Parent-led treatment, with therapist support, can help children after trauma

A stepped care trauma-focused therapy where the first step includes a parent-led therapist-assisted treatment is an alternative way to deliver standard therapist-led treatment and is less costly

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, parent-led therapist-assisted treatment, a brief treatment empowering parents to help their child, is effective for many children and less costly than standard care.

"We need effective and less costly ways to deliver trauma-focused therapy to children in order to increase access and support parents in helping their children after trauma" said Alison Salloum, PhD, a professor in the School of Social Work at the University of South Florida, College of Behavioral and Community Sciences.

Many parents and caregivers experience barriers to access therapeutic care after their child suffers a traumatic event such as sexual abuse, witnessing domestic violence, or death of a parent. Barriers to treatment are numerous including cost, lack of specialized trauma therapists and associated long waitlists, and limited transportation. Stepped care interventions may address some of these treatment barriers.

Salloum and colleagues developed and tested a stepped care trauma-focused cognitive behavioral therapy (TF-CBT) protocol that includes a parent-led therapist-assisted treatment as step 1 within a stepped care model. Step 1 incorporates the knowledge of the effectiveness of TF-CBT for children with posttraumatic stress disorder (PTSD) based on the work of Scheeringa and associates (e.g., CBT for PTSD with preschool children) and Cohen and associates (e.g., TF-CBT). The second step, for children needing more intensive treatment, provides therapist-led evidence-based TF-CBT as step 2. Pilot studies and the current randomized clinical trial found that approximately 70% of children receiving step 1 improved and did not need step 2. Treatment acceptability was lower for parents in stepped care although expected improvements and treatment satisfaction was not different for parents in standard care. Overall results found that stepped care TF-CBT was comparable to standard therapist-led TF-CBT, and the cost was 38.4% lower than that of standard care, with recurring costs being 54.7% lower. However, another study suggests that some parents with high parenting stress or children with high externalizing problems may need more sessions.

In response to the new stepped care model results, Eric A. Youngstrom, PhD at the University of North Carolina at Chapel Hill, wrote an editorial about the study noting that "we need new models for providing care-methods that will accomplish more with the same resources, or change the scale of services and improve access. Salloum et al. offer an intriguing model that does that." He added, "Although it is not a complete solution, it is a major advance; and there are opportunities for us to apply some of these ideas in our own work, and not wait for other systems to implement stepped care."

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Research reported in this publication about stepped care TF-CBT was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH107522. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Notes for editors

The article is "Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial" Alison Salloum, PhD, Yuanyuan Lu, MS, Henian Chen, MD, PhD, Troy Quast, PhD, Judith A. Cohen, MD, Michael S. Scheeringa, MD, Kristen Salomon, PhD,

Eric A. Storch, PhD https://doi.org/10.1016/j.jaac.2021.12.013. It currently appears on the JAACAPArticles In Press page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 61, issue 8 (August 2022), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at [email protected] or +1 202 587 9674. Journalists wishing to interview the authors may contact Alison Salloum, PhD; e-mail: [email protected]

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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