Adjudicated youth have high rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) which place them at increased risk for future offending and incarceration. Few of these youth receive evidence-based developmentally appropriate PTSD treatment. This study proposes to evaluate two alternative strategies for training therapists to deliver a proven youth trauma treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to adjudicated youth in ten juvenile justice RTF programs in New England. All RTF programs will receive organizational readiness consisting of 1) novel integrated trauma training for RTF staff (direct care milieu staff, teachers and administrators) about trauma impact and how to support TF-CBT implementation in the RTF;and 2) PTSD assessment training for therapists. Randomization will then occur within each RTF program at the therapist level, to one of two TF-CBT delivery strategies: 1) Web-based TF-CBT Delivery ("W") in which therapists will receive web-based training and web-based consultation via the TF-CBTWeb and TF-CBTConsult distance learning programs;or 2) W+ Live ("W+L") in which therapists will receive W+ face-to-face 2-day expert TF-CBT training and ongoing twice monthly expert phone consultation and training to TF-CBT fidelity standards via audiotape rating. The study's central hypothesis is that W+L will lead to superior outcomes. However, based on cost- effectiveness analyses, W may be acceptable. The study will evaluate the differences in outcomes between the two strategies in terms of the following hypotheses: 1) fidelity: W+L strategy will lead to greater treatment fidelity and to youth receiving greater RTF staff support in TF-CBT delivery than W;several mechanisms are proposed for these differences;2) improved youth outcomes: W+L will lead to greater improvement in youth PTSD and depressive symptoms than W;and 3) broad and sustained TF-CBT uptake: more youth will receive TF-CBT from W+L than from W therapists;4) cost effectiveness: W may be acceptable due to cost effectiveness analyses.

Public Health Relevance

Adjudicated youth have high rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) but most have never received effective treatment. The purpose of this study is to test two alternative methods for training therapists to deliver an evidence- based trauma treatment to adjudicated youth with PTSD symptoms during residential treatment and therefore decrease their risk of future offending and incarceration.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-I (03))
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Chambers, David A
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Allegheny-Singer Research Institute
United States
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Cohen, Judith A; Scheid, Jeanette; Gerson, Ruth (2014) Transforming trajectories for traumatized children. J Am Acad Child Adolesc Psychiatry 53:9-13
Ritvo, Rachel Z; Cohen, Judith A (2013) Past imperfect, future tense: psychotherapy and child psychiatry. J Am Acad Child Adolesc Psychiatry 52:891-3