Implementing Trauma Focused-Cognitive Behavioral Therapy for Youth under Probation: Lessons Learned

Maria Eva Pangilinan


OBJECTIVE: The implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) for youth under probation is underresearched. Since a TF-CBT project implementation goal was not met, the author aimed to address the following questions: What were the unaddressed barriers to TF-CBT participation and completion? What factors could have significantly impacted TF-CBT completion? Were the positive outcomes of TF-CBT on the project's proposed measures confirmed?  The author likewise aimed to capture the lessons from this project’s implementation.

METHOD: Review of administrative documents focused on project set-up, flow of participation and TF-CBT completion to identify the barriers. Chart reviews included data for 54 out of 60 TF-CBT participants. Three TF-CBT youth groups were identified. TF-CBT with: no in vivo (C7, n = 12); four to six TF-CBT components, including trauma narration (C4-6, n = 13); and one to four components in phase I of TF-CBT (C1-4, n = 29). All statistical tests were set at p < .05. Groups were compared on demographics, pre-TF-CBT trauma and functioning, assessment and treatment services, justice involvement, and services satisfaction. Outcome measures were change scores on the UCLA Post Traumatic Stress Disorder Reaction Index, Youth Outcome Questionnaire and youth arrests.

RESULTS: The unaddressed barriers could very well be due to youth’s low disclosure and development of trust and therapist’s skills. Significant between-groups difference in parental involvement (χ2 = 6.08, p < .05) and number of trauma events experienced (F = 3.58, p < .05); and significant decrease in overall trauma symptom scores before and after TF-CBT participation with a very large effect size in group C7 (t = 3.73, p < .001, d = 1.08) were found.

LESSONS LEARNED: The therapists were possibly viewed by the youth as part of the police system (which justice involved youth likely do not trust). Future implementations must seriously consider: the need for sufficient training of therapists; waiving program eligibility requirements; the value of a coherent communications protocol, clinical quality review and management, early assessment of services satisfaction, and information on families of justice involved youth; and, tracking behaviors that are incompatible with those that warrant arrests.




juvenile justice; youth under probation; trauma; TF-CBT; fidelity; PTSD

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Zelechoski, A. (2016). Trauma, adverse experience, and offending. In K. Heilbrun (Ed.), APA handbook of psychology and juvenile justice (pp. 325-342).

Abram, K., Teplin, L., Charles, D., Longworth, S., McClelland, G., & Dulcan, M. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61, 403-410.

Abram, K., Washburn, J., Teplin, L., Emanuel, K., Romero, E., & McClelland, G. (2007). Posttraumatic stress disorder and psychiatric comorbidity among detained youths. Psychiatric Services, 58(10), 1311-1316. doi:10.1176/

Maschi, T., Bradley, C., & Morgen, K. (2008). Unraveling the link between trauma and delinquency. Youth Violence and Juvenile Justice, 6, 136-157.

Bender, K. (2010). Why do some maltreated youth become juvenile offenders? A call for further investigation and adaptation of youth services. Children and Youth Services Review, 32, 466-473.

Wilson, H., Stover, C., & Berkowitz, S. (2009). Research review: The relationship between childhood violence exposure and juvenile antisocial behavior: a meta-analytic review. The Journal of Child Psychology and Psychiatry, 50(7), 769-779. doi:10.1111/j.1469-7610.2008.01974.x

Ford, J., Elhai, J., Connor, D., & Frueh, B. (2010). Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. Journal of Adolescent Health, 46(6), 545-552.

Ford, J. (2012). Posttraumatic stress disorder among youth involved in juvenile justice. In E.L. Grigorenko (Ed.), Handbook of juvenile forensic psychology and psychiatry (pp. 485-501). doi:10.1007/978-1-4614-0905-2_31

Heilbrun, K., & Locklair, B. (2016). Forensic assessment of juveniles. In K. Heilbrun (Ed.), APA handbook of psychology and juvenile justice (pp. 345-363).

Feierman, J. & Ford, J. (2016). Trauma informed juvenile justice systems and approaches. In K. Heilbrun (Ed.), APA handbook of psychology and juvenile justice (pp. 545-573).

Ford, J., Chapman, J., Mack, M., & Pearson, G. (2006). Pathway from traumatic child victimization to delinquency: Implications for juvenile and permanency court proceedings and decisions. Juvenile and Family Court Journal, 57, 13-26.

Norman, S., Elbogen, E., & Schnurr, P. (Updated Feb 2016). Research findings on PTSD and violence. Retrieved from

Allwood, M., Bell, D., & Horan, J. (2011). Posttrauma numbing of fear, detachment, and arousal predict delinquent behaviors in early adolescence. Journal of Clinical Child & Adolescent Psychology, 40, 659-667. doi:10.1080/15374416.2011.597081

Chassin, L., Mansion, A., Nichter, B. & Pandika, D. (2016). Substance use and substance use disorders as risk factors for juvenile offending. In K. Heilbrun (Ed.), APA handbook of psychology and juvenile justice (pp. 277-305).

