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Næss A, Haabrekke KJ, Päivärinne HM, Skjærvø I, Martinsen M, Ormhaug SM. The therapist role in parent-led cognitive behavioral therapy for children after trauma: treating trauma from a distance. Cogn Behav Ther 2024:1-21. [PMID: 38836409 DOI: 10.1080/16506073.2024.2360042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/07/2024] [Indexed: 06/06/2024]
Abstract
This article examines the therapist experience of their role in providing Stepped Care Cognitive-Behavioral-Therapy for Children after Trauma (SC-CBT-CT), a semi-homebased, parent-led trauma-treatment for children (7-12). Previous research has documented that parent-led, therapist-assisted psychological interventions are an acceptable and effective type of service delivery. Yet, the therapist perspective on their role when providing parent-led treatments has received limited research attention. Attention is therefore directed to the therapist experience of engaging parents, establishing relationships, and working with children's trauma narratives from a distance-through the engagement of parents. The data material consists of semi-structured interviews with SC-CBT-CT therapists. To identify patterns of experience, thought, and viewpoints in the overall data, a stepwise thematic analysis approach was applied. Two core themes emerged: 1) Perceptions of therapeutic control and therapeutic presence when engaging parents to lead their own children through an exposure-based program; 2) Establishment and maintenance of therapeutic alliances with and between parents and children. Although parents are inherently well-positioned to engage with their own children about trauma, the article highlights that treatment adherence, progression, and perseverance is contingent upon systematic therapist guidance, monitoring, and availability for support and problem-solving.
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Affiliation(s)
- Anders Næss
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Kristin J Haabrekke
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Heidi M Päivärinne
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Ingeborg Skjærvø
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Marianne Martinsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Inland Norway University of Applied Sciences, Hamar, Norway
| | - Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
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Ormhaug SM, Skjærvø I, Dyrdal GM, Fagermoen EM, Haabrekke KJ, Jensen TK, Knutsen ML, Næss A, Päivärinne HM, Martinsen M. Stepping Together for Children After Trauma (ST-CT): Feasibility and Predictors of Outcome of a Parent-led, Therapist Assisted Treatment. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01199-5. [PMID: 38739305 DOI: 10.1007/s10802-024-01199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/14/2024]
Abstract
Stepping Together for Children after Trauma (ST-CT) is the first step of the promising intervention Stepped Care CBT for Children after Trauma. In ST-CT, the task of leading treatment is partially shifted to the parents, and the child and parent work together to complete therapeutic tasks from a workbook with therapist supervision. We aimed to investigate the feasibility of ST-CT in Norwegian first line services and explore child factors predicting outcome. Eighty-two children (mean age 9.9 years, 56% girls) participated. Feasibility was defined by treatment completion, reductions of child posttraumatic stress symptoms (PTSS) mid- and post-treatment, and client treatment satisfaction. Predictors included child baseline PTSS, depressive symptoms, posttraumatic cognitions, externalizing symptoms, number of different traumatic events, and type of trauma. Results showed that rates of completion (78.0%) and response (81% of completers/59.8% intention-to-treat) were comparable to previous studies by the ST-CT developer. Overall treatment effect was d = 2.46 and client treatment satisfaction was high (mean score child: 8.3, parent: 9.0, on a scale from 0 - 10). Higher baseline PTSS and depressive symptoms predicted poorer outcome at both mid- and post-treatment, while more posttraumatic cognitions, and exposure to interpersonal trauma predicted poorer outcome at mid-treatment only. These associations were no longer significant in the fully adjusted models. In conclusion, ST-CT shows promise as an effective first line treatment in this new context, with two of three children responding to the treatment. Baseline PTSS, depression, post-traumatic cognitions and type of trauma may be related to outcomes and should be explored further. (Trial registration: ClinicalTrials.gov Identifier: NCT04073862. Retrospectively registered June 3rd 2019, first patient recruited May 19th 2019).
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Affiliation(s)
- Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway.
| | - Ingeborg Skjærvø
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gunvor M Dyrdal
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Department of Health Sciences in Gjøvik, NTNU, Gjøvik, Norway
| | | | - Kristin J Haabrekke
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tine K Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Marie L Knutsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Anders Næss
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | | | - Marianne Martinsen
- Faculty of Education, Innland Norway University of Applied Science, Hamar, Norway
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Fagermoen EM, Skjærvø I, Birkeland MS, Jensen TK, Ormhaug SM. The bidirectional associations between caregiver and child symptoms in the parent-led treatment stepping together for children after trauma. Behav Res Ther 2024; 173:104459. [PMID: 38128401 DOI: 10.1016/j.brat.2023.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND An innovative approach to child trauma treatment in which caregivers are allocated treatment tasks has shown promising results, but less is known about the bidirectional associations between caregiver and child symptoms during treatment. METHODS Eighty-two child-caregiver dyads who participated in the parent-led therapist-assisted Stepping Together for Children after Trauma (ST-CT) were included (child age: 7-12 years, mean = 9.9 years). Caregivers' emotional reactions and anxiety/depression and children's posttraumatic stress (PTS) and depression were assessed pretreatment, mid-treatment, and posttreatment. We investigated the possible directional associations between caregivers' emotional reactions and anxiety/depression and children's PTS and depression using random intercept cross-lagged panel models. RESULTS Symptoms improved in both caregivers and children. Lower levels of caregiver emotional reactions at pretreatment predicted improved child PTS at mid-treatment; lower levels of caregiver emotional reactions at mid-treatment predicted improved child depression at posttreatment; and lower levels of child PTS at mid-treatment predicted improved caregiver emotional reactions at posttreatment. CONCLUSIONS These findings suggest that caregivers and children can impact each other's responses to a parent-led child trauma-focused treatment. Notably, children with caregivers who were less affected by their own emotional reactions exhibited greater improvement in both PTS and depression. Supporting the caregivers may benefit both children and caregivers. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862.
