Abstract
Traumatic events are becoming more prevalent in youth, especially considering the increase in disaster exposure, impacting the wellbeing and mental health of youth. Youth in rural communities are more adversely impacted due to a lack of access to available support and services. Interventions geared toward treating traumatic stress are needed for youth residing in these communities. The Cognitive-behavioral Intervention in Schools is a school-based trauma-focused group therapy intervention geared for adolescents between 5 to 12th grade who have experienced traumatic events. The aim of this study was to test the feasibility, acceptability, and preliminary effectiveness of CBITS in a rural community impacted by a natural disaster.This study utilized a non-probability sample of youth attending primary and secondary school in a rural community impacted by Hurricane Michael. Data collection occurred with youth and parents at three-time points: pre-, post- and three months post-intervention. Feasibility and acceptability were measured through count data of referrals, assents/consents, and the number of sessions attended. Outcomes explored improvement in trauma symptomology and problem-solving skills. Results showed CBITS is a feasible and acceptable intervention for youth exposed to a natural disaster. Results of the outcome measures showed significant differences between baseline and three-month follow-up and from the post-test to the three-month follow-up on the youth self-report. Parent proxy report showed a significant decrease in PTSD symptomology from the post-test to the three-month follow-up. To examine predictors of improvement at follow-up, a regression analysis was conducted. Results showed that trauma exposure and gender were significant predictors for trauma symptom follow-up scores on the youth self-report. Youth trauma experiences vary, but for youth impacted by natural disasters, CBITS may be a feasible and acceptable intervention. School-based interventions are integral for serving youth who may not receive trauma intervention otherwise, especially for those in rural communities.
![](https://cdn.statically.io/img/media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12310-024-09677-3/MediaObjects/12310_2024_9677_Fig1_HTML.png)
Similar content being viewed by others
Data Availability
Research data are not shared.
References
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
Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. British Journal of Psychiatry, 190(2), 97–104. https://doi.org/10.1192/bjp.bp.106.021402
Blackstock, J., Chae, K. B., McDonald, A., & Mauk, G. W. (2018). Achieving access to mental health care for school-aged children in rural communities. The Rural Educator, 39, 12–25.
Bradshaw, C. P., Schaeffer, C. M., Petras, H., & Ialongo, N. S. (2010). Predicting negative life outcomes from early aggressive-disruptive behavior trajectories: Gender differences in maladaptation across life domains. Journal of Youth and Adolescence. https://doi.org/10.1007/s10964-009-9442-8
Branson, D. C. (2019). Vicarious trauma, themes in research, and terminology: A review of literature. Traumatology, 25(1), 2–10. https://doi.org/10.1037/trm0000161
Christiansen, J., Qualter, P., Friis, K., Pedersen, S., Lund, R., Andersen, C., Bekker-Jeppesen, M., & Lasgaard, M. (2021). Associations of loneliness and social isolation with physical and mental health among adolescents and young adults. Perspectives in Public Health, 141(4), 226–236. https://doi.org/10.1177/17579139211016077
Roberts, A., Rogers, J., Mason, R., Siriwardena, A. N., Hogue, T., Whitley, G. A., & Law, G. R. (2021). Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug and Alcohol Dependence, 229, 109150. https://doi.org/10.1016/j.drugalcdep.2021.109150
Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577. https://doi.org/10.1001/archpsyc.64.5.577
Cruz, J., White, P. C. L., Bell, A., & Coventry, P. (2020). Effect of extreme weather events on mental health: A narrative synthesis and meta-analysis for the UK. International Journal of Environmental Research and Public Health, 17(22), 8581. https://doi.org/10.3390/ijerph17228581
Data Resource Center for Child and Adolescent Help. (2022). The national survey of children’s health. The children and adolescent health measurement initiative. https://www.childhealthdata.org/learn-about-the-nsch/NSCH
Dew, A., Bulkeley, K., Veitch, C., Bundy, A., Gallego, G., Lincoln, M., Brentnall, J., & Griffiths, S. (2012). Addressing the barriers to accessing therapy services in rural and remote areas. Disability and Rehabilitation, 35(18), 1564–1570. https://doi.org/10.3109/09638288.2012.720346
Farina, V., Salemi, S., Tatari, F., Abdoli, N., Jouybari, T. A., Alikhani, M., Basanj, B., & Zakiei, A. (2018). Trauma-focused cognitive behavioral therapy a clinical trial to increase self-efficacy in abused the primary school children. Journal of Education and Health Promotion, 7, 33. https://doi.org/10.4103/jehp.jehp_80_17
Fondren, K., Lawson, M., Speidel, R., McDonnell, C. G., & Valentino, K. (2020). Buffering the effects of childhood trauma within the school setting: A systematic review of trauma-informed and trauma-responsive interventions among trauma-affected youth. Children and Youth Services Review, 109, 104691. https://doi.org/10.1016/j.childyouth.2019.104691
Frauenknecht, M., & Black, D. R. (1995). Social problem-solving inventory for adolescents (SPSI-A): Development and preliminary psychometric evaluation. Journal of Personality Assessment, 64(3), 522–539.
