Document Type


Publication Date



Stepped care, trauma‐focused cognitive behavioral therapy, young children, posttraumatic stress disorder, trauma

Digital Object Identifier (DOI)



To compare the effectiveness and cost of stepped care trauma‐focused cognitive behavioral therapy (SC‐TF‐CBT), a new service delivery method designed to address treatment barriers, to standard TF‐CBT among young children who were experiencing posttraumatic stress symptoms (PTSS).


A total of 53 children (ages 3–7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC‐TF‐CBT or TF‐CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC‐TF‐CBT, posttreatment, and 3‐month follow‐up. Trial registration:


There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC‐TF‐CBT compared to TF‐CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre‐ to posttreatment and pre‐ to 3‐month follow‐up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC‐TF‐CBT compared to TF‐CBT.


Although future research is needed, preliminary evidence suggests that SC‐TF‐CBT is comparable to TF‐CBT, and delivery costs are significantly less than standard care. SC‐TF‐CBT may be a viable service delivery system to address treatment barriers.

Was this content written or created while at USF?


Citation / Publisher Attribution

The Journal of Child Psychology and Psychiatry, v. 57, issue 5, p. 614-622

This is the peer reviewed version of the following article:Salloum, A. , Wang, W. , Robst, J. , Murphy, T. K., Scheeringa, M. S., Cohen, J. A. and Storch, E. A. (2016), Stepped care versus standard trauma‐focused cognitive behavioral therapy for young children. J Child Psychol Psychiatr, 57: 614-622., which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.