Judith A Cohen

Drexel University, Filadelfia, Pennsylvania, United States

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Publications (113)341.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists (N = 129) treating adjudicated youth were randomized by RTF program (N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire-Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening (p = .0005), completing treatment (p = .03), and completing TF-CBT with fidelity (p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD (p = .001) and depressive (p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.
    No preview · Article · Jan 2016 · Child Maltreatment
  • Judith A. Cohen · Anthony P. Mannarino · Kelly Kinnish
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    ABSTRACT: Commercially sexually exploited children and adolescents (“commercially exploited youth”)present numerous clinical challenges that have led some mental health providers to question whether current evidence-based treatments are adequate to address the needs of this population. This paper 1) addresses commonalities between the trauma experiences, responses and treatment challenges of commercially exploited youth and those of youth with complex trauma; 2) highlights the importance of careful assessment to guide case conceptualization and treatment planning for commercially exploited youth; and 3) describes strategies for implementing Trauma-Focused Cognitive Behavioral Therapy for complex trauma specific to these youth.
    No preview · Article · Dec 2015 · Journal of Child & Adolescent Trauma
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    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).MethodsA 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.ResultsThere 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.
    No preview · Article · Oct 2015 · Journal of Child Psychology and Psychiatry
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    ABSTRACT: Objective: This study explored the feasibility of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) relative to TF-CBT with children (aged 8–12).
    No preview · Article · Sep 2015 · Research on Social Work Practice
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    Tonje Holt · Judith A Cohen · Anthony Mannarino
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    ABSTRACT: Although many children experience violence and abuse each year, there is a lack of instruments measuring parents' emotional reactions to these events. One instrument, the Parent Emotional Reaction Questionnaire (PERQ), allows researchers and clinicians to survey a broad spectrum of parents' feelings directly related to their children's traumatic experiences. The objectives of this study were: (1) to examine the factor structure and the internal consistency of the PERQ; (2) to evaluate the discriminant validity of the instrument; and (3) to measure whether potential subscales are sensitive to change. A Norwegian sample of 120 primary caregivers of a clinical sample of 120 traumatized children and youths (M age=14.7, SD=2.2; 79.8% girls) were asked to report their emotional reactions to their child's self-reported worst trauma. Exploratory factor analysis was used to explore the underlying factor structure of the data. The analysis of the PERQ showed a three-factor structure, conceptualized as PERQdistress, PERQshame, and PERQguilt. The internal consistencies of all three subscales were satisfactory. The correlations between the PERQ subscales and two other parental measurements revealed small to moderate effect sizes, supporting the discriminant validity of the PERQ subscales. The differences in sum scores of the PERQ subscales before and after a therapeutic intervention suggest that all of the subscales were sensitive to change. Study findings support the validity of conceptualizing the PERQ as three separate subscales that capture clinically meaningful features of parents' feelings after their children have experienced trauma. However, the subscales need to be further evaluated using a larger sample size and a confirmatory factor analytic approach.
    Preview · Article · Sep 2015 · European Journal of Psychotraumatology
  • Judith A. Cohen · Anthony P. Mannarino
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    ABSTRACT: Trauma-focused cognitive behavioral therapy (TF-CBT) is a family-focused treatment in which parents or caregivers participate equally with their traumatized child or adolescent. TF-CBT is a components-based and phase-based treatment that emphasizes proportionality and incorporates gradual exposure into each component. Child and parent receive all TF-CBT components in parallel individual sessions that enhance skills to help the child recognize and regulate trauma responses, express thoughts and feelings about the child's trauma experiences and master avoidance of trauma memories and reminders. Parental participation significantly enhances the beneficial impact of TF-CBT for traumatized children. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Child and Adolescent Psychiatric Clinics of North America
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    ABSTRACT: Purpose: The aim of the current study is to test the validity and reliability of the Shame Questionnaire among traumatized girls in Lusaka, Zambia. Methods: The Shame Questionnaire was validated through both classical test and item response theory methods. Internal reliability, criterion validity and construct validity were examined among a sample of 325 female children living in Zambia. Sub-analyses were conducted to examine differences in construct validity among girls who reported sexual abuse and girls who did not. Results: All girls in the sample were sexually abused, but only 61.5% endorsed or reported that sexual abuse had occurred. Internal consistency was very good among the sample with alpha = .87. Criterion validity was demonstrated through a significant difference of mean Shame Questionnaire scores between girls who experienced 0-1 trauma events and more than one traumatic event, with