Addressing Mental Health and Trauma-Related Needs of Sheltered Children and Families with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)

Abstract

Children and adolescents (“youth”) experiencing homelessness are at a disproportionately high risk of exposure to potentially traumatic events (PTE). However, limited evidence exists as to what interventions are effective when implemented with this high-risk population. The purpose of this study was to (1) document the mental health and trauma-related needs of sheltered youth and their mothers, and (2) examine the feasibility/effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) administered within the context of a homeless shelter. Three hundred and twenty-one youth (Mage = 10.06 years, SD = 3.24 years, 56.4% male, 70.1% Black/African American, 34.6% Hispanic/Latinx) and their mothers were recruited from a homeless shelter and provided 10 weeks of TF-CBT, with the option for up to eight additional weeks of therapy based on clinical need. Families completed pre- and post-intervention assessments. Results demonstrated clinically elevated pre-intervention PTSD symptoms and rates of exposure to PTE in sheltered youth well above those previously reported in the general population. TF-CBT resulted in substantial reductions in both maternal and self-reported severity of youth PTSD symptomology, which were largely attributable to reductions in re-experiencing and arousal. Effectiveness of TF-CBT varied by age and the number of exposures to PTE. Overall, these findings illustrate the importance of assessing and addressing the mental health and trauma-related needs of sheltered youth and the feasibility and efficacy of embedding an evidence-based trauma-focused treatment protocol within a shelter environment. Additional implications of these findings are discussed.

Early intervention for families experiencing homelessness: A pilot randomized trial comparing two parenting programs.

“…For example, time-limited CPP was offered for children from birth to 17 months, time-limited PCIT was offered for children ages 6-7, (time-limited) trauma-focused cognitive behavioral therapy (TF-CBT) was offered for children over the age 7, and referrals were made as appropriate to third-party providers. See Arcia (2020), for details regarding the additional therapeutic services, clinical needs, and outcome data for nonrandomized sample as well as Spiegel et al (2022) regarding the TF-CBT services provided and related outcomes.…”

Effects of Early Psychological Trauma on Limbic System Structure and Function

“…Thus, therapeutic success largely depends on the brain's responsiveness and changes in mistrained neural circuits. Some studies have shown the neurological healing effects of creative therapies such as dance/movement, music, drama, and art, which often impact at a non-verbal level involving the limbic system basal ganglia and other areas (Lusebrink 2010, Garrett 2020), while others discuss the effects of trauma-focused cognitive-behavioral therapy (Spiegel et al 2022) on neuroplasticity and the reduction of trauma-related symptoms.…”

Exploring mental health services for youth experiencing homelessness in East Asia Pacific regions: A systematic scoping review.

“…Understanding these cross-cultural differences is crucial for mental health professionals to provide effective and culturally sensitive care for YEH, as it involves adapting treatment strategies that align with cultural norms [47] in EAP. Although several studies have evaluated the effectiveness of interventions for this population, [48][49][50] there is a lack of understanding of the different mental health interventions and programs for youth homelessness in EAP regions. Most systematic reviews and previous studies have focused on interventions conducted primarily in Western countries.…”