Adapting Trauma-Informed Group Therapy for Youth in Residential Treatment: Applying the ADAPT-ITT Framework

Introduction: Youth in foster care are at an increased risk of experiencing adverse childhood experiences, leading to higher rates of mental health challenges and substance use disorders compared to their peers. Cognitive Behavioral Intervention for Trauma in the Schools (CBITS) is an evidence-based trauma intervention typically delivered in school settings to address post-traumatic stress and depression. This study adapted CBITS using stages of the ADAPT-ITT framework to assess its feasibility and acceptability for youth in out-of-home care in a community-based group home setting. Methods: The study used the first five phases of the ADAPT-ITT framework: assessment, decision, administration, production, and review by topical experts. Researchers interviewed stakeholders at both national and local levels to identify the needs of youth in the group home. A theater testing of CBITS was conducted with 17 youth, aged 10–18, using a non-probability sample. Participants completed pre- and post-intervention self-report surveys measuring trauma symptomology and problem-solving skills. Qualitative data were also collected through focus groups and interviews. Results: Of the 17 youth who assented, 13 completed the intervention. Participants exhibited high rates of trauma at baseline. Qualitative analysis revealed how youth found CBITS to be beneficial and what encouraged and discharged engagement. Qualitative themes reflected participants’ perceptions of CBITS as helpful for managing stress, building coping skills, and reframing challenges, alongside barriers to attendance such as competing activities. Conclusion: The adapted CBITS programming showed preliminary success in being feasible and appropriate for youth residing in out-of-home care. Future adaptations, including increased individual sessions, may further enhance the intervention’s effectiveness for this population. The early findings suggest feasibility for broader implementation.