Child Mental Health in Action Award: Project Update

Child Mental Health in Action Award: Project Update

By Amy Hyoeun Lee, PhD & Kristin Bernard, PhD

We are grateful to SCCAP for sponsoring a funding mechanism that is intended to have a direct impact on children and families and clinicians providing mental health care. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2017) is an evidence-based intervention for youth with trauma-related mental health problems and their caregivers. Despite its robust evidence base (see Thielemann et al., 2022 for a recent meta-analytic review) and the high prevalence of trauma-related mental health problems among treatment-seeking youth, the availability of TF-CBT in community mental health settings continues to be limited. Moreover, disparities persist for youth from historically marginalized communities (e.g., racial ethnic minority, low-income immigrant families) in both rates of trauma exposure and access to evidence-based trauma treatments such as TF-CBT. Thus, the primary aim of our CMHA project, titled “Addressing Mental Health Inequity by Enhancing Trauma-Specific Care for Youth from Historically Marginalized Communities,” was to train a team of clinicians across two outpatient clinics at Stony Brook University in TF-CBT to address these gaps in trauma-specific services for youth with marginalized identities. A secondary aim was to pilot a single TF-CBT group for Black teens and their families adapted to address the additional burden of racial trauma and related stressors (Metzger et al., 2021). We provide brief updates on each of these aims below.

With the support from CMHA grant, we implemented an initial 3-day training in TF-CBT with a nationally certified trainer in September 2021. Twenty-nine faculty and trainees across Departments of Psychiatry & Behavioral Health and Psychology participated in this training. Clinicians who attended the initial training self-reported moderate levels of confidence in working with traumatized youth and families prior to the training (Modal response=3; 1=Not at all, 5=Extremely high). Following the training, the clinicians reported that the training was both beneficial for learning to treat traumatized children (Modal response=5) and that they would readily use TF-CBT (Modal response=5). The CMHA funds also supported monthly consultation calls for a subset of 15 clinicians pursuing eventual certification in the model. Participating clinicians included both full-time faculty and trainees (e.g., psychology interns, psychiatry resident), who presented on their ongoing TF-CBT cases twice over the course of the training year for feedback and consultation. At the end of the training year, these clinicians rated highly the perceived efficacy of TF-CBT with their clients (Modal response=5), confidence in implementing TF-CBT (Modal response=5), and the added value of TF-CBT to their practice (Modal response=5). Clinicians’ positive feedback is further illustrated by the following comments we received:

“Thanks for the thorough training initiative, I feel very comfortable with TF-CBT despite only using it in one case and would use it again in the future.”

“It has been great with the group supervision… [the trainer] is able to see the real life of the families we work and not panic with the needs of the families. I appreciate the flexibility of TF-CBT.”

“It has a been a wonderful program, I’ve learned how to conduct a full TF-CBT treatment and look forward to practicing this therapeutic intervention as needed in my clinical practice.”

In all, we estimate that TF-CBT was provided to 30-35 youth and their families during the training year, with the majority of these youth holding one or more marginalized identities (i.e., racial/ethnic minority, low income and/or public health insurance, sexual or gender minority, developmentally disabled, non-English primary language). Three of the clinicians trained through the initiative are now certified in TF-CBT, and others have indicated that they will be pursuing certification in the near future. A team of clinicians at Stony Brook University continues to meet monthly to hold space for peer consultation of ongoing TF-CBT cases.

The secondary aim of this project, focusing on piloting a TF-CBT group with culturally responsive adaptations for Black youth and their caregivers to assess initial acceptability and feasibility, was also successfully completed. Five Black adolescents and their caregivers participated in this group, facilitated by 3 trainees and 3 supervisors who completed the initial TF-CBT training and an additional workshop on TF-CBT adaptations for Black youth with Dr. Isha Metzger. The group concluded successfully in June 2022 after 12 sessions. Preliminary outcome data suggest adequate feasibility, acceptability, and appropriateness, and highlight the collective healing potential of group-based trauma treatments, which may be consistent with the cultural values of many minoritized communities (Lee, Silver, Shen, Farquharson, Bernard, & Metzger, submitted for publication).

We are confident that the clinicians who have been trained in TF-CBT through this project, both full-time faculty at Stony Brook University and trainees who have since moved onto other institutions, will continue to make an impact on youth and families with marginalized identities in need of trauma-specific care. We extend our thanks to SCCAP, the participating clinicians, and other internal champions who made this work possible.