for individual family members, family relationships and the family as a whole, click on any of the model's boxes.   

Kaysen, D., Resick, P. A., & Wise, D. (2003). Living in danger: the impact of chronic traumatization and the traumatic context on posttraumatic stress disorder. Trauma Violence & Abuse, 4(3), 247-264.
Kiser, L. J. (2006). Protecting children from the dangers of urban poverty. Clinical Psychology Review, 27(2), 211-225.
Kiser, L. J., & Black, M. A. (2005). Family processes in the midst of urban poverty. Aggression and Violent Behavior, 10(6), 715-750.

For further reference please see: Family processes in the midst of urban poverty: What does the trauma literature tell us? and our Model presentation (PDF).