Increasing Treatment Access in Trauma Exposed Children: Developing an Adapted Step One Intervention (RCT)

The University of Texas System (UT)

Status: Begins enrollment in 4 months

Conditions: Posttraumatic Stress Disorder; Trauma

Treatments: Behavioral: Treatment as Usual (TAU); Behavioral: Personalized Stepped Care Cognitive Behavioral Therapy for Children after Trauma (pSC-CBT-CT)

Study type: Interventional

Funder types: Other

Identifiers

NCT07396974

HSC-MS-25-0929 (RCT)

Details and patient eligibility

About

One of the most common and widely disseminated trauma treatments is Trauma Focused Cognitive Behavioral Therapy (TF-CBT). TF-CBT is a therapist-led, structured and sequential intervention, with treatment organized around P.R.A.C.T.I.C.E. (Psychoeducation, Parent training, Relaxation, Affective Regulation, Cognitive Coping, Trauma Narrative, In-Vivo Exposure, Cognitive Reprocessing, and Enhancing Safety) components. Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT) is an alternative delivery system that incorporates the best available evidence on the treatment of childhood Post-traumatic Stress Disorder (PTSD) within a stepped care model and utilizes task-shifting with caregiver involvement, which engages caregivers in actively helping their children. Stepped care approaches are characterized by a personalized approach to care in which a lower intensity (i.e., fewer number of sessions) intervention is initially provided before the child is reevaluated or ''stepped up'' for additional care should symptoms persist. The goal of this study is to assess a personalized modification of SC-CBT-CT for Latino families (pSC-CBT-CT). The hypothesis is that personalizing SC-CBT-CT will improve outcomes for Latino children.

Enrollment: 30 estimated patients

Sex: All

Ages: 7 to 14 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• parent and child agree that the target event/index trauma occurred;
• report of at least five symptoms of PTSD (1 from re-experiencing category or 1 from avoidance);
• suicidal ideation does not exclude as long as there is no active plan/intent. Safety planning implemented and continued assessment for plan/intent;
• children ages 7-12 and a legal guardian willing to participate;
• can be fluent in English or Spanish;
• at least 4 weeks since child's exposure to one or more potentially traumatic events;
• trauma exposure occurred after child was 36 months old.

Exclusion criteria

• Children with pervasive developmental disorders or Autism;
• legal guardian or child with active psychosis;
• any condition that may limit the legal guardian ability to understand CBT and the child's ability to follow instructions;
• children who have unsupervised visitation with their perpetrator;
• perpetrator (person that harmed child) is living in the home;
• active substance use disorder;
• child is currently receiving trauma-focused therapy;
• legal guardian is actively suicidal will be excluded from participation;
• children who have not been stable on psychotropic medication for 4 or more weeks, and/or for benzodiazepines/stimulants not stable for 2 or more weeks will not be eligible for the trial.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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30 participants in 2 patient groups

Personalized Stepped Care Cognitive Behavioral Therapy for Children after Trauma (pSC-CBT-CT)

Experimental group

Description:

The SC-CBT-CT intervention in this study is a data driven, stakeholder-informed revision of SC-CBT-CT that incorporates Latino specific values and beliefs, that is, personalized SC-CBT-CT (pSC-CBT-CT). The intervention consists of two steps utilizing Cognitive Behavioral Therapy (CBT). Step one (Stepping Together for Children after Trauma, SC-CT) involves a caregiver-led, therapist-assisted first step with narrative, imaginal, and exposure therapy, and step two consists of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which utilizes gradual exposure. SC-CT includes three therapist-led caregiver-child meetings over 6-9 weeks, with brief weekly phone support (10-15 minutes) from the therapist to caregiver. During 11 home-based, caregiver-led meetings, the child and caregiver work together on therapeutic tasks (i.e., exposure tasks, a trauma narrative, and in-vivo exposure reminders) guided by an empirically supported activity book.

Treatment:

Behavioral: Personalized Stepped Care Cognitive Behavioral Therapy for Children after Trauma (pSC-CBT-CT)

Treatment as Usual (TAU)

Active Comparator group

Description:

Participants in the TAU condition will be given a list of community resources offering child mental health services for trauma survivors. TAU will likely be Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or another trauma-informed psychotherapy, which may include similar components.

Treatment:

Behavioral: Treatment as Usual (TAU)