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Stepped Care Trauma-Focused Cognitive Behavioral Therapy (Stepped Care TF-CBT)


Delivery Approach:
  • Individual
  • Dyadic
Delivery Format:
  • In-person
  • Virtual
  • Hybrid
Provider Requirements:
  • Licensed/Certified Professional Led
  • No Provider Requirements
Type of Experience Addressed:
  • Child Abuse
  • Community Violence
  • Domestic Violence
  • Homicide/Familicide
  • Neglect
  • Sexual Abuse
  • Substance Abusing Caregiver
  • Verbal/Emotional Abuse
  • Mental Health Issues/Concerns
  • Other Types of Experiences Addressed
Engagement Methods:
  • Talk-based
  • Somatic
  • Experiential
Level of Intervention:
  • Intervention
  • Greater than 12 weeks
  • Home
  • Community-based Agencies
  • Family Service Agencies
  • Mental Health Setting
  • Health Services
  • Other Settings
Program Details:
Type of services provided:

Stepped care approach to trauma-focused cognitive behavioral therapy (Stepped TF-CBT) has a parent-led, therapist-assisted Step One with four phases that includes phone support, a parent-child workbook, web-based resources and monitoring that can step up to therapist-directed care (standard TF-CBT) when indicated.

Program setting:

Home settings and outpatient

Length of program/number of sessions:

All steps completed within 12 to 16 weeks. Step One is six weeks in length and if assessment indicates a positive response so that stepping up to Step Two is not indicated there is a parent-led maintenance phase for six weeks. When Step Two is indicated, there are nine therapist-led sessions provided over 6-9 weeks.

Type(s) of trauma/concerns addressed:

TF-CBT is one of the most widely used treatments for young children experiencing trauma, it has been adapted for children in domestic violence shelters and was included in our baseline scan for interventions with children exposed to domestic violence.

Symptoms addressed:

Posttraumatic stress symptoms

Education level of providers:


Additional information:


Unique/Innovative Characteristics:

Stepped-Care TF-CBT builds on the foundation of what is considered one of the most effective treatments for children experiencing posttraumatic stress symptoms to create a more cost-effective, two-step approach to treatment. Step One is parent-led and home-based. Alternatives are provided for parents/caregivers who have difficulty with the therapist sessions that are part of Step One and support is provided through multiple modalities including telephone consultations, a workbook and the internet (with alternatives for parents who don’t have internet access).

Date Added/Updated:


Population Served

  • 0-5 (Early Childhood)
  • 6-12 (Childhood)
Population Language:
  • English
Ethnic Racial Group:
  • White
  • Unspecified Ethnic Racial Group
  • Child
  • Child and Non-abusive Parent/Caregiver
  • Family
  • Survivor parent
Population Adaptations:
Age range of children served:

Young children

Are parent/adult caregiver(s) included in intervention?


Ethnic/racial and other groups served:

A case study was with a Hispanic child and a small pilot study included an African American and a Hispanic/Latino child.

Specific cultural adaptations:

None indicated

Languages that service/resource is available:

Publications are in English


Goals of the program/services:

A stepped care approach to TF-CBT was developed to improve accessibility and efficiency and reduce the cost of treatment for young children experiencing posttraumatic stress symptoms. In Step One, there are three in-office therapist-directed sessions which include orientation, psychoeducation and relaxation techniques. The remaining treatment is parent-led, therapist-assisted treatment at home with weekly telephone support, web-based resources including video demonstrations and handouts, and 11 parent-child meetings using a parent-child workbook called “Stepping Together.” The “Stepping Together” workbook includes components on stress management techniques, behavior management and skill-building activities such as identifying emotions and recognizing reactions to trauma.

If the child responses to Step One, it is followed by a parent-led maintenance phase to facilitate open communication between the children and parent/caregiver and reinforce use of the tools learned in Step One. Children who need more treatment progress to more intensive care with Step Two, standard TF-CBT for young children which includes reviewing psychoeducation on trauma, relaxation strategies, affect modulation, cognitive coping, trauma narrative and enhancing safety.

Evaluation Studies:
Has there been any evaluation?

One case study by Salloum & Storch, 2011. One pilot study by Salloum et al, 2013.

Key evaluation results:

In a case study, a 5-year old Hispanic boy who was physically abused and witnessed domestic violence completed Step One with his grandmother as caregiver and responded positively to the treatment. (Salloum & Storch, 2011)

In a small open trial with nine children, ages 3 to 6 years old, five of the six children who completed Step One responded positively to treatment. Exposure to domestic violence was the source of trauma for two of the children in the pilot study. Treatment gains were maintained at post-assessment except for one case, a child that had experienced two new traumatic events since mid-assessment. Treatment gains for the other children were maintained at three months follow-up. Parents found Step One to be acceptable and were satisfied with treatment. (Salloum et al, 2013)

Is there an evaluation currently in progress or planned?

A randomized controlled clinical trial comparing Stepped Care TF-CBT to standard care TF-CBT is underway.

Publications about the program:


Salloum A, Scheeringa MS, Cohen JA, Storch EA. (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive Behavioral Practice, 21(1),97-108.


Salloum A, Stroch EA. (2011). Parent-led therapist-assisted First Line Treatment for Young Children After Trauma: A Case Study. Child Maltreatment, 16(3):227-232.

Salloum A, Robst J, Scheeringa MS, Cohen JA Wang W, Murphy T, Storch EA (2014). Step One Within Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children: A Pilot Study. Child Psychiatry and Human Development, 45(1), 65-77.

Rated/Reviewed by Evidence Based Registries:

California Evidence-Based Clearinghouse for Child Welfare

Training & Resources

Training Language:
  • Not Applicable
Training Available:
  • No
Training Details:
Training manuals/protocols:

Not specific to Stepped Care TF-CBT indicated at this time. Refer to review for TF-CBT to see information about training options for standard TF-CBT which is Step Two.

Languages that training/resource is available:

Not applicable

Training Details:
  • Not Applicable

Program Contact

Alison Salloum, PhD LCSW
(813) 974-1535