Research That Matters (January 17 - 20, 2008)

Purpose: Eighteen months after the September 11th Disaster at the World Trade Center (WTC), the Child and Adolescent Trauma Treatments and Services (CATS) Consortium evaluated the impact of trauma-focused cognitive behavioral therapies (TF-CBT) on youth affected by the disaster and other traumatic events. Despite elevated rates of mental health disorders city-wide following 9/11, only a small proportion of youth had sought or received any services from a mental health professional. Consequently, evidence-based strategies to promote engagement and prevent premature termination were integrated into CATS TF-CBT services. Authors present descriptive results regarding the mental health needs, initial engagement, and retention of youth in a large-scale effectiveness study of CATS TF-CBT. Methods: Clinicians, supervisors, and staff at nine participating community child mental health center sites were trained to deliver TF-CBT treatment (1-37 sessions) for traumatized youth and to employ evidence-based engagement strategies. Key features of engagement provider training focused on (1) evidence-based phone contact and initial interview engagement skills; (2) evaluating the effects of new engagement procedures; and (3) fostering providers' ability to form collaborative working relationships with adult caregivers and youth (McKay, Hibbert, Hoagwood, Rodriguez, Murray, Legerski, & Fernandez, 2004). Study participants (n = 445) were recruited (non-random) via outreach presentations to disaster-specific trauma service providers, non-disaster related mental health providers, as well as through referrals from the participating sites. Primary inclusion criteria included children aged 5-19 having any WTC disaster exposure (based on a 32 item-survey reflecting direct, indirect, secondary, and media exposure to 9/11 attacks), and who manifested a score of on the UCLA PTSD Reaction Index (Pynoos et al., 1998). Participation in TF-CBT treatment was tracked via contact logs and case completion forms. Show rates for pretreatment and treatment were obtained by dividing the number of valid “shows” for pretreatment and treatment visits by the number of total possible contacts. Results: Overall, 56% of youth experienced high impact WTC disaster exposure (range: 40-82%). PTSD symptom severity scores averaged 36 (range: 32-40). These scores approach clinical significance for a full PTSD diagnoses (PTSD score = 38). Show rates for pretreatment engagement, intake, and assessment visits were over 79%. Treatment attendance rates were over 88% across the nine sites. More importantly, over 85% (n = 394) of youth eligible for CATS TF-CBT received some level treatment. Over two-thirds received the minimum number of sessions to detect meaningful effects (e.g. 8 or more sessions) or the optimal course of treatment (e.g. 12 or more sessions). Conclusions: Results indicated that show-rates for both initial assessment and subsequent treatment appointments were well above previously estimated levels of treatment utilization in general (e.g. 25-50%; Lerman & Pottick, 1995; Kazdin, 1993), and estimated levels of treatment utilization for children following traumatic events (e.g. 6.8-22%; Hoven, et al., 2002; Stuber et al., 2002; DeVries et al, 1999; Pfefferbaum, Call, & Sconzo, 1999). Results suggest that integrating systematic strategies for engagement can improve service utilization for evidence-based treatments in children's mental health. Moreover, engagement strategies can substantially increase service use for treatment following traumatic events.