Recorded CGR #2: Implementation of Trauma-focused Cognitive Behavioral Therapy in Latin America and the Caribbean/Implementación de la Terapia Cognitiva Conductual-Enfocada en Trauma en Latino América y el Caribe (2023 CONVENTION RECORDING)


Rosaura Orengo-Aguayo, Ph.D.

Assistant Professor
Medical University of South Carolina
Charleston, South Carolina

*This event is presented entirely in Spanish*

Recorded on Friday, November 17, 2023 at the 57th Annual ABCT Convention in Seattle, WA

1.5 CE Credits Awarded

$15 Student ABCT Members / $25 ABCT Members / $35 Non-Members

All prices listed in US currency


Abstract:

Each year, approximately one billion youth worldwide will experience a traumatic event (e.g., physical, emotional, or sexual abuse, neglect, community or family violence, traumatic loss, disaster; Hillis et al., 2016). Moreover, the COVID-19 pandemic has increased the risk of trauma exposure for already vulnerable youth and families (Khan et al., 2020; Xiong et al., 2020). Exposure to traumatic events increases the risk of developing posttraumatic stress disorder (PTSD), depression, behavior problems, substance use disorders, and suicidal ideation/self-harm (Fairbank & Fairbank, 2009; Lai et al., 2017). Trauma exposure is also associated with poor academic and occupational achievement and adverse physical health outcomes that can last a lifetime (Carliner et al., 2016; Holt et al., 2007; McLaughlin et al., 2012; Ormel et al., 2008). 

The limited data available suggest that 30–60% of children in Latin America have experienced a traumatic event during their lifetime (Speizer et al. 2008). Latin American countries (including Central and South American countries) have a long-standing history of political instability, gang-related violence, poverty, and forced migration that has further exposed youth to potentially traumatic events (Wirtzet al. 2016). Furthermore, the 21st century has seen an alarming increase of severe weather events (e.g., hurricanes, floods, wildfires, tornadoes, earthquakes, tsunamis) resulting in loss of life, infrastructure, safety, social support, and adverse mental and physical health outcomes (Goldmann & Galea, 2014; World Disasters Report, 2018). An estimated 175 million youth around the globe will continue to be affected each year by the devastating effects of climate change (Seballos et al., 2011), further increasing youth's risk of exposure to traumatic events (Augustinavicius et al., 2021).

Effective mental health interventions for trauma-exposed youth, particularly those that live in Latin America and the Caribbean, are crucial for supporting resilient outcomes in children exposed to compound trauma. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017) is an evidence-based, manualized treatment protocol designed to treat posttraumatic stress and co-occurring symptoms such as depression, anxiety, and mild-to-moderate behavior problems in trauma-exposed children and youth ages 3–18 and their supportive and non-offending caregivers. TF-CBT is divided into nine cognitive and behavioral components, all of which incorporate gradual exposure to trauma memories and reminders. These components are summarized by the acronym PRACTICE: (1) psychoeducation, (2) parenting skills, (3) relaxation skills, (4) affective modulation skills, (5) cognitive processing skills, (6) trauma narration and processing, (7) in-vivo mastery of trauma reminders, (8) conjoint child-parent sessions, and (9) enhancing future safety and development. TF-CBT is typically delivered in 12–25 weekly sessions (via a combination of individual, caregiver, and conjoint sessions). TF-CBT is one of the most researched and efficacious mental health treatments for trauma-exposed youth. Over 23 randomized controlled trials across the U.S. and the globe have documented its effectiveness at treating posttraumatic stress symptoms (PTSS) in children and adolescents (Cohen et al., 2017, pp. 74–80; de Arellano et al., 2014), including youth in low- and middle-income countries like Zambia (Murray et al., 2013), the Democratic Republic of the Congo (McMullen et al., 2013; O’Callaghan et al., 2013), and Kenya and Tanzania (Dorsey et al., 2020). In the United States, TF-CBT applications have also been developed for Hispanic youth (de Arellano et al., 2012) and American Indians and Alaska Natives (BigFoot & Schmidt, 2010). TF-CBT, however, had not yet been systematically evaluated in Latin America or the Caribbean context, particularly with Hispanic youth exposed to multiple disasters, violence, and other traumatic exposures.

