Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)
About This Program
Target Population: Children (3-12) experiencing posttraumatic stress symptoms and their caregivers
For children/adolescents ages: 3 – 12
For parents/caregivers of children ages: 3 – 12
Program Overview
The primary objective of Stepped Care CBT for Children after Trauma (SC-CBT-CT) [formerly called, Stepped Care TF-CBT] is to decrease posttraumatic stress symptoms in children. SC-CBT-CT aims to improve the accessibility, efficiency, and cost of delivering treatment to children after trauma. SC-CBT-CT consists of two steps: Step One, Stepping Together for Children after Trauma (Stepping Together-CT) includes brief cognitive-behavioral therapy (CBT) (3 therapist–parent–child sessions over 6 weeks) and 11 parent–child meetings that take place in the home without the therapist, where the parent works with the child using a parent-child activity book. Step Two, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), provides therapist-led TF-CBT as a “step up” for children needing more intensive care.
Program Goals
The goals of Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) are:
For children:
- Improve posttraumatic stress symptoms
- Improve functioning
For parents:
- Improve parent depression
- Improve parent posttraumatic stress
- Improve parenting stress
- Improve parent-child communication
Logic Model
The program representative did not provide information about a Logic Model for Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT).
Essential Components
The essential components of Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) include:
- Step One: Stepping Together for Children after Trauma (Stepping Together-CT) which includes:
- Three primary therapy sessions with the therapist, parent, and child are provided:
- Session 1 main tasks are to:
- Review with the parent the assessment information
- Provide psychoeducation to parent and child
- Teach a deep breathing exercise to parent and child
- Help the parent and child prepare to work together in the activity book
- Session 2 main tasks are to:
- Review the parent-child activity book
- Explore with the child feelings of guilt and blame
- Provide a rationale for trauma-focused activities
- Set up the Next Steps activities (which consist mainly of in vivo activities)
- Session 3 main tasks are to:
- Review the parent-child activity book
- Plan additional Next Step activities
- Provide supportive counseling to the parent regarding feelings and concerns about the impact of the child’s trauma
- Two additional flexible therapy sessions may be provided as needed to address specific concerns such as:
- Safety
- Problematic behaviors
- Severe anxiety
- The parent-child activity book based on Preschool PTSD Treatment which incorporates existing knowledge of the use of CBT for posttraumatic stress
- Two versions based on age:
- Salloum, A., Scheeringa, M. S., Cohen, J. A., & Amaya-Jackson, L. (2009). Stepping Together: Parent-child workbook for children (ages 3 to 7) after trauma. [Unpublished book].
- Salloum, A., Scheeringa, M. S., Cohen J. A., & Amaya-Jackson, L. (2011). Stepping Together: Parent-child workbook for children (ages 8 to 12) after trauma. [Unpublished book].
- The activity books both include the following addressed in the age-appropriate ways:
- Psychoeducation
- Parenting
- Relaxation
- Feelings
- Trauma narrative of what happened
- Rating of moments of what happened in terms of reminders that are not too distressing to reminders or moments of the trauma that are the worst
- Trauma exposure including drawing moments of the trauma, imaginal exposure and in vivo activities called Next Steps
- Safety planning
- Relapse prevention
- Grief related activities (used only if needed)
- A celebration of the work the parent and child completed together
- Provision of website link for psychoeducation to the National Child Traumatic Stress Network (https://www.nctsn.org) where caregivers may find information on different types of trauma and additional information that may be relevant to their child
- Weekly therapist phone support with the caregivers for 10 to 15 minutes to check in about the parent-child meetings and problem-solve any concerns
- Website demonstration of three therapeutic techniques:
- Relaxation
- Draw, Imagine it (i.e., imaginal exposure)
- Next Step (e.g., in vivo activity)
- Responder status criteria and use of monitoring tools:
- Track progress
- Indicate if the child needs to move to the maintenance phase of Stepping Together-CT or step up to TF-CBT
- Stepping Together-CT Maintenance Phase for children who meet the responder status criteria to move into the maintenance phase:
- Lasts for 6 weeks
- 11 structured parent–child meetings without the therapist
- The purpose of these meetings is for the parent and child to:
- Use the parent-child activity book to practice skills they learned in Stepping Together-CT such as:
- Praising positive behavior
- Implementing a behavior plan, if needed
- Practicing relaxation strategies
- Identifying and communicating feelings
- Have shared relaxing and/or fun activities to foster open communication and to strengthen their relationship
- Step Two: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is provided for children who do not meet responder status criteria and need more intensive treatment. This may be provided by either the therapist who provided Step One or another trained TF-CBT provider. For a description and research summaries on TF-CBT, check out the program’s page on this website: https://www.cebc4cw.org/program/trauma-focused-cognitive-behavioral-therapy/
Program Delivery
Child/Adolescent Services
Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) directly provides services to children/adolescents and addresses the following:
- Posttraumatic stress symptoms, functional impairment, sleep disturbances, anger problems, internalizing problems, and externalizing problems
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: If there are other caregivers involved, the other caregivers are provided with psychoeducation materials.
