Journal of the American Academy of Child & Adolescent Psychiatry
INVITED COLUMN: EVIDENCE-BASED PRACTICEImplementing an Evidence-Based Trauma Treatment in a State System After September 11: The CATS Project
Section snippets
CLINICAL CASE SCENARIO
Billy W., a 10-year-old boy from a multiethnic family, was referred to the Child and Adolescent Trauma Treatments and Services Consortium (CATS) of the New York State Office of Mental Health (OMH) in December 2003, when he was in grade 5. Since the death of his uncle in the World Trade Center (WTC) attacks on September 11, 2001, Billy was often tearful and “mad at the world,” according to his parents. His deceased uncle was the beloved brother of Mr. W. The family believed that the uncle had
BACKGROUND TO THE CATS PROJECT
Following the WTC attacks, an extensive screening survey was undertaken to assess mental health needs of New York City's school-age children (Hoven et al., 2003). This survey demonstrated that as many as 75,000 children in New York City (10.5%) had symptoms of posttraumatic stress disorder (PTSD) and high percentages of children reported other psychiatric symptoms including depression (8.4%), anxiety (12.3%), agoraphobia (15.0%), separation anxiety (12.3%), and conduct disorder (10.9%). Rates
IMPLEMENTATION ISSUES
The implementation challenges in this project were significant. Enlisting the acceptance of clinicians across the sites required intensive efforts by the OMH clinical and evaluation team and local supervisory staff plus extensive local site support through regular conference calls and site visits. Challenges included varying attendance on the consultation calls by site supervisors and clinicians, variations in acceptance of the protocol by site supervisors, and varying clinician experiences
Engagement
Because TF-CBT requires that youths and parents confront traumatic experiences, clinicians need active buy-in from parents and youths in the treatment and development of strong alliances. In this case, engagement was facilitated by referral from the family's trusted Project Liberty counselor. Consistent with our emphasis on engagement (McKay et al., 2001), the potential obstacle of the family's complex schedule was overcome for the assessment by scheduling it in late December to accommodate the
CONCLUSIONS
The CATS Consortium successfully created an infrastructure across 9 provider organizations and 45 sites. The infrastructure has facilitated efficiencies of effort and supported uniform provision of standardized assessments and manual-based EBP treatments to almost 600 children and adolescents and enabled a cross-site evaluation of implementation processes and outcomes to be conducted in the largest naturalistic services study for traumatized children ever. It is important to bear in mind the
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The CATS Consortium is a cooperative multisite treatment study performed by nine independent teams in collaboration with the New York State Office of Mental Health (OMH). The New York State collaborators are Kimberly Eaton Hoagwood, Ph.D. (Columbia University), Chip Felton, M.S.W., Anita Appel, M.S.W., Sheila Donahue, Ph.D., Jameson Foster, M.P.H., Sudha Mehta, M.P.H., Marleen Radigan, Dr.P.H., Marian Schwager, M.A. (OMH); Jessica Mass Levitt, Ph.D., Laura Murray, Ph.D., James Rodriguez, Ph.D., David Fernandez, M.A., Michelle Chung, B.A., Jacob Gisis, B.S., Joanna Legerski, B.S., Jennifer Sawaya, B.A. (NYSPI). The principal investigators and co-investigators from the nine sites are Robert Abramovitz, M.D. (JBFCS), A. Reese Abright, M.D. (St. Vincent's Hospital), Peter D'Amico, Ph.D. (North Shore-Long Island Jewish), Giuseppe Constantino, Ph.D. (Lutheran Hospital), Carrie Epstein, C.S.W.-R. (Safe Horizon), Jennifer Havens, M.D. (Columbia University), Sandra Kaplan, M.D. (North Shore-Long Island Jewish), Jeffrey Newcorn, M.D. (Mount Sinai), Wendy Paisner, Psy.D. (North Shore-Long Island Jewish), Moises Perez, Ph.D. (Alianza Dominicana), Raul Silva, M.D. (NYU/Bellevue), Heike Thiel de Bocanegra, Ph.D. (Safe Horizon), Juliet Vogel, Ph.D. (North Shore-Long Island Jewish). The Scientific Advisors to the project are Leonard Bickman, Ph.D. (Vanderbilt University), Peter S. Jensen, M.D. (Columbia University), Mary McKay, Ph.D. (Mount Sinai Medical School), Susan Essock, Ph.D. (Mount Sinai Medical School), Sue Marcus, Ph.D. (Mount Sinai Medical School), Wendy Silverman, Ph.D. (Florida International University), Robert Pynoos, M.D. (University of California, Los Angeles); Allan Steinberg, Ph.D. (University of California, Los Angeles); Lawrence Palinkas, Ph.D. (University of California, San Diego); and Joseph Cappelleri, Ph.D. (Pfizer). The Treatment Developers and Scientific Consultants to the project are Judy Cohen, M.D. (Allegheny General Hospital), Anthony Mannarino, Ph.D. (Allegheny General Hospital), Christopher Layne, Ph.D. (Brigham Young University), William Saltzman, Ph.D. (University of California, Los Angeles). This project was financially supported by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), grant no. H07 SM00143
The patient(s) and/or parent(s) have given consent for this report to be published, and the case details have been changed so that the person described is not recognizable.
Disclosure: The authors have no financial relationships to disclose.