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Stepping together for children after trauma: protocol for a randomized controlled trial of a parent-led treatment in
Silje Mørup Ormhaug1, Tine K Jensen1,2, Kate Louise Porcheret3
1Norwegian Centre for Violence and Traumatic Stress Symptoms (NKVTS), Oslo, Norway.
Insights
Stepping Together for Children after Trauma (ST-CT) is a novel parent-led intervention showing promise for reducing childhood trauma symptoms. This study evaluates its effectiveness, cost-effectiveness, and implementation in mental health services.
Area of Science:
- Child Psychology
- Public Health
- Mental Health Services Research
Background:
- Childhood trauma presents a significant public health challenge with a notable service/needs gap.
- Low-intensive, caregiver-led treatments can alleviate therapist burden and bridge this gap.
- Stepping Together for Children after Trauma (ST-CT) is a promising parent-led, therapist-assisted intervention with demonstrated feasibility and acceptance in Norway.
Purpose of the Study:
- To conduct the first independent randomized controlled trial (RCT) of ST-CT.
- To assess ST-CT's effectiveness in reducing post-traumatic stress symptoms (PTSS), related mental health issues, and sleep problems, while improving daily functioning.
- To evaluate ST-CT's cost-effectiveness, future healthcare utilization, change processes, and implementation strategies for first-line mental health services.
Main Methods:
- A type 1 hybrid effectiveness-implementation design was employed.
- 160 child-parent dyads (children aged 7-12 with PTSS symptoms) were randomized to ST-CT or therapy as usual (TAU).
- Assessments occurred at five time points over one year, with objective sleep measurement and 3-year registry data for healthcare utilization and medication use.
Main Results:
- This section is to be filled once the study is completed and results are available.
Conclusions:
- Study results will enhance understanding of ST-CT's effectiveness and underlying change mechanisms.
- Findings are expected to inform the future dissemination and implementation of ST-CT in routine mental health care.
Abstract:
Background: Childhood trauma is a public health challenge, and there is currently a service/needs gap. Low-intensive treatments where the task of leading the treatment is partially shifted to a caregiver can help bridge this gap by freeing therapist resources. Stepping Together for Children after Trauma (ST-CT), is a novel parent-led, therapist-assisted treatment with promising results in the U.S. Also, it has shown to be feasible as a first-line intervention in Norwegian municipal services and ST-CT is well accepted by children, caregivers, and therapists.Objective: This study is the first randomized controlled trial of ST-CT by independent researchers. The study consists of three work-packages: WP1: Investigates (a) the effectiveness of ST-CT compared to therapy as usual (TAU) in reducing post-traumatic stress symptoms (PTSS), related mental health symptoms, sleep problems and increasing daily functioning; (b) the cost-effectiveness of ST-CT compared to TAU in terms of quality adjusted life years; (c) future health care utilization. WP2: Looks at change processes in ST-CT, with changes in sleep, post-traumatic cognitions and child-parent relationship as potential mediators of reductions in child PTSS. WP3: Investigates keys to implementation into regular first-line mental health services.Methods: The study has a type 1 hybrid effectiveness-implementation design. Children between 7-12 years of age with symptoms of PTSS and their caregivers are randomized to either ST-CT or TAU and participants are assessed at five time points during the first year. Sleep quality is measured with a non-contact radar 1 week pre- and post-treatment and registry data of use of prescribed medications and mental health service utilization will be collected 3 years post-inclusion. The study aims to include 160 child-parent dyads from 30 municipalities.Conclusion: Results can help gain a better understanding of the effectiveness and change processes of ST-CT and may provide important knowledge for a future dissemination and implementation.Trial registration: ClinicalTrials.gov identifier: NCT05734547.
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