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Bounce Back

Topic Areas
Scientific Rating
Child Welfare Relevance
Trauma Treatment - Client-Level Interventions (Child & Adolescent)
3  — Promising Research Evidence
Medium

About This Program

Target Population: Children in elementary school grades Kindergarten through 5th grade (ages 5-11) who have experienced traumatic events

For children/adolescents ages: 5 – 11

Program Overview

Developed as an adaptation to the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program. Bounce Back is a cognitive-behavioral, skills-based group intervention aimed at relieving symptoms of child posttraumatic stress disorder (PTSD), anxiety, depression, and functional impairment among elementary school children (ages 5-11) who have been exposed to traumatic events. It is used most commonly for children who experienced or witnessed community, family, or school violence, or who have been involved in natural disasters, or traumatic separation from a loved one due to death, incarceration, deportation, or child welfare detainment. It includes 10 group sessions where children learn and practice feelings identification, relaxation, courage thoughts, problem solving and conflict resolution, and build positive activities and social support. It is designed to be used in schools with children from a variety of ethnic and socio-economic backgrounds and acculturation levels. It also includes 2-3 individual sessions in which children complete a trauma narrative to process their traumatic memory and share it with a parent/caregiver. Bounce Back also includes materials for parent education sessions.

Program Goals

The goals for Bounce Back are:

  • Reduce symptoms of PTSD, anxiety, and depression
  • Build skills to enhance resilience to stress
  • Enhance students coping and problem solving strategies
  • Impact students' academic performance by improving their attendance and ability to concentrate
  • Build peer and caregiver support

Logic Model

The program representative did not provide information about a Logic Model for Bounce Back.

Essential Components

The essential components of Bounce Back include:

  • Screening
    • While not a part of the Bounce Back intervention itself, a screening procedure is recommended for use in the general school population to assist in identifying children who have been exposed to traumatic events and have current moderate to severe PTSD symptoms.
    • If a student screens positively, it is important to meet individually with them to verify their appropriateness for the group.
    • A call or in-person meeting with parents/caregivers is recommended before the start of treatment to answer questions, review expectations for child and parent involvement and obtain consent.
  • Bounce Back Group Formation
    • Bounce Back groups are designed to be implemented at school preferably during a nonacademic period. Schools may also choose for groups to run after the school day.
    • Bounce Back groups meet one time per week for ten weeks.
    • Bounce Back group is designed to last 45-60 minutes (one class period).
    • Bounce Back groups are typically comprised of 4-7 students.
  • Bounce Back Group Content/Key Components
    • Psychoeducation
    • Feelings Identification
    • Positive Activities
    • Relaxation Training
    • Cognitive Coping
    • Gradual Exposure for Functional Impairment
    • Trauma Narrative
    • Social Support/Connecting with Others
    • Problem Solving/Conflict Resolution
  • Bounce Back Individual Sessions
    • Bounce Back includes 2-3 individual sessions for each student.
    • Children complete a trauma narrative to process their traumatic memory.
    • Children share the trauma narrative with a parent/caregiver.
  • Parent sessions
    • Bounce Back includes material for up to 3 parent education sessions.
    • Information can be presented in one longer session or divided into 2-3.
    • Parents learn all of the skills that children are taught in Bounce Back so they can reinforce their practice and progress at home.

Program Delivery

Child/Adolescent Services

Bounce Back directly provides services to children/adolescents and addresses the following:

  • Symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, stress, poor coping and problem solving skills, poor academic performance due to poor attendance and inability to concentrate

Recommended Intensity:

45- to 60-minute weekly group sessions plus two or three 45- to 60-minute individual sessions

Recommended Duration:

10 weeks

Delivery Setting

This program is typically conducted in a(n):

  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Bounce Back includes a homework component:

Homework assignments described as take home practice are given each week. Assignments typically ask students to practice cognitive-behavioral skills taught during group. Some assignments encourage students to engage in new behaviors or activities that might be uncomfortable for them. Lack of homework compliance is not treated as failure.