Parent/Caregiver Services
Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) directly provides services to parents/caregivers and addresses the following:
- Parents of children with posttraumatic stress symptom problems; parent depression, parent posttraumatic stress, parenting stress
Recommended Intensity:
Therapist-involved sessions consist of Step One, Stepping Together–CT, which includes three 60- to 90-minute sessions every other week plus two additional 60-minute sessions, if/as needed and, if child qualifies, Step Two, TF-CBT, which includes 9 to 12 weekly 60- to 90-minute sessions. If the child does not qualify for Step Two, then parent-led meetings include another 11 meetings conducted approximately twice a week.
Recommended Duration:
Stepping Together–CT (Step One) is 1.5 to 2 months. TF-CBT (Step Two, if needed) is 3 to 4 months Stepped Together-CT Maintenance Phase (done if TF-CBT not pursued) is 6 weeks.
Delivery Settings
This program is typically conducted in a(n):
- Outpatient Clinic
- Community-based Agency / Organization / Provider
- Virtual (Online, Telephone, Video, Zoom, etc.)
Homework
Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) includes a homework component:
The Stepping Togerther-CT parent–child activity book is a step-by-step guide that helps parents conduct 11 meetings with their child at home, without the therapist. The book includes activities that are trauma-focused and grief-focused, which are to be used if the trauma involves loss. The therapist provides assistance to the parent about how to implement the activities. The maintenance phase of Stepping Together-CT consists of the parents continuing some of the activities at home after the initial 3 therapist sessions.
Languages
Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) has materials available in a language other than English:
Norwegian
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:
Resources for copying the parent-child activity book worksheets and a private space/room
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Mental health–related degree with at least a Master’s level education
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual information:
- Salloum, A. (2023). Stepping Together for children after trauma: Therapist manaual. [Unpublished book].
Contact Training Contact below for more information.
Training Information
There is training available for this program.
Training Contact:
- Alison Salloum
asalloum@usf.edu
phone: (813) 974-1535
Training Type/Location:
Training may be provided virtually or onsite at the trainee’s organization.
Number of days/hours:
Onsite training:
- Providers receive 2 days of training (7 hours each day) plus 12 consultation calls on providing Stepping Together–CT with at least two cases. Providers will also need to be trained in Step Two (TF-CBT).
Virtual training:
- Days and duration may vary. For example, two 7-hour trainings may be broken up into a four half-day trainings.
Implementation Information
Pre-Implementation Materials
There are no pre-implementation materials to measure organizational or provider readiness for Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT).
Formal Support for Implementation
There is no formal support available for implementation of Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT).
Fidelity Measures
There are fidelity measures for Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) as listed below:
There are three fidelity measures utilized after each therapy session and phone call:
- The clinician measure provides a checklist for the three sessions and 6 phone calls for the therapist to indicate if the essential topic was addressed.
- The clinician completes a parent fidelity measure to indicate what essential topics the parent completed with the child. The clinician and parent also both rate the amount of effort the parent contributed toward completing the parent-child meetings.
- The clinician completes a child fidelity measure to indicate what activities the child completed.
Implementation Guides or Manuals
There are no implementation guides or manuals for Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT).