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Affiliation(s)
| | - Ingeborg Skjærvø
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway
| | | | - Tine K Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway; Department of Psychology, University of Oslo, 0317 Oslo, Norway
| | - Silje Mørup Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway
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Storch EA, Schneider SC, Olsen SM, Ramirez AC, Berry LN, Goin-Kochel RP, McNeel M, Candelari AE, Guzick AG, Cepeda SL, Weinzimmer S, Voigt RG, Quast T, Goodman WK, Salloum A. Stepped-Care Cognitive Behavioral Therapy in Children on the Autism Spectrum with Co-occurring Anxiety. J Autism Dev Disord 2024; 54:93-108. [PMID: 36239830 PMCID: PMC9561323 DOI: 10.1007/s10803-022-05775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
This trial examined stepped-care cognitive-behavioral treatment (CBT) among 96 autistic youth with co-occurring anxiety. Step 1 included an open trial of parent-led, therapist-guided bibliotherapy. Step 2 was family-based CBT for those who did not respond to Step 1 or maintenance for those who did. Eighteen participants (28%) who completed Step 1 responded. Responders reported significantly lower pre-treatment anxiety, internalizing symptoms, and functional impairment than non-responders. After Steps 1 and 2, 80% of completers (55% intent-to-treat) were responders. Anxiety, impairment, and ASD-related impairments significantly improved. Youth in maintenance experienced faster improvement through post-treatment, though there were no group differences at 3-month-follow-up. A stepped approach may help some individuals in Step 1, particularly those who are less anxious.
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Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA.
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sean M Olsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ana C Ramirez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Morgan McNeel
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abigail E Candelari
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L Cepeda
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Saira Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Robert G Voigt
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Troy Quast
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
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Clarke AT, Grassetti SN, Brumley L, Ross KY, Erdly C, Richter S, Brown ER, Pole M. Integrating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health. J Prev Interv Community 2023; 51:332-351. [PMID: 38349066 DOI: 10.1080/10852352.2024.2313382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Community gun violence disproportionately impacts youth in low-income urban neighborhoods. Integrating trauma-informed mental health care in community-based out-of-school time (OST) programs is an innovative method of service delivery for these youth. This article provides justification for integrating evidence-based, trauma-informed services in OST programs within communities characterized by high rates of violent crime to minimize the impact of violence exposure on youth mental health. We describe the initial feasibility of a model program, the Violence Intervention and Prevention (VIP) Initiative, implemented in a small city in southeastern Pennsylvania. Within the first six months of the VIP Initiative, 95 community residents (90% under age 18; 51% Hispanic) received intervention services, primarily through single-session and short-term weekly group intervention in OST programs, and 80% of OST youth development staff participated in at least one trauma-informed professional development training. Recommendations to enhance and expand the delivery of trauma-informed services in the novel setting of OST programs are provided.
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Affiliation(s)
- Angela T Clarke
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Stevie N Grassetti
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Lauren Brumley
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Kyle Y Ross
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Courtney Erdly
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Sarah Richter
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Emily R Brown
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
| | - Michele Pole
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
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Godfrey LB, Cloitre M, Elwy AR, Fortuna LR, Fuchs C, Valentine SE. Study protocol for a hybrid 1 effectiveness-implementation trial of Brief Skills Training in Affective and Interpersonal Regulation (Brief STAIR) and web-administered STAIR (webSTAIR) for posttraumatic stress disorder in integrated primary care. Contemp Clin Trials 2023; 131:107241. [PMID: 37244367 PMCID: PMC10527289 DOI: 10.1016/j.cct.2023.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) disproportionally affects low-income, racial and ethnic minoritized communities, where prevalence is high, yet access to evidence-based treatments (EBTs) is low. As such, there is a need to identify effective, feasible, and scalable interventions for PTSD. Stepped care approaches that include brief, low-intensity treatments are one approach to improving access yet have not been developed for adults with PTSD. Our study aims to test the effectiveness of a step one PTSD treatment in primary care while gathering information on implementation to maximize sustainability in the setting. METHODS This study will be conducted in integrated primary care in the largest safety net hospital in New England using a hybrid type 1 effectiveness-implementation design. Eligible trial participants are adult primary care patients who meet full or subthreshold criteria for PTSD. Interventions include Brief clinician-administered Skills Training in Affective and Interpersonal Regulation (Brief STAIR) versus web-administered STAIR (webSTAIR) during a 15-week active treatment period. Participants complete assessments at baseline (pre-treatment), 15 weeks (post-treatment), and 9 months (follow-up) post-randomization. We will assess feasibility and acceptability post-trial using surveys and interviews with patients, study therapists, and other key informants, and will assess the preliminary effectiveness of interventions in terms of PTSD symptom change and functioning. CONCLUSION This study will provide evidence for the feasibility, acceptability, and preliminary effectiveness of brief, low-intensity interventions in safety net integrated primary care, with the aim of including these interventions in a future stepped care approach to PTSD treatment. CLINICAL TRIAL NUMBER NCT04937504.
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Affiliation(s)
- Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Marylène Cloitre
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; National Center for PTSD, Dissemination and Training Division at VA Palo Alto Health Care, Palo Alto, CA, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences at University of California, San Francisco, San Francisco, CA, USA
| | - Cara Fuchs
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Fagermoen EM, Jensen TK, Martinsen M, Ormhaug SM. Parent-Led Stepped Care Trauma Treatment: Parents' Experiences With Helping Their Child Recover. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1-13. [PMID: 37359465 PMCID: PMC10064603 DOI: 10.1007/s40653-023-00537-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
Purpose There is a need for interventions for traumatized children that are easily accessible and effective, and that involve parents directly in the recovery process. To meet this challenge, stepped care trauma-focused cognitive behavioral treatment (SC TF-CBT), which consists of a parent-led therapist-assisted intervention as the first step, was developed. Parent-led trauma-treatment is a promising, but novel approach. The aim of this study was therefore to gain knowledge on how parents experience the model. Methods Parents who participated in a SC TF-CBT feasibility study were consecutively recruited and interviewed with semi-structured interviews, which were then analysed using interpretative phenomenological analysis. Results The parents described that the intervention gave them insights that led to a sense of parental agency. Through the analysis we identified and labelled four themes: (i) understanding my child: how the trauma has affected my child and our relationship; (ii) understanding myself: how my reactions have stood in the way of helping my child; (iii) gaining competence: how to learn specific tasks that were not part of my normal parenting skills; and (iv) receiving support: how guidance, warmth and encouragement was necessary. Conclusions The results from this study show how the shifting of therapeutic tasks to parents may facilitate parental empowerment and improve the parent-child relationship. This knowledge may guide clinicians on how to provide support to parents so they can take a leading role in their child's recovery process after trauma. Trial registration ClinicalTrials.gov, NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019), https://clinicaltrials.gov/ct2/show/NCT04073862.