Languages

Bounce Back has materials available in a language other than English:

Spanish

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:

  • Support of the school principal and administration
  • Parental consent
  • Training manual and workbook
  • Regular meeting space
  • A whiteboard or large writing pad
  • Extra copies of the activity worksheets for each session

    • Manuals and Training

    Prerequisite/Minimum Provider Qualifications

    Service providers should be master's-level mental health clinicians. Supervisors should be licensed mental health professional with a Master's degree and with experience with cognitive-behavioral techniques and preferably child trauma.

    Manual Information

    There is a manual that describes how to deliver this program.

    Training Information

    There is training available for this program.

    Training Contact:
    Training Type/Location:

    Training consists of reading background materials and the manual, attending an in-person training delivered by a certified Bounce Back trainer. An online training course is also available to augment in-person training.

    Trainers typically travel to site requesting training. In addition to the clinical components, the training also addresses issues related to successful delivery of a mental health program in a school setting.

    Ongoing consultation from a local clinician with expertise in CBT and/or child trauma treatment is recommended. The manual is available at https://traumaawareschools.org/index.php/learn-more-bounce-back/.

    An on-line training course and implementation support materials can be found at https://traumaawareschools.org/index.php/learn-more-bounce-back/.

    Number of days/hours:

    The in-person training is typically 1.5 days. Online training is also available.

    Implementation Information

    Pre-Implementation Materials

    There are pre-implementation materials to measure organizational or provider readiness for Bounce Back as listed below:

    Several resources are available for preparing a school for Bounce Back including a short video for educators, a slide deck explaining the impact of trauma on learning, and a trauma toolkit for educators. All can be downloaded at https://traumaawareschools.org/index.php/learn-more-bounce-back/

    Formal Support for Implementation

    There is formal support available for implementation of Bounce Back as listed below:

    Consultation from Bounce Back Faculty is available to all sites whether they have been trained in-person or online. Bounce Back faculty work with sites to tailor ongoing supervision and implementation support to meet the specific needs of sites.

    Supervision Calls: Implementers and/or supervisors may participate in regular conference calls on a prescheduled (i.e., twice per month) or an as-needed basis with our faculty, for ongoing clinical and implementation consultation as they implement the program.

    Booster Session: Sites may choose to bring Bounce Back faculty back to the site to conduct one-day booster session.

    Online Support: A large number of implementation materials are available at https://traumaawareschools.org/index.php/learn-more-bounce-back/ for subscribers. Evaluations of the training website reveal that clinicians use the materials and videos to support the implementation process.

    Fidelity Measures

    There are fidelity measures for Bounce Back as listed below:

    For sites interested in monitoring fidelity, clinicians can tape-record groups which are then reviewed and rated by our Bounce Back faculty.

    Fidelity rating guide can be found at https://traumaawareschools.org/index.php/learn-more-bounce-back/.

    Implementation Guides or Manuals

    There are implementation guides or manuals for Bounce Back as listed below:

    A complete training manual and implementation guide is available at https://traumaawareschools.org/index.php/learn-more-bounce-back/.

    Research on How to Implement the Program

    Research has not been conducted on how to implement Bounce Back.

    Relevant Published, Peer-Reviewed Research

    Child Welfare Outcome: Child/Family Well-Being

    Langley, A. K., Gonzalez, A., Sugar, C. A., Solis, D., & Jaycox, L. (2015). Bounce Back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. Journal of Consulting and Clinical Psychology, 83(5), 853–865. https://doi.org/10.1037/ccp0000051

    Type of Study: Randomized controlled trial
    Number of Participants: 74

    Population:

    • Age — Mean=7.65 years
    • Race/Ethnicity — 49% Latino, 27% Caucasian, 18% African American, 5% Biracial, and 1% Asian
    • Gender — 50% Male
    • Status — Participants were students in Grades 1–5, who had been exposed to traumatic events.

