Intervention For Trauma In Schools Research Articles

Evaluation of “Cognitive Behavioral Intervention for Trauma in Schools” (CBITS) in child welfare programs in Germany: study protocol of a randomized controlled trial

BackgroundChildren and adolescents growing up in child welfare institutions have been frequently exposed to traumatic events and psychosocial stress and show elevated rates of mental disorders. Yet, there is a lack of empirically supported treatments to provide adequate mental health care for children in care suffering from trauma-related mental disorders such as posttraumatic stress disorder (PTSD), depression, and anxiety. The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evaluated trauma-focused cognitive-behavioral group intervention, which has proven to be effective in reducing symptoms of PTSD, depression, and anxiety for traumatized children in group settings. The trial will evaluate the effectiveness of the CBITS intervention as an outreach treatment compared with an enhanced treatment-as-usual condition (TAU +) within the German mental health and child welfare system.MethodsIn a randomized controlled trial (RCT) involving N = 90 children and adolescents, we will compare CBITS with TAU + . Participants between 8 and 16 years, reporting at least one traumatic event and moderate posttraumatic stress symptoms (PTSS), will be randomized within their child welfare institution to either one of the conditions using a CATS-2 severity-stratified block randomization. Assessments will take place at baseline, as well as 4 months and 10 months after baseline. The primary outcome is the severity of PTSS after 4 months. Secondary outcomes are depression, anxiety, irritability/anger, quality of life, and global functioning level.DiscussionThe results of our trial will provide evidence regarding effective treatment options for traumatized children in care, which represent an understudied population with limited access to mental health care. Additionally, it could serve as a blueprint for implementing trauma-focused outreach group treatments for children in care and increase the accessibility to appropriate treatment.Trial registrationClinical Trials.gov NCT06038357 D. September 13, 2023.

Coping and Resilience: PTSD Screening and Brief Intervention for Underrepresented Students at a Public University

The undetected and untreated PTSD symptoms (difficulty paying attention, nightmares and difficulty sleeping, irritability or aggression, flashbacks, diminished interest in activities, self-destructive behavior, and feeling isolated) of college students may interfere with their relationships, well-being, learning, and academic success. To examine the feasibility, acceptability, and impact of providing a short-term trauma-specific evidence-based group intervention, Coping & Resilience (C&R), an adaptation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was implemented at a large urban public university. Fifty college students (54 percent male, 90 percent students of color), with a mean PTSD symptom score of 34 at pretest (considered in the moderate range of symptom severity) participated in C&R groups. As expected, student PTSD symptoms improved after group participation. A Quade test showed a significant decrease in the scores from pretest to follow-up for PTSD and two subscales (intrusion and avoidance). Large public universities serving underrepresented students are uniquely positioned to become trauma- and resilience-informed systems and to provide trauma support services to promote student well-being.

Measuring the Impact of Trauma-Focused, Cognitive Behavioral Group Therapy with Middle School Students

This study examines differential effects of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program on behavioral and academic outcomes of middle school students. Researchers administered screenings to grade 6 students to assess traumatic stress and then randomized those with elevated levels to the CBITS treatment (n = 150; 47% female) or comparison group (n = 143; 53% female). Analyses examined the overall impact of CBITS and differential effects among subpopulations of students who reported clinically significant externalizing (n = 75; 67% female) or internalizing behavior (n = 185; 53% female) at baseline. Overall, students who received CBITS reported significantly reduced post-traumatic stress symptoms and marginally significant improvements in internalizing symptoms. Relative to counterparts in the comparison group, students exhibiting externalizing behaviors in the CBITS group reported significantly reduced post-traumatic stress, dissociation, anger, internalizing and total behavior problems, and also significantly improved scores on a standardized literacy assessment at posttest and follow-up. Students with internalizing behavior problems showed differential academic effects at 1-year follow-up; those in CBITS did significantly better on standardized math tests.

Cognitive behavioral intervention for trauma in adolescent girls in child welfare: A randomized controlled trial

This study tested the effectiveness of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in adolescent girls involved in the child welfare system. Three outcomes were evaluated: symptoms of posttraumatic stress disorder (PTSD), depression, and social problem-solving skills. A randomized controlled trial was utilized to compare the effects of an adapted version of CBITS with usual care (UC) services. Participants were ages 12 to 19 (N = 249), the majority of whom (69.5%) were African American. Participants’ symptoms of PTSD, depression, and social problem-solving skills were evaluated at pre, post (3 months), and follow-up (6 months) assessments. Linear mixed models were used to compare condition by time interactions using all available data. Control variables were demographics, service use, and number of types of traumas. Treatment fidelity, participant acceptability, and satisfaction with the intervention were also examined. Analyses indicated that participants in the CBITS condition showed significantly greater increases in social problem-solving than the UC condition. For both PTSD and depression symptoms, there were no significant differences between the two conditions. Both the CBITS and UC participants showed significant reductions in symptoms. Results also indicated that this intervention is an acceptable model for this population. Despite the growth of trauma-focused, evidence-supported interventions for reducing PTSD and depression, knowledge of effective interventions in child welfare youth lags behind. Because CBITS is more effective than UC in increasing social problem-solving skills, this intervention may be an important treatment option for this population.

Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review.

A systematic review was conducted to identify determinants (barriers and facilitators) of implementing evidence-based psychosocial interventions for children and youth who experience emotional or behavioral difficulties due to trauma exposure. Determinants were coded, abstracted, and synthesized using the Exploration, Preparation, Implementation, and Sustainment framework. Twenty-three articles were included, all of which examined implementation of Trauma-Focused Cognitive Behavioral Therapy or Cognitive-Behavioral Intervention for Trauma in Schools. This review identified multilevel and multiphase determinants that can be addressed by implementation strategies to improve implementation and clinical outcomes, and suggests how future studies might address gaps in the evidence base.

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): A School Social Work Perspective

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): A School Social Work Perspective

The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention

BackgroundIndividual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector.MethodsAs part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked.ResultsA series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls.ConclusionFindings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed.Trial registrationClinicalTrials.gov Identifier: NCT03791281. Registered 31 December 2018—Retrospectively registered

A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program.

Schools have been identified as an ideal setting for increasing access to mental health services particularly for underserved minority youth. The emerging field of implementation science has begun to systematically investigate strategies for more efficiently integrating evidence-based practices into community settings. Significantly less translational research has focused specifically on the school setting. To address this need, we examined the implementation of a school-based trauma intervention across three distinct regions. We conducted key informant interviews guided by Mendel's Framework of Dissemination in Health Services Intervention Research with multiple school stakeholders to examine what school organizational characteristics influence the adoption and implementation process and sustainability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants were selected from schools in three geographic regions in the United States: Western, Midwestern, and Southern. Our findings reveal that while sites had some common organizational factors that appeared to facilitate implementation, regions differed in how they compensated for less robust implementation domains. Across all regions, school stakeholders recognized the need for services to support students impacted by trauma. In the Western region, there was no centralized district policy for implementation; therefore, implementation was facilitated by school-level change agents and supervision support from the district mental health unit. In the Midwestern region, centralized district policies drove implementation. In both the Midwestern and Southern regions, implementation was facilitated by collaboration with a local mental health agency. This study contributes to the paucity of empirical information on the organizational factors that influence the implementation of evidence-based mental health interventions in schools. Our findings reveal that different implementation strategies across policies, structures, and resources can result in implementation of a school-based intervention. Frameworks such as Mendel's can be helpful in identifying areas of strength and improvement of implementation within a school organization.

Trauma Without Borders: The Necessity for School-Based Interventions in Treating Unaccompanied Refugee Minors

This article explores migration trauma among Mexican and Central American unaccompanied refugee minors (URM) with the purpose of developing an understanding of migration as a tripartite process consisting of: pre-migration exposure to traumatic stressors, in-journey stressors, and post-migration stressors. The migration experience of these youth may be subjectively different depending on a wide range of factors. The complexities of migration are explored as a traumatic, tripartite process. These three salient components of migration may act as precursors, often resulting in psychological sequelae such as: post-traumatic stress disorder (PTSD), anxiety, and depression. Of all migrant groups, URM are more likely to develop psychiatric symptoms. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Behavioral Intervention for Trauma in Schools (CBITS), and Mental Health for Immigrants Program (MHIP) are among the most effective interventions in the treatment of PTSD, anxiety, and depression in refugee minors. Social workers in schools are in unique positions to provide mental health services to URM. A case example illustrating a cultural adaptation of TF-CBT in an urban public high school is included. Clinical implications of culturally responsive and trauma-informed treatment of URM in schools will be discussed. Additionally, this article will emphasize the importance of bridging the gap between research and culturally responsive, trauma-informed interventions for URM in schools.

Statewide implementation of an evidence-based trauma intervention in schools.

The goal of the current article is to describe the implementation and outcomes of an innovative statewide dissemination approach of the evidence-based trauma intervention Cognitive Behavioral Intervention for Trauma in Schools (CBITS). In the context of a 2-year statewide learning collaborative effort, 73 CBITS groups led by 20 clinicians from 5 different school-based mental health provider organizations served a total of 350 racially and ethnically diverse (66.9% Hispanic, 26.2% Black/African American, 43.7% White, and 30.1% Other), majority female (61%) children, averaging 12.2 years (SD = 2.4, range 8-19). Of the 350 children who began CBITS, 316 (90.3%) successfully completed treatment. Children demonstrated significant reductions in child posttraumatic stress disorder (PTSD) symptoms (42% reduction, d = .879) and problem severity (25% reduction, d = .396), and increases in child functioning, t(287) = -3.75, p < .001 (5% increase, d = .223). Findings point to the need, feasibility, and positive impact of implementing and scaling up school-based interventions for students suffering from posttraumatic stress. (PsycINFO Database Record

Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare.