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Affiliation(s)
- Else Merete Fagermoen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
| | - Tine K. Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Marianne Martinsen
- Faculty of Education, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Silje M. Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
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Salloum A, Palantekin S, Claudio Torres AM, Holley R, Storch EA. Stepping Together in Stepped Care Trauma-Focused Cognitive Behavioral Therapy: Case Report of Core Components. J Cogn Psychother 2023; 37:7-25. [PMID: 36787998 DOI: 10.1891/jcpsy-d-20-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
New service delivery systems are needed to expand the reach of evidence-based practices for childhood trauma. Cognitive behavioral therapy is an effective approach for treating -childhood trauma, yet treatment barriers remain. Stepped care models that incorporate parent-led -treatment with therapist assistance may be one approach to improve access. This case study highlights the core components of a parent-led therapist-assisted treatment called Stepping Together that serves as a Step 1 treatment within a stepped care model. The components and structure of Stepping Together are described, along with excerpts from therapy sessions to illustrate the therapist's implementation of the model. Results of the case, in which improvements occurred, are presented. Stepping Together, a parent-led therapist-assisted first-line treatment within stepped care trauma-focused cognitive behavioral therapy, may be an effective treatment for some children after trauma and their caregivers, although more research is needed.
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Affiliation(s)
- Alison Salloum
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | | | | | - Robb Holley
- School of Social Work, University of South Florida, Tampa, Florida, USA
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Fagermoen EM, Skjærvø I, Jensen TK, Ormhaug SM. Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response. Eur J Psychotraumatol 2023; 14:2225151. [PMID: 37366166 DOI: 10.1080/20008066.2023.2225151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Stepped care cognitive behavioural therapy for children after trauma (SC-CBT-CT; aged 7-12 years) can help to increase access to evidence-based trauma treatments for children. SC-CBT-CT consists of a parent-led therapist-assisted component (Step One) with an option to step up to standard therapist-led treatment (Step Two). Studies have shown that SC-CBT-CT is effective; however, less is known about what parent variables are associated with outcome of Step One.Objective: To examine parent factors and their relationship with completion and response among children receiving Step One.Method: Children (n = 82) aged 7-12 (M = 9.91) received Step One delivered by their parents (n = 82) under the guidance of SC-CBT-CT therapists. Logistic regression analyses were used to investigate whether the following factors were associated with non-completion or non-response: the parents' sociodemographic variables, anxiety and depression, stressful life experiences and post-traumatic symptoms, negative emotional reactions to their children's trauma, parenting stress, lower perceived social support, and practical barriers to treatment at baseline.Results: Lower level of educational achievement among parents was related to non-completion. Higher levels of emotional reactions to their child's trauma and greater perceived social support were related to non-response.Conclusions: The children seemed to profit from the parent-led Step One despite their parents` mental health challenges, stress, and practical barriers. The association between greater perceived social support and non-response was unexpected and warrants further investigation. To further increase treatment completion and response rates among children, parents with lower education may need more assistance on how to perform the interventions, while parents who are very upset about their child's trauma may need more emotional support and assurance from the therapist.Trial registration: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019).
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Affiliation(s)
| | - Ingeborg Skjærvø
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tine K Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Giallo R, Fogarty A, Savopoulos P, Cox A, Toone E, Williams K, Jones A, Treyvaud K. Capturing the experiences of clinicians implementing a new brief intervention for parents and children who have experienced family violence in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1599-e1610. [PMID: 34587313 DOI: 10.1111/hsc.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/25/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Family violence (FV) affects one in four families. While the evidence regarding therapeutic interventions for children and families who experience FV is expanding, little research has been conducted about clinicians' experiences of implementation. The current study aimed to capture the voices of clinicians delivering a brief dyadic intervention for women and their children after FV exposure. The Brief Relational Intervention and Screening (BRISC) is an evidence-informed intervention designed by Berry Street (Australia) for mothers and children with recent experiences of FV. Consisting of four sessions, BRISC was implemented across one regional and one metropolitan site. Thirteen BRISC clinicians participated in semi-structured interviews individually or in a focus group. Thematic analysis of transcripts was conducted using NVivo. Clinicians considered key strengths of BRISC to be related to the intervention principles, including the hopeful and relationship-focused approach, the intervention implementation such as the timing, structure and flexibility, as well as the systems and processes in place, such as intake and triage, supervision structure and their team environment. Challenges described by clinicians included aspects of delivery such as limited referral options and safety concerns, the nature of the program including the mechanics of delivery and specific role challenges such as vicarious trauma. Clinicians also shared suggestions for improvements for delivery, supervision and training. This study emphasises the importance of clinician perspectives when identifying factors that can promote the successful implementation of innovative interventions in real-world community settings.
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Affiliation(s)
- Rebecca Giallo
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Alison Fogarty
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Allison Cox
- Berry Street, Melbourne, Victoria, Australia
| | - Emma Toone
- Berry Street, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | | | - Amanda Jones
- Victorian Aboriginal Child Care Agency, Melbourne, Victoria, Australia
| | - Karli Treyvaud
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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11
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Salloum A, Lu Y, Chen H, Quast T, Cohen JA, Scheeringa MS, Salomon K, Storch EA. Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:1010-1022.e4. [PMID: 35032578 PMCID: PMC9273807 DOI: 10.1016/j.jaac.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 12/05/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial. METHOD A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied. RESULTS SC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower. CONCLUSION Stepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents. CLINICAL TRIAL REGISTRATION INFORMATION Stepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.
