Students who participated in the assessments consisted of slightly more girls than boys (girls 55.9%; boys 44.1%), with average age 11.6 years old (SD = 1.4). Forty-eight percent of children were non-Hispanic White, 46% were African American or Black, 5% were Hispanic, and 2% were from other racial/ethnic backgrounds. Of those determined to be “at-risk” based on PTSD symptoms scores, there were more girls (63%) than boys (37%), with an average age of 11.5 (SD = 1.5; median = 11.3; range 9.0–15.5). Fifty-two percent of students were African American or Black, 42% were non-Hispanic White, 4% were Hispanic, and 2% were from other racial / ethnic backgrounds.
Students in the study reported a median of one type of hurricane exposure (range 0–7). As seen in , the most common experiences were having seen something very upsetting or being separated from parent or caregiver. Rates of being trapped, rescued, or stranded in New Orleans were much lower, around 5%.
Lifetime trauma exposure was common, with students reporting a median of 4 traumatic events (range 0–10) at the baseline assessment. As seen in , the most common traumatic events reported were vicarious traumas (learning about the death or injury of a loved one, witnessing violence) but personal exposures to trauma (car accident, victim of violence, medical procedure) were also common. At the 10-month assessment, students reported on exposure to traumatic events since the last assessment. During this time, students reported a median of 3 additional recent traumatic exposures (range 0–8; mean 3.3, SD = 2.1).
Mean scores for PTSD, depression, and behavior problems are shown in . With regard to PTSD symptoms, all had scores of 12 or higher by definition, with 82.2% in the clinically significant range (scores of 15 or higher). For depression, 52.5% of students reported clinically significant symptoms (scores of 13 or more on the Children’s Depression Inventory). Teachers reported behavior problems indicative of the “borderline” range (a score of 12–15) for 11.9% of students and problems in the “abnormal” range (a score of 16 or above) for 15.3% of students. The two groups of children were comparable to one another, as shown in , as intended following the randomization procedure.
Exposures and Symptoms among “At-risk” Students at Baseline (15 months post-Katrina)
Of children randomized to be offered CBITS in schools, 57/58 (98%) began treatment, and 53 (91%) completed treatment. For children randomized to be offered TF-CBT at Mercy Family Center, therapists began calling parents immediately after randomization to schedule the intake, including confirming PTSD. Twenty-two of the 60 (37%) attended the initial assessment, which occurred weeks to months after the baseline assessment. Of this number, seven (32%) did not meet PTSD criteria on the K-SADS and were not provided with TF-CBT treatment, most commonly because distress was not linked to a specific traumatic event. Instead, these children were offered a different form of therapy within Mercy Family Center. Another child had a pervasive developmental disorder that precluded inclusion in the study. Thus, 14 (23%) began TF-CBT, and 9 (15%) completed treatment by the time of the 10-month follow up (4 dropped out of treatment, and 1 began late and had not completed treatment; See ). These rates of uptake varied by school: in School 1, 9 of 9 students began CBITS and 2 of 7 attended the TF-CBT intake appointment, in School 2, 28 of 28 began CBITS and 17 of 29 attended the TF-CBT intake, and in School 3, 20 of 21 began CBITS and 3 of 24 attended the TF-CBT intake.
As seen in , PTSD scores at 10 months improved in both interventions including all students that began treatment, as compared to baseline scores. Mean PTSD scores for the TF-CBT group had moved to the normal range while mean scores in the CBITS group were in the low clinical range. Sixty-five per cent of the children (37/57) in the CBITS group remained in the “at-risk” range (≥ 12) on the Child PTSD Symptom Scale at the 10-month follow-up, whereas 43% (6/14) of the children who received TF-CBT remained at-risk. A Fisher’s Exact test revealed these two rates of clinical change were comparable across the two groups (2-tailed p-value = 0.22). According to the KSADS, only 1/9 (11%) children completing TF-CBT treatment met criteria for PTSD at the end of treatment. Changes in depressive symptoms also improved for both groups, but this improvement was only statistically significant for the CBITS group. Mean depression scores moved to the normal range for both groups. Thus both statistically and clinically significant gains were achieved by students in both interventions.
Changes Observed Among Intervention Starters
Since few children took part in TF-CBT, we could not evaluate predictors of treatment response. Instead, we examined predictors of attending the intake for TF-CBT (see ). Baseline trauma exposure, severity of symptoms, and social support were not predictive of attending the intake. Boys and younger children had higher odds of attending the intake appointment. African American students had lower odds than Caucasian students, as also reflected in the higher odds of students in School 2 (with a largely Caucasian student body) attending the appointment. Rates of attendance also differed by distance between home and clinic. School, race/ethnicity, and distance were confounded (with students at School 3 living the shortest distances and students at School 1 the longest), but school and race were too highly confounded in the TF-CBT group to examine separately. When school as well as distance were used in the same regression, school remained a significant predictor of attendance, Wald’s χ2 (2) = 7.38, p < .05, while distance did not, Wald’s χ2 (1) = 2.22, ns.
Odds of Attendance at TF-CBT Intake (N=60)
Predictors of treatment outcome for the CBITS group were examined, predicting PTSD symptoms at 10 months while controlling for baseline PTSD. Baseline PTSD was a strong predictor of PTSD at 10 months (See ). Support from family predicted lower PTSD scores, whereas higher baseline depressive symptoms and additional exposures to traumatic events as reported at follow-up predicted higher PTSD scores. Gender, school, teacher reported behavior problems at baseline, hurricane exposures, and social support from friends were unrelated to PTSD at follow-up.
Predictors of 10-month Follow-up PTSD Symptoms within the CBITS Group1 (N=57)