This study describes the process of adapting and implementing Girls Aspiring toward Independence (GAIN), a trauma-focused, group-based therapy adapted from Cognitive Behavioral Intervention for Trauma in Schools (CBITS) for girls in child welfare. Descriptive data were examined on 3 outcomes: posttraumatic stress disorder (PTSD), depression, and social problem-solving skills among adolescent girls in the child welfare system. Qualitative and quantitative methods were utilized to inform the adaptation of the CBITS intervention, evaluate feasibility, treatment fidelity, and acceptability, and to test the effects of the intervention. Girls ages 12 to 18 (N = 27) were randomly assigned to the experimental and usual care conditions. Participants' symptoms of PTSD and depression and social problem-solving skills were evaluated at pre, post- (3 months), and follow-up (6 months) assessments. Adaptations for GAIN were primarily related to program structure. Data indicated that the program was receptive to girls in child welfare and that it was feasible to recruit, randomize, assess outcomes, and implement with adequate fidelity. Retention was more successful among younger girls. Descriptive initial data showed greater reductions in the percentage of girls with PTSD and depression, and modest increases in social problem-solving skills in the experimental versus usual care condition. Despite the growth of knowledge in dissemination and implementation research, the application of trauma-focused empirically supported treatment to child welfare populations lags behind. A large-scale RCT is needed to determine if GAIN is effective in reducing mental health problems and social problem-solving in the child welfare population. (PsycINFO Database Record

Implementing Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with Latino Youth

Objective Many Latino youth are often unable to access mental health services and support following exposure to traumatic and stressful events. This study assesses the benefits and effectiveness of utilizing Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a school based intervention, with Spanish speaking, Latino youth residing in New Orleans, Louisiana, in effort to address presenting symptoms of trauma and depression.

Parent perspectives from participating in a family component for CBITS: Acceptability of a culturally informed school-based program.

This study explored parents' responses to a family component developed as an addition to the Cognitive Behavioral Intervention for Trauma in Schools (CBITS). The family component was developed to improve engagement and participation in CBITS and to support parents' own skill-building. To evaluate the acceptability and feasibility of the family component from the perspective of parents who participated, qualitative interviews were conducted with 15 low-income, Latino parents (80% female; 80% immigrants; average age = 38.07). Themes emerged across 3 primary categories: Need for CBITS + Family, Results of Participating in CBITS + Family, and Implications for Feasibility. Parents agreed that there was a need for programs like CBITS and expressed a firm belief in the importance of parental involvement with their children and schools. Parents reported a high level of satisfaction with the family component and indicated that it was beneficial to them, culturally relevant, and that they would recommend it to others. Still, some logistical barriers to participation and areas for improvement were noted. Overall, the results of this study indicate that CBITS + Family is an appropriate, acceptable, and feasible intervention for Latino families. Supplemental data from children whose parents participated in the program provide further support for the value of the family component. Clinical implications for implementing culturally sensitive, school-based interventions with parents are discussed. (PsycINFO Database Record

Improving Implementation of a School-Based Program for Traumatized Students: Identifying Factors that Promote Teacher Support and Collaboration

The purpose of this study was to delineate the factors that influence teachers’ support and involvement in successful implementation of an early intervention, school-based trauma program, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). In schools that had already used the intervention for at least one school year, we interviewed teachers and other stakeholders to understand what factors influence teacher support and clarify the role teachers desire in the implementation process. This paper also illuminates barriers to their support and collaboration and identifies methods to improve future implementation and sustainability. We conducted 40 semi-structured qualitative telephone interviews with school staff across three geographic regions in the USA. Participants were asked about their experiences with CBITS in their schools and asked to share both facilitators and challenges to implementation. Four key themes emerged: Support for CBITS was related to teachers’ perceived need for a trauma program on campus; teachers struggled with the competing priorities of balancing students’ social-emotional needs with their missing class to attend CBITS; teachers desired more direct communication with clinicians; and teachers felt they needed more trauma education. Suggested improvements include acknowledging teacher concerns about lost instructional time for CBITS sessions and offering groups during non-core academic instruction, expanding trauma education for teachers, so they can better respond to and connect traumatized students with intervention services, including regular consultation between teacher and clinicians about participating students, and improvements in academic performance following the intervention should be shared with teachers to improve their support.

