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Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial
Journal article   Open access

Stepped Care Versus Standard Care for Children After Trauma: A Randomized Non-Inferiority Clinical Trial

Alison Salloum, Yuanyuan Lu, Henian Chen, Troy Quast, Judith A. Cohen, Michael S. Scheeringa, Kristen Salomon and Eric A. Storch
Journal of the American Academy of Child and Adolescent Psychiatry, v 61(8), pp 1010-1022
Aug 2022
DOI: https://doi.org/10.1016/j.jaac.2021.12.013
PMID: 35032578
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.jaac.2021.12.013View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

childhood posttraumatic stress disorder cost analysis parent-led treatment stepped care
Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial. A total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied. SC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower. Stepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents. Stepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.

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17 Record Views
28 citations in Web of Science
28 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
Psychiatry
Psychology, Developmental
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