Group Trauma‐Informed Treatment for Adolescent Psychiatric Inpatients: A Preliminary Uncontrolled Trial

Abstract

Despite high rates of trauma exposure (46%-96%) and significant posttraumatic stress disorder (PTSD; 21%-29%) symptoms in adolescent psychiatric inpatients, there is a dearth of research on effective interventions delivered in inpatient settings. The current report describes the development of Brief STAIR-A, a repeatable 3-module version of skills training in affective and interpersonal regulation (STAIR) developed for adolescents in inpatient care. An uncontrolled design was used to conduct a preliminary examination of the group intervention's effectiveness. Adolescent psychiatric inpatients (N = 38; ages 12 years-17 years) admitted to a public hospital participated in Brief STAIR-A and attended a median of 6 sessions (range 3-36). They completed measures of PTSD and depressive symptom severity, coping skill use, and coping efficacy upon admission and again prior to discharge. Participants reported significant reductions in symptom severity (d = 0.65-0.67), no change in the absolute level of coping skills used (d = 0.16), but greater coping efficacy when discharged from care (d = 0.75). Results from this pilot study suggest that this brief group treatment shows promise for treating adolescents' trauma-related difficulties in inpatient psychiatry settings, but additional research examining its effectiveness is essential.

Implementation and Evaluation of the Skills Training in Affective and Interpersonal Regulation (STAIR) in a Community Setting in the Context of Childhood Sexual Abuse

“…Three studies were conducted in an individual format, two of which were randomized controlled trials (Cloitre et al, 2002; Cloitre, Stovall-McClough, Nooner, Zorbas, Cherry, Jackson, et al, 2010), and the other was a benchmark study evaluating the implementation of STAIR by community providers (Levitt, Malta, Martin, Davis, & Cloitre, 2007). Of relevance to our efforts, STAIR has also been tested in three studies in a group format: one a comparative study in which group STAIR was assessed compared to treatment as usual among inpatients with comorbid PTSD and schizoaffective disorder (Trappler & Newville, 2007) and two open trials with adolescents, one in a school setting (Gudiño, Leonard, & Cloitre, 2016) and the other in an inpatient unit (Gudiño, Weis, Havens, Biggs, Diamond, et al, 2014).…”

An intensive form of trauma focused cognitive behaviour therapy in an acute adolescent inpatient unit: An uncontrolled open trial

“…Furthermore, current interventions for PTSD in acute settings largely focus on stabilisation, safety and improving coping skills (Foa et al, 2000). Gudiño et al (2014) examined a group trauma-informed treatment for adolescents with PTSD in an inpatient setting which focused on skills training including psychoeducation, emotion regulation, communication and safety planning. This group programme was a brief version of the Skills Training in Affective and Interpersonal Regulation (Cloitre et al, 2006) programme adapted for adolescents (Brief STAIR-A) which targeted stabilisation, functioning, symptom reduction and safety.…”

“…This group programme was a brief version of the Skills Training in Affective and Interpersonal Regulation (Cloitre et al, 2006) programme adapted for adolescents (Brief STAIR-A) which targeted stabilisation, functioning, symptom reduction and safety. They found some reduction in PTSD symptoms at discharge compared with intake and increased coping efficacy at discharge, adding support to inpatient units providing trauma-specific interventions (Gudiño et al, 2014).…”

“…There is a high rate of PTSD among adolescents admitted to inpatient mental health units, yet there is a lack of research regarding empirically supported treatments for this population. This study builds on Gudiño et al (2014) by exploring the implementation of an empirically supported treatment, TF-CBT, that includes an exposure component. As it is unknown that TF-CBT can be implemented in an adolescent inpatient unit, an uncontrolled open trial was conducted to explore this issue further.…”

Trauma and post-traumatic stress disorder among psychiatric inpatient children and adolescents

“…Despite the high prevalence and clinical significance of early recognition of trauma exposure and PTSD in mental health settings, currently there are few empirical data that shed light on the treatment implications in acute care: 40–50% of children and adolescents up to the age of 18 have been exposed to traumatic events and 6% suffer from PTSD. In psychiatric inpatients, the percentages are 46–96% and 21–29% respectively (Gudiño et al, 2014). Young people are also at risk of presenting with psychiatric symptoms, including anxiety, depression, delinquent behaviour, separation anxiety and self-harming behaviours (Havens et al, 2012).…”