Gonzalez, A., Monzon, N., Solis, D., Jaycox, L., & Langley, A. K. (2016). (2016) Trauma exposure in elementary school children: Description of screening procedures, level of exposure, and posttraumatic Stress symptoms. School Mental Health, 8, 77–88. https://doi.org/10.1007/s12310-015-9167-7
Goodkind, J. R., LaNoue, M., & 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
Handley, T., Kelly, B., Lewin, T. J., Coleman, C., Stain, H. J., Weaver, N., & Inder, K. (2015). Long-term effects of lifetime trauma exposure in a rural community sample. BMC Public Health, 15, 1–8. https://doi.org/10.1186/s12889-015-2490-y
Hansel, T. C., Osofsky, H. J., Osofsky, J. D., Costa, R. N., Kronenberg, M., & Selby, M. (2010). Attention to process and clinical outcomes of implementing a rural school-based trauma treatment program. Journal of Traumatic Stress, 23(6), 708–715. https://doi.org/10.1002/jts.20595
Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675–1678. https://doi.org/10.2105/ajph.94.10.1675
Heleniak, C., Jenness, J. L., Stoep, A. V., McCauley, E., & McLaughlin, K. A. (2016). Childhood maltreatment exposure and disruptions in emotion regulation: A transdiagnostic pathway to adolescent internalizing and externalizing psychopathology. Cognitive Therapy and Research, 40(3), 394–415. https://doi.org/10.1007/s10608-015-9735-z
Hirn, R. G., Hollo, A., & Scott, T. M. (2017). Exploring instructional differences and school performance in high-poverty elementary schools. Preventing School Failure, 62(1), 37–48. https://doi.org/10.1080/1045988x.2017.1329197
Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 139(1), e20151175. https://doi.org/10.1542/peds.2015-1175
Hoffman, M. L. (2001). Empathy and moral development: implications for caring and justice. Contemporary Sociology, 30(5), 487. https://doi.org/10.2307/3089337
Hoover, S. A., & Mayworm, A. M. (2017). The benefits of school mental health. In K. D. Michael & J. P. Jameson (Eds.), Handbook of rural school mental health (pp. 3–16). Springer International Publishing.
Horton, K. B., & PhD, L. M. S. W. (2019). Cognitive behavioral intervention for trauma in schools (CBITS): A school social work perspective. International Journal of School Social Work, 4(1), 1–11. https://doi.org/10.4148/2161-4148.1044
Howard, S. (2021). A causal model of children’s vicarious traumatization. Journal of Child and Adolescent Trauma, 14(4), 443–454. https://doi.org/10.1007/s40653-020-00331-z
Hu, J., Feng, B., Yonghu, W., Wenqing, X., & Jiawei, Z. (2017). Gender differences in PTSD: Susceptibility and resilience. INTECH. https://doi.org/10.5772/65287
Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., Scott, M. M., & Schonlau, M. (2010). Children’s mental health care following hurricane Katrina: A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress, Official Publication of The International Society for Traumatic Stress Studies. https://doi.org/10.1002/jts.20518
Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., & Schonlau, M. (2009). Support for students exposed to trauma: A pilot study. School Mental Health, 1(2), 49–60. https://doi.org/10.1007/s12310-009-9007-
Jeynes, W. H. (2007). The relationship between parental involvement and urban secondary school student academic achievement: A meta-analysis. Urban Education, 42(1), 82–110. https://doi.org/10.1177/0042085906293818
Kataoka, S. H., Jaycox, L. H., Wong, M., Nadeem, E., Langley, A. K., 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. PubMed. https://pubmed.ncbi.nlm.nih.gov/22352083
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
Klest, B. (2012). Childhood trauma, poverty, and adult victimization. Psychological trauma: Theory, research, practice, and policy, 4(3), 245–251. https://doi.org/10.1037/a0024468
