Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia / Jeremy C. KANE in Journal of Child Psychology and Psychiatry, 57-10 (October 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-10 (October 2016) . - p.1194-1202 Titre : Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia Type de document : Texte imprimé et/ou numérique Auteurs : Jeremy C. KANE, Auteur ; Laura K. MURRAY, Auteur ; Judith A. COHEN, Auteur ; Shannon DORSEY, Auteur ; Stephanie SKAVENSKI VAN WYK, Auteur ; Jennica GALLOWAY HENDERSON, Auteur ; Mwiya IMASIKU, Auteur ; John MAYEYA, Auteur ; Paul BOLTON, Auteur Article en page(s) : p.1194-1202 Langues : Anglais (eng) Mots-clés : Posttraumatic stress disorder  orphans and vulnerable children  Zambia  trauma-focused cognitive behavioral therapy  moderation analysis Index. décimale : PER Périodiques Résumé : Background The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Methods Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Results Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. Conclusions This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible. En ligne : http://dx.doi.org/10.1111/jcpp.12623 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=295 [article] Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia [Texte imprimé et/ou numérique] / Jeremy C. KANE, Auteur ; Laura K. MURRAY, Auteur ; Judith A. COHEN, Auteur ; Shannon DORSEY, Auteur ; Stephanie SKAVENSKI VAN WYK, Auteur ; Jennica GALLOWAY HENDERSON, Auteur ; Mwiya IMASIKU, Auteur ; John MAYEYA, Auteur ; Paul BOLTON, Auteur . - p.1194-1202. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-10 (October 2016) . - p.1194-1202 Mots-clés : Posttraumatic stress disorder  orphans and vulnerable children  Zambia  trauma-focused cognitive behavioral therapy  moderation analysis Index. décimale : PER Périodiques Résumé : Background The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Methods Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Results Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. Conclusions This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible. En ligne : http://dx.doi.org/10.1111/jcpp.12623 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=295

Stepped care versus standard trauma-focused cognitive behavioral therapy for young children / Alison SALLOUM in Journal of Child Psychology and Psychiatry, 57-5 (May 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-5 (May 2016) . - p.614-622 Titre : Stepped care versus standard trauma-focused cognitive behavioral therapy for young children Type de document : Texte imprimé et/ou numérique Auteurs : Alison SALLOUM, Auteur ; Wei WANG, Auteur ; John ROBST, Auteur ; Tanya K. MURPHY, Auteur ; Michael S. SCHEERINGA, Auteur ; Judith A. COHEN, Auteur ; Eric A. STORCH, Auteur Article en page(s) : p.614-622 Langues : Anglais (eng) Mots-clés : Stepped care  trauma-focused cognitive behavioral therapy  young children  posttraumatic stress disorder  trauma Index. décimale : PER Périodiques Résumé : Background To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). Methods A total of 53 children (ages 3–7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. Trial registration: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. Results There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. Conclusions Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers. En ligne : http://dx.doi.org/10.1111/jcpp.12471 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=288 [article] Stepped care versus standard trauma-focused cognitive behavioral therapy for young children [Texte imprimé et/ou numérique] / Alison SALLOUM, Auteur ; Wei WANG, Auteur ; John ROBST, Auteur ; Tanya K. MURPHY, Auteur ; Michael S. SCHEERINGA, Auteur ; Judith A. COHEN, Auteur ; Eric A. STORCH, Auteur . - p.614-622. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-5 (May 2016) . - p.614-622 Mots-clés : Stepped care  trauma-focused cognitive behavioral therapy  young children  posttraumatic stress disorder  trauma Index. décimale : PER Périodiques Résumé : Background To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). Methods A total of 53 children (ages 3–7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. Trial registration: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. Results There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. Conclusions Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers. En ligne : http://dx.doi.org/10.1111/jcpp.12471 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=288

Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial / Michael S. SCHEERINGA in Journal of Child Psychology and Psychiatry, 52-8 (August 2011)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 52-8 (August 2011) . - p.853-860 Titre : Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial Type de document : Texte imprimé et/ou numérique Auteurs : Michael S. SCHEERINGA, Auteur ; Carl F. WEEMS, Auteur ; Judith A. COHEN, Auteur ; Lisa AMAYA-JACKSON, Auteur ; Donald GUTHRIE, Auteur Année de publication : 2011 Article en page(s) : p.853-860 Langues : Anglais (eng) Mots-clés : Posttraumatic stress disorder  cognitive behavioral therapy  children Index. décimale : PER Périodiques Résumé : Background:  The evidence base for trauma-focused cognitive behavioral therapy (TF-CBT) to treat posttraumatic stress disorder (PTSD) in youth is compelling, but the number of controlled trials in very young children is few and limited to sexual abuse victims. These considerations plus theoretical limitations have led to doubts about the feasibility of TF-CBT techniques in very young children. This study examined the efficacy and feasibility of TF-CBT for treating PTSD in three- through six-year-old children exposed to heterogeneous types of traumas. Methods:  Procedures and feasibilities of the protocol were refined in Phase 1 with 11 children. Then 64 children were randomly assigned in Phase 2 to either 12-session manualized TF-CBT or 12-weeks wait list. Results:  In the randomized design the intervention group improved significantly more on symptoms of PTSD, but not on depression, separation anxiety, oppositional defiant, or attention deficit/hyperactivity disorders. After the waiting period, all participants were offered treatment. Effect sizes were large for PTSD, depression, separation anxiety, and oppositional defiant disorders, but not attention-deficit/hyperactivity disorder. At six-month follow-up, the effect size increased for PTSD, while remaining fairly constant for the comorbid disorders. The frequencies with which children were able to understand and complete specific techniques documented the feasibility of TF-CBT across this age span. The majority were minority race (Black/African-American) and without a biological father in the home, in contrast to most prior efficacy studies. Conclusions:  These preliminary findings suggest that TF-CBT is feasible and more effective than a wait list condition for PTSD symptoms, and the effect appears lasting. There may also be benefits for reducing symptoms of several comorbid disorders. Multiple factors may explain the unusually high attrition, and future studies ought to oversample on these demographics to better understand this understudied population. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2010.02354.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=132 [article] Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial [Texte imprimé et/ou numérique] / Michael S. SCHEERINGA, Auteur ; Carl F. WEEMS, Auteur ; Judith A. COHEN, Auteur ; Lisa AMAYA-JACKSON, Auteur ; Donald GUTHRIE, Auteur . - 2011 . - p.853-860. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 52-8 (August 2011) . - p.853-860 Mots-clés : Posttraumatic stress disorder  cognitive behavioral therapy  children Index. décimale : PER Périodiques Résumé : Background:  The evidence base for trauma-focused cognitive behavioral therapy (TF-CBT) to treat posttraumatic stress disorder (PTSD) in youth is compelling, but the number of controlled trials in very young children is few and limited to sexual abuse victims. These considerations plus theoretical limitations have led to doubts about the feasibility of TF-CBT techniques in very young children. This study examined the efficacy and feasibility of TF-CBT for treating PTSD in three- through six-year-old children exposed to heterogeneous types of traumas. Methods:  Procedures and feasibilities of the protocol were refined in Phase 1 with 11 children. Then 64 children were randomly assigned in Phase 2 to either 12-session manualized TF-CBT or 12-weeks wait list. Results:  In the randomized design the intervention group improved significantly more on symptoms of PTSD, but not on depression, separation anxiety, oppositional defiant, or attention deficit/hyperactivity disorders. After the waiting period, all participants were offered treatment. Effect sizes were large for PTSD, depression, separation anxiety, and oppositional defiant disorders, but not attention-deficit/hyperactivity disorder. At six-month follow-up, the effect size increased for PTSD, while remaining fairly constant for the comorbid disorders. The frequencies with which children were able to understand and complete specific techniques documented the feasibility of TF-CBT across this age span. The majority were minority race (Black/African-American) and without a biological father in the home, in contrast to most prior efficacy studies. Conclusions:  These preliminary findings suggest that TF-CBT is feasible and more effective than a wait list condition for PTSD symptoms, and the effect appears lasting. There may also be benefits for reducing symptoms of several comorbid disorders. Multiple factors may explain the unusually high attrition, and future studies ought to oversample on these demographics to better understand this understudied population. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2010.02354.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=132

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