RESUMO
BACKGROUND: In Chile demand for specialist care following exposure to interpersonal violence (IPV) in youth far exceeds capacity. Group interventions may improve access to care for youth. OBJECTIVE: To evaluate the effectiveness and acceptability of two low-intensity group interventions: Trama Focused Cognitive Behavioral Therapy (TF-CBT); Interpersonal Psychotherapy (IPT); and treatment as usual, Art therapy-based support (ATBS). Outcomes measured were post-traumatic stress symptoms, depression, interpersonal functioning and affect regulation. PARTICIPANTS AND SETTING: Participants were 67 Chilean youth aged 13-17 years, victims of IPV on a waiting list to receive specialist individual intervention. METHODS: Using a randomised controlled trial design, participants were randomly assigned to one of the interventions. Self-report measures were completed at 5 timepoints between baseline and follow up eight weeks after intervention ended. Dropout rates and attendance were also analysed. RESULTS: TF-CBT showed significant decreases for PTSD (d = 0.91) and depression (d = 0.77) symptoms, sustained at follow-up with affect regulation problems also showing significant decrease from baseline (d = 0.43). IPT showed significant decreases in PTSD symptoms (d = 0.64) and affect regulation problems (d = 0.66), both sustained at follow-up. ATBS showed statistically significant decrease for PTSD (d = 0.79) and interpersonal problems (d = 0.65) but only change in PTSD was sustained at follow-up. There were no significant differences in dropout or attendance between the interventions. CONCLUSION: Group interventions provide a viable and effective first-phase option for reducing psychological distress in IPV-exposed youth in high-demand contexts. Effectiveness may be further improved through the more active involvement of parents and carers.
Assuntos
Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Transtornos de Estresse Pós-Traumáticos , Humanos , Adolescente , Chile , Feminino , Masculino , Projetos Piloto , Psicoterapia de Grupo/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Terapia Cognitivo-Comportamental/métodos , Funcionamento Psicossocial , Depressão/terapia , Depressão/psicologia , Arteterapia/métodos , Psicoterapia Interpessoal/métodos , Exposição à Violência/psicologiaRESUMO
PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.