Cognitive Behavioral Intervention for Trauma in Schools

Target Population

CBITS is used with students from 4th grade through 12th grade who have witnessed or experienced traumatic life events and have significant symptoms of PTSD or depression.

Dosage

CBITS includes ten 45-minute group sessions typically held once per week. Groups include six to eight students of similar ages. The program also includes one to three individual student sessions each lasting 30–45 minutes, two caregiver education sessions, and an optional teacher education session. CBITS is typically delivered over 10–12 weeks. 

Location/Delivery Setting

Recommended Locations/Delivery Settings

CBITS is designed to be implemented in school settings.

Location/Delivery Settings Observed in the Research

• School

Education, Certifications and Training

CBITS is implemented by mental health professionals with specialized training in cognitive behavioral therapy and experience working with people who have experienced traumatic events. Training delivered by certified CBITS trainers is recommended. Live training options include a 12 hour in-person 2-day training or a virtual training, typically delivered in four 3-hour modules. A self-led online training is also available.

Program or Service Documentation

Book/Manual/Available documentation used for review

Jaycox, L. H., Langley, A. K., & Hoover, S. A. (2018). Cognitive Behavioral Intervention for Trauma in Schools (2nd ed.). RAND Corporation.

Available languages

CBITS materials are available in English, Arabic, and Spanish.

Other supporting materials

CBITS Resources 

For More Information

Website: https://traumaawareschools.org/index.php/learn-more-cbits/   

Email: info@traumaawareschools.org  

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review	Number of Studies Identified and Reviewed for Cognitive Behavioral Intervention for Trauma in Schools
Identified in Search	17
Eligible for Review	3
Rated High	1
Rated Moderate	1
Rated Low	1
Reviewed Only for Risk of Harm	0

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings
Child well-being: Behavioral and emotional functioning	0.15 5	2 (26)	491	Favorable: 2 No Effect: 24 Unfavorable: 0
Child well-being: Educational achievement and attainment	0.03 0	1 (8)	293	Favorable: 0 No Effect: 8 Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings	Months after treatment when outcome measured
Child well-being: Behavioral and emotional functioning	0.15 5	2 (26)	491	Favorable: 2 No Effect: 24 Unfavorable: 0	-
Study 13157 - CBITS vs. Waitlist Control (Kataoka, 2003)
Children's Depression Inventory	0.38 * 14	-	198	-	1
Child PTSD Symptom Scale	0.42 * 16	-	198	-	1
Study 13169 - CBITS vs. Treatment as Usual (Sumi, 2021)
Trauma Symptom Checklist for Children – Alternate Version: Posttraumatic Stress Disorder	0.21 8	-	293	-	0
Trauma Symptom Checklist for Children – Alternate Version: Anxiety	0.13 5	-	293	-	0
Trauma Symptom Checklist for Children – Alternate Version: Depression	0.12 4	-	293	-	0
Trauma Symptom Checklist for Children – Alternate Version: Disassociation	0.10 3	-	293	-	0
Trauma Symptom Checklist for Children – Alternate Version: Anger	0.15 5	-	293	-	0
Youth Self-Report: Internalizing Problems	0.19 7	-	293	-	0
Youth Self-Report: Externalizing Problems	0.12 4	-	293	-	0
Youth Self-Report: Total Problems	0.13 5	-	293	-	0
Teacher's Report Form: Internalizing Problems	-0.09 -3	-	293	-	0
Teacher's Report Form: Externalizing Problems	-0.03 -1	-	293	-	0
Teacher's Report Form: Total Problems	-0.05 -1	-	293	-	0
Trauma Symptom Checklist for Children – Alternate Version: Posttraumatic Stress Disorder	-0.04 -1	-	293	-	12
Trauma Symptom Checklist for Children – Alternate Version: Anxiety	-0.06 -2	-	293	-	12
Trauma Symptom Checklist for Children – Alternate Version: Depression	0.07 2	-	293	-	12
Trauma Symptom Checklist for Children – Alternate Version: Disassociation	-0.09 -3	-	293	-	12
Trauma Symptom Checklist for Children – Alternate Version: Anger	0.08 3	-	293	-	12
Youth Self-Report: Internalizing Problems	-0.03 -1	-	293	-	12
Youth Self-Report: Externalizing Problems	-0.17 -6	-	293	-	12
Youth Self-Report: Total Problems	-0.09 -3	-	293	-	12
Teacher's Report Form: Internalizing Problems	0.02 0	-	293	-	12
Teacher's Report Form: Externalizing Problems	-0.13 -5	-	293	-	12
Teacher's Report Form: Total Problems	-0.10 -3	-	293	-	12
Academic Engaged Time Observations	0.16 6	-	293	-	0
Academic Engaged Time Observations	0.04 1	-	293	-	12
Child well-being: Educational achievement and attainment	0.03 0	1 (8)	293	Favorable: 0 No Effect: 8 Unfavorable: 0	-
Study 13169 - CBITS vs. Treatment as Usual (Sumi, 2021)
Woodcock-Johnson III: Letter-Word Identification	-0.02 0	-	293	-	0
Woodcock-Johnson III: Passage Comprehension	0.13 5	-	293	-	0
Woodcock-Johnson III: Calculation	-0.05 -1	-	293	-	0
Woodcock-Johnson III: Applied Problems	0.04 1	-	293	-	0
Woodcock-Johnson III: Letter-Word Identification	0.10 3	-	293	-	12
Woodcock-Johnson III: Passage Comprehension	-0.12 -4	-	293	-	12
Woodcock-Johnson III: Calculation	0.05 1	-	293	-	12
Woodcock-Johnson III: Applied Problems	0.07 2	-	293	-	12