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Affiliation(s)
| | | | | | | | - Judith A Cohen
- Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, Pennsylvania
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Berger M, Fernando S, Churchill A, Cornish P, Henderson J, Shah J, Tee K, Salmon A. Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults. Early Interv Psychiatry 2022; 16:327-341. [PMID: 34018335 PMCID: PMC9292436 DOI: 10.1111/eip.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. METHODS A scoping review was conducted involving both peer-reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12-24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full-text articles and extracted data to create a descriptive summary of the models. RESULTS Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. CONCLUSIONS Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.
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Affiliation(s)
- Mai Berger
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saranee Fernando
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - AnnMarie Churchill
- Student Wellness and Counseling Centre, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Cornish
- Director of Counseling and Psychological Services, University of California, Berkeley, Berkeley, California, USA.,Honorary Research Professor, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Karen Tee
- Foundry, Vancouver, British Columbia, Canada
| | - Amy Salmon
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Lui JHL, Brookman-Frazee L, Vázquez AL, Cox JR, Innes-Gomberg D, Taguchi K, Pesanti K, Lau AS. Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:506-520. [PMID: 34837572 PMCID: PMC9005401 DOI: 10.1007/s10488-021-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/09/2022]
Abstract
The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA.
- Department of Psychology, University of Maryland, College Park, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, USA
- Child and Adolescent Services Research Center, La Jolla, USA
| | | | - Julia R Cox
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA
| | | | - Kara Taguchi
- Los Angeles County Department of Mental Health, Los Angeles, USA
| | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA
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14
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Demaria F, Pontillo M, Tata MC, Gargiullo P, Mancini F, Vicari S. Psychoeducation focused on family accommodation: a practical intervention for parents of children and adolescents with obsessive-compulsive disorder. Ital J Pediatr 2021; 47:224. [PMID: 34742338 PMCID: PMC8572476 DOI: 10.1186/s13052-021-01177-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/23/2021] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is frequently diagnosed in children and adolescents. In pediatric OCD, family plays an important role in the development and maintenance of the disease. In this relationship, both genetic and behavioral factors, such as parental modeling and family accommodation, are significant. Parental modeling concerns the daily enactment of dysfunctional behavioral patterns by a parent with OCD, which may influence children. Family accommodation, in contrast, describes the direct participation of parents in their child's compulsive rituals, by modifying daily routines or by facilitating avoidance of OCD triggers, to decrease the child's distress and time spent executing compulsions. Approximately 80-90% of the relatives of OCD patients actively participate in patients' rituals. The literature demonstrates that a high level of family accommodation is associated with OCD symptom severity, reduced response to cognitive-behavioral treatment (CBT), and a higher risk of therapy dropout.Despite this, no studies have aimed at delineating practical guidance for psychotherapists to support parents in reducing family accommodation.The main aim of this paper is to propose a psychoeducation intervention focused on cognitive-behavioral strategies to help families to manage their child's OCD behaviors without enacting dysfunctional family accommodation behaviors in order to support their child's successful therapy.
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Affiliation(s)
- Francesco Demaria
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Francesco Mancini
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
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15
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McGuire A, Steele RG, Singh MN. Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children. Clin Child Fam Psychol Rev 2021; 24:20-37. [PMID: 33428071 DOI: 10.1007/s10567-020-00334-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the most widely studied and disseminated treatments for posttraumatic stress disorder (PTSD) and other comorbid conditions, and has been identified as a "level one" or "well-established" intervention for school-aged children and adolescents. The present systematic review examined the literature on the application of TF-CBT within a preschool-aged population (i.e., children ages three to six), as well as the developmental literature that could increase the efficacy of TF-CBT for preschool-aged children. Information on the use of TF-CBT with preschool-aged children was extracted from randomized controlled trials, case studies, meta-analyses, and other forms of empirical evidence, as part of the evidence-based practice in psychology framework. In comparison to research with school-aged children and adolescents, fewer studies have directly assessed the efficacy of TF-CBT for preschool-aged children who have been exposed to trauma. Given the few studies published to date and difference in treatment protocols for TF-CBT used with preschool-age children, TF-CBT appears to meet criteria as a "level two" or "probably efficacious" intervention for preschool-aged children specifically. According to the available literature, language and cognitive abilities, family context, culture, and clinician expertise are considered as potential variables to address when contemplating the use of TF-CBT for preschool-aged children with symptoms of post-traumatic stress.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA.
| | - Ric G Steele
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA
| | - Mehar N Singh
- Clinical Child Psychology Program, University of Kansas, 2015 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7556, USA
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16
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Cimolai V, Schmitz J, Sood AB. Effects of Mass Shootings on the Mental Health of Children and Adolescents. Curr Psychiatry Rep 2021; 23:12. [PMID: 33570688 DOI: 10.1007/s11920-021-01222-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To examine mass shootings in youth including mass shooting trends, risk and protective factors for emotional sequelae, mental health, prevention of mass shootings, and the assessment and treatment of survivors. RECENT FINDINGS Many youth are exposed to gun violence, with a smaller subset exposed to mass shootings. While youth have varying responses to mass shootings, possibly due to risk and protective factors as well as level of exposure, the mental health outcomes are significant and include posttraumatic stress, suicide, depression, substance abuse, and anxiety. Efforts at developing effective prevention and treatment programs are still underway but generally take a tiered public health approach. Mass shootings have significant mental health outcomes for youth survivors, particularly those with direct exposure or risk factors. Continued efforts are needed to better understand the effects of mass shootings and how to prevent them from occurring as well as how to best address the needs of survivors.
