Unformatted text preview: 1 Program Overview: Cognitive Behavioral Intervention for Trauma in Schools Category Program Name Cognitive Behavioral Therapy Definitions/ Notes blank Cognitive Behavioral Intervention for Trauma in Schools (CBITS) History of Program CBITS was developed in 1999 through a blank collaborative partnership between RAND Corporation, the Los Angeles Unified School District, and the University of California, Los Angeles (UCLA) to address the alarmingly high rates of violence exposure and trauma among the diverse student population in the Los Angeles inner‐city schools. Description of Program as it Relates to addressing CEV CBITS is a structured, school‐based, group blank intervention designed to address PTSD, depression, and behavior problems related to community and family violence. Groups (5‐8 students/ group) incorporate cognitive‐behavioral skills (e.g., relaxation training, changing disruptive/unhelpful thoughts, improving problem‐solving ) with exposure activities aimed at processing traumatic events, working through traumatic grief or addressing traumatic memories through the use of age‐appropriate didactic instruction, games, role‐plays, worksheets, and "homework assignments". Individuals are supported with supplemental individual sessions to help reduce posttraumatic stress. Parents are invited to attend 2 educational sessions and teachers are invited to 1 educational session to help foster resilience through establishing support for students. Secondary/Selective Intervention Tertiary/Targeted Intervention Domestic Violence Maltreatment (non‐specific) Community Violence School Violence (e.g., shootings; rape) Gang Violence Violence in the Wake of Mass Trauma blank blank Service Continuum Primary Exposure Type 2 Category Cognitive Behavioral Therapy Definitions/ Notes Refugee/Immigration/War/ Political Target Population Target Age Target Gender Appropriate for Unique Ethnic, Cultural, or Linguistic Populations? Individual Children/ Youth Middle Childhood (6 ‐ 12) Adolescence (13‐21) Both blank For children ages 10‐ 15 blank Has this program been used or evaluated with blank minority, cultural, or linguistically diverse groups? Yes If yes, please indicate: Latino/Hispanic African American Caucasian If yes, please describe: blank CBITS has been successfully implemented with a diverse student body in the Los Angeles United School District. It has also been adapted for use with Indian Americans, as well as with recent immigrant students and families from Russia, Korea, and Armenia. A toolkit for use with students in the foster care system has also been developed. Spanish language and low‐literacy worksheets and handouts are available. The program is currently being modified for elementary school children. CBITS has recently been adapted for use by non‐clinical school personnel (teachers and school counselors), in a new program called Support for Students Exposed to Trauma. Schools Mental Health Providers (e.g., Social Workers, Therapists) School Staff & Educators (e.g., Teachers) Assessment/ Triage/Screening Referrals Child Group Therapy Other (Please describe): Individual, parent and teacher sessions are used to supplement group as needed. blank blank What Adaptations have been made? Primary Settings Persons or Entities in charge of delivering Program Primary Components blank 3 Resource & Capacity Planning Program Name Length/Duration of Program Cognitive Behavioral Therapy Brief Description CBITS is typically delivered in Groups typically include 10, 60‐minute group sessions 5‐8 children. with additional 2‐3 individual sessions involving exposure activities. Parents participate in 2 and teachers participate in 1 supplemental educational session. Manuals/Program materials Fidelity Checklists/Assessments Other (Please Describe): Notebooks with handouts should be created for children; Chalkboard, large writing pad and easel, or white board for each session; Parental consent forms Parent materials and handouts are available in Spanish, although the facilitator's manual is currently only available in English. Face‐to‐face training Supervision Consultation Manuals for co‐ facilitators include a step‐by‐step guide, handouts, worksheets, common challenges and potential solutions to assist with implementation and adhere to fidelity. Required Materials Are Materials Available in Multiple Languages? blank Training Requirements Typical training sequence is as follows: 1. Read the manual and background materials 2. Attend a 2‐day training 3. Participate in on‐going supervision 4 Program Name Cognitive Behavioral Therapy Brief Description Trainers typically provide pre‐training consultation on implementation issues, and also provide extensive materials relating to implementation, such as background reading, sample forms and evaluation tools, screening tools and information, fidelity checklists and instructions on how to use them, adaptations for Spanish speakers and low‐literacy students, and materials useful for professional development and in‐ service trainings with educators. An on‐line training course is currently in development. Provider Certification/Training/Requirements No Degree /Certification/ Training/ requirements stated Although not required, developers