CBITS-RTM Pilot Study

The study examines the intervention's feasibility and acceptability, as well as its effectiveness in reducing incarcerated youth's posttraumatic stress symptoms, improving academic functioning, and decreasing intentions to use substances post-release.

• Adapted Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with a Racial Trauma Module (RTM) (Behavioral), also known as CBITS-RTM: The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is a school-based, group and individual intervention designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, and coping skills. The CBITS intervention was adapted to juvenile justice settings with an added Racial Trauma Module (RTM), which provides youth with an overview of the effects of racism on levels of traumatic stress.

Primary outcomes

• Child PTSD Symptom Scale (CPSS) [Baseline, 3 months post-baseline]: The CPSS is used to measure posttraumatic stress among youth (8-18 years). It assesses past month posttraumatic stress symptom severity and impairment of endorsed symptoms on daily functioning. Scores range from 0-80, with 31+ indicating probable PTSD.

Secondary outcomes

• Youth Alcohol and Drug Use Survey [Baseline, 3 months post-baseline]: The Youth Alcohol and Drug Use Survey will be used to gather youth's intention to use substances post-release using items rated on a scale from 1 (unlikely) to 10 (very likely).
• Texas Christian University (TCU) Drug Screen [Baseline, 3-months post-baseline]: The TCU will be administered to gather information on substance use quantity and frequency as well as risk for SUD (corresponds with DSM-5 criteria) on the 3-months prior to incarceration and past 3 months at post-release.

Other outcomes

• Youth Background Characteristics [Baseline]: Demographics questionnaire used to gather standard demographics (e.g., age, gender, race) and information such as state agency involvement (e.g., age at first contact with juvenile legal system, number of prior arrests), immigration status.
• Treatment Acceptability Form [3-months post-baseline]: This form will be used to assess the acceptability of the adapted CBITS-RTM intervention. Items are scored from 1 "Strongly disagree" to 5 "Strongly agree." Scores range from 10-50 with higher scores indicating higher acceptability.
• CBITS-RTM Group Evaluation Posttest [3-months post-baseline]: This will assess knowledge of trauma, changes in ability to cope with stress, and acceptability of the intervention and its delivery. Items are true/false or qualitative in nature.
• Clinician personal and professional background characteristics [Baseline]: Questionnaire used to gather personal and professional background characteristics (e.g., clinical discipline, experience with trauma treatment, years of practice in juvenile detention setting).
• Cognitive Behavioral Intervention for Trauma in Schools-Fidelity Adherence Measure 2.0 [20% of the sessions]: This measure will be used to assess how closely clinicians adhere to the adapted CBITS-RTM intervention. The scale describes the core components expected to be covered in each session, and the rater indicates the degree to which each component was delivered with fidelity using a 4-point item rating ranging from 0 (not covered at all) to 3 (covered thoroughly). Higher item scores indicate greater fidelity to the intervention curriculum.
• The Evidence-Based Practice Attitude Scale (EBPAS) [Baseline]: The EBPAS (15-items) will be used to assess clinician's attitudes toward adopting new evidence-based practices (EBPs). It consists of four subscales: appeal, requirements, openness, and divergence. Items are rated on a 5-point Likert scale from 0 (not at all) to 4 (to a very great extent). Higher scores on the Appeal, Requirements, and Openness subscales indicate more positive attitudes toward adopting EBPs, whereas higher Divergence scores indicate less favorable attitudes.

Sex: All, ages: 13 Years to any

Inclusion Criteria:

* Youth must 1) be currently incarcerated in a partnering juvenile detention center, 2) be between 13-18 years of age, and 3) have a minimum of 3 months remaining on their sentence (i.e., sufficient time required to complete CBITS-RTM). Youth will complete a screening with a study team member involving the 2-item Abbreviated PTSD Checklist-Civilian version, with scores ≥4 considered a positive screen
* Clinicians are eligible if they are behavioral health staff working with youth at the detention school..

Exclusion Criteria:

* Observable cognitive or developmental delays or active psychosis that would interfere with completing consent, assessment or intervention.

• Johanna Folk, PhD, Principal investigator, University of California, San Francisco