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Affiliation(s)
- Valentina Cimolai
- Virginia Treatment Center for Children, Virginia Commonwealth University, 1308 Sherwood Avenue, Richmond, VA, 23220, USA
| | - Jacob Schmitz
- Virginia Treatment Center for Children, Virginia Commonwealth University, 1308 Sherwood Avenue, Richmond, VA, 23220, USA
| | - Aradhana Bela Sood
- Virginia Treatment Center for Children, Virginia Commonwealth University, 1308 Sherwood Avenue, Richmond, VA, 23220, USA.
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17
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Brigden A, Shaw A, Anderson E, Crawley E. Chronic fatigue syndrome/myalgic encephalomyelitis in children aged 5 to 11 years: A qualitative study. Clin Child Psychol Psychiatry 2021; 26:18-32. [PMID: 33092395 PMCID: PMC7802053 DOI: 10.1177/1359104520964528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Treatments for paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have not been designed or evaluated for younger children (5-11-years). The development of a complex intervention for this population requires an in-depth understanding of the perspectives and psychosocial context of children and families. Children with CFS/ME (5-11-years) and their families were recruited from a specialist CFS/ME service, and interviewed using semi-structured topic guides. Data were analysed thematically. Twenty-two participants were interviewed; eight parents, two children (aged nine and ten) and six parent-child dyads (aged 5-11-years). Theme 1: CFS/ME in younger children is complex and disabling. Theme 2: Children aged eight and over (in comparison to those under eight) were more able to describe their illness, engage in clinical consultation, understand diagnosis and self-manage. Theme 3: Parents of children under eight took full responsibility for their child's treatment. As children got older, this increasingly became a joint effort between the parent and child. Parents felt unsupported in their caring role. Clinicians should consider different treatment approaches for children under eight, focusing on: parent-only clinical sessions, training parents to deliver treatment, and increasing support for parents. Children over eight may benefit from tools to help them understand diagnosis, treatment and aids for self-management.
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Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Anderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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18
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Rech M, Weinzimmer S, Geller D, McGuire JF, Schneider SC, Patyk KC, De Nadai AS, Cepeda SC, Small BJ, Murphy TK, Wilhelm S, Storch EA. Symptom Trajectories of Early Responders and Remitters among Youth with OCD. J Obsessive Compuls Relat Disord 2020; 27:100580. [PMID: 35990243 PMCID: PMC9390966 DOI: 10.1016/j.jocrd.2020.100580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT). METHODS One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively. RESULTS At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model. CONCLUSIONS Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
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Affiliation(s)
- Megan Rech
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Saira Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kevin C Patyk
- Department of Psychology, Texas State University, San Marcos, Texas
| | | | - Sandra C Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Brent J Small
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- University of South Florida School of Aging Studies, Tampa, Florida
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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19
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Development and Implementation of a Transdiagnostic, Stepped-Care Approach to Treating Emotional Disorders in Children via Telehealth. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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20
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March S, Donovan CL, Baldwin S, Ford M, Spence SH. Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies. Internet Interv 2019; 18:100281. [PMID: 31890629 PMCID: PMC6926334 DOI: 10.1016/j.invent.2019.100281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. OBJECTIVE This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. METHODS Three case studies are presented and include young males (aged 11-12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 - five sessions of self-guided ICBT and Step 2 - five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). RESULTS In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. CONCLUSIONS The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials.
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Affiliation(s)
- Sonja March
- University of Southern Queensland, School of Psychology and Counselling and Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia,Corresponding author at: 37 Sinnathamby Boulevard, Springfield Central, QLD 4300, Australia.
| | - Caroline L. Donovan
- Griffith University, School of Applied Psychology, Mt Gravatt, QLD, Australia
| | - Sarah Baldwin
- University of Southern Queensland, Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia
| | - Martelle Ford
- University of Southern Queensland, School of Psychology and Counselling and Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia
| | - Susan H. Spence
- Griffith University, Australian Institute for Suicide Research and Prevention, Mt Gravatt, QLD, Australia
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21
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Hartinger-Saunders RM, Jones AS, Rittner B. Improving Access to Trauma-Informed Adoption Services: Applying a Developmental Trauma Framework. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:119-130. [PMID: 32318185 PMCID: PMC7163853 DOI: 10.1007/s40653-016-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Foster and adopted children often experience multiple traumatic and adverse experiences. A growing body of literature indicates the negative impact of trauma on developmental milestones and brain development, which supports the need to address complex trauma among this vulnerable population of foster and adopted youth. This paper presents an overview of the unique needs of children adopted from the foster care system from the perspective of adverse childhood experiences (ACEs), complex trauma, and developmental trauma disorder (DTD). There is an increasing number of evidence-based trauma-focused services and interventions for children and youth. However, many adoptive parents have limited trauma-informed training and limited access to trauma-informed and adoption-competent professionals, particularly long-term supports across developmental stages, making them ill-prepared to meet the needs of children in their care. This paper contributes to the understanding of how access to these trauma-focused services can be increased through new technologies, to better prepare and empower adoptive parents to deal effectively with difficult adoption issues when they arise and to improve outcomes for children and youth adopted from the public child welfare system. Several innovative approaches toward this end include harnessing technology to: (1) improve access to suitable adoption resources, (2) improve mechanisms to track critical events, behaviors, emotions, functional abilities, strengths, etc., in order to determine timely, on-demand contextual services, and (3) extend professional, supportive environments beyond the adoptive family context by proposing the use of technology to build interdisciplinary, virtual community partners.
