SUCCESSFUL STRATEGIES FOR TREATING TRAUMATIZED CHILDREN IN CHALLENGING CIRCUMSTANCES

ABSTRACT

Objectives: The COVID-19 pandemic highlights behavioral health disparities that impact low-resource communities and make it challenging to provide evidence-based treatments to children in these settings. This Symposium presents successful strategies and data for implementing an evidence-based trauma treatment, trauma-focused CBT (TF-CBT) for children in low-resource and otherwise challenging settings. Methods: Rosaura Orengo-Aguayo, PhD, describes partnership and adaptation strategies for implementing TF-CBT in postdisaster Puerto Rico. Regan Stewart, PhD, describes strategies for implementing TF-CBT via telehealth in schools or homes. Aubrey R. Dueweke, PhD, describes strategies for implementing TF-CBT in El Salvador, and Shannon Dorsey, PhD, describes treatment outcomes and acceptability among traumatized bereaved children in Africa randomized to receive TF-CBT or usual care (UC) when training, supervision, and treatment were provided by experienced local lay counselors. All studies used the Child PTSD Symptom Scale for DSM-5 (CPSS) to evaluate improvement in PTSD symptoms from before to after TF-CBT treatment. Results: A total of 31 children in postdisaster Puerto Rico experienced large improvement in their PTSD symptoms (d = 1.94), and 70 children receiving TF-CBT via telehealth experienced significant improvement in their PTSD (d = 2.23), with low dropout rates (11.4%). A total of 121 Salvadoran children experienced significant improvement in their PTSD (d = 2.04). At posttreatment in 3 of 4 African settings, children receiving TF-CBT experienced significantly greater improvement in PTSD than those receiving UC with high acceptability;at 1-year follow-up, children in the 2 settings with greater adversities who had received TF-CBT continued to experience significantly greater improvement than those who had received UC. Marilyn B. Benoit, MD, discusses the clinical, public health, and research implications of these findings. Conclusions: Successful implementation strategies can lead to positive outcomes for trauma-impacted children receiving TF-CBT in a variety of low-resource settings. PTSD, EBP, R