Kronenberg, M. E., Hansel, T. C., Brennan, A. M., Osofsky, H. J., Osofsky, J. D., & Lawrason, B. (2010). Children of Katrina: Lessons learned about postdisaster symptoms and recovery patterns. Child Development, 81(4), 1241–1259. https://doi.org/10.1111/j.1467-8624.2010.01465.x
La Greca, A. M., Silverman, W. K., Lai, B., & Jaccard, J. (2010). Hurricane-related exposure experiences and stressors, other life events, and social support: Concurrent and prospective impact on children’s persistent posttraumatic stress symptoms. Journal of Consulting and Clinical Psychology, 78, 794–805. https://doi.org/10.1037/a0020775
Lambert, H. K., King, K. M., Monahan, K. C., & McLaughlin, K. A. (2016). Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence. Development and Psychopathology, 29(3), 929–940. https://doi.org/10.1017/s0954579416000584
Lawrence-Sidebottom, D., Huffman, L. G., Beam, A. B., Guerra, R., Parikh, A., Roots, M., & Huberty, J. (2024). Rates of trauma exposure and posttraumatic stress in a pediatric digital mental health intervention: Retrospective analysis of associations with anxiety and depressive symptom improvement over time. JMIR Pediatrics and Parenting, 7(1), e55560.
Lehrner, A., & Yehuda, R. (2018). Cultural trauma and epigenetic inheritance. Development and Psychopathology, 30(5), 1763–1777. https://doi.org/10.1017/s0954579418001153
Lissek, S., & Van Meurs, B. (2015). Learning models of PTSD: Theoretical accounts and psychobiological evidence. International Journal of Psychophysiology, 98(3), 594–605. https://doi.org/10.1016/j.ijpsycho.2014.11.006
Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59, 1218–1239.
Lochman, J. E., Vernberg, E., Powell, N. P., Boxmeyer, C. L., Jarrett, M., McDonald, K., Qu, L., Hendrickson, M., & Kassing, F. (2017). Pre–post tornado effects on aggressive children’s psychological and behavioral adjustment through one-year postdisaster. Journal of Clinical Child & Adolescent Psychology, 46(1), 136–149. https://doi.org/10.1080/15374416.2016.1228460
López-Zerón, G., & Parra-Cardona, J. R. (2015). Elements of change across community-based trauma interventions. Journal of Systemic Therapies, 34(3), 60–76. https://doi.org/10.1521/jsyt.2015.34.3.60
Lowe, S. R., McGrath, J. A., Young, M. N., Kwok, R. K., Engel, L. S., Galea, S., & Sandler, D. P. (2019). Cumulative disaster exposure and mental and physical health symptoms among a large sample of Gulf Coast residents. Journal of Traumatic Stress, 32(2), 196–205. https://doi.org/10.1002/jts.22392
Marusak, H. A., Martin, K. R., Etkin, A., & Thomason, M. E. (2015). Childhood trauma exposure disrupts the automatic regulation of emotional processing. Neuropsychopharmacology, 40(5), 1250–1258. https://doi.org/10.1038/npp.2014.311
McCrory, E., De Brito, S. A., Sebastian, C., Mechelli, A., Bird, G., Kelly, P. A., & Viding, E. (2011). Heightened neural reactivity to threat in child victims of family violence. Current Biology, 21(23), R947–R948. https://doi.org/10.1016/j.cub.2011.10.015
McLaughlin, K. A., Peverill, M., Gold, A. L., Alves, S., & Sheridan, M. A. (2015a). Child maltreatment and neural systems underlying emotion regulation. Journal of the American Academy of Child and Adolescent Psychiatry, 54(9), 753–762. https://doi.org/10.1016/j.jaac.2015.06.010
McLaughlin, K. A., Sheridan, M. A., Gold, A. L., Duys, A., Lambert, H. K., Peverill, M., Heleniak, C., Shechner, T., Wojcieszak, Z., & Pine, D. S. (2015b). Maltreatment exposure, brain structure, and fear conditioning in children and adolescents. Neuropsychopharmacology, 41(8), 1956–1964. https://doi.org/10.1038/npp.2015.365
McLeigh, J. D., McDonell, J. R., & Lavenda, O. (2018). Neighborhood poverty and child abuse and neglect: The mediating role of social cohesion. Children and Youth Services Review, 93, 154–160. https://doi.org/10.1016/j.childyouth.2018.07.018
McMurtry, S. L., & Hudson, W. W. (2000). The client satisfaction inventory: results of an initial validation study. Research on Social Work Practice, 10(5), 644–663.
