Parents’ Perception of Stepped Care and Standard Care Trauma-Focused Cognitive Behavioral Therapy for Young Children

Abstract

Delivery systems other than in-office therapist-led treatments are needed to address treatment barriers such as accessibility, efficiency, costs, and parents wanting an active role in helping their child. To address these barriers, stepped care trauma focused-cognitive behavioral therapy (SC-TF-CBT) was developed as a parent-led, therapist-assisted therapy that occurs primarily at-home so that fewer in-office sessions are required. The current study examines caregivers’ perceptions of parent-led (SC-TF-CBT) and therapist-led (TF-CBT) treatment. Participants consisted of 52 parents/care-givers (25–68 years) of young trauma-exposed children (3–7 years) who were randomly assigned to SC-TF-CBT (n = 34) or to TF-CBT (n = 18). Data were collected at mid-and post-treatment via interviews inquiring about what participants liked, disliked, found most helpful, and found least helpful about the treatment. Results indicated that parents/caregivers favored relaxation skills, affect modulation and expression skills, the trauma narrative, and parenting skills across both conditions. The majority of parents/caregivers in SC-TF-CBT favored the at-home parent–child meetings and the workbook that guides the parent-led treatment, and there were suggestions for improving the workbook. Reported disliked and least helpful aspects of treatments were minimal across conditions, but themes that emerged that will need further exploration included the content and structure, and implementation difficulties for both conditions. Collectively, these results highlight the positive impact that a parent-led, therapist-assisted treatment could have in terms of providing caregivers with more tools to help their child after trauma and reduce barriers to treatment.

Feasibility of a Parent-led Stepped Care Trauma-focused Cognitive Behavioural Therapy for Children: a Mixed Methods Pilot Trial Protocol

“…Factors that have been found to predict outcomes include caregiver-therapist therapeutic alliance (32), child-perceived caregiver-support (94), the caregivers' mental health status and changes in caregivers' symptoms (95), and caregivers' social support (96). In addition, the quality of the childcaregiver working alliance is a factor that can be assumed to in uence outcome (27).…”

“…Caregivers have reported overall satisfaction with the treatment (16) and were equally satis ed with receiving stepped care TF-CBT and standard TF-CBT (27). However, about 1 out of 5 caregivers felt uncertain in their roles when leading meetings with the child (16) and about 15% found the parent-led approach to be the least helpful aspect of the stepped care treatment (27).…”

“…Caregivers have reported overall satisfaction with the treatment (16) and were equally satis ed with receiving stepped care TF-CBT and standard TF-CBT (27). However, about 1 out of 5 caregivers felt uncertain in their roles when leading meetings with the child (16) and about 15% found the parent-led approach to be the least helpful aspect of the stepped care treatment (27). This illustrates that caregivers and families differed in how suitable this parent-led model was, and more knowledge of enablers and barriers for parent-led treatment is necessary to better select and tailor appropriate treatment for individual families.…”

The role of context in the implementation of trauma-focused treatments: effectiveness research and implementation in higher and lower income settings

“…Research in HICs has focused on how clinician characteristics, such as profession, theoretical orientation, or years of experience, influence clinical outcome [27] and willingness to implement EBPs [28]. Some implementation efforts in HICs have attempted to broaden the umbrella of “treatment provider” by examining whether parents [29] can be trained to deliver components of TFTs effectively to children.…”

Integrating dialectical behaviour therapy into my clinical practice model as a northern social worker

“…Affective modulation and expression are trauma-focused CBT terms for the ability to identify, regulate, and appropriately express a range of emotional experiences (Salloum, Swaidan, Torres, Murphy, & Storch, 2016). In DBT, emotion regulation requires the insight and ability to observe, describe and appropriately express emotional experiences (Van Dijk, 2012).…”