Dierkhising, C., Ko, S., Woods-Jaeger, B., Briggs, E., Lee, R., & Pynoos, R. (2013). Trauma histories among justice-involved youth: findings from the national child traumatic stress network. European Journal of Psychotruamatology, 4: 20274 -

Ford, J., Chapman, J., Hawke, J., & Albert, D. (2007). Trauma among youth in the juvenile justice system: Critical issues and new directions (Research and Program Brief). Delmar, NY: National Center for Mental Health and Juvenile Justice.

Kerig, P., Ward, R., Vanderzee, K., & Arnzen Moedell, M. (2009). Posttraumatic stress as a mediator of the relationship between trauma and mental health problems among juvenile delinquents. Journal of Youth and Adolescence, 38, 1214-1225.

Kerig, P., Bennett, D., Thompson, M., & Becker, S. (2012). “Nothing really matters”: Emotional numbing as a link between trauma exposure and callousness in delinquent youth. Journal of Traumatic Stress, 25, 272-279.

King, D., Abram, K., Romero, E., Washburn, J., Welty, L., & Teplin, L. (2011). Childhood maltreatment and psychiatric disorders among detained youths. Psychiatric Services, 62, 1430-1438.

Mallett, C., Stoddard Dare, P., & Seck, M. (2009). Predicting juvenile delinquency: The nexus of childhood maltreatment, depression and bipolar disorder. Criminal Behavior and Mental Health, 19, 235-246.

Rosenberg, H., Vance, J., & Rosenberg, S., Wolford, G., Ashley, S., & Howard, M. (2014). Trauma exposure, psychiatric disorders, and resiliency in juvenile-justice-involved youth. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 430-437.

Cohen, J. Mannarino, A., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. New York, NY: The Guilford Press.

Cary, C & McMillen, C. (2012). The data behind dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth, Children and Youth Services Review, 34, 748-757. doi:10.1016/j.childyouth.2012.01.003

Cohen, J. Mannarino, A., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: The Guilford Press.

Dorsey, S., Pullmann, M., Berliner, L., Koschmann, E., McKay, M. & Deblinger, E. (2014). Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies. Child Abuse & Neglect, 38, 1508-1520.

Cohen, J.A., Mannarino, A. P., Janlowski, K., Rosenberg, S., & Wolford, G.L. (2016). A randomized implementation study of TF-CBT for adjudicated teens in residential treatment facilities. Child Maltreatment, 21, 156-167. doi:10.1177/1077559515624775

Arellano de, M., Lyman, D., Jobe-Shields, L., George, P., Dougherty, R., Daniels, A., Ghose, S., Huang, L., & Delphin-Rittmon, M (2014). Trauma-focused cognitive behavioral therapy: Assessing the evidence. Psychiatric Services, 65, 591-602. doi:101176/

Osher, F. (2012a, March). Implementing evidence-based practices. Orientation and Technical Assistance Events for FY 2011 JMHCP. Plenary session conducted at the Council of State Governments Justice Center, Washington D.C.

Osher, F. (2012b, March). Targeting the right people for the right intervention. Orientation and Technical Assistance Events for FY 2011 JMHCP. Plenary session conducted at the Council of State Governments Justice Center, Washington D.C.

Santa Clara County Superior Court (2011). Justice and Mental Health Collaborative Project Proposal Submitted to the Bureau of Justice Assistance. Unpublished.

Santa Clara County Superior Court (2012-2015). Santa Clara County Superior Court Reports to Bureau of Justice Assistance: 2012-2015. Retrieved from

Pynoos, R. & Steinberg, A. (2012). University of California Post Traumatic Stress Disorder Reaction Index (UCLA PTSD-RI) Version 2012. Unpublished.

Burlingame, G., Wells, M., Lambert, M., & Reisinger, C. (1998 & 2002). Youth Outcome Questionnaire (Y-OQ®-30.2). American Professional Credentialing Services.

Attkisson, C. & Larsen, D. (2009). Client Satisfaction Questionnaire.

Santa Clara County Social Services Agency (January 1, 2011). Quarterly Statistical Data of Public Assistance Families in the County of Santa Clara. Retrieved from

Steinberg, A., Brymer, M., Decker, K., & Pynoos, R. (2004). The University of California, Los Angeles Post Traumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6(2), 96-100.

Steinberg, A., Brymer, M., Kim, S., Briggs, E., Ippen, C., Ostrowski, S., Gully, K., & Pynoos, R. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress, 26:1- 9.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Burlingame, G., Dunn, T., Hill, M., Cox, J., Wells, M.G., Lambert, M., & Brown, G. (2004). Administration and Scoring Manual for the Y-OQTM-30.2.

Attkisson, C. & Greenfield, T. (2004). The UCSF Client Satisfaction Scales: I. The Client Satisfaction Questionnaire-8. In M.E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (3rd Ed) (pp. 799-811). Vol 3. Mahwah, NJ: Lawrence Erlbaum Associates.