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Affiliation(s)
- Robin M. Hartinger-Saunders
- School of Social Work, Andrew Young School of Policy Studies, Georgia State University, 1269 Urban life, 140 Decatur Street, Atlanta, GA 30303 USA
| | - Annette Semanchin Jones
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Barbara Rittner
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY USA
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22
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Williamson V, Creswell C, Butler I, Christie H, Halligan SL. Parental Experiences of Supporting Children with Clinically Significant Post-Traumatic Distress: a Qualitative Study of Families Accessing Psychological Services. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:61-72. [PMID: 32318180 PMCID: PMC7163877 DOI: 10.1007/s40653-017-0158-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to investigate the experiences of parents in providing support to their child following trauma exposure in cases where children are experiencing clinically significant levels of post-traumatic distress. Qualitative interviews were conducted with parents whose child was exposed to a trauma and referred for psychological treatment. Parents reported considerable anxiety in coping with their child's post-traumatic distress. Avoidance of trauma-related discussions was encouraged due to concerns that non-avoidant approaches may worsen children's post-trauma difficulties. Nonetheless, parents were often sensitive to their child's distress and offered reassurance and other forms of support. Many barriers existed to accessing psychological treatment, and perceptions of inadequate guidance from therapists on supporting child adjustment contributed to parental distress. The results illustrate the strategies used by parents in supporting their child post-trauma and may assist mental health professionals in providing acceptable guidance to parents following child trauma.
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Affiliation(s)
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6UA UK
| | - Ian Butler
- Department of Humanities and Social Sciences, University of Bath, Bath, BA2 7AY UK
| | - Hope Christie
- Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath, BA2 7AY UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7700 South Africa
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23
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Anderson RE, Edwards LJ, Silver KE, Johnson DM. Intergenerational transmission of child abuse: Predictors of child abuse potential among racially diverse women residing in domestic violence shelters. CHILD ABUSE & NEGLECT 2018; 85:80-90. [PMID: 30170920 PMCID: PMC6214774 DOI: 10.1016/j.chiabu.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/10/2018] [Accepted: 08/07/2018] [Indexed: 05/18/2023]
Abstract
Parental risk for perpetrating child abuse is frequently associated with intergenerational patterns of abuse: being abused increases the risk for future abuse. Yet, the mechanisms of intergenerational abuse are unclear, and the risk factors for perpetrating child abuse are interrelated. Research suggests that history of childhood abuse, psychiatric distress, and exposure to intimate partner violence (IPV) are all related risk factors for perpetrating child abuse. We investigated these three risk factors using the developmental psychopathology framework in a racially diverse sample of high-risk women: women residing in domestic violence shelters. 211 mothers residing in domestic violence shelters completed measures of their own childhood abuse (defined narrowly in a 10-item self-report survey), exposure to and severity of IPV victimization, and structured interviews to diagnose psychiatric disorders. We utilized a hierarchical regression model to predict child abuse potential, accounting for risk factors in blocks roughly representing theorized temporal relationships: childhood abuse followed by psychiatric diagnoses, and then recency of exposure to IPV. Consistent with hypotheses, the strongest predictor of current child abuse potential was the psychiatric diagnosis of PTSD. Mediation tests further explicated that the relationship between maternal history of childhood sexual abuse and current potential for perpetrating child abuse is mediated by IPV-related PTSD symptoms. Results suggest that IPV-related PTSD symptoms, rather than exposure to abuse (i.e., childhood abuse or IPV), is most strongly associated with child abuse potential in recent IPV survivors. Interventions which can ameliorate maternal psychopathology and provide resources are recommended for these vulnerable families.
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Affiliation(s)
- RaeAnn E Anderson
- Kent State University, Psychological Sciences, 144 Kent Hall, Kent, OH, 44242, United States; University of North Dakota, Psychology, 2000 Columbia Hall, Grand Forks, ND, 58202, United States.
| | | | - Kristin E Silver
- University of Akron, Department of Psychology, Akron, OH, 44325-4301, United States
| | - Dawn M Johnson
- University of Akron, Department of Psychology, Akron, OH, 44325-4301, United States
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24
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Stover CS, Keeshin B. Research domain criteria and the study of trauma in children: Implications for assessment and treatment research. Clin Psychol Rev 2018; 64:77-86. [PMID: 27863803 PMCID: PMC5423862 DOI: 10.1016/j.cpr.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 05/07/2015] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
By definition, the Diagnostic and Statistical Manual (DSM) diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic event. Yet, the DSM diagnostic requirements for children and adolescents for PTSD may fail to capture traumatized youth with significant distress and functional impairment. Many important studies have utilized PTSD diagnosis as a mechanism for grouping individuals for comparative studies examining brain functioning, neuroendocrinology, genetics, attachment, and cognition; however, focusing only on those with the diagnosis of PTSD can miss the spectrum of symptoms and difficulties that impact children who experience trauma and subsequent impairment. Some studying child trauma have focused on examining brain and biology of those with exposure and potential impairment rather than only those with PTSD. This line of inquiry, complementary to PTSD specific studies, has aided our understanding of some of the changes in brain structure and neuroregulatory systems at different developmental periods following traumatic exposure. Application of the Research Domain Criteria (RDoC) framework proposed by NIMH to the study of child trauma exposure and subsequent impairment is an opportunity to examine domains of function and how they are impacted by trauma. Research to date has focused largely in the areas of negative valence, regulatory, and cognitive systems, however those studying complex or developmental trauma have identified an array of domains that are impacted which map onto many of the RDoC categories. This paper will review the relevant literature associated with child trauma as it relates to the RDoC domains, outline areas of needed research, and describe their implications for treatment and the advancement of the field.
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Affiliation(s)
- Carla Smith Stover
- University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33647, Salt Lake City, Utah, United States.
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Comparison of Stepped Care Delivery Against a Single, Empirically Validated Cognitive-Behavioral Therapy Program for Youth With Anxiety: A Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry 2017; 56:841-848. [PMID: 28942806 DOI: 10.1016/j.jaac.2017.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/16/2017] [Accepted: 08/03/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program. METHOD A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. RESULTS Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. CONCLUSION Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819.
