Implementing Trauma Focused-Cognitive Behavioral Therapy for Youth under Probation: Lessons Learned

Abstract

OBJECTIVE: The implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) for youth under probation is underresearched. Since a TF-CBT project implementation goal was not met, the author aimed to address the following questions: What were the unaddressed barriers to TF-CBT participation and completion? What factors could have significantly impacted TF-CBT completion? Were the positive outcomes of TF-CBT on the project's proposed measures confirmed?  The author likewise aimed to capture the lessons from this project’s implementation.METHOD: Review of administrative documents focused on project set-up, flow of participation and TF-CBT completion to identify the barriers. Chart reviews included data for 54 out of 60 TF-CBT participants. Three TF-CBT youth groups were identified. TF-CBT with: no in vivo (C7, n = 12); four to six TF-CBT components, including trauma narration (C4-6, n = 13); and one to four components in phase I of TF-CBT (C1-4, n = 29). All statistical tests were set at p < .05. Groups were compared on demographics, pre-TF-CBT trauma and functioning, assessment and treatment services, justice involvement, and services satisfaction. Outcome measures were change scores on the UCLA Post Traumatic Stress Disorder Reaction Index, Youth Outcome Questionnaire and youth arrests.RESULTS: The unaddressed barriers could very well be due to youth’s low disclosure and development of trust and therapist’s skills. Significant between-groups difference in parental involvement (χ2 = 6.08, p < .05) and number of trauma events experienced (F = 3.58, p < .05); and significant decrease in overall trauma symptom scores before and after TF-CBT participation with a very large effect size in group C7 (t = 3.73, p < .001, d = 1.08) were found.LESSONS LEARNED: The therapists were possibly viewed by the youth as part of the police system (which justice involved youth likely do not trust). Future implementations must seriously consider: the need for sufficient training of therapists; waiving program eligibility requirements; the value of a coherent communications protocol, clinical quality review and management, early assessment of services satisfaction, and information on families of justice involved youth; and, tracking behaviors that are incompatible with those that warrant arrests.