Implementation Cost
There have been studies of the costs of implementing Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) which are listed below:
Salloum, A., Lu, Y., Chen, H., Quast, T., Cohen, J. A., Scheeringa, M. S., Salomon, K., & Storch, E. A. (2022). Stepped care versus standard care for children after trauma: A randomized non-inferiority clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 61(8), 1010–1022. https://doi.org/10.1016/j.jaac.2021.12.013
Salloum, A., Robst, J., Scheeringa, M. S., Cohen, J. A., Wang, W., Murphy, T. K., Tolin, D. F., & Storch, E. A. (2014). Step one within stepped care trauma-focused cognitive behavioral therapy for young children: A pilot study. Child Psychiatry & Human Development, 45(1), 65–77. https://doi.org/10.1007/s10578-013-0378-6
Salloum, A., Small, B. J., Robst, J., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2017). Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice, 27(6), 653–663. https://doi.org/10.1177/1049731515601898
Salloum, A., Wang, W., Robst, J., Murphy, T. K., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2016). Stepped care versus standard trauma-focused cognitive behavioral therapy for young children. Journal of Child Psychology and Psychiatry, 57(5), 614–622. https://doi.org/10.1111/jcpp.12471
Research on How to Implement the Program
Research has not been conducted on how to implement Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT).
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Salloum, A., Dorsey, C. S., Swaidan, V. R., & Storch, E. A. (2015). Parents' and children's perception of parent-led Trauma-Focused Cognitive Behavioral Therapy. Child Abuse & Neglect, 40(2), 12–23. https://doi.org/10.1016/j.chiabu.2014.11.018
Type of Study:
Randomized controlled trial
Number of Participants:
17
Population:
- Age — Children: 8–12 years; Adults: Not specified
- Race/Ethnicity — Children and Adults: 65% White and 35% African American
- Gender — Children: 53% Female; Adults: Not specified
- Status — Participants were children with posttraumatic stress disorder (PTSD) and their caregivers.
Location/Institution: Community mental health nonprofit agency in an urban area
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to explore parent and child experiences of a parent-led, therapist-assisted treatment in a subset of a population that received Stepped-Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)]. Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-IV) Child/Parent Version, the UCLA PTSD Index for DSM-IV (UCLA-PTSD-Index), the Child Behavior Checklist (CBCL), and the Clinical Global Impression-Improvement (CGI-Improvement). Results indicate that for children 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. Limitations include small sample size, lack of control group, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Salloum, A., Swaidan, V. R., Torres, A. C. Murphy, T. K., & Storch, E. A. (2016). Parents' perception of Stepped Care and standard care Trauma-Focused Cognitive Behavioral Therapy for young children. Journal of Child and Family Studies, 25(1), 262–274. https://doi.org/10.1007/s10826-015-0207-6
Type of Study:
Randomized controlled trial
Number of Participants:
52
Population:
- Age — Children: 3–7 years (Mean=7.17 years); Adults: 25–68 years (Mean=33.8 years)
- Race/Ethnicity — Children and Adults: 64% White, 27% African American, 8% Mixed, and 2% American Indian/Alaskan Native
- Gender — Children: 52% Male and 48% Female; Adults: Not specified
- Status — Participants were parents of children with posttraumatic stress disorder (PTSD).
Location/Institution: Community-based setting in a large metropolitan city in the United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine caregivers’ perceptions of parent-led Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)] and therapist-led Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) treatment. Participants were randomly assigned to SC-TF-CBT or to TF-CBT. Measures utilized include the Diagnostic Infant and Preschool Assessment (DIPA), the Trauma Symptom Checklist for Young Children (TSCYC), and the Clinical Global Impression-Improvement Scale. Results indicate that parents/caregivers favored relaxation skills, the trauma narrative, parenting skills, and affect modulation and expression skills across both conditions. The majority of parents/caregivers in SC-TF-CBT that completed both the parent-led and therapist-led parts favored the at-home parent-child meetings and the workbook that guides the Step 1 parent-led treatment over the Step 2 weekly therapist-led treatment, and there were suggestions for improving the workbook. Limitations include small sample size and lack of follow-up.
Length of controlled postintervention follow-up: None.
Salloum, A., Wang, W., Robst, J., Murphy, T. K., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2016). Stepped Care versus standard Trauma-Focused Cognitive Behavioral Therapy for young children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57(5), 614–622. https://doi.org/10.1111/jcpp.12471
Type of Study:
Randomized controlled trial
Number of Participants:
53
Population:
- Age — 3–7 years
- Race/Ethnicity — 50% White, 44% African American, and 6% Mixed
- Gender — 56% Female and 44% Male
- Status — Participants were children with posttraumatic stress symptoms.
