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dents who may not otherwise be receiving any mental health services. In this chapter, we describe the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program, how it addresses child abuse specifically, the theoretical rationale for the program, and the evidence supporting its effectiveness . We discuss when and why CBITS might be an appropriate intervention and the advantages and disadvantages of its use. Lastly, we address expected outcomes of CBITS program delivery. We hope that, by the end of this chapter, readers will understand the CBITS program and its potential utility for addressing the mental health needs of students who have experienced child abuse and neglect. THE CBITS INTERVENTION The Cognitive Behavioral Intervention for Trauma in Schools program began as an effort to intervene with recent immigrant students in the Los Angeles Unified School District who had been exposed to community violence in the United States or in their countries of origin, or both. We created a partnership in 1998 between the RAND Corporation, the University of California, Los Angeles, and the Los Angeles Unified School District to create and evaluate this program (Stein et al., 2002). In contrast to many interventions developed in academic settings and then later transported to community settings, the CBITS program was developed iteratively from the beginning in collaboration with school partners who were delivering CBITS in public schools as part of their work on school campuses, and thus the program was designed to fit school culture and be maximally flexible in addressing diverse students and diverse needs. The primary focus of the program was on symptoms of posttraumatic stress, both because these are very common following exposure to violence (e.g., Berman et al., 1996; GENERAL CONSIDERATIONS From the perspective of a clinic-based practitioner or child/ family services worker, it may seem counterintuitive to intervene in the school setting for children who have been abused. Don’t child welfare systems need to get involved to ensure the safety of the child? Don’t families experiencing abuse of one or more of their children require intensive family intervention? Yes, we believe that both of these types of intervention are important parts of the treatment plan for children who have been abused, but school-based early mental health intervention programs can play an essential role in early detection of and treatment for many types of trauma, including abuse and neglect. Our initial school-based trauma interventions sought to address the negative mental health and functional sequelae following children’s exposure to community violence. As we screened students for exposure to community violence, however, it became apparent that many children had also experienced abuse and neglect. Refinements to our intervention program were made to ensure it was flexible enough to accommodate these children and address some of their needs related to anxious and depressive symptoms, as well as some of their behavior problems. We believe that to provide effective, early intervention in the school setting for children exposed to violence and trauma, we must be prepared to work with children who have experienced abuse and neglect and that our intervention must target some of the sequelae of abuse experiences, particularly as evidenced by changes in classroom and schoolyard behavior and disrupted classroom learning. School-based interventions are not a panacea for abused children. Rather, we see them as a way to complement and extend services provided by the child welfare, child protection, and clinicbased mental health systems and to increase access for stuEarly Intervention for Abused Children in the School Setting LISA H. JAYCOX, PH.D. AUDRA K. LANGLEY, PH.D. BRADLEY D. STEIN, M.D., PH.D. SHERYL H. KATAOKA-ENDO, M.D., M.S.H.S MARLEEN WONG, PH.D. 8 Early Intervention in the School Setting 77 intervention will allow children to develop skills and coping strategies that reduce the psychological sequelae that commonly follow trauma exposure. CBITS has several aims: to directly reduce psychological reactions, such as symptoms of anxiety, depression, and PTSD, and thereby reduce child distress, and to mobilize resilience factors to allow the student to function more adaptively at school, at home, and socially. As a targeted intervention, the CBITS program is intended for students who have experienced trauma and have current symptoms of PTSD. There are many possible ways to identify such students, but we generally recommend screening students on a broad scale, because symptoms of PTSD often go undetected by parents or counselors while still causing significant distress. Most of our work has screened for a range...

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