After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians who practice in regions that are far from the recent attacks should be prepared to assist people with trauma-related symptoms of stress.

N THE LAST DECADE, THERE HAS BEEN heightened awareness of the extent to which children personally witness or experience violence. [1][2][3] Public health officials have responded by identifying violence as one of the most significant US public health issues. [4][5][6] Large numbers of US children experience such violence, and an even greater number may experience symptoms of distress after personally witnessing violence directed at others. 2,7-9 For many children, personally experiencing or directly witnessing multiple incidents of violence is the norm. 3,10,11 Violence affects all racial, ethnic, and socioeconomic groups, but its burden falls disproportionately on urban, 5,12 poor, and minority populations. 13,14 Several studies have found that the majority of children exposed to violence, defined as personally witnessing or directly experiencing a violent event, display symptoms of posttraumatic stress disorder (PTSD), 15,16 and a substantial minority develop clinically significant PTSD. [17][18][19] However, the harmful effects of violence extend beyond symptoms of PTSD. Exposure to violence is associated with depression 20 and behav-Author Affilations are listed at the end of this article.

No abstract

Although schools can improve children’s access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6–18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers.