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Perceptions of Evidence-based Treatment among Youth and Caregivers Receiving Trauma Focused-Cognitive Behavioral Therapy

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Abstract

Objectives

There is growing recognition that it is important to involve youth and caregivers in the implementation of evidence-based treatments (EBTs). This study explored how youth and caregivers who received trauma-focused cognitive-behavioral therapy (TF-CBT) in a public behavioral health system perceived the concept of EBT, their experience with treatment, their perceptions of TF-CBT, and whether their perceptions varied as a function of clinical improvement.

Methods

Participants were eight youth (aged 10–17) and nine caregivers/legal guardians who received TF-CBT in community mental health centers. Semi-structured interviews were conducted post-treatment and symptoms were assessed at pre- and post-treatment. An integrated approach was used to analyze the interview data and the reliable change index was used to assess whether youth and caregivers’ impressions varied as a function of clinical improvement.

Results

Participants rarely had exposure to the term “evidence-based” and often had the misconception that evidence referred to personal experience. Youth and caregivers found the concept of receiving treatment supported by research appealing but did not like the specific term “evidence-based” and worried that treatment guided by research alone may not individualize to their needs. Personal stories were noted as a good way to market TF-CBT and the therapist emerged as an important advocate for promoting this treatment approach. Clinical improvement was associated with the perception of therapists as collaborative and with trauma narrative completion.

Conclusions

Findings suggest that language and how therapists communicate EBTs to youth and caregivers may be important for targeted implementation strategies.

Highlights

  • This study used mixed methods to explore youth and caregiver perceptions of evidence-based treatments.

  • Participants rarely had exposure to the term “evidence-based” and found it unappealing.

  • Marketing treatment to youth and caregivers requires careful language and explanation.

  • Therapists should be selective in their explanations of treatment to engage youth and caregivers.

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Authors and Affiliations

  1. University of Pennsylvania, Philadelphia, PA, USA

    Kelsie H. Okamura, Laura C. Skriner, Emily M. Becker-Haimes, Danielle R. Adams, Hilary E. Kratz & Rinad S. Beidas

  2. Weill Cornell Medicine, New York, NY, USA

    Laura C. Skriner

  3. University of Chicago, School of Social Administration, Chicago, IL, USA

    Danielle R. Adams

  4. Brown University, Providence, RI, USA

    Sara Becker

  5. Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA

    Kamilah Jackson & Arturo Zinny

  6. Pennsylvania Hospital Hall Mercer, Philadelphia, PA, USA

    Steve Berkowitz & Lauren Cliggitt

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  1. Kelsie H. Okamura
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  2. Laura C. Skriner
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  3. Emily M. Becker-Haimes
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  4. Danielle R. Adams
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Contributions

K.O.: collaborated with the design of the study, lead data analyses, and wrote the paper. L.S.: designed and executed the study, assisted with data analyses, and collaborated with the writing of the study. E.B.H.: assisted with data analyses and collaborated with the writing of the study. D.A.: designed and executed the study and collaborated with the writing of the study. SB: designed and executed the study and collaborated with the writing of the study. H.K.: designed and executed the study and collaborated with the writing of the study. K.J., S.B., AZ., and L.C.: collaborated with the design and execution of the study and editing of the final manuscript. R.B.: designed and executed the study, assisted with data analyses, and collaborated with the writing of the paper.

Corresponding author

Correspondence to Kelsie H. Okamura.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (University of Pennsylvania and the City of Philadelphia) and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Okamura, K.H., Skriner, L.C., Becker-Haimes, E.M. et al. Perceptions of Evidence-based Treatment among Youth and Caregivers Receiving Trauma Focused-Cognitive Behavioral Therapy. J Child Fam Stud 29, 1712–1722 (2020). https://doi.org/10.1007/s10826-020-01708-2

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