Implementing CBT for Traumatized Children and Adolescents After September 11: Lessons Learned from the Child and Adolescent Trauma Treatments and Services (CATS) Project

Abstract

The Child and Adolescent Trauma Treatments and Services Consortium (CATS) was the largest youth trauma project associated with the September 11 World Trade Center disaster. CATS was created as a collaborative project involving New York State policymakers; academic scientists; clinical treatment developers; and routine practicing clinicians, supervisors, and administrators. The CATS project was established to deliver evidence-based cognitive-behavioral trauma treatments for children and adolescents affected by the September 11 terrorist attack in New York City and to examine implementation processes and outcomes associated with delivery of these treatments. Referrals were obtained on 1,764 children and adolescents; of these, 1,387 were subsequently assessed with a standardized clinical battery and 704 found to be eligible for services. Ultimately 700 youth participated in the project. Treatments were delivered in either school or clinic settings by clinicians employed in 9 provider organizations in New York City. All participating clinicians were trained on the cognitive behavioral therapy models by the treatment developers and received case consultation for 18 months by expert clinician consultants and the treatment developers. The challenges of mounting a large trauma treatment project within routine clinical practices in the aftermath of a disaster and simultaneously evaluating the project have been significant. We outline the major challenges, describe strategies we employed to address them, and make recommendations based on critical lessons learned.

Child Sexual Abuse

“…68,72,73 Recent RCTs, quasi-experimental trials, and open trials included children exposed to multiple traumatic events. 74–76 There is also a growing body of literature on the implementation of TF-CBT for youth with ongoing traumas. 77–79 TF-CBT has been adapted and used effectively with a variety of populations including Latino youth, 80 Native American youth, 81 and orphans and vulnerable children in Zambia.…”

Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children

“…In fact, in a recent study of 262 clinicians providing treatment to maltreated children, TF-CBT was the most widely used evidence-based treatment (Allen, Gharagozloo, & Johnson, 2012). By using a method such as TF-CBT that is well into the dissemination phase of treatment development (e.g., CATS Consortium, 2007) in a stepped care model, training therapists on the implementation of Stepped Care TF-CBT may not take as long as it would if a completely new treatment method were being provided. However, training for Step One on how to implement the parent-led therapist-assisted treatment needed to occur even for those therapists already trained in Preschool PTSD Treatment (Scheeringa et al, 2011) and TF-CBT.…”

How do components of evidence-based psychological treatment cluster in practice?

“…Such adaptation appears ubiquitous (Blasinski, Goldman, & Unutzer, 2006;CATS Consortium, 2007;Palinkas et al, 2008;Ringwalt et al, 2003). Empirically supported treatments are not 100% successful, nor are they tested across all populations (Simon & Perlis, 2010).…”