Trauma Treatment in Norwegian Child Advocacy Centers

Norwegian child and advocacy centers´ core activities include both forensic services (e.g., forensic interviews) and follow-up services (e.g., treatment), aiming to coordinate the different services involved in each case to prevent additional burdens for youth in already vulnerable situations. However, a recent study indicates that very few receive follow-up after the forensic interview and that the follow-up in most cases includes one-time or occasional support and only in rare cases treatment. In the same study, youth receiving follow-up in the CAC in Oslo revealed significantly higher levels of common mental health problems than a comparable community sample, yet lower than clinical samples, indicating that many youths in CACs may be falling between different services within the health care system, not necessarily receiving the help they need elsewhere.

The current project will investigate four issues related to these knowledge needs;

1. How do children and parents experience receiving trauma treatment at child advocacy centers?
2. What predicts treatment effects?
3. What is the prevalence of symptoms of burnout and secondary traumatic stress among employees working in child advocacy centers, and can training in evidence-based treatment prevent burnout and secondary traumatic stress?

Study Overview

• Status: Recruiting
• Conditions: Post Traumatic Stress Disorder
• Intervention / Treatment: Other: Trauma-focused cognitive behavioral therapy (TF-CBT)

Detailed Description

Employees in the child advocacy centers (CAC) received training in trauma screening and a sub-sample received training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

To address the knowledge gaps, this project will answer the following research questions, corresponding to four Work Packages (WP):

1. Youth's and caregiver´s experiences with trauma treatment in CACs: How do youth and caregivers experience receiving trauma treatment in Norwegian CACs, and how are their experiences affected by CACs dual role as both a forensic institution and a treatment institution?
2. Response, non-response and dropout in trauma treatment in CACs: What predicts treatment outcomes for youth receiving TF-CBT in Norwegian CACs?
3. Therapists' experiences with trauma treatment in CACs: How do therapists in Norwegian CACs experience job demands and job resources, including burnout and secondary traumatic stress, and how can working with TF-CBT influence this?
4. Descriptive study of leadership, turnover, and secondary traumatic stress among staff in Norwegian Child Advocacy Centers.

To answer research question 1, qualitative interviews with children and caregivers will be conducted following their participation in TF-CBT.

For research question 2, quantitative data will be collected during the TF-CBT sessions. The child advocacy centers identify eligible TF-CBT clients through systematic trauma screening and establish routines for how TF-CBT is offered and delivered.

Research question 3 is qualitative, with semi-structured interviews with therapists.

Lastly, both questionnaire data and interviews will be used to answer research question 4.

• Study Type: Observational
• Enrollment (Anticipated): 100

Contacts and Locations

• Study Contact: Name: Ane-Marthe S Skar, PhD; Phone Number: +4797661591; Email: a.m.s.skar@nkvts.no
• Study Contact Backup: Name: Karina M Egeland, PhD; Phone Number: +4790602326; Email: karina.egeland@nkvts.no

Study Locations

• Norway
  • Oslo, Norway, 0655
    • Recruiting
    • Nowegian Center for Violence and Traumatic Stress Studies
    • Contact: Ane-Marthe Skar; Phone Number: 97661591; Email: amskar@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Children and adolescents who receive services at Norwegian child and adolescent advocacy centers. They are screened for posttraumatic reactions to the potential traumatising events that they have experienced, and are offered trauma-focused cognitive behavioral therapy if scoring above the clinical cut-off for PTS:

Description

Inclusion Criteria:

• Trauma exposure
• Post-traumatic stress symptoms above clinical cut-off

Exclusion Criteria:

• Clinical assessment concludes that the child should receive services in the child and adolescent specialist services

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Study group; Data will be collected from 2 child advocacy centers	Other: Trauma-focused cognitive behavioral therapy (TF-CBT); TF-CBT is a phase-based evidence-based treatment method for children and adolescents between 6-18 years who experience posttraumatic stress symptoms following trauma exposure. Parents or other close caregivers receive parallel sessions. It is normally provided through 12-16 sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Child and Adolescent Trauma Screen (CATS)	CATS is a screening instrument for PTSD based on the DSM-5 criterias.Total score range is between 0-60. A higher score indicates more symptoms, with a cut-off ≥ 21 as indication of a clinically relevant level of symptoms.	2021-2023

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child Post-Traumatic Cognitions Inventory (cPTCI)	Measures maladaptive cognitions in children and young people following trauma exposure. Total score range is between 0-60. A higher score indicates more symptoms.	2021-2023
Short Moods and Feelings Questionnaire (SMFQ)	Measures moods and feelings. Total score range is between 0-26. A higher score indicates more symptoms.	2021-2023
Duke-UNC Functional Social Support Questionnaire (FSSQ)	Measures social support. Total score range is between 8-40. The higher the average score, the greater the perceived social support.	2021-2023
Project specific questionnaire, inspired by the Working Alliance Inventory (WAI)	Measures trust. Total score range is between 12-48. The higher the average score, the greater the perceived alliance.	2021-2023
Client Satisfaction Questionnaire (to the caregiver)	Measures cilients satisfaction with TF-CBT. Total score range is between 0-32.The higher the average score, the greater client satisfaction.	2021-2023
Child Satisfaction Questionnaire (developed by NKVTS)	3 items (children) developed by NKVTS, to measure child satisfaction with the treatment. Total score range from 3-12. The higher the average score, the higher child satisfaction.	2021-2023

Collaborators and Investigators

• Sponsor: Norwegian Center for Violence and Traumatic Stress Studies
• Investigators: Principal Investigator: Ane-Marthe Solheim Skar, Norwegian Center for Violence and Traumatic Stress Studies

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2020
• Primary Completion (Anticipated): December 31, 2023
• Study Completion (Anticipated): December 31, 2024

Study Registration Dates

• First Submitted: March 24, 2022
• First Submitted That Met QC Criteria: March 24, 2022
• First Posted (Actual): April 6, 2022

Study Record Updates

• Last Update Posted (Actual): September 30, 2022
• Last Update Submitted That Met QC Criteria: September 27, 2022
• Last Verified: September 1, 2022

More Information

Terms related to this study

• Keywords: PTSD; Childhood trauma; Child advocacy center
• Additional Relevant MeSH Terms: Mental Disorders; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: Child advocacy centers

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: This is not included in the consent letter to the participants.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No