Guide to Effective Programs
for Children and Youth

Cognitive-Behavioral Intervention for Trauma in Schools

OVERVIEW

The Cognitive-Behavioral Intervention for Trauma in Schools (CBITS), is a school-based intervention for reducing posttraumatic stress disorder (PTSD) and depression in school-aged children who have been exposed to violence. Prior research shows that children who have been exposed to violence are at high-risk of PTSD, depression, and behavioral problems. The 10-session program was designed to test the effectiveness of cognitive-behavioral group intervention in schools. Experimental evaluations 3 months after baseline show that, children in the intervention group showed significantly lower symptoms of PTSD, depression, and psychological dysfunction than children in the wait-list group. Neither group, however, showed a significant difference for teacher-reported problems such as acting out, shyness/anxiousness, and learning.

DESCRIPTION OF PROGRAM

Target population: Sixth-grade students who report exposure to violence and symptoms of PTSD

According to prior studies, children who have personally witnessed violence or directly experienced a violent event are more likely to have poor school performance, low IQ and reading ability, low grade point average, and school absences. The Cognitive-Behavioral Intervention for Trauma in Schools is aimed at reducing these symptoms of PTSD and depression in children who have been exposed to violence to improve their psychosocial functioning and classroom behavior. The groups most often met once a week. The 10 sessions includes a mix of didactic presentation, age-appropriate examples and games to solidify concepts, and individual work (i.e. worksheets) between sessions. The sessions addressed symptoms of PTSD, anxiety, and depression and were delivered by school mental health clinicians on school campuses. School clinicians were trained and supervised and worked from a manual but had flexibility to meet the needs of individual students.

EVALUATION(S) OF PROGRAM

Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W., Elliott, M.N., Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized control trial. Journal of the American Medical Association, 29(5), 603-611.

Evaluated population: 126 sixth grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had symptoms of posttraumatic stress disorder.

Approach: Students were eligible to participate in the intervention if they had experienced substantial exposure to violence, had symptoms of PTSD in the clinical range, and did not appear too disruptive. After baseline assessment, 126 students remained. Of this group, 61 were randomly assigned to the intervention group and 65 were randomly assigned to the wait-list delayed intervention. The wait-list group received the intervention 6 months after the initial intervention group.

Data were collected at baseline and 3 months after the intervention. After the 3-month data were collected, wait-list students received the intervention, and data were collected again six months after baseline. Students’ PTSD symptoms were evaluated using the Child PTSD Symptom Scale (CPSS). The CPSS asked children to rate how often they were bothered by each symptom in the past month. Symptoms of depression were assessed using the Child Depression Inventory (CDI). The CDI measured students' cognitive, affective, and behavioral symptoms of depression and the Pediatric Symptoms Checklist was used to rate the frequency of the student’s emotional and behavioral problems. Finally, the Teacher-Child Rating scale measured shyness/anxiousness, learning problems, and acting out behavioral problems.

Results: At baseline, students enrolled in the intervention group and wait-list group had significant levels of exposure to violence and posttraumatic stress disorder. The students did not show significant differences on the CPSS scale, CDI scale, or other baseline characteristics.

After 3-months, in the intervention group, students reported significantly fewer symptoms of PTSD than the wait-list group. The adjusted mean difference was –7.0. Of the intervention group, 86 percent reported lower scores of PTSD. The intervention group also reported lower symptoms of depression on the CDI. The adjusted mean difference for depression was –3.4. The parents of the students in the intervention group also reported less psychosocial dysfunction in their children (78 percent had fewer psychosocial problems). No differences were reported for teacher-reported classroom problems, shyness/anxiousness, and learning.

At the 6-month assessment, after both groups had received the intervention, the differences in symptoms and behaviors between the intervention group and the wait-list group were significantly smaller. Both groups showed similar PTSD, depression, psychosocial function, and teacher-reported ratings. Results show that a 10-session standardized cognitive-behavioral therapy can significantly reduce the symptoms of PTSD and depression in students exposed to violence. The intervention also decreases psychosocial dysfunction, but does not have a significant impact on classroom behavior.

SOURCES FOR MORE INFORMATION

Link to program curriculum: http://store.cambiumlearning.com/InitialSearchResults.aspx?searchtype=Basic&sorttype=Basic&Query=CBITS&criteria=0000&site=sw

References

Program categorized in this guide according to the following:

Evaluated participant ages: 11-12

Program age ranges in the Guide: 6-11, 12-14

Program components: counseling/therapy; school-based

Measured Outcomes: social and emotional health and development; behavioral problems; mental health

Program information last updated 3/16/07