In this clinical grand round, Dr. Rosaura Orengo-Aguayo will describe the implementation and outcomes of TF-CBT in two different low-resourced contexts (Puerto Rico and El Salvador) impacted by poverty, natural disasters, and violence guided by principles of cultural humility, language justice, implementation science, and community based participatory research. ***This presentation will be fully in Spanish with English language simultaneous interpretation available for audience members who need it.*** This is the first ever ABCT presentation offered completely in a language that is not English.

Outline:

1. Introduction to:
a. Cultural Humility
b. Language Justice
c. Implementation Science framework
d. Community Based Participatory Action Research

2. Introduction to:
a. Prevalence of childhood trauma
b. Impact of childhood trauma

3. Description of the context in El Salvador and Puerto Rico
a. Historical and sociopolitical context
b. Significant traumatic events impacting youth in recent decades
c. Need for trauma treatment

4. Implementation of TF-CBT in Puerto Rico
a. Building partnerships
b. Culturally and linguistic tailoring
c. Contextual tailoring
d. Implementation strategies
e. Outcomes
f. Lessons learned

5. Implementation of TF-CBT in El Salvador
a. Building partnerships
b. Culturally and linguistic tailoring
c. Contextual tailoring
d. Implementation strategies
e. Outcomes
f. Lessons learned

6. Future Directions

Learning Objectives:

At the end of this workshop, the learner will be able to:

1. Describe the implementation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in two different low resourced contexts (Puerto Rico and El Salvador) impacted by poverty, natural disasters, and violence.

2. Describe the implementation of TF-CBT using principles of cultural humility, language justice, implementation science, and community based participatory research.

3. Describe program evaluation outcomes, lessons learned, and future directions for global implementation of TF-CBT in Latin America and the Caribbean.

4. Long- term Goal: TF-CBT has preliminary effectiveness (via non-randomized pilot trials) in two, low-resourced contexts in Latin America and the Caribbean (Puerto Rico and El Salvador).

5. Long-term Goal: The incorporation of principles of cultural humility, language justice, implementation science, and community based participatory research were crucial in the successful implementation of TF-CBT in these two low-resourced and diverse contexts.

Recommended Readings:

1. Orengo-Aguayo, R., Dueweke, A.R., Nicasio, A., de Arellano, M., Rivera, S., Cohen, J.A., Mannarino, A.P., & Stewart, R.W. (2022). Trauma Focused Cognitive Behavioral Therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes. Child Abuse & Neglect, 129, 105671. https://doi.org/10.1016/j.chiabu.2022.105671

2. Stewart, R.W., Orengo-Aguayo, R., Villalobos, B.T., Nicasio, A.V., Dueweke, A., Alto, M., Cohen, J.A., Mannarino, A.P., & de Arellano, M.A. (2021). Implementation of an evidence-based psychotherapy for trauma-exposed children in a lower-middle income country: The use of Trauma-Focused Cognitive Behavioral Therapy in El Salvador. Journal of Child & Adolescent Trauma, 14, 433-441. https://doi.org/10.1007/s40653-020-00327-9

3. Orengo-Aguayo, R., Stewart, R. W., Villalobos, B. T.,Hernandez Rodriguez, J., *Dueweke, A. R., de Arellano, M. A., & Young, J. (2020). Listen, don’t tell: Partnership and adaptation to implement trauma-focused cognitive behavioral therapy in low-resourced settings. American Psychologist, 75(8), 1158–1174. https://doi.org/10.1037/amp0000691


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Implementation of Trauma-Focused Cognitive Behavioral Therapy in Latin America and the Caribbean/Implementación de la Terapia Cognitiva Conductual-Enfocada en Trauma en Latino América y el Caribe
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