Trauma Translated into Therapeutic Practice: Posttraumatic Stress Disorder and Correspondence with Treatment Target Selection in a Usual Care Setting

Although much research has been conducted to identify efficacious psychosocial treatments for children and adolescents, the research findings have not always translated into improved mental health care in real world practice settings. Understanding what clinicians attempt to target in treatment is an essential starting point to bridging the gap between research and practice in youth mental health and improving mental health treatment for youth in real world settings, particularly given research findings that therapists tend to use a broader variety of treatment strategies with less intensity than typically found in evidence-based treatments. It is possible that clinicians in the community target broader areas of functioning than symptoms in treatment or that targets lack the focus on symptom change often seen in research trials. To address this concern, clinician-reported monthly targets of treatment and intake diagnoses for youth in the Hawaii state mental health system were examined. Given the high rates of trauma exposure among American youth and the broad negative sequelae associated with exposure to trauma, a primary focus on the diagnosis of PTSD and the target of traumatic stress for treatment was selected. Clinician-reported monthly targets of treatment and intake diagnoses for youth in the Hawaii state mental health system were examined. With the exception of the traumatic stress, clinicians addressed similar symptoms and areas of functioning for youth with and without a PTSD diagnosis. Although clinicians did target traumatic stress for treatment significantly more often in youth with a PTSD diagnosis compared with youth without a PTSD diagnosis, the proportion of youth with a PTSD diagnosis and in which traumatic stress was a target of treatment was unexpectedly low (<50%). Furthermore, when exploratory analysis identified natural groups of cases with similar treatment targets in the sample, assignment to Multisystemic Therapy (MST) was a strongly related to grouping. This finding indicates that treatment selection may drive target selection rather than vice versa. When clinicians targeted traumatic stress in youth without a PTSD diagnosis, major depressive disorders were more frequently the primary diagnosis than in the full sample. These findings suggest that diagnosis may not be the only factor to influence clinician selection of what to address in treatment.