Stepped care versus standard trauma-focused cognitive behavioral therapy for young children
Open accessAbstract
BACKGROUND: To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). METHODS: A total of 53 children (ages 3-7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. TRIAL REGISTRATION: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. RESULTS: There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. CONCLUSIONS: Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.
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Stepped-care and brief treatment adaptations of a transdiagnostic treatment like the UP allow for more efficient targeting of symptoms and may reduce financial and pragmatic barriers to care.
“Stepped-care and brief treatment adaptations of a transdiagnostic treatment like the UP allow for more efficient targeting of symptoms and may reduce financial and pragmatic barriers to care (Rapee et al., 2017, Salloum et al., 2016).”
From Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example (2021) · cites this paper as Salloum et al., 2016
The Introduction describes stepped care as using accessible, lower-cost first-line treatment and reserving intensive resources for patients who need them. The Discussion reports lower costs and fewer in-office visits for stepped-care TF-CBT. This paper studies trauma-focused CBT in young children, however, not a brief or transdiagnostic adaptation of the UP. (LLM, conf=0.86)
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- Authors
- Salloum, A., Wang, W., Robst, J., Murphy, T. K., Scheeringa, M. S., Cohen, J. A., & Storch, E. A.
- Affiliations
- University of South Florida (US)
- Tulane University (US)
- Allegheny General Hospital (US)
- Corresponding author
- Salloum, Alison
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2015-10-07
- Volume
- 57
- Issue
- 5
- Pages
- 614-622
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC4824681
- OpenAlex
- W1879940263
- Cited by
- 97
- References
- 29
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 13 · 2023: 13 · 2022: 12 · 2021: 9 · 2020: 15 · 2019: 9 · 2018: 5 · 2017: 4 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons - University of South Florida (University of South Florida) (submittedVersion)
- Funders
- National Institute of Mental Health (R34MH092373)
- Florida Agency for Health Care Administration
- International OCD Foundation
- National Institutes of Health
- Otsuka Pharmaceutical
- Pfizer
- F. Hoffman-La Roche
- Shire
- National Institute of Child Health and Human Development
- Substance Abuse and Mental Health Services Administration
- Janssen Pharmaceuticals
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- stepped care, trauma-focused cognitive behavioral therapy, posttraumatic stress symptoms, young children, post-traumatic stress disorder, service delivery, barriers to treatment, cost-effectiveness, internalizing problems, externalizing problems, parental satisfaction
- MeSH terms
- Child, Child, Preschool, Female, Humans, Male, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Outcome Assessment, Health Care
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