Application of the ADAPT-ITT Model to Develop Trauma-Focused Cognitive Behavioral Therapy for Interpersonal and Racial Trauma and Racial Socialization: Protocol for a Mixed Methods Study.

backgroundBlack youth experience higher rates of interpersonal and racial trauma than other youth, yet they are less likely to use and benefit from evidence-based mental health services. These disparities highlight the need for culturally responsive adaptations of existing interventions.

objectiveThis study integrated racial socialization (RS)-a protective process for Black youth-into trauma-focused cognitive behavioral therapy (TF-CBT) using the ADAPT-ITT framework (assessment, decision, adaptation, production, topical experts-integration, training, and testing) to improve treatment engagement, acceptability, and outcomes for Black youth and their families.

methodsAdaptation followed the 8 phases of the ADAPT-ITT model. During assessment, a literature review and previous studies identified racial discrimination and socialization as salient risk and protective factors for Black youth, underscoring the need for culturally responsive interventions. In the decision phase, TF-CBT was chosen given its evidence base and gaps in addressing racial trauma. The administration phase embedded RS messages such as racial pride, barriers, spirituality, and extended family involvement into TF-CBT's components (psychoeducation, relaxation, affect modulation, cognitive coping, trauma narrative and processing, in vivo mastery, conjoint sessions, and enhancing safety) to enhance psychoeducation, coping, trauma processing, conjoint sessions, and safety planning. In the production phase, manuals and fidelity checklists were drafted to preserve TF-CBT's core elements while embedding RS content. To ensure clinical and cultural relevance, the topical experts phase included interviews with 10 Black caregivers and 12 Black youths (aged 12-18 years) who had completed TF-CBT, as well as focus groups with 15 clinicians. Thematic analysis identified adaptations to increase feasibility and acceptability. During integration, a racial trauma task force of faculty, graduate, and undergraduate researchers refined the model and produced The C.A.R.E. Package for Racial Healing, a culturally informed workbook. In the training phase, 28 clinicians from 13 community organizations participated in a Substance Abuse and Mental Health Services Administration-funded learning community, receiving 2 days of training and 12 months of consultation on delivering TF-CBT that integrates RS (TF-CBT-RS). Role-plays, demonstrations, and case discussions supported fidelity and cultural responsiveness. Finally, during testing, surveys and feedback indicated that TF-CBT-RS was feasible, acceptable, and associated with improved clinician efficacy, greater treatment engagement, and positive client perceptions of support. Preliminary outcomes suggested reductions in trauma symptoms and improved coping, supporting the need for larger randomized trials.

resultsIntegrating RS into TF-CBT enhanced cultural relevance, engagement, and preliminary effectiveness for Black youth and their families.

conclusionsTF-CBT-RS offers a culturally responsive adaptation of trauma treatment that validates racial stressors, incorporates cultural strengths, and promotes engagement. Broader dissemination of the TF-CBT-RS manual and further testing may reduce disparities in trauma outcomes for Black youth. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/77762.