title: Stepped care versus standard trauma-focused cognitive behavioral therapy for young children.
abstract: 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.
  
  
  BACKGROUND
  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.
authors.affiliation: School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Salloum
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Mental Health Law and Policy and Department of Economics, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: John
authors.initials: J
authors.lastname: Robst
authors.affiliation: Department of Pediatrics, College Of Medicine Pediatrics, University of South Florida, Tampa, FL, USA.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Scheeringa
authors.affiliation: Center for Traumatic Stress in Children and Adolescents, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, College Of Medicine Pediatrics, University of South Florida, Tampa, FL, USA.|Rogers Behavioral Health, Tampa, FL, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*
keywords: Stepped care; posttraumatic stress disorder; trauma; trauma-focused cognitive behavioral therapy; young children