In this project, the investigators will introduce the method of Stepped-Care Trauma-Focused Behavioral Cognitive Therapy (SC-TF-CBT) in a selection of municipalities across Norway. SC-TF-CBT is a parent-led – therapist-assisted low-threshold method aimed at treating children exposed to abuse, sexual assault, or other trauma and who are at risk of developing severe trauma-related difficulties (Salloum, et al. 2014). The treatment runs over a course of approximately 12-15 weeks and has two phases. The first phase lasts 6-9 weeks and consists of exercise conducted by the child and a caregiver at home, following a workbook translated to Norwegian. In cases where symptom improvement is evident after 6-9 weeks, the following 6 weeks is a maintenance phase. Should symptoms persist or worsen, however, the treatment is stepped-up to TF-CBT. In the Norwegian context, stepping up will imply that responsibility for the treatment is transferred from the municipal service level to a Child and Youth Psychiatric Policlinic (BUP).
The investigators aim to answer the following overarching questions:
- How does the SC-TF-CBT model fit the Norwegian health care culture and service system?
- When testing Stepped-Care in a Norwegian context, the model is set to involve both the municipal and specialist service levels. Severe cases will be stepped up/transferred to the specialist level for TF-CBT treatment. How do these transitions work for the participating families, and what are the experiences and perspectives of practitioners and service-leaders regarding coordination and collaboration between service levels?
- Do the children, parents, and therapists like working with the method?
- Do recipients of the treatment (children and parents) report symptom improvement?
- Which children and parents seem to benefit the most from the method, and who do not?
Since this is the first test of SC-TF-CBT in Norway, and outside the US, data will be attained for evaluating the feasibility and efficiency of the treatment in a Norwegian context through a pre-post design. The preparatory stage the project involves providing SC-TF-CBT training to recruited therapists (primarily clinical psychologists with experience in trauma treatment and work with children/ families). Following training, the therapists will receive referrals as usual, but will be equipped with an additional treatment method.
Clinical and experiential research data are to be collected through the therapist’s SC-TF-CBT cases. The therapist will ask caregivers and children receiving SC-TF-CBT to provide information about symptoms and treatment experiences at several points throughout the treatment trajectory. Caregivers and children will submit this information to the investigators by way of assessment forms made available for completion on iPads. The therapists will also submit evaluations throughout the trajectory of each family by way of online assessment forms. Audio recordings from treatment session will aid in determining fidelity. To attain data on entire trajectories, from pre-screening through completed treatment, quantitative treatment data will be supplemented by qualitative, semi-structured interviews with children, caregivers, and therapists.
The research project is funded by the Norwegian Directorate of Health (HDiR), and is conducted in collaboration with the University of South Florida (USF).