title: Responder Status Criterion for Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children.
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/nonresponse to the first step within Stepped Care TF-CBT, and (2) to explore the preliminary clinical utility of the early response/non-response criterion.
  
  
  METHODS
  Data from two studies were used: (1) treatment outcome data from a clinical trial in which 17 young children (ages 3 to 6 years) received therapist-directed CBT for children with PTSS were examined to empirically establish the number of posttraumatic stress symptoms 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 3 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.
  
  
  CONCLUSIONS
  Although further investigation is needed, the responder status criterion for young children used after Step One of Stepped Care TF-CBT appears promising.
authors: University of South Florida, School of Social Work, Department of Pediatrics, Associate Professor, University of South Florida, 13301 Bruce B. Downs Blvd., MHC1400, Tampa, FL 33612-3870, asalloum@usf.edu.
authors: Alison
authors: A
authors: Salloum
authors: Tulane University, Department of Psychiatry, Section of Child and Adolescent Psychiatry, 1440 Canal St., TB52, New Orleans, LA 70112 mscheer@tulane.edu.
authors: Michael S
authors: MS
authors: Scheeringa
authors: Center for Traumatic Stress in Children and Adolescents, Allegheny General Hospital, Pittsburgh, PA, JCOHEN1@wpahs.org.
authors: Judith A
authors: JA
authors: Cohen
authors: University of South Florida, Departments of Pediatrics and Psychiatry, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, estorch@health.usf.edu.
authors: Eric A
authors: EA
authors: Storch
keywords: PTSD; TF-CBT; adaptive treatment; stepped care; young children