Parent-Led, Therapist-Assisted, First-Line Treatment for Young Children After Trauma: A Case Study

School of Social Work, University of South Florida, Tampa, USA.
Child Maltreatment (Impact Factor: 2.77). 08/2011; 16(3):227-32. DOI: 10.1177/1077559511415099
Source: PubMed


Due to the prevalence of childhood posttraumatic stress disorder and barriers to treatment, novel service delivery approaches such as parent-led, therapist-assisted, trauma-focused cognitive behavioral therapy (PTA-TF-CBT) within a stepped care model are needed. This case study presents the treatment of a 4-year-old boy with posttraumatic stress symptoms whose parent led the treatment with therapist assistance and empirically supported materials. Findings from this case study indicated that: (a) PTA-TF-CBT was an acceptable and satisfactory treatment to the parent, (b) therapist time delivering the treatment was limited thereby conserving resources, and (c) clinically significant improvements in child and parent distress were reported posttreatment and at 5 weeks follow-up. Additional research on the feasibility and efficacy of PTA-TF-CBT within a stepped care model is warranted.

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    ABSTRACT: Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.
    No preview · Article · Jan 2013 · Cognitive and Behavioral Practice
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    ABSTRACT: This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3-6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy.
    No preview · Article · Apr 2013 · Child Psychiatry and Human Development
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    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. Copyright © 2014 Elsevier Ltd. All rights reserved.
    No preview · Article · Dec 2014 · Child Abuse & Neglect
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