Evaluation of “Cognitive Behavioral Intervention for Trauma in Schools” (CBITS) in child welfare programs in Germany: A Randomized Controlled Trial

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A large body of research shows that children and adolescents in child welfare programs report more traumatic events compared with the general population. Prevalence rates of trauma-related disorders (PTSD, depression, anxiety) are significantly higher which makes trauma-focused treatments for this vulnerable population especially promising. Due to several structural and individual barriers, particularly the lack of therapists with training in trauma-focused treatments, only few children/ adolescents in child welfare programs receive a needs-oriented treatment. Current (inter-)national guidelines recommend trauma-focused cognitive behavioral approaches for treating traumatized children and adolescents with symptoms of PTSD. Due to its scientific evidence and broad dissemination, the group treatment “Cognitive Behavioral Intervention for Trauma in Schools (CBITS)” has been recommended in particular. The manualized group treatment builds on evidence-based (trauma-focused) behavioral methods, is implemented by therapists and comprises 10 group sessions with 6-8 participants. This study aims at evaluating the group treatment CBITS in a randomized controlled trial (RCT) (CBITS vs. treatment as usual) regarding its effectiveness in reducing PTSD symptoms as well as its feasibility for children/ adolescents in child welfare programs. Therapists in three study centers (University Ulm, Ruhr University Bochum, and Philipps-University Marburg) will be specifically trained and supervised by the treatment developers. Study participants will be recruited in collaborating child welfare institutions and randomized by an independent epidemiological institute after study inclusion. The study design comprises three measurement time points (before/ after treatment, 6-month post-treatment) in order to test the hypothesis of superiority of CBITS compared with the control condition on the primary outcome (PTSD) and secondary outcomes (anxiety, depression, quality of life, functional impairment, drop-out of child welfare). Exploratory analysis will be performed with several potential treatment process variables (e.g. therapeutic alliance). This is the first study evaluating a trauma-focused group treatment in the German mental health system, bridging the gap between systems by implementing an outreach approach in which the therapist will deliver the treatment within the child welfare setting.