Cognitive behavioral treatments for children and adolescents exposed to traumatic events: A meta-analysis examining variables moderating treatment outcomes.

Due to the negative impact of trauma exposure, effective treatments are necessary to prevent and improve negative trauma-related outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for children and adolescents exposed to traumatic events. Despite the various meta-analyses that have examined trauma treatments, there is a paucity of research on the moderating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of treatment components on outcomes. A search identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was shown to be effective for trauma-exposed youth. CBT subtreatments did not produce significantly different results from one another. Moderators shown to significantly impact CBT treatment outcomes for posttraumatic stress symptom were trauma type, Q = 24.09, p = .004, ds = -0.22 to -1.42, and gender, Q = 10.68, p = .005, ds = -0.53 to -1.36, whereas moderators shown to impact treatment outcomes for depression were study design, Q = 10.95, p = .004, ds = -0.26 to -0.50, and treatment setting, Q = 10.98, p = .004, ds = -0.31 to -0.56. The implications of these findings for research and practice are discussed.

Exploring attrition, fidelity, and effectiveness of wraparound services among low-income youth of different racial backgrounds.

INTRODUCTION: Wraparound services (i.e., community-based collaborative care) for children with severe mental health needs have been reported as effective. Yet, no attention has been given to aggregating treatment results across racially and economically diverse groups of youth. While controlling for socioeconomic status (i.e., free/reduced lunch status) this study explored potential racial disparities in response to wraparound services. METHOD: Data from a diverse statewide sample (N = 1,006) of low-income youth (ages 6-18 years) identified as having a serious emotional disturbance were analyzed for differences in wraparound attrition, fidelity, and effectiveness. RESULTS: African American youth receiving free/reduced lunch failed to complete wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores. DISCUSSION: Collaborative community-based mental health services improve youth outcomes and physicians and school personnel should strive to be part of these teams. Further research is needed to more closely examine the challenges of helping youth to meet the goals associated with their wraparound services. Relatively higher service attrition rates in low-income African American youth warrants further investigation. (PsycINFO Database Record