Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
About This Program
Target Population: 3rd through 8th grade students who screened positive for exposure to a traumatic event and symptoms of posttraumatic stress disorder related to that event, largely focusing on community violence exposure; may be used with older students as well
For children/adolescents ages: 8 – 15
Program Overview
CBITS is a school-based, group and individual intervention designed to reduce symptoms of posttraumatic stress disorder (PTSD), depression, and behavioral problems among students exposed to traumatic life events, such as exposure to community and school violence, accidents, physical abuse, and domestic violence. It is designed for students, who have experienced a traumatic event and have current distress related to that event. The goals of the intervention are to reduce symptoms and behavior problems and improve functioning, improve peer and parent support, and enhance coping skills. The program includes 10 student group sessions, 1-3 student individual sessions, 2 parent sessions, and a teacher educational session. Developed for the school setting in close collaboration with school personnel, the program is well suited to the school environment.
Program Goals
The goals of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) are:
- Reduce symptoms related to trauma exposure
- Build skills and enhance resilience to stress
- Build peer and caregiver support
Logic Model
The program representative did not provide information about a Logic Model for Cognitive Behavioral Intervention for Trauma in Schools (CBITS).
Essential Components
The essential components of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) include:
- Techniques based on cognitive and behavioral theories of adjustment to traumatic events delivered in an individual or group (with 6-10 participants) format:
- Psycho-education
- Relaxation
- Social problem solving
- Cognitive restructuring
- Imaginal exposure
- Exposure to trauma reminders
- Development of a trauma narrative
Program Delivery
Child/Adolescent Services
Cognitive Behavioral Intervention for Trauma in Schools (CBITS) directly provides services to children/adolescents and addresses the following:
- Symptoms of post-traumatic stress disorder include re-experiencing the traumatic event (nightmares, flashbacks, recurrent thoughts), avoidance of trauma reminders (places, things, or memories of the trauma), heightened arousal (irritability, sleep problems, hypervigilence), and numbing of emotions
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: The program includes extensive outreach to parents as well as 2 parent sessions to keep them informed about what is happening in the groups as well as to teach them some of the same skills as the child is learning.
Recommended Intensity:
Weekly 45-minute sessions in group format, plus 1-3 individual 30-minute sessions throughout treatment
Recommended Duration:
10 weeks
Delivery Setting
This program is typically conducted in a(n):
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Homework
Cognitive Behavioral Intervention for Trauma in Schools (CBITS) includes a homework component:
The program uses activities to be practiced between sessions. Worksheets and handouts included with the manual.
Languages
Cognitive Behavioral Intervention for Trauma in Schools (CBITS) has materials available in a language other than English:
Spanish
For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
- Whiteboard, blackboard, or flipchart with markers
- Private meeting room
- Some specific materials required for sessions as detailed in the manual
Manuals and Training
Prerequisite/Minimum Provider Qualifications
A Master's or doctorate degree in a clinical field
Manual Information
There is a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- Pamela Vona
pamela@safeandresilient.org
Training Type/Location:
Extensive training and implementation materials are available to subscribers at https://traumaawareschools.org/index.php/learn-more-cbits/. Usually training is on-site. Some regional trainings are offered.
Number of days/hours:
2-day training, sometimes with ongoing consultation afterward
Implementation Information
Pre-Implementation Materials
There are pre-implementation materials to measure organizational or provider readiness for Cognitive Behavioral Intervention for Trauma in Schools (CBITS) as listed below:
There is a readiness measure publicly available for download off of the website. They are available to subscribers at https://traumaawareschools.org/index.php/learn-more-cbits/.
Formal Support for Implementation
There is formal support available for implementation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) as listed below:
CBITS has a Trauma Services Adaptation Center for Schools funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) that supports implementation, as well as a website that provides an online training course, ask-an-expert function, collaborative workspace, and many implementation tools.
Fidelity Measures
There are fidelity measures for Cognitive Behavioral Intervention for Trauma in Schools (CBITS) as listed below:
Fidelity measures are provided on the website as well, including those used in research studies and some used to monitor quality on an ongoing basis in the field. They are available to subscribers at https://traumaawareschools.org/index.php/learn-more-cbits/.
Implementation Guides or Manuals
There are implementation guides or manuals for Cognitive Behavioral Intervention for Trauma in Schools (CBITS) as listed below:
There is a detailed manual with scripts and handouts available. Available in English, Spanish, and Arabic at: https://www.rand.org/pubs/tools/TL272.html. Adaptation for Amerian Indian Youth at: https://www.rand.org/pubs/tools/TLA1134-1.html
Research on How to Implement the Program
Research has not been conducted on how to implement Cognitive Behavioral Intervention for Trauma in Schools (CBITS).
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. Journal of the American Medical Association, 290(5), 603–611. https://doi.org/10.1001/jama.290.5.603
Type of Study:
Randomized controlled trial
Number of Participants:
126
Population:
- Age — 10–12 years
- Race/Ethnicity — Not specified
- Gender — 56% Female and 44% Male
- Status — Participants were sixth-grade students with exposure to violence and clinical levels of posttraumatic stress disorder (PTSD) symptoms.
Location/Institution: 2 large East Los Angeles middle schools
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children’s symptoms of PTSD and depression resulting from exposure to violence. Participants were randomly assigned to a 10-session standardized early intervention group, the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS), or to a wait list delayed intervention comparison group. Students and teachers completed questionnaires at baseline, 3 months, and 6 months. Measures utilized include the Child PTSD Symptom Scale (CPSS), Children’s Depression Inventory (CDI), Pediatric Symptom Checklist (PSC), and the Teacher-Child Rating Scale (TCRS). All children eventually participated in the intervention at some point during the academic year. Results indicate that at 3 months students assigned to the intervention had significantly lower scores of PTSD, depression, and psychosocial dysfunction than the children in the wait list group; but no significant differences were detected for teacher-reported classroom problems in acting out, shyness/anxiousness, or learning. Results at 6 months, when both groups had received the intervention, indicated no significant differences between groups. Limitations included possible symptom detection and definition discrepancies among teachers, and lack of blinding to condition.
Length of controlled postintervention follow-up: Approximately 14 weeks for the early intervention group. None for delayed intervention control group.
Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., Scott, M., & Schonlau, M. (2010). Children's mental health care following Hurricane Katrina: A field trial of trauma–focused psychotherapies. Journal of Traumatic Stress, 23(2), 223–231. https://doi.org/10.1002/jts.20518
Type of Study:
Randomized controlled trial
Number of Participants:
118
Population:
- Age — Range=9–15.5 years
- Race/Ethnicity — 52% African American, 42% Caucasian, 4% Hispanic, and 2% Other
- Gender — 63% Female and 37% Male
- Status — Participants were children in three schools with elevated posttraumatic stress disorder (PTSD) symptoms assessed 15 months following Hurricane Katrina.
Location/Institution: Three New Orleans schools and Mercy Family Center's Metairie, Louisiana clinic
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on New Orleans school children who participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Participants were randomized into one of two trauma-specific interventions: Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) and Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). Measures utilized include the Disaster Experiences Questionnaire, UCLA PTSD Reaction Index, Child PTSD Symptom Scale (CPSS), Children’s Depression Inventory (CDI), Social Support Scale for Children (SSSC), Strengths and Difficulties Questionnaire (SDQ), and the PTSD section of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-PTSD). Results indicate that at baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Results indicate that both treatments led to significant reduction of PTSD symptoms, but many still had elevated PTSD symptoms at post-treatment. Limitations include smaller field trial and limited ability to utilize complex regression methods, and the analysis had to shift from the original aims of examining predictors of intervention response to predictors of uptake of the therapy for TF-CBT.
Length of controlled postintervention follow-up: 4–5 months for CBITS groups; 1 month for TF-CBT groups.
Additional References
Feldman, E. (2007). Implementation of the cognitive behavioral intervention for trauma in schools (CBITS) with Spanish-speaking, immigrant middle-school students: Is effective, culturally competent treatment possible within a public school setting? Dissertation Abstracts International Section A, 68, 1325.
Schultz, D., Barnes-Proby, D., Chandra, A., Jaycox, L. H., Maher, E., & Pecora, P. (2010). Toolkit for adapting Cognitive Behavioral Intervention for Trauma in Schools (CBITS) or Supporting Students Exposed to Trauma (SSET) for implementation with youth in foster care. TR722. RAND Corporation. http://www.rand.org/pubs/technical_reports/TR772/
Stein, B. D., Elliott, M. N., Tu, W., Jaycox, L. H., Kataoka, S. H., Wong, M., & Fink, A. (2003). School-based intervention for children exposed to violence: Reply. Journal of the American Medical Association, 290(19), 2542–2543. https://doi.org/10.1001/jama.290.19.2542-a
Contact Information
- Lisa Jaycox, PhD
- Agency/Affiliation: RAND Corporation
- Website: traumaawareschools.org/index.php/learn-more-cbits
- Email: jaycox@rand.org
- Phone: (703) 413-1100 x5118
Date Research Evidence Last Reviewed by CEBC: September 2022
Date Program Content Last Reviewed by Program Staff: December 2017
Date Program Originally Loaded onto CEBC: April 2011