higher mean Shame Questionnaire scores among girls who had more than one traumatic event (p = .004 for 0-1 compared to 2 and 3 events and p = .016 for 0-1 compared to 4+ events). Girls who reported a history of witnessing or experiencing physical abuse had a significantly higher mean Shame Questionnaire score than girls who did not report a history of witnessing or experiencing physical abuse (p<.0001). There was no significant difference in mean Shame Questionnaire score between girls who reported a sexual abuse history and girls who did not. Exploratory factor analysis indicated a two-factor model of the Shame Questionnaire, with an experience of shame dimension and an active outcomes of shame dimension. Item response theory analysis indicated adequate overall item fit. Results also indicate potential differences in construct validity between girls who did and did not endorse sexual abuse. Conclusions: This study suggests the general utility of the Shame Questionnaire among Zambian girls and demonstrates the need for more psychometric studies in low and middle income countries.
    Full-text · Article · Apr 2015 · PLoS ONE
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    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/non-response 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 3–6 years) received therapist-directed CBT for children with posttraumatic stress symptoms (PTSS) were examined to empirically establish the number of PTSS 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 three 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.
    No preview · Article · Feb 2015 · Child and Youth Care Forum
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    ABSTRACT: To better understand how parents react to their child's trauma exposure and evaluate whether different reactions are related to different types of traumas, 120 parents (79.2% mothers, 18.3% fathers, 2.5% other caregivers) were asked about their emotional reactions related to their child's self-reported worst trauma. Emotional reactions were assessed with the Parental Emotional Reactions Questionnaire (PERQ). Parents reported high levels of distress and guilt. Furthermore, there was a significant relationship between type of trauma and parents' overall emotional reactions. Parental distress was equally endorsed among the different trauma groups. Parents of children who experienced intrafamilial violence and extrafamilial sexual abuse reported the highest levels of guilt, and child exposure to intrafamilial violence was associated with higher levels of parental shame.
    Preview · Article · Dec 2014 · Journal of Aggression Maltreatment & Trauma
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    ABSTRACT: This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic stress and their guardians who participated in this open trial. The TF-CBT for Child Traumatic Grief protocol was adapted for use with a group, resulting in 12 weekly sessions for children and guardians separately with conjoint activities and 3 individual visits with child and guardian. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary child outcomes assessed were symptoms of grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pretreatment, posttreatment, and 3 and 12 months after the end of treatment. Results showed improved scores on all outcomes posttreatment, sustained at 3 and 12 months. Effect sizes (Cohen's d) for baseline to posttreatment were 1.36 for child reported grief symptoms, 1.87 for child-reported PTS, and 1.15 for guardian report of child PTS.
    No preview · Article · Dec 2014 · Journal of Traumatic Stress
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    ABSTRACT: This article describes the National Children's Disaster Mental Health Concept of Operations ("CONOPS") model as a method to address discrepancies between research advances that have been made and the typical methods of providing mental health services to children after disasters. Three key CONOPS strategies are described: (1) the PsySTART Disaster Mental Health Triage System, (2) a child-focused Incident Action Plan (IAP), and (3) a continuum of risk stepped-care model that matches the level of evidence-based treatment interventions with the level of identified risk using a stepped-care framework. Together, these strategies provide an integrated "disaster systems of care" method for the needs of children. With the goal to strengthen the resilience of children, the CONOPS provides clear operational strategies to facilitate mental health care addressing the full continuum of risk and resilience in the child population. Adapting this tool to health care systems is a vital step to improving mental health services and resilience outcomes for children after a disaster.
    No preview · Article · Nov 2014 · Clinical Pediatric Emergency Medicine
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    ABSTRACT: The purpose of this study was to examine prevalence, correlates and predictors of mental health in children in New Orleans 15 months post-Hurricane Katrina. Analyses were conducted on 195 children who completed self-reports of hurricane and lifetime trauma exposure, social support, post-traumatic stress disorder (PTSD) symptoms, and depression. Teachers completed the Strengths and Difficulties Questionnaire. Children reported high incidence of PTSD symptoms: 36.9% moderate to severe and 23.6% mild. In multiple regression analyses, gender, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted PTSD. Age, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted child depressive symptoms. Teachers reported lower levels of problems and no significant predictors of teacher reports other than age and school. PTSD and depression were significant problems for children 15 months post-Hurricane Katrina. Lifetime trauma exposure was the strongest predictor of both PTSD and depression. Effective and accessible treatment is needed for such children.
    No preview · Article · Sep 2014 · Journal of Child & Adolescent Trauma
  • Stephen J Cozza · Judith A Cohen · Joseph G Dougherty

