Helping Abused Children in South Carolina

Helping Abused Children in South Carolina

When Gaye Allen-Cook first heard about Project BEST, one of her clients instantly came to mind. 

At 9, the little girl had been physically and sexually abused for six years. Although she was finally safe and living with a loving family, “Sherry” still suffered severe symptoms of posttraumatic stress disorder. 

“She was checking the windows and doors every night, panicking that her abuser was going to come find her,” says Allen-Cook, a trauma therapist in Florence, South Carolina.  “I had been treating her for a while and she wasn’t making progress. We were stuck.” 

Through Project BEST, Allen-Cook hoped to find the tools to help Sherry move forward. 

Facing the Trauma 

Project BEST is a 10-year, community-based effort that began in 2007. Coordinated by the Dee Norton Lowcountry Children Center and the National Crime Victims Research and Treatment Center of the Medical University of South Carolina in Charleston, the program aims to help every community in South Carolina offer high quality help for abused children. The acronym “BEST” stands for “Bringing Evidence Supported Treatments” to children and families. 

Multiple studies have shown that exposure to violence and abuse in childhood is a significant risk factor for serious social, emotional and behavioral problems. Effective treatments have been tested and are ready for use in the field – but making those treatments widely available is a struggle. 

In South Carolina, Project BEST is taking on that challenge. 

 “Abused children are suffering needlessly because they and their families are not receiving proven, effective, evidence-based trauma treatment,” says Ben Saunders, associate director of the National Crime Victims Research and Treatment Center. “In some communities, when we ask ‘What are the chances right now that an abused and traumatized child would receive appropriate mental health treatment,’ the answer is close to zero.” 

Initially, Project BEST is focusing on helping clinicians in South Carolina receive training in a mental health intervention called Trauma-Focused Cognitive Behavioral Therapy. Through extensive testing, it has been shown to “outperform” usual care in reducing the negative consequences of abuse and trauma. 

Experts say it’s easy to learn because it incorporates clinical skills that many therapists already have, and it’s easy to implement because it requires no special equipment. 

During sessions, children who have experienced the trauma of abuse learn how to talk about what happened and overcome related difficulties, such as symptoms of posttraumatic stress disorder. It also includes time with family members, guiding them as they support their children. 

“There are certainly many good evidence-based treatments,” says Rochelle Hanson, a professor and licensed clinical psychologist at the National Crime Victims Research and Treatment Center. “But when it comes to trauma-related symptoms among children ages 3 to 17, this is the one with the strongest evidence. There’s a high demand for this training because therapists know it’s an excellent treatment.” 

It Takes a Community 

But training frontline clinicians is just one part of the challenge. To make this effective treatment available to children across the state, communities must recognize its importance. 

To help, Project BEST creates a collaborative of mental health clinicians, agency leaders and “brokers” of mental health services (professionals who identify and refer abused children to the treatment providers). Brokers include child welfare case workers, guardians ad litem, victim advocates and juvenile justice case workers. 

With leadership and coordination from the local children’s advocacy center, the “Community Change Team” works together for 14 to 18 months. Clinicians learn from expert trainers, and receive ongoing consultation and technical assistance. Brokers learn how to assess, refer and monitor individual cases. Agency leaders learn how to identify implementation obstacles and overcome them. 

Creating and training a strong local team improves the chances of sustaining the program and eliminating barriers to wide-spread use. With knowledge comes acceptance, Saunders believes – and delivering proven, effective services to every child becomes a community value. 

“The usual approach is, ‘Send everybody to training and they’ll come back and start using it and everyone will be happy,’” he says. “But there’s supply and demand at work. So we’re trying to increase a broker’s awareness about evidence supported treatments – specifically Trauma-Focused Cognitive Behavioral Therapy – and then they’ll more likely seek out a clinician who has been trained in that. It takes both supply and demand to implement a new treatment model.” 

Expanding the Impact 

Project BEST has conducted four community-based learning collaboratives involving 302 child abuse professionals from 105 agencies in 28 South Carolina counties. Now, with another grant from The Duke Endowment, Project BEST plans to expand to other regions in the state. Organizers are using lessons learned from the first phase to refine the process. 

“When Project BEST comes into a community, we bring the training, the implementation approach, the consultation – but you still have to have a structure in your community to make this happen,” Saunders says. “It takes a shared vision and a strong commitment.” 

Rachel Garrett, head of client and community services at Dee Norton, agrees. “In Phase II, we’ll work with communities to help them determine if they’re ready, but we’ll also help them get ready if they aren’t,” she says. “Based on what we learned and continue to learn, we’re getting a better idea of what it takes to get them ready for success.” 

At her office in Florence, Gaye Allen-Cook says the intense effort was worth it. Now trained in Trauma-Focused Cognitive Behavioral Therapy, she’s receiving referrals from physicians, children’s advocacy centers, attorneys and child welfare agencies. Some families drive hours to see her. During court trials, she uses what she learned to educate the jury about abuse and its impact. 

“Because of what it has done for my clients, Project BEST is the best thing that has happened to me in my career,” she says. “Children can learn that trauma doesn’t have to control their lives anymore.” 

Her 9-year-old client, Sherry, is one success story. “I’m happy to tell you that in 12 to 15 sessions, we were done,” Allen-Cook says. “Her life is as normal as a kid’s could get.”

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Phillip H. Redmond Jr.
Director of Child Care


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