Summary: Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, and Fink A. "A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial," Journal of the American Medical Association vol 290 (5): 603-611. 2003.

Violence is a serious public health problem throughout the country, but some children are more likely than others to be its victims. Children from poor, urban, and minority backgrounds are at an increased risk for witnessing and being victimized by violence. While more likely to become victims, these children are less likely to receive services that could help them deal with the psychological outcomes of exposure to violence. A recent report of the United States Surgeon General called for the provision of more mental health services in schools. In response to the dual crises of exposure to violence and lack of traditional mental health services for the disadvantaged, clinicians and educators in Los Angeles established and evaluated a school-based treatment program in two middle schools. This article reports the outcomes of that intervention.

The Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) was designed to be used in inner-city schools with children of diverse backgrounds. This study reports on the use of the program in two middle schools in East Los Angeles, a working class, mostly Latino neighborhood. Almost 800 children were screened to determine their exposure to violence. In the end, 126 children were eligible to participate in the study and agreed to do so. Researchers randomly assigned the children to one of two groups. Approximately half of the children immediately began receiving treatment, while the second group received treatment three months later.

The CBITS program uses cognitive behavioral methods to help children cope with symptoms of posttraumatic stress disorder, anxiety, and depression. The school-based therapists working with the children were trained in CBITS and were closely supervised by the researchers. They followed a manual but had some flexibility in how they worked with specific groups. In 10 group and individual sessions, the children learned about reactions to stress; practiced relaxation techniques and problem solving, and were given homework assignments to reinforce what they had learned in each session.

Every three months the children's progress was assessed. In the first assessment, the children who had immediately received treatment had fewer symptoms of PTSD and depression than the children who had not yet been treated. Three months later, the second group of children-now in treatment-was doing as well as the first group. Parents also reported that their children were functioning better-with the second group of children doing as well as the first group at the six-month follow-up.