Usual care for trauma-exposed youth: Are clinician-reported therapy techniques evidence-based?

The current study examined the extent to which usual care interventions targeting childhood traumatic stress involved the application of practice elements (Chorpita, Daleiden, & Weisz, 2005) represented among the evidenced-based treatments (EBTs) for trauma. Youth age and the presence of conduct problems at intake were examined as potential predictors of differences in the presence of elements from EBTs. Data were obtained from archival records from 814 youth who received services from a large, community-based mental health system. Results showed that usual care clinicians reported a variety of practices, only some of which were common to the evidence base for traumatic stress. ‘Exposure’ stood out as the most common practice element among EBTs for treating traumatic stress, but it was reported in fewer than a quarter of usual care cases. For youth receiving out-of-home services, a diagnosis of PTSD predicted that fewer practice elements from EBTs for trauma were reported. Also, as youth age increased, clinicians reported using more practice elements from the evidence base. These findings point to possible opportunities for service improvement in usual care settings for trauma-exposed youth and at the same time call into question whether aspects of the context or population warrant increased use of techniques not associated with EBTs for traumatic stress (cf. Brookman-Frazee, Haine, Baker-Ericzén, Zoffness, & Garland, 2010; Southam-Gerow, Chorpita, Miller, & Gleacher, 2008).

► Clinicians reported using a variety of practice elements with trauma-exposed youth.
► The use of exposure was reported in fewer than one quarter of usual care cases.
► PTSD did not predict higher use of trauma-related evidence-based practice elements.
► Age significantly predicted higher reports of evidence-based practice elements.
► Results highlight specific training needs for providers (e.g., use of exposure).