Miller, C. E., & Vasan, R. S. (2021). The southern rural health and mortality penalty: A review of regional health inequities in the United States. Social Science and Medicine, 268, 113443. https://doi.org/10.1016/j.socscimed.2020.113443
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
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
National Institute of Justice. (2011). Program profile: Cognitive behavioral intervention for trauma in schools. Crime Solutions. https://crimesolutions.ojp.gov/ratedprograms/139#:~:text=Institute%20of%20Justice-,Program%20Profile%3A%20Cognitive%20Behavioral%20Intervention%20for%20Trauma%20in%20Schools%20(CBITS,caused%20by%20exposure%20to%20violence
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
Pearce, J., Witten, K., & Bartie, P. (2006). Neighbourhoods and health: A GIS approach to measuring community resource accessibility. Journal of Epidemiology and Community Health, 60(5), 389–395. https://doi.org/10.1136/jech.2005.043281
Peek-Asa, C., Zwerling, C., & Stallones, L. (2004). Acute traumatic injuries in rural populations. American Journal of Public Health, 94(10), 1689–1693. https://doi.org/10.2105/ajph.94.10.1689
Perry, D. L., & Daniels, M. L. (2016). Implementing trauma—informed practices in the school setting: A pilot study. School Mental Health, 8(1), 177–188. https://doi.org/10.1007/s12310-016-9182-3
Putnam, F. W. (2009). The impact of trauma on child development. Juvenile Family Court Journal, 57(1), 1–11. https://doi.org/10.1111/j.1755-6988.2006.tb00110.x
Rohrbach, L. A., Grana, R., Vernberg, E., Sussman, S., & Sun, P. (2009). Impact of hurricane Rita on adolescent substance use. Psychiatry, 72(3), 222–237. https://doi.org/10.1521/psyc.2009.72.3.222
Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N., Risch, E., Rosner, R., & Goldbeck, L. (2017). International development and psychometric properties of the child and adolescent trauma screen (CATS). Journal of Affective Disorders, 210, 189–195. https://doi.org/10.1016/j.jad.2016.12.040
Santiago, C. D., Pears, G., Baweja, S., Vona, P., Tang, J., & Kataoka, S. H. (2013). Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS. School Mental Health, 5, 209–220. https://doi.org/10.1007/s12310-012-9100-2
Simon, N. S., & Johnson, S. M. (2015). Teacher turnover in high-poverty schools: What we know and can do. Teachers College Record, 117(3), 1–36.
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. JAMA, 290(5), 603. https://doi.org/10.1001/jama.290.5.603
Suzuki, H., Luby, J. L., Botteron, K. N., Dietrich, R., McAvoy, M. P., & Deanna, M. (2014). Early life stress and trauma and enhanced limbic activation to emotionally valenced faces in depressed and healthy children. Journal of the American Academy of Child and Adolescent Psychiatry, 53(7), 800-813.e10. https://doi.org/10.1016/j.jaac.2014.04.013
Sznitman, S. R., Reisel, L., & Romer, D. (2011). The neglected role of adolescent emotional well-being in national educational achievement: Bridging the gap betweeneducation and mental health policies. Journal of Adolescent Health, 48(2), 135142. https://doi.org/10.1016/j.jadohealth.2010.06.013
Victorino, C., & Gauthier, A. H. (2009). The social determinants of child health: variations across health outcomes—a population-based cross-sectional analysis. BMC Pediatrics, 9, 1–12. https://doi.org/10.1186/1471-2431-9-53
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Renn, T., Dowdy-Hazlett, T., Collins, C. et al. The Feasibility and Acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in a Rural Community Impacted by Environmental Trauma and Covid-19. School Mental Health (2024). https://doi.org/10.1007/s12310-024-09677-3
Accepted:
Published:
DOI: https://doi.org/10.1007/s12310-024-09677-3