Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Area of Science:

• Public Health
• Mental Health Services Research
• Trauma Treatment

Background:

• Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) initiated a city-wide implementation of trauma-focused cognitive behavioral therapy (TF-CBT) in 2012.
• This initiative aimed to integrate evidence-based PTSD treatment into the public behavioral health system.
• The report details the 10-year implementation and effectiveness of this TF-CBT initiative.

Purpose of the Study:

• To evaluate the 10-year implementation outcomes of TF-CBT across Philadelphia's behavioral health system.
• To assess the effectiveness of TF-CBT in reducing PTSD symptoms among youth.
• To examine the adoption, reach, and sustainment of TF-CBT within the public health network.

Main Methods:

• The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided the implementation evaluation.
• Implementation outcomes (adoption, reach, sustainment) were collected from participating agencies.
• Effectiveness outcomes (PTSD symptom changes) were analyzed from a subset of youth receiving TF-CBT using linear mixed-effects models.

Main Results:

• DBHIDS trained 478 clinicians and screened 23,401 youths, with 7,550 receiving TF-CBT between 2012 and 2021.
• The network of TF-CBT providers expanded from 3 to 20 agencies, with 16 agencies sustained over the decade.
• Analysis of 202 youths showed significant reductions in PTSD symptoms following TF-CBT.

Conclusions:

• DBHIDS successfully implemented and sustained TF-CBT city-wide over a 10-year period.
• High levels of adoption, reach, and sustainment were achieved for TF-CBT.
• TF-CBT proved effective in reducing PTSD symptoms for youth in Philadelphia's behavioral health system.