Child and parent secondary outcomes in stepped care versus standard care treatment for childhood trauma

Introduction: Stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) is comparable in efficacy to standard TF-CBT for child posttraumatic stress symptoms (PTSS), but less is known about the effectiveness of SC-TF-CBT on child and parent secondary outcomes. The aim of this community-based randomized clinical trial was to compare child-and caregiver-secondary outcomes among SC-TF-CBT versus TF-CBT participants. Methods: Children (ages 4 to 12) with PTSS and their caregivers were randomly assigned to either SC-TF-CBT (n = 91) or TF-CBT (n = 92). Secondary child (internalizing and externalizing behavior problems, anger outburst and sleep disturbances) and parent outcomes (PTSS, depression symptoms, and parenting stress) were measured at baseline, post-treatment and 6- and 12-month follow-up. Results: There were comparable changes at all-time points in child and caregiver secondary outcomes. Non-inferiority tests indicated that for completers and intent-to-treat samples, SC-TF-CBT was non-inferior to TF-CBT for all outcomes except parenting stress at 6-months. The analysis with completers did not support non-inferiority at post-treatment for internalizing and externalizing problems and at 6-and 12-month follow-up assessments for externalizing problems, but the intent-to-treat analysis did support non-inferiority. Limitations: Limitations included modest rates of attrition, excluding in vivo component for standard TF-CBT, parent-only assessments, and no control condition. Conclusions: SC-TF-CBT is an effective alternative treatment method although parents with high stress may need more support and children with externalizing problems may need more standard TF-CBT sessions.

Automated summary

This study compared the effectiveness of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) and standard TF-CBT on child and parent secondary outcomes. The results showed that there were similar changes in child and caregiver secondary outcomes at all-time points. The non-inferiority tests indicated that SC-TF-CBT was non-inferior to TF-CBT for all outcomes except parenting stress at 6-months. However, the analysis with completers did not support non-inferiority for some outcomes, while the intent-to-treat analysis did support non-inferiority.