    No preview · Article · Apr 2014 · Child and adolescent psychiatric clinics of North America
  • Laura K Murray · Amanda Nguyen · Judith A Cohen
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    ABSTRACT: This article begins by defining sexual abuse, and reviews the literature on the epidemiology of child sexual abuse (CSA). Clinical outcomes of CSA are described, including health and mental health. An outline is given of all the services often involved after an incident of CSA, and the need for coordination among them. Treatment strategies and evidence-based recommendations are reviewed. Challenges around dissemination and implementation, cultural considerations, and familial dynamics are described. Possible future directions are discussed.
    No preview · Article · Apr 2014 · Child and adolescent psychiatric clinics of North America

  • No preview · Article · Feb 2014 · Journal of child and adolescent psychopharmacology
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    ABSTRACT: This study examined Zambian counselors, children, and caregivers' perceptions of an evidence-based treatment (EBT) for trauma (Trauma-Focused Cognitive Behavioral Therapy [TF-CBT]) utilized in Zambia to address mental health problems in children. Semistructured interviews were conducted with local counselors trained in TF-CBT (N = 19; 90% of those trained; 12 female) and children/caregivers who had received TF-CBT in a small feasibility study (N = 18; 86% of the children and N = 16; 76% of the caregivers) who completed TF-CBT (total completed; N = 21). Each client was asked six open-ended questions, and domain analysis was used to explore the data. Counselors were positive about the program, liked the structure and flexibility, reported positive changes in their clients, and discussed the cultural adaptation around activities and language. Counselors stated the training was too short, and the supervision was necessary. Challenges included client engagement and attendance, availability of location, funding, and a lack of community understanding of "therapy." Children and caregivers stated multiple positive changes they attributed to TF-CBT, such as better family communication, reduction of problem behaviors, and ability to speak about the trauma. They recommended continuing the program. This study brings a critical examination of providers' and clients' perspectives of the implementation of an EBT for children in a low-resource setting. Clinical implications include changing implementation methods based on responses. Research implications include future study directions such as an effectiveness trial of TF-CBT and an examination of implementation factors.
    No preview · Article · Jan 2014 · Journal of Clinical Child & Adolescent Psychology
  • Judith A Cohen · Jeanette Scheid · Ruth Gerson

    No preview · Article · Jan 2014 · Journal of the American Academy of Child and Adolescent Psychiatry
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    ABSTRACT: The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
    Full-text · Article · Oct 2013 · International Journal of Mental Health Systems
  • Rachel Z Ritvo · Judith A Cohen

    No preview · Article · Sep 2013 · Journal of the American Academy of Child and Adolescent Psychiatry
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    ABSTRACT: This study examined perceived challenges to implementation of an empirically supported mental health treatment for youth (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) and explored the potential use of technology-based resources in treatment delivery. Thematic interviews were conducted with 19 approved national TF-CBT trainers to assess their perspectives about challenges to implementation of TF-CBT and to explore their perceptions about the potential value of innovative, technology-based solutions to enhance provider fidelity and improve quality of care. These data offer some important insights and implications for training in evidence-based treatments, provider fidelity and competence, and patient engagement, particularly for those interventions targeting trauma-related symptoms among youth.
    No preview · Article · Apr 2013 · Administration and Policy in Mental Health and Mental Health Services Research

Publication Stats

5k Citations
341.74 Total Impact Points

Institutions

  • 2005-2015
    • Drexel University
      • Department of Psychiatry
      Filadelfia, Pennsylvania, United States
  • 1996-2015
    • Allegheny General Hospital
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 2006-2014
    • Drexel University College of Medicine
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
  • 2013
    • Temple University
      Filadelfia, Pennsylvania, United States
  • 2012
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1998
    • Allegheny University
      Pittsburgh, Pennsylvania, United States
  • 1986-1994
    • University of Pittsburgh
      • • School of Social Work
      • • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States