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"Deblinger, Esther"
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Trauma-focused CBT for children and adolescents : treatment applications
\"Since the publication of Cohen et al.'s authoritative Treating Trauma and Traumatic Grief in Children and Adolescents, trauma-focused cognitive behavioral therapy (TF-CBT) has become the leading empirically supported treatment for children exposed to traumatic life events. This book featuring a wealth of clinical examples describes ways that TF-CBT is being applied in a range of contexts and with diverse populations. Experienced clinicians provide specific recommendations for effectively implementing the approach in schools, foster care, and residential and international settings; incorporating play strategically; and tailoring TF-CBT for adolescents with complex trauma, children with developmental challenges, military families, and Latino and Native American children\"-- Provided by publisher.
Disseminating Trauma-Focused Cognitive Behavioral Therapy with a Systematic Self-care Approach to Addressing Secondary Traumatic Stress: PRACTICE What You Preach
by
Cooper, Beth
,
Steer, Robert A.
,
Deblinger, Esther
in
Activities of daily living
,
Augmentation
,
Behavior modification
2020
This pilot study evaluated the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training programs augmented with a systematic “PRACTICE What You Preach” (PWYP) self-care focus, which has trainees personally utilize the coping skills they teach their clients. Participants were 115 clinicians/supervisors who completed a PWYP TF-CBT training program. Pre- to post-training analyses documented significant increases in participants’ competency and fidelity in implementing TF-CBT (
p
s < .001), significantly more frequent use of coping skills including instrumental social support (
p
< .01), active coping (
p
< .001), humor (
p
< .01), and restraint (
p
< .01), and significant decreases in secondary traumatic stress (STS;
p
< .001). Children’s symptoms of PTSD (
p
s < .001) and behavior problems (
p
< .05) also decreased significantly. This preliminary evidence suggests that training augmented with PWYP may enhance clinicians’/supervisors’ personal coping and reduce their levels of STS without compromising treatment implementation efforts and client outcomes.
Journal Article
Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions
by
Lenert, Leslie A
,
Nemeth, Lynne S
,
Higgins, Kristen A
in
Barriers
,
Caregivers
,
Cognitive ability
2021
BackgroundHomework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions.MethodsSemi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n = 21) and youth TF-CBT patients ages 8–17 (n = 15) and their caregivers (n = 12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers.ResultsThe results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities).ConclusionsThis study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.
Journal Article
Engaging Ukrainian TF-CBT therapists in a PRACTICE skills course to support their wellbeing
by
Cooper, Beth
,
Harrison, Julie P.
,
Garbade, Maike
in
Adaptation, Psychological
,
Adult
,
Behavior modification
2025
Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.
The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of war in Ukraine. Specifically, this study examined if course participation was associated with increased PRACTICE coping skills usage, decreased burnout and STS, increased feelings of TF-CBT competency/confidence, and increased empathy for clients' experiences when implementing the skills.
The eight-session virtual course included cultural adaptations to increase its compatibility with Ukrainian culture. Thirteen matched pre-post course surveys were analysed to provide preliminary data on the course's effect on PRACTICE coping skills usage, burnout, and STS. The course's impact on therapist coping/wellbeing, TF-CBT competency/confidence, and empathy for clients was also examined qualitatively.
PRACTICE coping skills were utilized significantly more frequently at post-course compared to pre-course (
= .010). Therapists also reported lower average scores for burnout and STS after course completion, though these changes were not statistically significant. Most participants (92.3%) reported professional benefits from course participation including increased competency/confidence and empathy for clients. All therapists (100%) reported personal benefits from course participation including increased use of coping skills.
Results indicate that participants experienced professional and personal benefits from course completion. This study provides helpful preliminary evidence of a positive impact, however, given the small sample size, larger scale implementation is needed.
Journal Article
Trauma-focused cognitive behavioural therapy for young children: clinical considerations
by
Deblinger, Esther
,
Pollio, Elisabeth
in
Addictive behaviors
,
Behavior modification
,
Caregivers
2017
Trauma-focused Cognitive Behavioural Therapy (TF-CBT) has been utilized with children of a wide age range and with diverse trauma experiences. This article will focus on the application of TF-CBT to young children. After presenting an overview of the model, challenges and developmentally-sensitive and creative strategies for engaging young children and their caregivers in TF-CBT PRACTICE components will be highlighted. A brief review of the strong empirical support for TF-CBT will then be provided.
