Abstract
Background
In order to develop Stepped Care trauma-focused cognitive behavioral therapy (TF-CBT), a definition of early response/non-response is needed to guide decisions about the need for subsequent treatment.
Objective
The purpose of this article is to (1) establish criterion for defining an early indicator of response/non-response to the first step within Stepped Care TF-CBT, and (2) to explore the preliminary clinical utility of the early response/non-response criterion.
Method
Data from two studies were used: (1) treatment outcome data from a clinical trial in which 17 young children (ages 3–6 years) received therapist-directed CBT for children with posttraumatic stress symptoms (PTSS) were examined to empirically establish the number of PTSS to define early treatment response/non-response; and (2) three case examples with young children in Stepped Care TF-CBT were used to explore the utility of the treatment response criterion.
Results
For defining the responder status criterion, an algorithm of either three or fewer PTSS on a clinician-rated measure or being below the clinical cutoff score on a parent-rated measure of childhood PTSS, and being rated as improved, much improved or free of symptoms functioned well for determining whether or not to step up to more intensive treatment. Case examples demonstrated how the criterion were used to guide subsequent treatment, and that responder status criterion after Step One may or may not be aligned with parent preference.
Conclusion
Although further investigation is needed, the responder status criterion for young children used after Step One of Stepped Care TF-CBT appears promising.
Similar content being viewed by others
References
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for ASEBA preschool-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Almirall, D., Compton, S. N., Gunlicks-Stoessel, M., Duan, N., & Murphy, S. A. (2012). Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy. Statistics in Medicine, 31(17), 1887–1902.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders text revision (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: Access, effectiveness and efficiency. Narrative literature review. The British Journal of Psychiatry: The Journal of Mental Science, 186, 11–17. doi:10.1192/bjp.186.1.11.
Briere, J. (2005). Trauma Symptom Checklist for Young Children: Professional manual. Lutz, FL: Psychological Assessment Resources Inc.
Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, J., Gil, E., et al. (2001). The Trauma Symptom Checklist for Young Children (TSCYC): Reliability and association with abuse exposure in a multi-site study. Child Abuse and Neglect, 25(8), 1001–1014.
Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review, 32(10), 1291–1299. doi:10.1016/j.childyouth.2010.04.021.
Caporino, N. E., Brodman, D. M., Kendall, P. C., Albano, A. M., Sherrill, J., Piacentini, J., et al. (2013). Defining treatment response and remission in child anxiety: Signal detection analysis using the pediatric anxiety rating scale. Journal of the American Academy of Child and Adolescent Psychiatry, 52(1), 57–67. doi:10.1016/j.jaac.2012.10.006.
Carrion, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2), 166–173. doi:10.1097/00004583-200202000-00010.
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402. doi:10.1097/00004583-200404000-00005.
Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35(1), 42–50. doi:10.1097/00004583-199601000-00011.
Cohen, J., & Mannarino, A. P. (2008). Disseminating and implementing trauma-focused CBT in community settings. Trauma, Violence and Abuse, 9(4), 214–226.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press.
Collins, L. M., Murphy, S. A., & Bierman, K. L. (2004). A conceptual framework for adaptive preventive interventions. Prevention Science, 5(3), 185–196.
Collins, L. M., Murphy, S. A., & Strecher, V. (2007). The multiphase optimization strategy (MOST) and the sequential multiple assignment randomization trial (SMART): New methods for more potent eHealth Intervention. American Journal of Preventive Medicine, 32(5 Suppl), S112–S118. doi:10.1016/j.amepre.2007.01.022.
Deblinger, E., Stauffer, L. B., & Steer, R. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4), 332–343.
Egger, H. L., Erkanli, A., Keeler, G., Potts, E., Walter, B. K., & Angold, A. (2006). Test–retest reliability of the preschool age psychiatric assessment (PAPA). Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 538–549. doi:10.1097/01.chi.0000205705.71194.b8.
Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10(1), 5–25.
Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., et al. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48(9), 851–855.
Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., et al. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806–813. doi:10.1037/a0025933.
Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Washington, DC: US Department of Health, Education, and Welfare.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.
King, N. J., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., et al. (2000). Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39(11), 1347–1355. doi:10.1097/00004583-200011000-00008.
Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Murphy, S. A. (2012). A “SMART” design for building individualized treatment sequences. Annual Review of Clinical Psychology, 8, 21–48. doi:10.1146/annurev-clinpsy-032511-143152.
Levendosky, A. A., Huth-Bocks, A. C., Semel, M. A., & Shapiro, D. L. (2002). Trauma symptoms and preschool-age children exposed to domestic violence. Journal of Interpersonal Violence, 17(2), 150–164. doi:10.1177/0886260502017002003.
Lieberman, A. F., Van Horn, P., & Ippen, C. G. (2005). Toward evidence-based treatment: Child–parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241–1248. doi:10.1097/01.chi.0000181047.59702.58.
