Trauma-Focused Cognitive Behavioral Therapy Among Therapists Participating in Learning Collaboratives: Examining Two Implementation Strategies.

Abstract

Background: A Community-Based Learning Collaborative (CBLC) is a training/implementation package for evidence-based treatments (EBTs) involving multidisciplinary professionals to improve a community's response to trauma and the sustained adoption of EBTs. While CBLCs improve community-, organization-, and clinician-level factors for implementation and result in positive treatment outcomes, they require more investment than the standard Learning Collaborative (LC) model.

Objective: Research is needed to examine CBLC and LC treatment outcomes to inform decision-making on the selection of effective and cost-efficient training/ implementation packages. This study aims to address this gap by examining the impact of training type (CBLC vs LC) on TF-CBT outcomes.

Method: This study involved 441 community therapists participating in a TF-CBT LC (n=188) or CBLC (n=253). Analyses compared TF-CBT outcomes for 660 youth, ages 8-18.

Results: Mixed effect linear regressions with youth nested within therapists demonstrated no sample differences across models for child age or PTS at pre-treatment. Youth in the CBLC were more likely to be White, exhibit depressive symptoms at pre-treatment, and complete post-treatment assessments. Across both models, youth demonstrated significant decreases in PTS and depressive symptoms. The interaction of outcomes by training was not significant for depression, suggesting equivalent outcomes for the CBLC and LC. However, the significant interaction for PTS suggests the LC-trained therapists had better outcomes for youth than the CBLC.

Conclusions: The LC and CBLC for TF-CBT have similar effects on child depression, with the LC demonstrating more efficient results for the treatment of PTS. The multidisciplinary training within the CBLC may support accurate identification of depressive symptoms after a traumatic event as well as treatment retention.