Journal Article
Evaluation of the feasibility and effectiveness of trauma-focused cognitive behavioural therapy for children and youth in Ukraine during the war
by
Birgersson, Anette
,
Onsjö, Marja
,
Beer, Renée
in
Caregivers
,
Children & youth
,
Cognitive behavioral therapy
2025
BackgroundThe large-scale Russian invasion of Ukraine in early 2022 resulted in a humanitarian crisis with hundreds of thousands of children exposed to traumatic events. To date, trauma-focused evidence-based treatments (EBTs) for children and youth have not been systematically evaluated and implemented in Ukraine. This study aims at evaluating 1) the feasibility of a training program for Ukrainian therapists on Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and 2) the feasibility and effectiveness of the treatment for children, youth, and their families in and from Ukraine during the ongoing war.MethodsThe project “TF-CBT Ukraine” was implemented between March 2022 and May 2024, in close collaboration with local and international partners. Therapists completed questionnaires before/after the training, and patients were asked to complete a measure on PTSD before and after treatment.ResultsAltogether 138 therapists started the training program and 44.9% were certified as TF-CBT therapists. The program completers reported overall high satisfaction with the training program, a positive change in their attitude towards EBTs and trauma-related knowledge gain. The patients (age 3–21, 37% male) reported significant improvement in symptoms of PTSD at the end of treatment with large pre-post effect sizes for DSM-5 PTSD (dselfreport = 2.36; dcaregiverreport = 2.27), ICD-11 PTSD (dselfreport = 1.97; dcaregiverreport = 1.77), ICD-11 CPTSD (dselfreport = 2.04; dcaregiverreport = 1.99), and DSM-5 pre-school PTSD (dcaregiverreport = 3.14).ConclusionsThe results of this study are promising in regard to the general implementation of trauma-focused EBTs in active conflict areas. Future studies need to replicate these findings in a randomized controlled study design.
Journal Article
Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
by
Thompson, Kelly
,
Berliner, Lucy
,
Pullmann, Michael D.
in
Behavioral health
,
Children’s mental health
,
Clinical coding
2018
Background
Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials.
Methods
Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels.
Results
Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level.
Conclusions
Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness.
Trial registration
NCT01800266
, Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results])
Journal Article
Implementation of an evidence-based trauma-focused treatment for traumatised children and their families during the war in Ukraine: a project description
by
Birgersson, Anette
,
Onsjö, Marja
,
Beer, Renée
in
Adolescent
,
Child
,
Cognitive Behavioral Therapy - methods
2023
The full-scale invasion of Ukraine by Russia in February 2022 led to an increase of traumatic events and mental health burden in the Ukrainian general population. The (ongoing) traumatisation can have a crucial impact on children and adolescents as they are especially vulnerable for developing trauma-related disorders such as Post Traumatic Stress Disorder (PTSD) or Depression. To date, these children have only very limited access to trauma-focused evidence-based treatments (EBTs) by trained mental health specialists in Ukraine. The fast and effective implementation of these treatments in Ukraine is crucial to improve the psychological wellbeing of this vulnerable population. This letter to the editor describes an ongoing project which implements a trauma-focused EBT called 'Trauma-Focused Cognitive Behavioural Therapy' (TF-CBT) in Ukraine during the war. In collaboration with Ukrainian and international agencies, the project 'TF-CBT Ukraine' was developed and implemented starting in March 2022. The project entails a large training programme for Ukrainian mental health specialists and the implementation of TF-CBT with children and their families in and from Ukraine. All components of the project are scientifically evaluated on a patient and therapist level, cross-sectionally and longitudinally, in a mixed-methods design. All together nine training cohorts with N = 133 Ukrainian therapists started the programme, all monthly case consultations (15 groups) and treatments of patients are still ongoing. Lessons learnt from this first large-scale implementation project on an EBT for children and adolescents impacted by trauma in Ukraine will help inform the field on challenges and also possibilities to expand such efforts. On a broader level, this project could be one small step in the process of helping children overcome the negative effects and experience resilience in the context of a war-torn nation.
Journal Article
Child Sexual Abuse
by
Deblinger, Esther
in
Adolescent Psychiatry -- methods
,
Child Abuse, Sexual
,
Child Psychiatry -- methods
2015
Based on over 25 years of research supported by grants from the National Institute of Mental Health (NIMH), the National Center on Child Abuse and Neglect (NCCAN), and other funding sources, Child Sexual Abuse describes a premier empirically supported treatment approach for children, adolescents, and non-offending parents/caregivers impacted by child sexual abuse.
TF-CBT Training Augmented with a Self-Care Focus: Understanding Facilitators and Barriers to Treatment Implementation
2023
Clinicians working with youth exposed to trauma may be at increased risk for experiencing elevated levels of stress and symptoms of secondary traumatic stress, which can negatively impact clinician wellbeing and ultimately contribute to reduced access to quality care for clients. An innovative Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training incorporating self-care practices (i.e., Practice What You Preach; PWYP) was developed to help facilitate the implementation of TF-CBT and to enhance clinicians’ coping and decrease stress. The primary purpose of this study was to determine whether the PWYP-augmented training met three Objectives: (1) increase clinicians’ feelings of TF-CBT competency; (2) improve clinicians’ coping abilities/reduce clinicians’ stress; and (3) increase clinicians’ insight into the benefits and/or challenges clients may experience in treatment. An exploratory aim was also developed to identify additional facilitators and barriers of TF-CBT implementation. The written reflections of 86 community-based clinicians who participated in the PWYP-augmented TF-CBT training were examined using qualitative methods. The majority of clinicians indicated increased feelings of competency and improved coping abilities and/or stress levels; almost half mentioned increased insight into clients’ experiences. The most frequently mentioned additional facilitators were related to elements of the TF-CBT treatment model. Anxiety/self-doubt was the barrier most frequently mentioned, though all clinicians who mentioned this barrier indicated it lessened or resolved over the course of the training. Incorporating self-care strategies into trainings may serve as a facilitator for TF-CBT implementation by enhancing the competency and well-being of clinicians. The additional insights into barriers and facilitators can be used to further improve the PWYP initiative and future training and implementation efforts.
Journal Article