While TF-CBT was specifically developed to help children and adolescents after trauma, regular CBT is for people of all ages. We described the effectiveness of the service—that is, how well the outcomes of the studies met the service goals. We compiled the findings for separate outcome measures and study populations, summarized the results, cognitive behavioral therapy and noted differences across investigations. We considered the quality of the research design in our conclusions about the strength of the evidence and the effectiveness of the service. Based on the evidence, we also evaluated whether the practice should be considered for inclusion as a covered service in public and private health plans.
Effectiveness of the service
However, research reveals that high numbers of OVC present with psychological distress,8,49,50 which represents a highly prevalent need for specific services. Findings that nonspecific interventions are minimally effective for psychological problems in youth after conflicts33,36,38,45 in combination with the current trial raise important questions for OVC programming. Further studies are needed to evaluate the effectiveness of widely funded psychosocial support interventions within OVC programs relative to interventions such as the TF-CBT for addressing mental health problems. Children who have experienced sexual abuse are often taught the doctors’ names for private parts (with caregiver permission).
Evaluation of effectiveness
Many children are referred for TF-CBT via social services or other agencies that are involved with the child because of concerns about the caregiver’s capacity to provide care and safety, making full implementation of the caregiver components a challenge or impractical. The parallel-treatment components for caregivers can be provided to any available caregiver, such as a foster parent or another adult who can provide appropriate parenting support and is involved in the child’s daily life. During conjoint sessions, a child may choose to share the trauma narrative with an adult whom he or she identifies as supportive and trusted (for example, a grandparent, aunt, trusted teacher, or guidance counselor), regardless of whether this adult is involved in day-to-day care.
Child-specific sessions
The literature search for this AHRQ review merged individual and school group models (21,22) and included only one study of what was described as “cognitive-behavioral therapy” for trauma among children and adolescents (23). The authors reviewed two studies by TF-CBT developers that are covered here (24,25) but no others. Clearly, the implementation of this model as outlined depends on the presence of a competent, child-focused caregiver at the time of treatment, which cannot be presumed in all families affected by abuse and maltreatment.
Improve Coping Skills
In cases where there is ongoing risk of trauma exposure, the safety component is addressed at the beginning and often throughout TF-CBT11; 14–15. Communicating these to all family members and practicing their implementation at home enhances the child’s belief that everyone in the family will adhere to the safety plan going forward. The therapist meets with the parent each session to provide the parent with each PRACTICE component as the child is receiving that component. In this manner, the parent is able to help the child to practice using the appropriate TF-CBT skills during the week when the child is not in therapy. Many parents report that the TF-CBT skills are personally helpful to them, and that encouraging their children to use these is helpful in reminding the parent to use the skills as well. Often parents practice the skills together with their children at home and this encourages the development of family resilience rituals that continue long after the end of therapy.
Therapists may take note of the number of words children use in their verbal communications. Though challenging, it is helpful for clinicians to communicate in similarly simple 4–6-word sentences. Clinicians should also be aware of young children’s tendency to imitate words/expressions without fully understanding their meaning. A common error made with young children is use of the word ‘fault.’ While young children may imitate adults who say the trauma/abuse was not their fault, they may have little understanding of the meaning.
When caregivers do not overreact to normative fears/behaviours, they dissipate as children outgrow them. In the aftermath of trauma, however, caregivers may be particularly vulnerable to interpreting new behaviours as trauma reactions. For example, child sexual behaviour after an experience of sexual abuse may be misinterpreted as a reflection of the trauma. Undue attention to normative sexual behaviours can cause them to increase in intensity, frequency, and duration, thereby increasing the potential for them to become problematic.
- After identifying the child’s preferred affective modulation strategies, the therapist then educates, practices, and role plays with the parents about how they can support the child in implementing these skills.
- During this component, it is also important for young children, especially those exposed to bullying and/or other violence, to practice expressing their needs appropriately and being assertive verbally in role plays.
- For example, younger children often like to relax through blowing bubbles, dance (e.g., “Hokey Pokey”, Chicken Song) and song (“Row, Row, Row Your Boat”); while teens often prefer to relax using their favorite music, physical activities or crafts such as crochet or knitting.
- At this point in TF-CBT the therapist is not focusing on trauma-related thoughts with the child, since it is more effective to process these during the trauma narrative component.
In addition to these more general criteria, it is important to assess young children’s verbal capacity and memory of the trauma prior to initiating TF-CBT. This may be done by eliciting an account of a positive/neutral recent experience and then eliciting a baseline trauma narrative as described in Deblinger and colleagues (2015). To participate successfully in TF-CBT, young children should be able to provide at least a brief acknowledgement of the trauma(s) to be addressed and demonstrate an ability to share a narrative about a neutral experience with some details.
Child Report Measures
As young children learn a great deal through observing and interacting with caregivers, it is essential for caregivers to develop effective coping and parenting skills through participating in TF-CBT. Research has documented that caregivers’ levels of abuse-related distress strongly predicted young children’s emotional and behavioural responses to treatment. Parental https://ecosoberhouse.com/ support became an even greater predictor of children’s post-abuse adjustment during the year following treatment (Cohen & Mannarino, 1998). These findings highlight the important influence of nonoffending caregivers on young children’s response to treatment. Some children develop ongoing fears and avoidance of situations that are inherently innocuous.