Trauma Systems Therapy: 15-Month Outcomes and the Importance of Effecting Environmental Change

This study tracked the clinical course of 124 children receiving trauma systems therapy (TST). In addition, exploratory analyses compared hospitalization rates before and after implementation of the model and comparative cost savings were estimated. Children ages 3-20 who experienced potentially traumatic events received TST intervention. Measures of clinical course, children's psychiatric and psychosocial functioning, and social-environmental stability were taken at intake, 4-6 months, and 12-15 months. Exploratory analyses of cost savings were evaluated by comparing pre- and post-implementation hospitalization rates and lengths of stay for children under the care of the county mental health department. Emotion regulation, social-environmental stability, and child functioning/strengths improved significantly with treatment. Improvement in child functioning/strengths and in social-environmental stability significantly contributed to overall improvement in emotion regulation. Children who became stable enough to transition to office-based services during early treatment tended to stay in treatment and continued to improve. The number of children needing crisis-stabilization services at 15 months was reduced more than half for those who completed treatment. Poorer baseline emotion regulation was associated with hospitalization, and poorer social-environmental stability predicted fewer days-to-hospitalization. Exploratory analyses show that post-implementation hospitalization rates dropped 36% and average length of stay decreased by 23%, suggesting that further exploration of potential cost savings is warranted. These findings underscore the clinical importance of intervention and long-term treatment to stabilize the social environment of children and adolescents with posttraumatic stress, and emphasize the potential cost effectiveness of an intensive, community-based treatment approach at the county level.