Comparing Trauma-Focused Cognitive-Behavioral Therapy to Commonly Used Treatments in Usual Care for Children With Posttraumatic Stress Disorder

Objective: Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based treatment; however, few studies have examined the use of TF-CBT as part of routine clinical care, outside of research trials. This study used administrative data from a statewide system of care to examine differences in pretreatment characteristics and outcomes between children with posttraumatic stress disorder (PTSD) who received TF-CBT and those who received non-TF-CBT treatments. Method: The sample consisted of 1,861 children (59% female, 43% Hispanic, 35% White, and 14% Black) ages 3-17 with a primary diagnosis of PTSD who received outpatient psychotherapy at 25 clinics in Connecticut. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity and functioning using the Ohio Scales. Results: Approximately one-third of children received TF-CBT. There were some differences at intake between children who received TF-CBT and those who received another type of usual care treatment; children who experienced sexual victimization and more types of trauma as well as non-Hispanic White children were more likely to receive TF-CBT. Propensity score matching was used to balance intake differences between treatment groups, and results indicated that children who received TF-CBT had significantly greater improvements in problem severity and functioning than children who received other types of usual care treatments (effect size = 0.21-0.24), including generic cognitive-behavioral therapy (CBT). Conclusions: These findings reinforce the evidence for providing TF-CBT to children with PTSD in outpatient settings and suggest that supporting clinicians in implementing TF-CBT can result in greater improvements than usual care treatments.