Meeting Youth Where They Are: Adapting Trauma-Informed Group Therapy for Residential Care Settings

Background:
Youth involved in foster care experience disproportionately high rates of adverse childhood experiences (ACEs), placing them at elevated risk for trauma-related mental health challenges, including post-traumatic stress, depression, and substance use. Despite significant need, few evidence-based interventions are tailored specifically for youth in out-of-home care, particularly those in residential treatment settings. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an established, evidence-based group intervention designed for school environments. However, its applicability to residential care settings remains underexplored. This study aimed to adapt CBITS for youth in a group home setting using the ADAPT-ITT framework and assess its feasibility and acceptability.

Methods:
Guided by the first five phases of the ADAPT-ITT framework (assessment, decision, administration, production, and topical expert review), this study engaged national and local stakeholders to inform intervention adaptations. A pilot study was conducted with a non-probability sample of 17 youth (ages 10–18) residing in a group home. Thirteen youth completed the intervention. Participants completed pre- and post-intervention self-report measures assessing trauma symptoms (Child and Adolescent Trauma Screen) and problem-solving skills (Social Problem-Solving Inventory-Revised). Qualitative data were collected through focus groups, interviews, and open-ended survey responses. Descriptive and univariate analyses were conducted using SPSS.

Findings:
At baseline, all participants demonstrated clinically significant trauma symptoms, with an average of over five trauma exposures. Post-intervention results indicated modest reductions in trauma symptomology, including a decrease in median trauma scores and some participants falling below clinical thresholds. Changes in problem-solving skills were mixed, with slight decreases observed across several subscales, potentially reflecting ongoing cognitive processing during trauma-focused work. Qualitative findings highlighted strong acceptability: youth reported improved coping, emotional regulation, and stress management, frequently applying learned skills in daily life. Feasibility was supported by high engagement, with attrition primarily due to placement changes rather than disengagement. Key adaptations included increasing individual sessions for rapport-building and trauma processing, reducing group size, tailoring content to foster care experiences, and modifying data collection procedures to better fit developmental needs.

Conclusion:
Findings suggest that an adapted CBITS model is both feasible and acceptable for youth in residential care, with promising preliminary outcomes in reducing trauma symptoms and enhancing coping skills. This study underscores the importance of tailoring evidence-based interventions to the unique developmental, relational, and systemic contexts of youth in out-of-home care. The ADAPT-ITT framework proved useful in guiding systematic adaptation while maintaining intervention fidelity. Future research should include larger, controlled trials to evaluate effectiveness and further refine implementation strategies across diverse residential settings.