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtassoc.com.

The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.

For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.

Characteristics of the Participants in the Studies with Moderate or High Ratings
Study Location	Study Year	Age or Grade-level	Race, Ethnicity, Nationality	Gender	Populations of Interest*	Household Socioeconomic Status
Study 13157 - CBITS vs. Waitlist Control
Characteristics of the Children and Youth
Los Angeles, CA, USA	2000	Average age: 11 years; 68% in middle school; 32% in elementary school	57% Country of origin: Mexico 18% Country of origin: El Salvador 13% Country of origin: Other 11% Country of origin: Guatemala	50% Female	90% Children in the program had clinical levels of PTSD symptoms; 32% had comorbid PTSD and depressive symptoms in the clinical range; 10% had clinical levels of depression only.	--
Characteristics of the Adults, Parents, or Caregivers
Los Angeles, CA, USA	2000	--	--	--	--	64% Employed
Study 13169 - CBITS vs. Treatment as Usual
Characteristics of the Children and Youth
Northern California, USA	--	Sixth Grade: 100%	39% Latinx 24% Asian 18% Declined/missing 12% White 8% Black	50% Male 50% Female	--	--

“--” indicates information not reported in the study.

* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.

Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated High

Study 13169

Sumi, W. C., Woodbridge, M. W., Wei, X., Thornton, S. P., & Roundfield, K. D. (2021). Measuring the impact of trauma-focused, cognitive behavioral group therapy with middle school students. School Mental Health: A Multidisciplinary Research and Practice Journal, 13(4), 680-694. https://doi.org/10.1007/s12310-021-09452-8

This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)

Studies Rated Moderate

Study 13157

Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311-318. https://doi.org/10.1097/00004583-200303000-00011

This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)

Studies Rated Low

Study 13168

Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. JAMA, 290(5), 603-611. https://doi.org/10.1001/jama.290.5.603

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.

Studies Not Eligible for Review

Study 13150

Auslander, W., McGinnis, H., Tlapek, S., Smith, P., Foster, A., Edmond, T., & Dunn, J. (2017). Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare. The American Journal of Orthopsychiatry, 87(3), 206-215. https://doi.org/10.1037/ort0000233

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13151

Auslander, W., Edmond, T., Foster, A., Smith, P., McGinnis, H., Gerke, D., Tlapek, S., Threlfall, J., Voth Schrag, R., Dunn, J., & Jonson-Reid, M. (2020). Cognitive behavioral intervention for trauma in adolescent girls in child welfare: A randomized controlled trial. Children and Youth Services Review, 119. https://doi.org/10.1016/j.childyouth.2020.105602

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13152

Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., Scott, M., & Schonlau, M. (2010). Children's mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies. Journal of Traumatic Stress, 23(2), 223-231. https://doi.org/10.1002/jts.20518

