Stepped Care TF-CBT

Note: The Stepped Care TF-CBT program was not responsive to the CEBC's inquiry. The following information was obtained from publicly available sources.

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

Stepped Care TF-CBT has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Young children experiencing posttraumatic stress symptoms

Brief Description

Stepped Care TF-CBT's primary objective is to decrease posttraumatic stress symptoms in young children. Stepped Care TF-CBT has been developed to improve the accessibility, efficiency, and cost of delivering treatment to children after trauma. Stepped Care TF-CBT consists of two steps. Step One is a parent-led, therapist-assisted treatment where the majority of the treatment occurs at-home with the parent leading the treatment, without the therapist present. There are three in-office therapist-directed sessions. Step One provides an alternative approach for parents who have difficulty with scheduling or keeping weekly office-based sessions. Stepped Care TF-CBT also addresses the parent’s desire to solve the child’s problem on his/her own as the parent leads the trauma-focused meetings with the child at home, and it is less costly than standard treatment. Step One utilizes a parent-child workbook that was based on the Preschool PTSD Treatment and Step One includes all of the components of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) including an emphasis on trauma-focused exposures. Children needing more intensive care “step up” and receive Step Two, which consists of weekly TF-CBT sessions with the therapist leading the treatment.

Education and Training Resources

Publicly available information indicates there is a manual that describes how to implement this program, and there is some training available for this program.
See contact info below.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Salloum, A., Robst, J., Scheeringa, M. S., Cohen, J. A., Wang, W., Murphy, T., … Storch, E. A. (2014). Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy for young children: A pilot study. Child Psychiatry and Human Development, 45(1), 65-77. doi:10.1007/s10578-013-0378-6.

Type of Study: One-group pretest-posttest study
Number of Participants: 9 Parent-child dyads

Population:

  • Age — Children: 3-6 years (Mean=4.7 years), Adults: Mean=33 years
  • Race/Ethnicity — Children: 77.8% Caucasian, 11.11% African American, and 11.11% Hispanic/Latino; Adult: Not specified
  • Gender — Children: 77.8% Male; Adult: Not specified
  • Status — Participants were recruited from a community agency involved with Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT).

Location/Institution: Community agency

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study explored the preliminary efficacy, parent acceptability, and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Measures utilized include the Diagnostic Infant and Preschool Assessment (DIPA), the Trauma Symptom Checklist for Young Children, the Clinical Global Impression—Severity (CGI), the Clinical Global Impression—Improvement (CGI –Improvement), the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition With Psychotic Screen (SCID-RV), the Expectancy Rating Form, and the Client Satisfaction Questionnaire. Results indicated that 83.3% of completers and 55.6% of the original sample responded to Step One within SC-TF-CBT. Additionally, the cost per unit of improvements was reasonable. Treatment gains for the Step One within SC-TF-CBT responders were maintained at the 3-month assessment. Limitations include lack of randomization of participants, lack of control group, and small sample size.

Length of postintervention follow-up: 3 months.

Salloum, A., Small, B. J., Robst, J., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2015). Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice. Advance online publication. doi:10.1177/1049731515601898.

Type of Study: Randomized controlled trial
Number of Participants: 33

Population:

  • Age — Children: 8-12 years; Adult: Not specified
  • Race/Ethnicity — Children: 78.8% White and 21.2% African American; Adult: Not specified
  • Gender — Children: 54.5% Female, 45.5% Male; Adult: Not specified
  • Status — Participants were children with PTSD and their caregivers.

Location/Institution: Community based setting large metropolitan city in the United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study explored the feasibility of Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT) relative to Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with children (aged 8–12). Participants were randomly assigned to SC-TF-CBT (n=22) or to TF-CBT (n=11). 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 Child Behavior Checklist, Client Satisfaction Questionnaire (CSQ), and the Clinical Global Impression–Severity (CGI-Severity). Results indicated that at 3-month follow-up improvements in all child outcomes changed at similar rates over time for children in SC-TF-CBT and TF-CBT. Limitations include small sample size, lack of untreated control group, and length of follow-up.

Length of postintervention follow-up: 3 months.

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. doi:10.1016/j.chiabu.2014.11.018.

Type of Study: Randomized controlled trial (secondary analysis)
Number of Participants: 17

Population:

  • Age — Children: 8-12 years, Adults: Not specified
  • Race/Ethnicity — Children and Adults: 64.7% White and 35.3% African American
  • Gender — Children: 52.9% 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 comparison groups, outcomes, measures, notable limitations)
This study utilized information from Salloum et al. (2015). A subset of a population that received Stepped-Care Trauma Focused Cognitive-Behavioral Therapy (SC-TF-CBT) was used to explore parent and child experiences of a parent-led, therapist-assisted treatment. 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 indicated that children that utilized 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 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. doi: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 (M=33.8)
  • Race/Ethnicity — Children and Adults: 63.5% White, 26.9% African American, 7.7% Mixed, and1.9% American Indian/Alaskan Native
  • Gender — Children: 51.9% Male and 48.1% Female; Adults: Not specified
  • Status — Participants were parents of children with posttraumatic stress disorder (PTSD).

Location/Institution: Community based setting large metropolitan city in the United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The current study examines caregivers’ perceptions of parent-led Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) and therapist-led Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) treatment. Participants were randomly assigned to SC-TF-CBT (n = 34) or to TF-CBT (n = 18). 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 indicated 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 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. doi:10.1111/jcpp.12471.

Type of Study: Randomized controlled trial
Number of Participants: 53

Population:

  • Age — Children: 3-7 years; Adults: Not specified
  • Race/Ethnicity — Children: 50% White, 44.4% African American, and 5.6% Mixed; Adults: Not specified
  • Gender — Children: 55.6% Female and 44.4% Male; Adults: Not specified
  • Status — Participants were children with posttraumatic stress symptoms.

Location/Institution: Community mental health nonprofit agency in an urban area

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared the effectiveness and cost of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy (SC-TF-CBT) 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 (n = 35) or to TF-CBT (n = 18). 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 indicated 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 postintervention follow-up: 3 months.

References

No reference materials are currently available for Stepped Care TF-CBT.

Contact Information

Name: Alison Salloum, PhD, LCSW
Email:
Phone: (813) 974-1535

Date Research Evidence Last Reviewed by CEBC: July 2016

Date Program Content Last Reviewed by Program Staff: September 2016

Date Program Originally Loaded onto CEBC: October 2016