Introduction
Project BEST focuses on increasing access to trauma-informed, evidence-based treatments with high relevance for children exposed to potentially traumatic events. To date, Project BEST has focused on increasing access to three evidence-based Treatments (EBTs) across South Carolina. EBTs are treatments that have rigorous research showing their effectiveness (research for each model is described more below). The treatments, to date, are Trauma-Focused Cognitive Behavioral Therapy, Alternatives for Families: A Cognitive Behavioral Therapy, and Problematic Sexual Behaviors: Cognitive Behavioral Therapy.
Alternatives for Families: Cognitive Behavioral Therapy (AF-CBT)
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) is a trauma-informed, evidence-based intervention designed to improve the relationship between children and their caregivers by addressing individual and family problems relating to:
- Family conflicts
- Behavior problems, including physical aggression
- Anger and verbal aggression, including emotional abuse
- Harsh physical discipline, physical aggression, or child physical abuse, or
- Child trauma-related symptoms secondary to any of the above
These patterns may be shown by an individual caregiver or a child/adolescent, and/or by the family. Therefore, AF-CBT targets the caregiver, child/adolescent, and the larger family context.
AF–CBT is designed to work with a broad range of families engaged in verbal and/or physical aggression, whether the referral focuses upon the caregiver who is angry, the child who has behavior problems (e.g., ODD, CD), or the volatile or “at-risk” family. A family with any of the following may be eligible for AF-CBT:
- A family or caregiver and child who experience frequent conflicts, arguments, angry feelings, or explosiveness.
- A caregiver who uses or has used harsh physical force or discipline, or worries about doing something that could injure/hurt a child, or has a history of physical or emotional abuse involving one of his/her children.
- A child (5-17 years old) who exhibits challenging behaviors such as not listening, fighting, hard to manage, or who shows trauma symptoms (e, g., posttraumatic stress) related to #1 or #2 above.
Many eligible families who receive AF-CBT also experience other challenges such as living in different residences, domestic disputes,
substance use, incarceration, and/or prior traumatic experiences.
AF-CBT has 18 topical content areas or components, including initial orientation and graduation that are delivered across three treatment phases. Many families are scheduled for weekly services delivered over a 6- to 9-month period. However, the duration of treatment and number of sessions may vary, due to factors such as the complexity of the case, or availability of resources, as well as family cooperation and participation. Thus, scheduling is flexible, but is guided by the needed to maximize attendance and participation.
AF-CBT has been found to improve clinical functioning in school-aged children, their parents (caregivers), and other family members following a referral for concerns about parenting practices including child physical abuse (Kolko, 1996a; 1996b, Kolko et al., 2011), as well as a child’s behavior problems (Kolko et al., 2009, 2010, 2012).
With its effectiveness supported by outcome studies, AF-CBT has been recognized by other experts as a “model” or “promising” treatment program (see National Child Traumatic Stress Network, www.nctsn.org; Child). AF-CBT is rated a 3, Promising Practice, by the California Evidence Based Clearinghouse for Child Welfare (www.cebc4cw.org).
Prospective AF-CBT trainees must be mental health professionals with a Master’s degree or higher. We ask that each trainee commit to implementing AF-CBT with at least 2 families during the course of the year.
AF-CBT should be conducted by individuals who have been formally trained in the model and who are familiar with the content, methods, assessments, and fidelity tools that are required to ensure effective administration of this approach.
Please visit the Alternatives for Families A Cognitive Behavioral Therapy website at: http://www.afcbt.org/
At this time, Project BEST is not offering any training on AF-CBT. You may visit http://www.afcbt.org/training/sign-up-for-training for training opportunities.
Participants of Learning Collaboratives may access this LINK to retrieve information such as an assessments packet and other resources.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is a conjoint child and parent psychotherapy approach for children and adolescents who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.