Cohen, J. A., Jaycox, L. H., Walker, D. W., Mannarino, A. P., Langley, A. K., & DuClos, J. L. (2009). Treating traumatized children after Hurricane Katrina: Project Fleur-de-lis. Clinical Child and Family Psychology Review, 12(1), 55–64. https://doi.org/10.1007/s10567-009-0039-2 

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13153

Allison, A. C., & Ferreira, R. J. (2017). Implementing Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with Latino youth. Child & Adolescent Social Work Journal, 34(2), 181-189. https://doi.org/10.1007/s10560-016-0486-9

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13154

Goodkind, J. R., Lanoue, M. D., & Milford, J. (2010). Adaptation and implementation of Cognitive Behavioral Intervention for Trauma in Schools with American Indian youth. Journal of Clinical Child and Adolescent Psychology, 39(6), 858-872. https://doi.org/10.1080/15374416.2010.517166

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13155

Howard, J., Domingues, J., Kirmayer, L., & Mintzer, A. (2016). Disseminating trauma-focused cognitive-behavioral intervention in New York City public schools. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10S), S357-S357. https://doi.org/10.1016/j.jaac.2016.07.113

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13158

Kataoka, S., Jaycox, L. H., Wong, M., Nadeem, E., Langley, A., Tang, L., & Stein, B. D. (2011). Effects on school outcomes in low-income minority youth: Preliminary findings from a community-partnered study of a school-based trauma intervention. Ethnicity & Disease, 21(3 Suppl. 1), S1-71-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287975/pdf/nihms-353079.pdf

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13160

Jaycox, L. H., Langley, A. K., Dean, K. L., Stein, B. D., Wong, M., Sharma, P., Scott, M. M., Schonlau, M., & Kataoka, S. H. (2009). Making it easier for school staff to help traumatized students. RAND Corporation. https://www.rand.org/pubs/research_briefs/RB9443-1.html

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13161

Mendelson, T., Tandon, S. D., O'Brennan, L., Leaf, P. J., & Ialongo, N. S. (2015). Moving prevention into schools: The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43(1), 142-147. https://doi.org/10.1016/j.adolescence.2015.05.017

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 13162

Morsette, A., Swaney, G., Stolle, D., Schuldberg, D., van den Pol, R., & Young, M. (2009). Cognitive Behavioral Intervention for Trauma in Schools (CBITS): School-based treatment on a rural American Indian reservation. Journal of Behavior Therapy and Experimental Psychiatry, 40(1), 169-178. https://doi.org/10.1016/j.jbtep.2008.07.006

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13163

Morsette, A., van den Pol, R., Schuldberg, D., Swaney, G., & Stolle, D. (2012). Cognitive behavioral treatment for trauma symptoms in American Indian youth: Preliminary findings and issues in evidence-based practice and reservation culture. Advances in School Mental Health Promotion, 5(1), 51-62. https://doi.org/10.1080/1754730X.2012.664865

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13164

Ngo, V., Langley, A., Kataoka, S. H., Nadeem, E., Escudero, P., & Stein, B. D. (2008). Providing evidence-based practice to ethnically diverse youths: Examples from the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 858-862. https://doi.org/10.1097/CHI.0b013e3181799f19

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13166

Santiago, C. D., Lennon, J. M., Fuller, A. K., Brewer, S. K., & Kataoka, S. H. (2014). Examining the impact of a family treatment component for CBITS: When and for whom is it helpful? Journal of Family Psychology, 28(4), 560-570. https://doi.org/10.1037/a0037329

Santiago, C. D., Fuller, A. K., Lennon, J. M., & Kataoka, S. H. (2016). Parent perspectives from participating in a family component for CBITS: Acceptability of a culturally informed school-based program. Psychological Trauma: Theory, Research, Practice and Policy, 8(3), 325-333. https://doi.org/10.1037/tra0000076

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).

Study 13167

Santiago, C. D., Kataoka, S. H., Hu-Cordova, M., Alvarado-Goldberg, K., Maher, L. M., & Escudero, P. (2015). Preliminary evaluation of a family treatment component to augment a school-based intervention serving low-income families. Journal of Emotional and Behavioral Disorders, 23(1), 28-39. https://doi.org/10.1177/1063426613503497

This study is ineligible for review because it does not use an eligible design (Study Eligibility Criterion 4.1.4).