A substantial body of research has found child sexual assault to be prevalent and associated with both acute and long-term psychosocial problems. In response to this significant need, two very similarly structured cognitive behavioral interventions were developed to treat the symptoms often experienced by sexually abused children. These protocols have been combined and labeled Trauma-Focused-Cognitive Behavioral Therapy (TF-CBT). Thus far, five major studies by two clinical research groups have provided substantial empirical support for the efficacy of this intervention for sexually abused children with clinically significant posttraumatic stress symptoms (Cohen, Deblinger, Mannarino, & Steer, 2004; Cohen & Mannarino, 1996, 1998; Deblinger et al., 1996, 1999, 2001). However, no study has examined its effectiveness when used in community-based mental health agencies. There is a growing emphasis on the importance of evaluating the effectiveness of evidence-based interventions and identifying critical factors related to successful dissemination, implementation, adoption, and sustained use of evidence-based practices in front-line clinical settings. The primary focus of this pilot study is to begin to meet this deficit in our knowledge by evaluating therapist fidelity to the TF-CBT protocol across two different methods of training and implementation within a community mental health agency using a multiple baseline design. This pilot study will provide valuable feasibility data in preparation for a larger-scale randomized clinical trial (R-01) that will examine the effectiveness of this intervention. The proposed pilot project directly addresses the priority areas identified by leading researchers and the NIMH Advisory Council's """"""""Blueprint for Change: Research on Child and Adolescent Mental Health"""""""" (NIMH, 2000) by (1) utilizing a treatment with demonstrated efficacy; (2) examining the feasibility of transporting an empirically supported treatment (EST) to a community-based setting; and (3) isolating different methods of therapist training that may improve treatment fidelity and thus facilitate successful transportability. In addition, this project is directly in line with priorities discussed in the final report of the President's New Freedom Commission on Mental Health (2003), more specifically, the Nation's need for a more effective system to identify, disseminate, implement and evaluate evidence based treatments. This three-year pilot study comprises four primary conditions: (1) assessment of treatment as usual (TAU), which will serve as a historical control condition; (2) workshop training in the TF-CBT protocol; (3) supervision, which will be initiated 6 months following workshop training and introduced via multiple-baseline design, staggered across clinicians; and (4) withdrawal of supervision. Multiple baseline design will examine clinicians' fidelity to the treatment protocol across the four study conditions. Pilot data derived from this study will be used for a planned, large scale, multi-site clinical trial (R01) to examine the effectiveness of this empirically supported intervention for children with problems related to sexual abuse.