Children and parents learn new skills to help process thoughts and feelings related to traumatic life events; manage and resolve distressing thoughts, feelings, and behaviors related to traumatic life events; and enhance safety, growth, parenting skills, and family communication.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers. Research shows that TF-CBT successfully resolves a broad array of emotional and behavioral difficulties associated with single, multiple and complex trauma experiences. You can find more information, including how to become nationally certified, on the TF-CBT Website.
If you have participated in a past training, please see our TF-CBT Learning Collaboratives tab for resources and materials. If you need to access your certificate of completion, update your listing in our Roster of Professionals, or have questions, please contact the Project BEST Team.
TF-CBT has been found to be successful with children and adolescents (ages 3 to 18) who have significant emotional problems (e.g., symptoms of posttraumatic stress disorder, fear, anxiety, or depression) related to traumatic life events.
This treatment can be used with children and adolescents who have experienced a single trauma or multiple traumas in their life.
Children or adolescents experiencing traumatic grief can also benefit from this treatment.
TF-CBT can be used with children and adolescents residing in many types of settings, including parental homes, foster care, kinship care, group homes, or residential programs.
TF-CBT typically lasts between 8-25 sessions, and is typically delivered once per week. It is best delivered by creative, resourceful therapists who have developed close therapeutic alliances with their clients.
This treatment is designed to be provided in a flexible and developmentally appropriate manner to address the unique needs of each child and family.
It has been evaluated with Caucasian and African American children, and it has been adapted for Latino and hearing-impaired/deaf populations. It is currently being adapted for Native American children and for children in many other countries (e.g., Zambia, Uganda, South Africa, Pakistan, the Netherlands, Norway, Sweden, Germany, and Cambodia).
TF-CBT is the most well-supported and effective treatment for children who have been abused and traumatized. Multiple clinical research studies consistently have found it to help children with PTSD and other trauma-related problems. It has been rated a Model Program and Best Practice for use with abused and traumatized children. TF-CBT currently is being used successfully in community service agencies across the country.
TF-CBT has proven to be effective in addressing post-traumatic stress disorder, depression, anxiety, externalizing behaviors, sexualized behaviors, feelings of shame, and mistrust. The parental component increases the positive effects for children by reducing parents’ own levels of depression and emotional distress about their child’s abuse and improving parenting practices and support of their child.
TF-CBT was rated a “1-Well-supported, efficacious treatment”, the highest level of empirical support in the U.S. Department of Justice sponsored report Child Physical and Sexual Abuse: Guidelines for Treatment (PDF). The California Evidence-Based Clearinghouse for Child Welfare rated TF-CBT a “1-Well-supported, effective practice” its highest score for Scientific Rating and its highest score for Relevance to Child Welfare Rating. TF-CBT was selected as a “Best Practice” for cases of child abuse in the Kaufman Best Practices Task Force Final Report sponsored by the National Child Traumatic Stress Network.
This treatment can be used by a variety of mental health professionals, including clinical social workers, professional counselors, psychologists, psychiatrists, or clinical counselors.
TF-CBTWeb2.0 is a new web-based course for learning Trauma-Focused Cognitive-Behavioral Therapy. The new course reflects significant changes in the way the treatment is organized and trained, includes new training videos (along with some of the original ones), and expanded coverage of cultural considerations and developmental issues that affect the delivery of the treatment. Plus, the new course includes better web technology that allows it to function better and more attractively across desktop, laptop, and tablet computers.
TF-CBTWeb2.0 is designed to allow you to learn at your own pace, and use the learning experiences when it is convenient for you. Once you have completed TF-CBTWeb2.0, you can return as often as you like to “brush up” on techniques, watch demonstrations, or download the resources. There is a $35 registration fee for the course.
Access TF-CBTWeb2.0 at https://tfcbt2.musc.edu/
- California Evidence-Based Clearinghouse for Child Welfare
- TF-CBT Fact Sheet from the NCTSN (PDF)
- Review of TF-CBT from the Child Welfare Information Gateway
- NREPP Definition of TF-CBT (PDF)
- CARES Institute
Treatment Manual
Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guilford Press.
