TF-CBT for Adjudicated Youth in Residential Treatment

Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute)210 enrolled

Overview

Adjudicated youth often have traumatic stress responses but rarely receive treatment for these problems. This study is a randomized controlled trial to evaluate two alternative implementation strategies for providing an evidence-based trauma treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), to therapist who treat adjudicated youth in 18 residential treatment facilities (RTF) in New Hampshire, Vermont, and Connecticut: 1) web-based TF-CBT implementation strategy ("W"), consisting on only web-based training and consultation; versus 2) W plus live TF-CBT implementation strategy, consisting of W plus face-to face training and phone consultation with TF-CBT experts ("W+L").

Therapists in each of 18 participating RTFprograms that serve adjudicated youth are randomized to receive either: 1. W TF-CBT implementation strategy, provided via the free distance learning resources TF-CBTWeb, (www.musc/edu/tfcbt) and TF-CBTConsult (www.musc.edu/tfcbtconsult); or 2. W+L implementation strategy, provided through W + 2 day TF-CBT training plus one year of twice monthly TF-CBT consultation calls with a TF-CBT expert trainer. All RTF staff receive one day training in trauma-informed care. All therapists in both conditions receive training in screening youth for trauma exposure and symptoms. Data are collected regarding primary outcomes of: 1) number of youth therapists in each condition screen for trauma symptoms, 2) number of youth consent to TF-CBT treatment; 3) number of youth complete TF-CBT, 4) TF-CBT fidelity during treatment. Secondary outcomes include 1)changes in therapist knowledge and satisfaction regarding TF-CBT treatment and 2) youth outcomes including PTSD symptoms, depression and satisfaction with treatment.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

DOUBLE

Enrollment

210

Conditions

Eligibility

Sex: ALLMin age: 13 YearsMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: Consenting mental health therapists in participating residential treatment facilities (RTF)in New Hampshire, Vermont and Connecticut; and the adjudicated youth ages 12-17 years old who are residents in these RTF programs being treated by the participating therapists who 1) are screened positive for having at least one past trauma experience with UCLA PTSD Reaction Index score of \>22; 2) assent with legal guardian consent to participate in the project; and 3) are anticipated to remain in the RTF program at least 3 months (long enough to receive TF-CBT treatment). \- Exclusion Criteria: Guardian or youth refuses;youth does not endorse trauma exposure or symptoms; youth is being discharged too soon to participate; Therapist may use clinical judgment to exclude youth from study based on clinical presentation. \-

Outcomes

Primary Outcomes

Number of youth screened for trauma exposure and PTSD symptoms

Number of youth screened for trauma exposure and PTSD symptoms using the UCLA PTSD Reaction Index (online version)in W vs. W+L implementation condition

Time frame: Day 1

Number of youth starting TF-CBT

Number of youth who begin TF-CBT treatment in W vs W+L implementation condition

Time frame: Day 60

Number of youth completing TF-CBT in each condition

Number of youth completing TF-CBT in W vs W+L conditions

Time frame: Day 240 (6 months post start of treatment)

Fidelity of TF-CBT implementation

Therapist fidelity implementing TF-CBT across and between implementation conditions using TF-CBT Fidelity Checklist (online version)

Time frame: Day 240

Secondary Outcomes

Therapy Procedures Checklist

Therapist comfort with cognitive therapy practices (or change in this during the study) as a predictor of other outcomes between the W vs. W+L group

Time frame: Day 1; Day 900 (30 monhts later)

Attitudes toward Computer Usage Scale

Attitudes toward computer usage as a potential covariate of outcomes

Time frame: Day 1; Day 900

TF-CBTWeb Knowledge Test

Change in knowledge related to TF-CBT as a moderator of outcomes

Time frame: Day 1, Day 900

Youth UCLA PTSD Reaction Index

Change in youth PTSD scores across and between implementation conditions to be examined as a secondary outcome

Time frame: Day 1; Day 240 (post treatment_

Mood and Feelings Questionnaire-Short Version

Change in youth depression scores in youth across and between implementation conditions

Time frame: Day 1; Day 240 (post treatment)

Youth Satisfaction Survey

Youth satisfaction with therapy across and between implementation conditions

Time frame: Day 240 (post treatment)