Trauma-Focused Cognitive Behavioral Therapy in 13 Urban Public Schools: Mixed Methods Results of Barriers, Facilitators, and Implementation Outcomes

Abstract

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention to treat post-traumatic stress disorder among youth ages 3–18 years old. In this pilot study, 31 clinicians in 13 urban public schools received TF-CBT training to improve access to high-quality trauma treatment for youth in need. A mixed methods design was used to assess implementation barriers, facilitators, and outcomes to examine initial feasibility, acceptability, and appropriateness of TF-CBT delivered in school settings. Although 70% of clinicians reported confidence in the evidence-base of TF-CBT and its potential to support their students who have a very high prevalence of lifetime trauma exposure, implementation practice outcomes suggest a wide range of TF-CBT use (range = 0–11 students enrolled per clinician, mean = 1.4 students) with 23 clinicians implementing the TF-CBT model with at least one case. Results point to the potential value of training school mental health clinicians in TF-CBT based on its compatibility with student needs. Yet, by connecting focus group results to top-rated barriers and facilitators, we identify several adjustments that should be made to improve intervention-setting fit in future studies. Specifically, school setting-specific intervention adaptations, school-tailored implementation support, and thoughtful consideration of school-based clinicians’ roles and responsibilities are needed to enhance future implementation success.