    Location/Institution: Four elementary schools in Los Angeles County

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of the study was to test the effectiveness of the Bounce Back program in improving symptoms of posttraumatic stress, depression, and anxiety. Participants were randomized to immediate or delayed (3-month waitlist) intervention. Measures utilized include the Traumatic Events Screening Inventory for Children—Brief Form (TESI-C-Brief), the UCLA Posttraumatic Stress Disorder Reaction Index (RI), the Children’s Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders, (SCARED-C), the Social Adjustment Scale-Self-Report for Youth (SAS-SR-Y), the Coping Efficacy Measure, the Emotion Regulation Checklist (ERC) and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that at postintervention compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent- and child-reported posttraumatic stress and child-reported anxiety symptoms. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent- and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). Limitations include small sample size, lack of control group at 3-month follow-up, and length of follow-up.

    Length of controlled postintervention follow-up: 3 months (Intervention group only).

    Santiago, C. D., Raviv, T., Ros, A. M., Brewer, S. K., Distel, L. M. L., Torres, S. A., Fuller, A. K., Lewis, K. M., Coyne, C. A., Cicchetti, C., & Langley, A. K. (2018). Implementing the Bounce Back trauma intervention in urban elementary schools: A real-world replication trial. School Psychology Quarterly, 33(1), 1–9. https://doi.org/10.1037/spq0000229

    Type of Study: Randomized controlled trial
    Number of Participants: 52

    Population:

    • Age — Children: Mean=7.76 years; Parents: Mean=35.75
    • Race/Ethnicity — Children: 82% Latino, 8% Missing, 6% White, and 4% African American; Parents: Not specified
    • Gender — Children: 65% Male and 35% Female; Parents: 83% Female
    • Status — Participants were students in Grades 1–4, who had been exposed to traumatic events.

    Location/Institution: Eight schools within an urban school district in Illinois

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of the study was to test the effectiveness of the Bounce Back program in improving symptoms of posttraumatic stress, depression, and anxiety. Using block randomization, schools were randomly assigned to immediate treatment or to a waitlist control (3 months). Measures utilized include the Modified Traumatic Events Screening Inventory for Children—Brief Form (TESI-C-Brief), the University of California–Los Angeles PTSD Reaction Index (UCLA-RI), the Children’s Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders, (SCARED-C), the Responses to Stress Questionnaire (RSQ), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that differential treatment effects (Time X Group Interaction) were found for child-reported posttraumatic stress disorder (PTSD) and parent-reported child coping, indicating that the immediate treatment group showed greater reductions in PTSD and improvements in coping compared with the delayed group. Differential treatment effects were not significant for depression or anxiety. Significant maintenance effects were found for both child-reported PTSD and depression as well as parent-reported PTSD and coping for the immediate treatment group at follow-up. Significant treatment effects were also found in the delayed treatment group, showing reductions in child-reported PTSD, depression, and anxiety as well as parent-reported depression and coping upon receiving treatment. Limitations include small sample size, lack of control group at 3 month follow-up, and reliance on self-reported measures.

    Length of controlled postintervention follow-up: 3 months (intervention group only).

    Additional References

    Gonzalez, A., Monzon, N., Solis, D., Jaycox, L., & Langley, A. K. (2016). Trauma exposure in elementary school children: Description of screening procedures, level of exposure, and posttraumatic stress symptoms. School Mental Health, 8(1), 77-88. https://doi.org/10.1007/s12310-015-9167-7

    Langley, A. K., Santiago, C. D., Rodriguez, A., & Zelaya, J. (2013). Improving implementation of mental health services for trauma in multicultural elementary schools: Stakeholder perspectives on parent and educator engagement. Journal of Behavioral Health Services and Research, 40(3), 247-262. https://doi.org/10.1007/s11414-013-9330-6

    Contact Information

    Audra Langley, PhD
    Agency/Affiliation: UCLA
    Website: traumaawaresch.wpengine.com/index.php/learn-more-bounce-back
    Email:

    Date Research Evidence Last Reviewed by CEBC: July 2023

    Date Program Content Last Reviewed by Program Staff: July 2022

    Date Program Originally Loaded onto CEBC: June 2016