Background: Traumatizing events put children at risk of developing severe mental health problems. There is a large gap between the need for and access to evidence-based treatments for traumatized children and youth. To bridge this gap, the treatment model stepped care trauma-focused cognitive behavioural therapy (stepped care TF-CBT) has been developed. The model consists of a parent-led therapist assisted component (step one), with an option to step up non-responders to standard therapist-led TF-CBT treatment (step two). We will investigate the feasibility, acceptability, outcomes and predictors of an adapted stepped care TF-CBT model, where step one is placed in the first-line municipal health services and step two in the second-line specialist health services. We will include the perspectives of children, caregivers, therapists and service leaders. Methods: This is a multicentre feasibility study, with a mixed methods longitudinal research design. We recruited 45 therapists across 19 municipalities in Norway and provided training in the stepped care TF-CBT model. Through the therapists, an estimated 78-83 child-caregiver dyads will be recruited. The main criteria for inclusion are age 7-12 years, at least moderate post-traumatic stress symptoms following exposure to trauma, and that receiving parent-led treatment is safe for the child. Interviews to explore experiences with the model will be conducted with children, caregivers, therapists and municipal service leaders. Further data from children, caregivers and therapists will be collected throughout treatment and at 3-month follow-up to assess post-traumatic stress symptoms and mental health, daily functioning, quality of life and therapeutic alliance. Discussion: The results will help inform clinicians and policymakers of the potential benefits and barriers of providing step one of stepped care TF-CBT in a first-line setting. The study will increase knowledge of factors that characterize children and families that benefit from the parent-led step one, and families that may need modifications in the model, or different interventions.Trial registration: ClinicalTrials.gov, NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019), https://clinicaltrials.gov/ct2/show/NCT04073862

Purpose There is a need for interventions for traumatized children that are easily accessible and effective, and that involve parents directly in the recovery process. To meet this challenge, stepped care trauma-focused cognitive behavioral treatment (SC TF-CBT), which consists of a parent-led therapist-assisted intervention as the first step, was developed. Parent-led trauma-treatment is a promising, but novel approach. The aim of this study was therefore to gain knowledge on how parents experience the model. Methods Parents who participated in a SC TF-CBT feasibility study were consecutively recruited and interviewed with semi-structured interviews, which were then analysed using interpretative phenomenological analysis. Results The parents described that the intervention gave them insights that led to a sense of parental agency. Through the analysis we identified and labelled four themes: (i) understanding my child: how the trauma has affected my child and our relationship; (ii) understanding myself: how my reactions have stood in the way of helping my child; (iii) gaining competence: how to learn specific tasks that were not part of my normal parenting skills; and (iv) receiving support: how guidance, warmth and encouragement was necessary. Conclusions The results from this study show how the shifting of therapeutic tasks to parents may facilitate parental empowerment and improve the parent-child relationship. This knowledge may guide clinicians on how to provide support to parents so they can take a leading role in their child’s recovery process after trauma. Trial registration ClinicalTrials.gov, NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019), https://clinicaltrials.gov/ct2/show/NCT04073862.

Background: Stepped care cognitive behavioural therapy for children after trauma (SC-CBT-CT; aged 7–12 years) can help to increase access to evidence-based trauma treatments for children. SC-CBT-CT consists of a parent-led therapist-assisted component (Step One) with an option to step up to standard therapist-led treatment (Step Two). Studies have shown that SC-CBT-CT is effective; however, less is known about what parent variables are associated with outcome of Step One. Objective: To examine parent factors and their relationship with completion and response among children receiving Step One. Method: Children ( n = 82) aged 7–12 ( M = 9.91) received Step One delivered by their parents ( n = 82) under the guidance of SC-CBT-CT therapists. Logistic regression analyses were used to investigate whether the following factors were associated with non-completion or non-response: the parents’ sociodemographic variables, anxiety and depression, stressful life experiences and post-traumatic symptoms, negative emotional reactions to their children's trauma, parenting stress, lower perceived social support, and practical barriers to treatment at baseline. Results: Lower level of educational achievement among parents was related to non-completion. Higher levels of emotional reactions to their child's trauma and greater perceived social support were related to non-response. Conclusions: The children seemed to profit from the parent-led Step One despite their parents` mental health challenges, stress, and practical barriers. The association between greater perceived social support and non-response was unexpected and warrants further investigation. To further increase treatment completion and response rates among children, parents with lower education may need more assistance on how to perform the interventions, while parents who are very upset about their child's trauma may need more emotional support and assurance from the therapist. Trial registration: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862 . Retrospectively registered 03 June 2019 (first patient recruited May 2019).