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Williamson V, Creswell C, Fearon P, Hiller RM, Walker J, Halligan SL. The role of parenting behaviors in childhood post-traumatic stress disorder: A meta-analytic review. Clin Psychol Rev 2017; 53:1-13. [DOI: 10.1016/j.cpr.2017.01.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/05/2017] [Accepted: 01/16/2017] [Indexed: 12/01/2022]
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A preliminary study of cognitive-behavioral family-based treatment versus parent training for young children with obsessive-compulsive disorder. J Affect Disord 2017; 208:265-271. [PMID: 27792972 DOI: 10.1016/j.jad.2016.09.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive-Behavioral Family-Based Treatment (CBFT) is the standard of care in young children with OCD. Developmental considerations, parent desires, and cost-effective advantages motivate research to explore the relative efficacy of parent-only interventions. The main goal in this study was to test the effectiveness and feasibility of a parent only intervention for OCD in young children, comparing, in a preliminary fashion the relative efficacy of reducing obsessive-compulsive symptoms through two treatment conditions: 1) an individual CBFT for early OCD involving both parents and children, and 2) the family component of the intervention involving only individual Parent Training (PT). METHODS Twenty treatment-seeking families from two private outpatient clinics in Spain were alternately assigned to one of the two treatment conditions. Participants had a primary diagnosis of OCD and a mean age of 6.62 years (65% males). Interventions were conducted by the same therapist and the assessments were administered by independent clinicians who were blind to the experimental conditions of the participants. Assessment time-points were pretreatment, posttreatment, and 3-month follow-up (including diagnosis, symptom severity, global functioning, family accommodation, externalizing and internalizing symptoms, and satisfaction measures). RESULTS The two ways of implementation, involving child and parents (CBFT) or involving only parents (PT), produced clinical improvements and were well-accepted by parents and children. The CBFT condition was superior to the PT condition in reducing externalizing problems. LIMITATIONS reduced sample size and absence of randomization were the main limitations of this study. CONCLUSIONS these results suggest, in a preliminary manner, that the need to have the child present at session with the clinician could be decreased for some children, as well as the overall feasibility of working only with parents for the implementation of CBT for OCD in very young children.
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Neill EL, Weems CF, Scheeringa MS. CBT for Child PTSD is Associated with Reductions in Maternal Depression: Evidence for Bidirectional Effects. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:410-420. [DOI: 10.1080/15374416.2016.1212359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Erin L. Neill
- Department of Human Development and Family Studies, Iowa State University
| | - Carl F. Weems
- Department of Human Development and Family Studies, Iowa State University
| | - Michael S. Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
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Almirall D, Chronis-Tuscano A. Adaptive Interventions in Child and Adolescent Mental Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 45:383-95. [PMID: 27310565 DOI: 10.1080/15374416.2016.1152555] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment or prevention of child and adolescent mental health (CAMH) disorders often requires an individualized, sequential approach to intervention, whereby treatments (or prevention efforts) are adapted over time based on the youth's evolving status (e.g., early response, adherence). Adaptive interventions are intended to provide a replicable guide for the provision of individualized sequences of interventions in actual clinical practice. Recently, there has been great interest in the development of adaptive intervenions by investigators working in CAMH. The development of such replicable, real-world, individualized sequences of decision rules to guide the treatment or prevention of CAMH disorders represents an important "next step" in interventions research. The primary purpose of this special issue is to showcase some recent work on the science of adaptive interventions in CAMH. In this overview article, we review why individualized sequences of interventions are needed in CAMH, provide an introduction to adaptive interventions, briefly describe each of the articles included in this special issue, and describe some exciting areas of ongoing and future research. A hopeful outcome of this special issue is that it encourages other researchers in CAMH to pursue creative and significant research on adaptive interventions.
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Affiliation(s)
- Daniel Almirall
- a Survey Research Center, Institute for Social Research , University of Michigan
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Salloum A, Wang W, Robst J, Murphy TK, Scheeringa MS, Cohen JA, Storch EA. Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. J Child Psychol Psychiatry 2016; 57:614-22. [PMID: 26443493 PMCID: PMC4824681 DOI: 10.1111/jcpp.12471] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). METHODS A total of 53 children (ages 3-7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. TRIAL REGISTRATION ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. RESULTS There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. CONCLUSIONS Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.
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Affiliation(s)
- Alison Salloum
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Wei Wang
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - John Robst
- Department of Mental Health Law and Policy and Department of Economics, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Tanya K. Murphy
- Department of Pediatrics, College Of Medicine Pediatrics, University of South Florida, Tampa, FL, USA
| | - Michael S. Scheeringa
- Tulane University Health Sciences Centre, School of Medicine Department of Psychiatry and Neurology, Tulane University, New Orleans, LA, USA
| | - Judith A. Cohen
- Center for Traumatic Stress in Children and Adolescents, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Eric A. Storch
- Department of Pediatrics, College Of Medicine Pediatrics, University of South Florida, Tampa, FL, USA
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Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention. Curr Psychiatry Rep 2016; 18:5. [PMID: 26719308 DOI: 10.1007/s11920-015-0647-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.
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Salloum A, Swaidan VR, Torres AC, Murphy TK, Storch EA. Parents' Perception of Stepped Care and Standard Care Trauma-Focused Cognitive Behavioral Therapy for Young Children. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:262-274. [PMID: 26977133 PMCID: PMC4788389 DOI: 10.1007/s10826-015-0207-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Delivery systems other than in-office therapist-led treatments are needed to address treatment barriers such as accessibility, efficiency, costs, and parents wanting an active role in helping their child. To address these barriers, stepped care trauma focused-cognitive behavioral therapy (SC-TF-CBT) was developed as a parent-led, therapist-assisted therapy that occurs primarily at-home so that fewer in-office sessions are required. The current study examines caregivers' perceptions of parent-led (SC-TF-CBT) and therapist-led (TF-CBT) treatment. Participants consisted of 52 parents/care-givers (25-68 years) of young trauma-exposed children (3-7 years) who were randomly assigned to SC-TF-CBT (n = 34) or to TF-CBT (n = 18). Data were collected at mid-and post-treatment via interviews inquiring about what participants liked, disliked, found most helpful, and found least helpful about the treatment. Results indicated that parents/caregivers favored relaxation skills, affect modulation and expression skills, the trauma narrative, and parenting skills across both conditions. The majority of parents/caregivers in SC-TF-CBT favored the at-home parent-child meetings and the workbook that guides the parent-led treatment, and there were suggestions for improving the workbook. Reported disliked and least helpful aspects of treatments were minimal across conditions, but themes that emerged that will need further exploration included the content and structure, and implementation difficulties for both conditions. Collectively, these results highlight the positive impact that a parent-led, therapist-assisted treatment could have in terms of providing caregivers with more tools to help their child after trauma and reduce barriers to treatment.
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Affiliation(s)
- Alison Salloum
- School of Social Work, Department of Pediatrics, University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL 33612-3870, USA
| | - Victoria R. Swaidan
- School of Social Work, Department of Pediatrics, University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL 33612-3870, USA
| | | | - Tanya K. Murphy
- Departments of Pediatrics and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, USA
| | - Eric A. Storch
- Departments of Pediatrics and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Departments of Health Policy and Management and Psychology, University of South Florida, Tampa, FL, USA
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, USA
- Rogers Behavioral Health, Tampa, FL, USA
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Wamser-Nanney R, Scheeringa MS, Weems CF. Early Treatment Response in Children and Adolescents Receiving CBT for Trauma. J Pediatr Psychol 2016; 41:128-37. [PMID: 25362103 PMCID: PMC4710179 DOI: 10.1093/jpepsy/jsu096] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the incidence and correlates of early treatment response among youth receiving cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). METHODS 56 youth who participated in a randomized controlled trial of CBT for PTSD and D-cycloserine were included. Youth with PTSD symptoms below clinical cutoff after Session 4 of a 12-session protocol were classified as early treatment responders (32% of parent reports, 44.6% of child reports). Pretreatment characteristics were examined in relation to responder status. RESULTS Lower levels of pretreatment PTSD, depression, and anxiety symptoms and fewer trauma types were related to child- and parent-reported responder status (d = .57, d = .52, respectively). Early treatment response was maintained at follow-up. CONCLUSIONS Pretreatment symptoms levels and number of traumas may play an important role in predicting early treatment response. Correlates of early treatment response may provide avenues for identifying youth who could benefit from abbreviated protocols.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychiatry & Behavioral Sciences, Tulane University School of Medicine and
| | - Michael S Scheeringa
- Department of Psychiatry & Behavioral Sciences, Tulane University School of Medicine and
| | - Carl F Weems
- Department of Psychology, University of New Orleans
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Salloum A, Scheeringa MS, Cohen JA, Storch EA. Responder Status Criterion for Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children. CHILD & YOUTH CARE FORUM 2015; 44:59-78. [PMID: 25663796 PMCID: PMC4314718 DOI: 10.1007/s10566-014-9270-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In order to develop Stepped Care Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a definition of early response/non-response is needed to guide decisions about the need for subsequent treatment. OBJECTIVE The purpose of this article is to (1) establish criterion for defining an early indicator of response/nonresponse to the first step within Stepped Care TF-CBT, and (2) to explore the preliminary clinical utility of the early response/non-response criterion. METHOD Data from two studies were used: (1) treatment outcome data from a clinical trial in which 17 young children (ages 3 to 6 years) received therapist-directed CBT for children with PTSS were examined to empirically establish the number of posttraumatic stress symptoms to define early treatment response/non-response; and (2) three case examples with young children in Stepped Care TF-CBT were used to explore the utility of the treatment response criterion. RESULTS For defining the responder status criterion, an algorithm of either 3 or fewer PTSS on a clinician-rated measure or being below the clinical cutoff score on a parent-rated measure of childhood PTSS, and being rated as improved, much improved or free of symptoms functioned well for determining whether or not to step up to more intensive treatment. Case examples demonstrated how the criterion were used to guide subsequent treatment, and that responder status criterion after Step One may or may not be aligned with parent preference. CONCLUSION Although further investigation is needed, the responder status criterion for young children used after Step One of Stepped Care TF-CBT appears promising.
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Affiliation(s)
- Alison Salloum
- University of South Florida, School of Social Work, Department of Pediatrics, Associate Professor, University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL 33612-3870,
| | - Michael S Scheeringa
- Tulane University, Department of Psychiatry, Section of Child and Adolescent Psychiatry, 1440 Canal St., TB52, New Orleans, LA 70112
| | - Judith A Cohen
- Center for Traumatic Stress in Children and Adolescents, Allegheny General Hospital, Pittsburgh, PA,
| | - Eric A Storch
- University of South Florida, Departments of Pediatrics and Psychiatry, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701,
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Salloum A, Dorsey CS, Swaidan VR, Storch EA. Parents' and children's perception of parent-led Trauma-Focused Cognitive Behavioral Therapy. CHILD ABUSE & NEGLECT 2015; 40:12-23. [PMID: 25534316 DOI: 10.1016/j.chiabu.2014.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
This study explored parent and child experiences of a parent-led, therapist-assisted treatment during Step One of Stepped Care Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Seventeen parents/guardians and 16 children who were between the ages of 8 and 12 years were interviewed after Step One and six weeks after the completion of a maintenance phase about their perceptions of the parent-led, therapist-assisted treatment. Participants were asked what they liked and disliked about the treatment as well as what they found to be most and least helpful. Generally, parents and children liked the treatment and found it helpful. In terms of treatment components, children indicated that the relaxation exercises were the most liked/helpful component (62.5%) followed by trauma narrative activities (56.3%). A few children (18.8%) did not like or found least helpful the trauma narrative component as they wanted to avoid talking or thinking about the trauma. Parents indicated that the parent-child meetings were the most liked/helpful (82.4%) followed by the Stepping Together workbook (58.8%) and relaxation exercises (52.9%). Some parents (23.5%) noted that the workbook seemed too repetitive and some parents (17.6%) at times were uncertain if they were leading the parent-child meetings the best way. Parent-led, therapist-assisted TF-CBT may be an acceptable type of service delivery for both parents and children, although more research is needed.
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Affiliation(s)
| | | | | | - Eric A Storch
- University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children's Hospital, John Hopkins Medicine, St. Petersburg, FL, USA
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