Purpose: There is a compelling need for school-based interventions to ameliorate the behavioral and academic challenges of the growing number of students who experience acute or chronic trauma. However, rigorous evidence supporting the use of trauma-focused interventions in schools is scarce, and does not always include student outcomes that may be of interest for school personnel (e.g., teacher ratings of student behavior, academic outcomes). This research team will conduct a randomized controlled trial to test the efficacy of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) intervention, a promising school-based, structured, symptom-focused therapy program to improve behavioral outcomes (e.g., depression, symptoms of post traumatic stress disorder) for at-risk middle school students who have experienced a broad range of exposure to violence and trauma.

Project Activities: Middle school students in an urban city in California will be recruited in three cohorts and randomly assigned to either the intervention condition or typical school services. The CBITS intervention is group-based, and will be implemented by school clinicians in 1-hour weekly sessions over 10 weeks. Multiple measures will be used to assess student behavioral and academic outcomes. Researchers will also examine how fidelity of implementation influences treatment outcomes.

Products: The products of this project include evidence of the efficacy of the CBITS intervention, published reports, and presentations.

Structured Abstract

Setting: The research will take place in eight middle schools in an urban city in California.

Population: Approximately 450 6th grade students who have experienced significant trauma and are suffering from elevated levels of distress will participate.

Intervention: The CBITS program—a structured, symptom-focused therapy—was developed for use with diverse groups of school children (ages 11 through 15) who have experienced significant trauma and suffer from related emotional or behavioral problems. It is designed to be implemented by school-based mental health clinicians in a typical school setting through 10 group therapy sessions and one individual session. The program uses a skills-building, early intervention approach. Activities include training students in relaxation techniques to remedy anxiety, cognitive therapy to reduce negative thoughts and improve self-concept, real life exposure to feared situations to increase positive coping strategies, and social problem-solving to combat anger and impulsivity and improve relationships with peers and family members. CBITS students will participate in a weekly 1-hour group therapy session conducted at school for 10 weeks. Depending on the size of the school, two or more groups may run concurrently, with no group containing more than nine students.

Research Design and Methods: This study will utilize a three-cohort randomized trial where students serve as the unit of randomization (approximately 150 students per cohort). Students will be randomly assigned to the CBITS intervention or to services as usual. The immediate and long-term (i.e., one year following participation) effects of CBITS will be evaluated.

Key Measures: The researchers will assess student outcomes between the experimental and control groups across three domains with the following methods: (1) trauma symptoms and problem behaviors: students' self-reports of trauma exposure, symptoms of posttraumatic stress and related psychological symptomatology, and problem behaviors, and teacher ratings of problem behaviors; (2) academic outcomes: classroom observations of academic engagement, school performance indicators (e.g., grades, attendance, homework completion), teacher ratings of academic competence, and administration of standardized academic achievement tests in reading and mathematics; and (3) coping and social skills: students' self-reports of coping approaches and social skills, and teacher ratings of social skills. Dosage, adherence, quality of implementation, and social validity will also be assessed.

Data Analytic Strategy: The researchers will use hierarchical linear modeling (HLM) to test the following: (1) the general impact of the CBITS intervention on a wide range of students' behavior and academic outcomes; (2) the effect of CBITS on subgroups defined by potential moderators (e.g., gender, ethnicity, type of trauma experience, diagnosis of depression); and (3) the effect of possible mediation variables (e.g., academic engagement, coping skills, and social skills).

Control Condition: The control condition participants will receive "services-as-usual," which is the typical curriculum, services, and activities offered to all students.

Products and Publications

Journal article, monograph, or newsletter

Mercier, E. M., Woodbridge, M. W., Sumi, W. C., Thornton, S. P., Rouspil, K. M., Yu, J., Kataoka, S. H., & Langley, A. K. (in press). Traumatic experiences and associated symptomatology in Asian American middle school students. Asian American Journal of Psychology.

Woodbridge, M. W., Sumi, W. C., Thornton, S. P., Fabrikant, N., Rouspil, K. M., Langley, A. K., and Kataoka, S. H. (2015). Screening for Trauma in Early Adolescence: Findings from a Diverse School District. School Mental Health, 8(1): 89–105. doi:10.1007/s12310–015–9169–5