National Institute of Mental Health. (1985). Clinical Global Impressions Scale. Psychopharmacology Bulletin, 21, 839–843.
National Vital Statistics System, Centers for Disease Control. (2013). Leading causes of death report, 2010. Retrieved from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html.
Salloum, A., Robst, J., Scheeringa, M. S., Cohen, J. A., Wang, W., Murphy, T. K., et al. (2014a). Step one within stepped care trauma-focused cognitive behavioral therapy for young children: A pilot study. Child Psychiatry and Human Development, 45(1), 65–77. doi:10.1007/s10578-013-0378-6.
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Amaya-Jackson, L. (2009). Stepping together: Parent-child workbook for young children after trauma, version 1.2 (unpublished).
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014b). Development of stepped care trauma-focused cognitive-behavioral therapy for young children. Cognitive and Behavioral Practice, 21(1), 97–108. doi:10.1016/j.cbpra.2013.07.004.
Scheeringa, M. S., Amaya-Jackson, L., & Cohen, J. (2008). Preschool PTSD treatment manual, version 1.4. New Orleans, LA: Tulane Institute of Infant & Early Childhood Mental Health.
Scheeringa, M. S., & Haslett, N. (2010). The reliability and criterion validity of the diagnostic infant and preschool assessment: A new diagnostic instrument for young children. Child Psychiatry and Human Development, 41(3), 299–312. doi:10.1007/s10578-009-0169-2.
Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011a). Trauma-focused cognitive–behavioral therapy for posttraumatic stress disorder in three-through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry and Allied Disciplines, 52(8), 853–860.
Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37(3), 508–518. doi:10.1080/15374410802148178.
Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011b). PTSD in children and adolescents: Toward an empirically based algorithm. Depression and Anxiety, 28, 770–782.
Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561–570. doi:10.1097/01.chi.0000046822.95464.14.
Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 44(9), 899–906. doi:10.1097/01.chi.0000169013.81536.71.
Sigel, B. A., Benton, A. H., Lynch, C. E., & Kramer, T. L. (2013). Characteristics of 17 statewide initiatives to disseminate trauma-focused cognitive–behavioral therapy (TF-CBT). Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 323–333.
Storch, E. A., Lewin, A. B., De Nadai, A. S., & Murphy, T. K. (2010). Defining treatment response and remission in obsessive–compulsive disorder: A signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 708–717. doi:10.1016/j.jaac.2010.04.005.
Stover, C. M., & Berkowitz, S. (2005). Assessing violence exposure and trauma symptoms in young children: A critical review of measures. Journal of Traumatic Stress, 18, 707–717. doi:10.1002/jts.20079.
The Research Unit on Pediatric Psychopharmacology Anxiety Study Group (RUPP). (2001). Fluvoxamine for the treatment of anxiety disorders in children and adolescents. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group. New England Journal of Medicine, 344(17), 1279–1285. doi:10.1056/nejm200104263441703.
Thurston, I. B., & Phares, V. (2008). Mental health service utilization among African American and Caucasian mothers and fathers. Journal of Consulting and Clinical Psychology, 76(6), 1058–1067. doi:10.1037/a0014007.
Tolin, D. F., Diefenbach, G. J., & Gilliam, C. M. (2011). Stepped care versus standard cognitive–behavioral therapy for obsessive-compulsive disorder: A preliminary study of efficacy and cost. Depression and Anxiety, 28, 314–323.
U.S. Department of Health and Human Services. (2012). Child maltreatment 2011. http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2011.
van der Leeden, A. J., van Widenfelt, B. M., van der Leeden, R., Liber, J. M., Utens, E. M., & Treffers, P. D. (2011). Stepped care cognitive behavioural therapy for children with anxiety disorders: A new treatment approach. Behavioural and Cognitive Psychotherapy, 39(1), 55–75. doi:10.1017/s1352465810000500.
Zero to Three: National Center for Clinical Infant Programs. (1994). Diagnostic classification: 0–3. Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Washington, DC: Zero to Three: National Center for Clinical Infant Programs.
Acknowledgments
The preparation of this article was supported in part by the National Institute of Mental Health Grant R34MH092373 awarded to Alison Salloum, Ph.D., University of South Florida and 5R34MH070827 awarded to Michael S. Scheeringa, M.D., MPH, Tulane University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The authors would like to thank the Crisis Center of Tampa Bay, where the Stepped Care TF-CBT study treatment is currently underway, and Victoria Swaidan, B.A, the research assistant for the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salloum, A., Scheeringa, M.S., Cohen, J.A. et al. Responder Status Criterion for Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children. Child Youth Care Forum 44, 59–78 (2015). https://doi.org/10.1007/s10566-014-9270-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-014-9270-1