recommend intervention be delivered by providers with knowledge and expertise in children's mental health and trauma, and familiarity with running groups with children. System or Agency Recommendations for Serving CEV Populations With‐in Agency Support & blank Infrastructure It is important to gain buy‐ 5 Program Name Cognitive Behavioral Therapy in and support from principal and administration. Further, teachers who have students in the program should be invited to participate in the teacher education program. Implementers should include time for obtaining parental consent, as well as working with educators to identify children for the group. Referral for other services may be indicated for children who need more intensive services or who continue to exhibit symptoms at the end of the program. Brief Description Costs of Implementation Training & Consultation: blank Estimated $4,000 for training per 12‐15 trainees, plus trainer travel expenses (estimate based on 2009) Materials/Manuals: The CBITS manual costs approximately $40 in 2009 and is available from Cambium Publishing. It contains reproducible worksheets for use in the groups. Additional costs for implementation may include digital recorders for fidelity monitoring and supervision, and small prizes and snacks for student groups. Other (please describe): Implementation cost can 6 Program Name Cognitive Behavioral Therapy be calculated based on the salary of a full time school‐based mental health professional who is devoted to delivering CBITS. Estimated $430/ participant based on $90,000 annual salary for one professional delivering up to 30 CBITS groups per academic year (6‐8 students per group). Brief Description 7 Evidence for CEV Program Name Cognitive Behavioral Therapy Evidence for Preventing or Addressing Violence Exposure Program demonstrates a high degree of effectiveness in reducing either the risk of exposure and/or ameliorating the effects of exposure to violence (e.g., related behavioral distress, PTSD, perpetration/assault, Nightmares) among children or caregivers. Notes In general, when implemented with a high degree of fidelity (effectiveness), these programs demonstrate robust empirical findings in preventing children's exposure to violence or ameliorating the effects of exposure, using a reputable conceptual framework and an evaluation design of the highest quality, and has been used with populations known to be at risk for violence exposure (e.g., children in residential settings). Evaluation Design of Studies with CEV Waitlist control (randomized or pseudo‐randomized) Quasi‐experimental design Feasibility testing blank Violence Exposure‐ Related Outcomes Child (Briefly Describe) blank Compared to control group, children receiving CBITS show significant improvements in self‐reported traumatic stress and depression, as well as parent‐reported emotional and behavioral problems at 3 months following group. Studies have found that children maintain improvements in symptoms at 6‐ month follow‐up. For children with clinical levels of depression and PTSD, participation in the CBITS intervention group has been associated with a 29% and 35%, respectively, decrease in symptoms from baseline to follow‐up. Among children affected by exposure violence and chaos in the wake of a 8 Program Name Cognitive Behavioral Therapy natural disaster, initial evidence indicates that CBITS significantly lowers levels of PTSD and depressive symptoms from baseline to 10‐month follow‐up. Baseline levels of PTSD, social support, and depression, as well as number of prior trauma‐exposures were important predictors of levels of PTSD for CBITS participants at 10 month‐follow up. System (Briefly Describe) Initial evidence indicates favorable treatment uptake (i.e., percentage of referred students receiving treatment in timely manner ) for school‐based CBITS compared to a clinic‐based treatment in the wake of mass‐ trauma/natural disasters. Additional Research Information (This will be a link to another page, a drill down box or separate section) Study 1: Design, Setting, Participants: 126 6th graders from two large urban middles schools exposed to violence (based on lifetime exposure to violence and a PTSD symptoms scale) were randomly assigned to either an immediate CBITS intervention group (N = 61) or a waitlist (control) group (N=65). 90% of the students participated in both the 3‐month and 6‐month follow‐up assessments. Outcome Measures: Children completed the PTSD Symptom Scale and the Children's Depression Inventory (CDI). Parents completed a measure of psychosocial functioning (Pediatric Symptom Checklist) and teachers completed the Teacher‐Child RatingSystem to assess classroom behavior, such as acting‐out behaviors, withdrawal/shyness, and learning difficulties. Notes Study 1: Stein, B.D., Jaycox, L.H., Kataoka, S. H., Wong, M., Tu, W., Eliot, M.N., & Fink, A. (2003). School‐based intervention for children exposed to violence: A randomized controlled trial. JAMA, 290 (5), 603‐611. Study 2: Kataoka, S., Stein, B. D., Jaycox, L. H.,Wong, M.,Escuerdo, P., Tu,W., Zaragosa, C., &Fink, A. (2003). A 9 Program Name Cognitive Behavioral Therapy Study 2: Design, setting, Participants: 198 Spanish‐ speaking Latino immigrant students from 9 Los Angeles middle and high schools received and completed the CBITS intervention and 3‐month follow‐up. Of these, 152 students received the intervention immediately (67 participated in the intervention through random assignment, whereas 85 were not randomly assigned due to school structure), and 46 students were randomly assigned to the wait‐list control group. 