Using an Evidence-Based Approach to Reduce Trauma’s Impact on Children

When com­mu­ni­ty part­ners and pub­lic sys­tem lead­ers gath­ered in Prov­i­dence to choose pri­or­i­ty out­comes for youth as part of the Foundation’s Evidence2Success frame­work, a key focus was symp­toms asso­ci­at­ed with trau­ma, includ­ing anx­i­ety, depres­sion and emo­tion­al reg­u­la­tion. Prov­i­dence mid­dle and high school stu­dents report­ed high lev­els of these risk fac­tors on the Youth Expe­ri­ence Sur­vey. And when more than 120 stu­dents in two mid­dle schools in Evidence2Success pilot neigh­bor­hoods were screened for post-trau­mat­ic stress dis­or­der (PTSD), 91% had ele­vat­ed lev­els of trau­ma. The most preva­lent trau­mat­ic expe­ri­ences named by the 11- to 14-year-olds were:

• sep­a­rat­ed from par­ent or some­one you depend on
• slapped, punched or hit
• seen some­one else being attacked or stabbed with a knife
• seen some­one point­ing a real gun at some­one else

“We thought we knew what the preva­lence of trau­ma was,” says Matt Billings (pic­tured), project man­ag­er at the Prov­i­dence Chil­dren and Youth Cab­i­net, the con­ven­ing orga­ni­za­tion lead­ing the local Evidence2Success effort. ​“We had no idea.”

Those insights led Prov­i­dence Evidence2Success stake­hold­ers to select Cog­ni­tive Behav­ioral Inter­ven­tion for Trau­ma in Schools (CBITS) as one of the evi­dence-based pro­grams to meet their pri­or­i­ties. CBITS is designed to reduce symp­toms of PTSD among chil­dren and improve func­tion­ing, atten­dance and grades. The 10-ses­sion, school-based inter­ven­tion teach­es cog­ni­tive behav­ioral skills in a group for­mat, led by men­tal health pro­fes­sion­als, with six to eight stu­dents per group. Stu­dents are referred by school per­son­nel. After an ini­tial screen, if there is an indi­ca­tion of trau­ma, par­ents give con­sent to the CBITS coun­selor for a deep­er assess­ment to see if stu­dents are eli­gi­ble for the pro­gram. Com­po­nents of the pro­gram include relax­ation train­ing, com­bat­ing neg­a­tive thoughts, reduc­ing avoid­ance, devel­op­ing a trau­ma nar­ra­tive and build­ing social prob­lem-solv­ing skills. The pro­gram also incor­po­rates indi­vid­ual child ses­sions, option­al par­ent ses­sions and a teacher in-ser­vice session.

The first two CBITS groups were held at the Roger Williams Mid­dle School in the South Side of Prov­i­dence in the spring of 2015. ​“We had one stu­dent who was able to bring a prob­lem to the group and the group was able to give sug­ges­tions to help solve her par­tic­u­lar prob­lem,” says Aman­da Slocum, a stu­dent assis­tance coun­selor. ​“She felt safe enough to ask, and the group felt capa­ble to give sug­ges­tions. That was a win for us.”

It was also a win for the ini­tial cohort of chil­dren who com­plet­ed the pro­gram. Accord­ing to a fol­low-up assess­ment, they expe­ri­enced an aver­age reduc­tion of 35% in key trau­mat­ic stress indicators.

CBITS is only one pro­gram­mat­ic part of Evidence2Success in Prov­i­dence. By mak­ing deci­sions based on data and informed by a com­mu­ni­ty/cross-sys­tem part­ner­ship, Evidence2Success is demon­strat­ing a cost-effec­tive way of allo­cat­ing scarce pub­lic resources to improve out­comes for Providence’s vul­ner­a­ble chil­dren and families.