Murry, L., Skavenski, S., Kane, J., Mayeya, J., Dorsy, S., Cohen, J., Michalopoulos, L., Imasiku, M. & Bolton, P (2015). Effectiveness of trauma-focused behavioral therapy among trauma-affected children in Lusaka, Zambia: A randomized clinical trial. Journal of American Medical Association Pediatrics, 169, 761-769. doi:10.1001/jamapediatrics.2015.0580

O'Donnell, K., Dorsey, S., Gong, W., Ostermann, J., Whetten, R., Cohen, J., Itemba, D., Manongi, R. & Whetten, K (2014). Treating maladaptive grief and post-traumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive-behavioral therapy. Journal of Traumatic Stress, 27, 664-671. Abstract retrieved from

Sachser, C., Keller, F. & Goldbeck, L. (2016). Complex ptsd as proposed for ICD-11: Validation of a new disorder in children and adolescents and their response to trauma-focused cognitive behavioral therapy. Journal of Psychology and Psychiatry, No pagination Specified. Abstract retrieved from

Sanders, B. & Hanson, R. (2013, September). Can RCT treatment effects be achieved in community practice of trauma treatment? Paper presented at the Thirteenth ISPCAN European Regional Conference on Child Abuse and Neglect, International Society of Child Abuse and Neglect, Dublin, Ireland. Abstract retrieved from

Webb, C., Hayes, A., Grasso, D., Laurenceau, JP., & Deblinger, E. (2014). Trauma-focused cognitive behavioral therapy for youth: Effectiveness in a community setting. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 555-562.

Cohen, J., Mannarino, A., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence. Archives of Pediatrics & Adolescent Medicine, 165(1), 16-21.

Cohen, J., Mannarino, A., & Murray, L. (2011). Trauma-focused CBT for youth who experience ongoing traumas. Child Abuse and Neglect, 35, 637-646. DOI:10.1016/j.chiabu.2011.05.002

Tyler, T. (2015). Why trust matters with juveniles. American Journal of Orthopsychiatry, 85(6), 93-99.

Hurst, Y. (2007). Juvenile attitudes toward the police. Criminal Justice Review, 32(2), 121-141.

Appelbaum, P. (2002). Privacy in psychiatric treatment: Threats and responses. American Journal of Psychiatry, 159, 1809-1818.

Bonner, R., & Vandecreek, L. (2006). Ethical decision making for correctional mental health providers. Criminal Justice and Behavior, 33, 542-564.

Bruggen, Eytan, Gravier, & Elger (2013). Medical and legal professionals' attitudes towards confidentiality and disclosure of clinical information in forensic settings: A survey using case vignettes. Medicine, Science, and the Law, 53, 132-148. doi:10.1258/msl.2012.012045

Wangmo, T., Handtke, V., & Elger, B. (2014). Disclosure of past crimes: An analysis of mental health professionals' attitudes towards breaching confidentiality. Journal of Bioethical Inquiry, 11, 347-358.

Louden, J., Manchak, S., Ricks, E., & Kennealy, P. (2018). The role of stigma toward mental illness in probation officers' perceptions of risk and case management decisions. Criminal Justice and Behavior, 45, 573-588. doi:10.1177/00093854818756148

Baer, J. & Maschi, T. (2003). Random acts of delinquency: Trauma and self-destructiveness in juvenile offenders. Child and Adolescent Social Work Journal, 20, 85-98.

DeLisi, M., Drury, A., Kosloski, A., Caudill, J., Conis, P., Anderson, C., Vaugn, M. & Beaver, K. (2010). The cycle of violence behind bars: Traumatization and institutional misconduct among juvenile delinquents in confinement. Youth Violence and Juvenile Justice, 8, 107-121. doi:10.1177/1541204009349399

Krischer, M. & Sevecke, K. (2008). Early traumatization and psychopathy in female and male juvenile offenders. International Journal of Law and Psychiatry, 31, 253-262. doi:10.1016/j.ijlp.2008.04.008

Elliott, D. (1995). Lies, damn lies and arrest statistics. The American Society of Criminology Meetings. The Sutherland Award Presentation. Boston, Massachusetts. Retrieved from

Henggeler, S. (2016). Community-based interventions for juvenile offenders In K. Heilbrun (Ed.), APA handbook of psychology and juvenile justice (pp. 575-595).

Mendel, R. (2011). No place for kids: The case for reducing juvenile incarceration. Baltimore, MD: Annie E. Casey Foundation. Retrieved from

Bryer, S. & Levin, M. (2013). The comeback states: Reducing youth incarceration in the United States. Washington, DC: National Juvenile Justice Network and the Center for Effective Justice, Texas Public Policy Foundation.

Lambie, I., & Randell, I. (2013). The impact of incarceration on juvenile offenders. Clinical Psychology Review, 33, 448-459.

Petteruti, A., Walsh, N., & Velazquez, T. (2009). The costs of confinement: Why good juvenile justice policies make good fiscal sense. Washington, DC: Justice Policy Institute.



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