Preliminary Evaluation of a Family Treatment Component to Augment a School-Based Intervention Serving Low-Income Families

This pilot feasibility study provided a preliminary test of a community-partnered intervention that targeted engaging parents and improving parent functioning. This intervention was combined with the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS), allowing for a comparison of the CBITS-as-usual (CBITS) with the CBITS-plus-family treatment component (CBITS + Family). This study used a quasi-experimental design, capitalizing on ongoing CBITS implementation within a school system. A total of 19 parent–student dyads participated in CBITS groups and 21 parent–student dyads participated in CBITS + Family groups. Parents and students under both conditions completed pre- and posttreatment measures. Participants were from low-income, predominantly Latino families. Children were 59% female with an average age of 11.83 years. Parents who received the family treatment component reported higher satisfaction and attended a greater proportion of sessions than parents who received CBITS. In addition, parents who received the family treatment component reported improvements in primary control coping, secondary control coping, family loyalty and closeness, as well as decreases in involuntary engagement and family passive appraisal. Parents who received the family component also showed more warmth, monitoring, and less inconsistency at post-intervention. Results suggest that the family component may contribute to improved parent functioning that could benefit children in the long term.

Engaging Parents in Evidence-Based Treatments in Schools: Community Perspectives from Implementing CBITS

This study explored parent engagement in an evidence-based treatment, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which was delivered in a school setting. To examine the successes and challenges in engaging parents in this school-based program, we conducted qualitative interviews by phone to obtain data from clinicians, parents, and other school personnel across eleven schools from 3 different regions of the United States. Almost all of these schools served low-income and ethnically diverse communities. We describe general impressions of parent engagement, parent reactions and preferences with regard to CBITS, barriers to parent engagement, and how to overcome barriers from multiple perspectives. Parent engagement across schools varied, with extensive outreach and relatively good parent engagement in CBITS described in some schools, while in other schools, efforts to engage parents were not as consistent. Implications for future efforts to engage parents in school-based treatments are discussed.

Cognitive Behavioral Intervention for Trauma in Schools

Developed out a community participatory research partnership with schools, the Cognitive-Behavioral Intervention for Trauma in Schools Program is a targeted intervention for school children who have experienced a traumatic or violent event and have symptoms of posttraumatic stress disorder. This article describes the original development of the program, with its emphasis on student diversity and school culture. The authors describe the program and its elements, as well as developments over the past decade of work that include modifications for special populations, implementation and dissemination activities, and research on these efforts.

Cognitive behavioral treatment for trauma symptoms in American Indian youth: preliminary findings and issues in evidence-based practice and reservation culture

This study reports on the use of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), an evidence-based practice, with 43 students in six schools on three American Indian reservation communities. CBITS was helpful in treating the majority of American Indian children and adolescents who were experiencing symptoms of post-traumatic stress disorder and depression. Using a limited quasi-experimental design, on a measure of traumatic stress, there was symptom reduction with the passage of time; however, symptoms reduced more substantially with treatment. Local cultural experts, that is, Tribal Elders, were invited to provide traditional cultural activities and teachings in the introductory lesson and at graduation. A 3-year follow-up involving school counselors reported on acceptability and additional impacts of the program. They expressed that treating trauma was a priority for their students, CBITS was perceived as an advantageous approach, and counselors said they would use it in the future. Fur...

Going to Scale: Experiences Implementing a School-Based Trauma Intervention

.This article describes implementation experiences “scaling up” the Cognitive Behavioral Intervention for Trauma in Schools (CBITS)—an intervention developed using a community partnered research framework. Case studies from two sites that have successfully implemented CBITS are used to examine macro- and school-level implementation processes and strategies used to address implementation issues and create a successful implementation support system. Key elements of the implementation support system include pre-implementation work, ongoing clinical and logistical implementation supports, promotion of fidelity to the intervention's core components, tailored implementation to fit the service context, and a value on monitoring child outcomes.

Response to trauma in children: An examination of effective intervention and post-traumatic growth

It is clear that exposure to traumatic events is not uncommon in childhood and adolescence and psychologists working in schools should have some training in meeting the needs of this segment of the population. This manuscript summarizes the incidence of trauma in children worldwide and then discusses interventions for trauma (Trauma-Focused Cognitive Behavior Therapy &amp; Cognitive Behavioral Intervention for Trauma in Schools) which have been empirically validated for use with children and/or adolescents. A summary of a project (Project Fleur-de-lis) which attempted to integrate these two treatment approaches into a systematic intervention system is also discussed. In addition, the concept of post-traumatic growth, cultural considerations in working with children from diverse societies, and training needs of school psychologists are addressed.