Location/Institution: Community mental health nonprofit agency in an urban area
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness and cost of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)] to standard Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among young children who were experiencing posttraumatic stress symptoms (PTSS). Participants were randomly assigned to SC-TF-CBT or to TF-CBT . Measures utilized include the Expectancy Rating Form (ERF), the Trauma Symptom Checklist for Young Children (TSCYC), the Child Behavior Checklist (CBCL), the Diagnostic Infant and Preschool Assessment (DIPA), the Clinical Global Impression-Improvement Client Satisfaction Questionnaire (CSQ), the Therapist/Patient Time Tracking System (TTTS), and the Clinical Global Impression–Severity (CGI-Severity). Results indicate that at 3-month follow-up there were comparable improvements over time in PTSS and the secondary outcomes of severity and internalizing symptoms in both SC-TF-CBT and TF-CBT. Results were not similar between SC-TF-CBT and TF-CBT for externalizing symptoms. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. Limitations include small sample size, cost data being limited in that other mental health and health services were not collected, and length of follow-up.
Length of controlled postintervention follow-up: 3 months.
Salloum, A., Small, B. J., Robst, J., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2017). Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice, 27(6), 653–663. https://doi.org/10.1177/1049731515601898
Type of Study:
Randomized controlled trial
Number of Participants:
33
Population:
- Age — Children: 8–12 years; Adults: Not specified
- Race/Ethnicity — Children: 26 White, 24 Not Hispanic/Latino, 9 Hispanic/Latino, and 6 African American; Adults: 26 White, 24 Not Hispanic/Latino, 7 African American, and 6 Hispanic/Latino
- Gender — Children: 18 Female and 15 Male; Adults: 33 Female
- Status — Participants were children with posttraumatic stress symptoms.
Location/Institution: Community mental health nonprofit agency in an urban area
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to explore the feasibility of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)] relative to Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with children. Participants with posttraumatic stress symptoms (PTSS) were randomly assigned (2:1) to SC-TF-CBT or TF-CBT. SC-TF-CBT consisted of Step 1, parent-led therapist-assisted treatment, and Step 2 (nine TF-CBT sessions). TF-CBT consisted of 12 therapist-directed sessions. Baseline, post-Step 1, posttreatment, and 3-month follow-up assessments occurred. Measures utilized include the Anxiety Disorders Interview Schedule Child/Parent Version (ADIS-IV-C/P), the University of California Los Angeles (UCLA) PTSD Index for DSM-IV (UCLA PTSD-Index), the Clinical Global Impression–Severity (CGI-Severity), the CGI-Improvement, the Child Behavior Checklist (CBCL), Structured Clinical Interview for DSM-IV-TR Axis I Disorders, the Therapist/Patient Time Tracking System (TTTS), and the Client Satisfaction Questionnaire (CSQ). Results indicate that in all, 64% to 82% responded to Step 1. Group x Time interactions were not statistically significant for PTSS, severity, and internalizing/externalizing symptoms, indicating comparable improvements in outcomes across both conditions. There were no significant differences in parental treatment credibility, expectations, and satisfaction. SC-TF-CBT total costs were significantly lower than TF-CBT. Limitations include small sample size; a control group was not included in the current research design to compare any positive developments over time that may occur naturally; child’s perception of treatment credibility and improvement expectations or comfort level ending after Step 1 was not gathered, limits in the ability to establish that randomization was successful and to control for slight differences between groups; and length of follow-up.
Length of controlled postintervention follow-up: 3 months.
Salloum, A., Lu, Y., Chen, H., Quast, T., Cohen, J. A., Scheeringa, M. S., Salomon, K., & Storch, E. A. (2022). Stepped care versus standard care for children after trauma: A randomized non-inferiority clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 61(8), 1010–1022. https://doi.org/10.1016/j.jaac.2021.12.013
Type of Study:
Randomized controlled trial
Number of Participants:
183
Population:
- Age — 4–12 years
- Race/Ethnicity — 94 White, 57 Black/African American, 49 Hispanic/Latino, 31 Mixed race, and 1 Asian
- Gender — 101 Female and 82 Male
- Status — Participants were children with posttraumatic stress symptoms.