37% of the parents receiving the CBITS intervention attended at least one parent session. Inclusion criteria included exposure to violence (at least 3 exposures or a reported witnessing or being a direct victim of violence involving a gun or knife) and clinical levels of PTSD and/or depression. Outcome Measures: Exposure to violence was measured using an adapted version of the Life Events Scale which assesses exposure in multiple settings including community, home, school, over the past year and lifetime. PTSD symptoms experienced during the past month were assessed using the Child PTSD Symptom Scale (CPSS, Foa et al., 2001). The measures were translated to Spanish, pretested with students with similar cultural and immigration experiences, and checked for comprehension. It should be noted that the measures have not been validated for Spanish‐speaking populations. Study 3: Design, setting, Participants: CBITS and TF‐CBT were provided to Hurricane Katrina victims as part of a stepped‐care model, in which both treatments were expected to improve Notes school‐based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311‐318. 10 Program Name Cognitive Behavioral Therapy trauma‐related distress. Recruitment was based upon direct hurricane exposure and exposure to post‐hurricane destruction and chaos, presence of secondary traumas resulting from living in violent, highly impoverished areas of New Orleans, and pre‐existing complex traumas. 609 4th‐8th grade students at 3 schools were invited to participate. 195 completed baseline assessments (55% girls; 48% non‐Hispanic White; 46% African American, 5% Hispanic) and 118 (61%) met criteria for elevated levels of PTSD symptoms. Using a process that allowed for representative groups, children were randomly assigned to 10 group and 1‐3 individual CBITS sessions (N=58) or 12 individual and conjoint TF‐ CBT sessions (N=60). Assessments were conducted at baseline, 5‐months, and 10‐ month follow‐up. Outcomes: Multiple traumatic exposure types, including exposure to violence, were assessed through several self‐report measures, including the Disaster Experiences Questionnaire (DEQ) to assess hurricane‐specific trauma, the UCLA PTSD Reaction Index (UCLA PTSD RI) to obtain information about lifetime violenceand trauma exposure, and the Child Posttraumatic Stress Scale (CPSS) to assess levels of PTSD symptoms during the last 5 months. Children also reported on their levels of depressive symptoms and perceptions of available peer support using the Children’s Depression Inventory (CDI; Kovacs, 1981) and the Support from Friends subscale of the Social Support Scale for Children . Teacher reports of children's behavioral difficulties, including emotional, conduct, attention problems, were obtained via the Strengths and Difficulties Questionnaire (SDQ) . Notes 11 Program Name Cognitive Behavioral Therapy Is this Program an Evidence‐ Based Practice in other Family/ Youth Development Areas? Sources No Notes blank Empirical Studies (peer‐reviewed journal) Evaluation Conducted by Program OJJDP Model Programs Find Youth Info Other (describe): NCTSN (www.nctsNet.org) blank Contact Information Treatment Developers: RAND Corporation, the Los Angeles Unified School District, and Lisa Jaycox, Bradley Stein, Marleen Wong, & Sheryl Kataoka Contact Lisa H. Jaycox, Ph.D. RAND 1200 South Hayes Street Arlington, VA 22202 Phone: (703) 413‐1100 Fax: (703) 414‐4725 E‐mail: [email protected] Websites: http://www.rand.org http://www.hsrcenter.ucla.edu/research/cbits.shtml Technical Assistance & Training Provider: Audra Langley, Ph.D. 300 Medical Plaza, Room 1265 University of California at Los Angeles Los Angeles, CA 90095 Phone: (310) 825‐4132 Fax: (310) 267‐4925 E‐mail: [email protected] 12 Selected Publications/References www.NCTSNet.org, Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Cohen, J. A., Jaycox, L. H., Walker, D. W., Mannarino, A. P., Langley, A. K., & DuClos, J. L. (2009). Treating traumatized children after Hurricane Katrina: Project Fleur‐de Lis. Clinical Child Family Psychology Review, 12, 55‐64. Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., & Schonlau, M. (2009). Support for student exposed to trauma: A pilot study. School Mental Health, 1, 49‐60. Jaycox, L., Cohen, J., Mannarino, A., Langley, A., Gegenheimer, K., Scott, M., Schonlau, M. (in press). Children’s mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies. Journal of Traumatic Stress. Kataoka, S., Stein, B. D., Jaycox, L. H., Wong, M., Escuerdo, P., Tu, W., Zaragosa, C., & Fink, A. (2003). A school‐based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311‐318. Stein, B.D., Jaycox, L.H., Kataoka, S. H., Wong, M., Tu, W., Eliot, M.N., & Fink, A. (2003). School‐ based intervention for children exposed to violence: A randomized controlled trial. JAMA, 290 (5), 603‐611. ...
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