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
population: Sixth-grade students who report exposure to violence and
symptoms of PTSD
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
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.
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.
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.
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
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
Link to program curriculum: http://store.cambiumlearning.com/cognitive-behavioral-intervention-for-trauma-in-schools/
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,
School-based, Anxiety Disorders/Symptoms, Depression/Mood Disorders,
Aggression/Violence/Externalizing Problems, Academic Achievement, Co-ed, Middle
School, Conduct/Disruptive Disorders, Adolescents, Children, Counseling/Therapy,
information last updated 3/16/07