At this time, Project BEST is not offering any training on TF-CBT. You may visit the Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program for training options.
Pre-Work Online Assessment
Problematic Sexual Behaviors: Cognitive Behavioral Therapy (PSB-CBT)
PSB-CBT is a group treatment model originally designed to treat youth ages 7 to 12 who present with PSB. The PSB-CBT treatment approach uses concurrent groups for youth and their caregivers with combined multi-family group sessions about once a month. Active participation of a caregiver is required, with the caregiver defined as the person who provides primary care of the child in the home (e.g., mother, father, step-parent, grandparent, foster parent). PSB-CBT shares the common theory base and core components of evidence-based programs (EBP) for PSB. The underlying approach is strengths-based, focusing on the youth as children first with capacity to learn and implement appropriate behavior, make safe decisions, and develop healthy relationships. Using cognitive-behavioral approaches, the youth are taught rules about sexual behavior and specific skills of coping, self-control, and decision making. Core treatment components with caregivers address managing child behavior, supporting healthy development, sex education, abuse prevention, and rules about sexual behavior. The PSB-CBT treatment manual provides structure and guidelines to the sessions, but it is not a “cookbook” that is rigidly implemented. Rather, the therapists implement the core component with adaptations to fit the families being served. The group modality includes sessions with the children and caregivers together concurrently. These sessions are about once a month. For the family modality, sessions vary in terms of setup: Caregiver alone, child alone, and the family together.
You can find more information on the University of Oklahoma’s Website.
Providers seeking to become certified to implement PSB-CBT must meet the following training and consultation requirements for the school-age model. Through this process, providers implementing the group modality will need to complete requirements for both youth and caregiver groups. Completion of these requirements and fidelity in the school-age group or family modality is determined by the PSB-CBT Master Trainers, or Approved Trainer.
Training, including fidelity modality requirements include:
- Completion of the full exploration of PSB fit-to-agency process as demonstrated by completion of the OUHSC PSB-CBT Program Organizational Assessment and Agency Application after the community has self-evaluated readiness.
- Completion of all required readings and pre-work assignments resulting from review of the exploration phase materials.
- Attendance and active participation in a PSB-CBT intensive clinical training approved by the OU PSB-CBT T/TA Program.
- Completion of at least one-year (12-months) of experience conducting PSB-CBT treatment with a minimum of four families (e.g., caregiver and youth) in group modality, or six-months with a minimum of two families in the family modality through completion.
- Implementation of the PSB-CBT model per the treatment curriculum and with appropriate conceptualization of youth with PSB.
- Active participation in consultation calls, at minimum 80% attendance, facilitated by an OU PSB-CBT Approved Trainer until fidelity to the model has been met. “Actively participated” means, at a minimum, directly involved in consultation discussion, regularly sending recorded sessions to a Master Trainer for fidelity monitoring, and evidence of application of feedback from consultation by a PSB-CBT Approved Trainer.
- Regularly submit recordings of PSB-CBT sessions for fidelity monitoring by a Master Trainer or Approved Trainer. Clinicians are encouraged to review own recordings using the OU PSB-CBT fidelity monitoring forms to evaluate their own performance.
- Demonstrate competence in assessing PSB families’ progress in treatment using clinical judgement and the CSBI (and other standardized measures) to make appropriate decisions about completion of PSB-CBT treatment services.
- Upon successful completion, clinician must agree to continue to implement the OU-PSB-CBT model(s) with fidelity and adhere to administrative decisions from OU PSB-CBT T/TA Program regarding the OU PSB-CBT model. Meeting the above requirements is the first step to becoming a Within-Agency Trainer
You can find more information on the University of Oklahoma’s Website.
At this time, Project BEST is not offering any training on TF-CBT. You may visit https://connect.ncsby.org/psbcbt/training-calendar/school-age-training for training options.