The Large-Scale Implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in Community Practice Settings: An Examination of Client and Implementation Outcomes

Abstract

Although significant progress has been made in the development of trauma-focused evidence-based treatments (EBTs) for children and adolescents, the transfer of these interventions from academic to community practice settings remains challenging. This investigation is one of the first to assess the statewide implementation of a popular trauma-focused EBT for youth in routine practice settings. Using nine years of baseline and follow-up data, this investigation examined the implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) with 2,980 clients, 596 clinicians, and 75 community practice agencies. Clients were highly traumatized, reporting exposure to an average of four trauma types (SD = 2.85). Multilevel modeling indicated that clients participating in TF-CBT demonstrated statistically significant reductions in posttraumatic stress symptomatology from baseline to follow-up, as well as self- and parent-reported reductions in emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and the overall impact of these difficulties from baseline to follow-up. Clients also showed a statistically significant self- and parent-reported improvement in prosocial relations from baseline to follow-up. Although clinician TF-CBT implementation fidelity was not related to changes in client outcomes from baseline to follow-up, both clinician license and supervisory status were statistically significantly related to implementation fidelity score. Findings suggest that the large-scale implementation of TF-CBT is a promising approach to increasing the availability of trauma-focused EBTs in routine practice settings, while also reducing the primary and secondary effects of trauma in the lives of children and their families.