Location/Institution: Five community behavioral health nonprofit organizations
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)] to standard Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in a community-based non-inferiority trial. Participants were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Measures utilized include the Expectancy Rating Form (ERF), the Trauma Symptom Checklist for Young Children (TSCYC), the Child Sheehan Disability Scale–Parent version, the Clinical Global Impression–Severity (CGI-S), the Clinical Global Impression Improvement (CGI-I), the Diagnostic Infant and Preschool Assessment (DIPA), the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist (CBCL), the Clinical Global Impression-Improvement Client Satisfaction Questionnaire (CSQ), the Therapist/Patient Time Tracking System (TTTS), and the Barriers to Participation Treatment Scale Critical Events subscale. Results indicate that 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 posttraumatic stress symptoms (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. Limitations include standard TF-CBT did not include the optional in vivo component, which potentially limits the full impact of TF-CBT; no comparison group comprising usual care provided by the community agencies; first author provided ongoing consultation and because several expert consultations were provided, fidelity without expert consultation is not known; fidelity measures did not include the quality of how any component or task was delivered; and cost analysis did not include medication costs.
Length of controlled postintervention follow-up: 6 and 12 months.
Salloum, A., Lu, Y., Chen, H., Salomon, K., Scheeringa, M. S., Cohen, J. A., Swaidan, V., & Storch, E. A. (2022). Child and parent secondary outcomes in stepped care versus standard care treatment for childhood trauma. Journal of Affective Disorders, 307, 87–96. https://doi.org/10.1016/j.jad.2022.03.049
Type of Study:
Randomized controlled trial
Number of Participants:
183
Population:
- Age — 4–12 years
- Race/Ethnicity — 94 White, 57 Black/African American, 49 Hispanic/Latino, 31 Mixed race, and 1 Asian
- Gender — 101 Female and 82 Male
- Status — Participants were children with posttraumatic stress symptoms.
Location/Institution: Five community behavioral health nonprofit organizations
Summary:
(To include basic study design, measures, results, and notable limitations)
The study uses the same sample as Salloum et al. (2022). The purpose of the study was to compare child- and caregiver-secondary outcomes among Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) [now called Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT)] versus Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) participants. Participants were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Measures utilized include the Expectancy Rating Form (ERF), the Trauma Symptom Checklist for Young Children (TSCYC), the Child Sheehan Disability Scale–Parent version, the Clinical Global Impression–Severity (CGI-S), the Clinical Global Impression Improvement (CGI-I), the Diagnostic Infant and Preschool Assessment (DIPA), the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist (CBCL), the Clinical Global Impression-Improvement Client Satisfaction Questionnaire (CSQ), the Therapist/Patient Time Tracking System (TTTS), and the Barriers to Participation Treatment Scale Critical Events subscale. Results indicate that there were comparable changes at all-time points in child and caregiver secondary outcomes. Non-inferiority tests indicate that for completers and intent-to-treat samples, SC-TF-CBT was non-inferior to TF-CBT for all outcomes except parenting stress at 6-months. The analysis with completers did not support non-inferiority at posttreatment for internalizing and externalizing problems and at 6- and 12-month follow-up assessments for externalizing problems, but the intent-to-treat analysis did support non-inferiority. Limitations include standard TF-CBT did not include the optional in vivo component, which potentially limits the full impact of TF-CBT; did not have a comparison group comprising usual care provided by the community agencies; fidelity measures did not include the quality of how any component or task was delivered; and cost analysis did not include medication cost.
Length of controlled postintervention follow-up: 6 and 12 months.
Additional References
Salloum, A., Palantekin, S., Claudio Torres, A. M., Holley, R., & Storch, E. A. (2023). Stepping together in Stepped Care Trauma-Focused Cognitive Behavioral Therapy: Case report of core components. Journal of Cognitive Psychotherapy, 37(1), 7–25. https://doi.org/10.1891/JCPSY-D-20-00060
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for young children. Cognitive and Behavioral Practice, 21(1), 97–108. https://doi.org/10.1016/j.cbpra.2013.07.004
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2015). Responder status criterion for Stepped Care Trauma-Focused Cognitive Behavioral Therapy for young children. Child & Youth Care Forum, 44(1), 59–78. https://doi.org/10.1007/s10566-014-9270-1
Contact Information
- Alison Salloum, PhD, LCSW
- Email: asalloum@usf.edu
- Phone: (813) 974-1535
Date Research Evidence Last Reviewed by CEBC: February 2023
Date Program Content Last Reviewed by Program Staff: August 2023
Date Program Originally Loaded onto CEBC: October 2016
