Session Preparation, Behavioral Rehearsal and Homework Assignment: Do these Therapeutic Delivery Strategies Improve Trauma Treatment Outcomes for Youth in Community Outpatient Settings?

Several studies have demonstrated that trauma-focused cognitive-behavioral therapy (TF-CBT) is effective but many children do not complete treatment and some improve less than others, suggesting it is important to look at potential treatment moderators. Although the components of TF-CBT outline what content to cover in sessions, therapeutic delivery strategies (i.e., adjunct techniques therapists use to provide treatment content beyond the prescribed clinical components) may also contribute to outcomes. This study used administrative data from a statewide dissemination of TF-CBT to examine whether three therapeutic delivery strategies (session preparation, behavioral rehearsal and homework assignment) predicted posttraumatic stress symptom improvement and successful treatment completion. The sample included 2,499 children ages 3-17 who received TF-CBT from 448 therapists. Therapists collected data from families on demographics and posttraumatic stress symptoms, and therapists reported on treatment dosage and therapeutic delivery strategies provided to each family. Approximately 44% of children successfully completed treatment. When children or caregivers engaged in behavioral rehearsal of TF-CBT skills in more sessions, caregivers reported greater child symptom improvement and the child was more likely to successfully complete treatment. The extent that therapists prepared for sessions and discussed homework during sessions did not significantly predict outcomes. Analyses controlled for child characteristics at intake and treatment dosage. These findings suggest that therapists should plan ample opportunities for families to engage in behavioral rehearsal when implementing TF-CBT.