Table 3.
Determinants of Practice for TF-CBT Implemented in Schools
| Determinant | Definition | Facilitator N (%) | Barrier N (%) | Both N (%) | Neither N (%) |
|---|---|---|---|---|---|
| TF-CBT Factors | |||||
| 1. Quality of evidence | Level of confidence that TF-CBT is based in good science | 19 (70%) | 1 (4%) | 3 (11%) | 4 (15%) |
| 2. Strength of recommendation | Level of confidence that TF-CBT will help clients more than it hurts them | 19 (70%) | 1 (4%) | 5 (19%) | 2 (7%) |
| 3. Clarity | Clarity about who TF-CBT is for | 19 (70%) | 1 (4%) | 5 (19%) | 2 (7%) |
| 4. Cultural appropriateness | Level of fit between TF-CBT and students in this district | 6 (22%) | 5 (19%) | 16 (59%) | 0 |
| 5. Feasibility | Extent to which TF-CBT is practical in schools | 3 (11%) | 13 (48%) | 11 (41%) | 0 |
| 6. Compatibility | Level of fit between TF-CBT and other interventions I do with students | 14 (52%) | 5 (19%) | 8 (30%) | 0 |
| 7. Effort | Amount of effort required to implement TF-CBT | 3 (11%) | 14 (52%) | 9 (33%) | 1 (4%) |
| 8. Trialability | My ability to “try out” TF-CBT before really implementing (e.g., using PRAC skills with non-TF CBT students or practicing in training) | 14 (52%) | 4 (15%) | 3 (11%) | 6 (22%) |
| 9. Observability | Extent to which you can see and know other clinicians are implementing TF-CBT | 7 (26%) | 8 (30%) | 5 (19%) | 7 (26%) |
| Clinician Factors | |||||
| 10. Domain knowledge | Extent to which you already had expertise about trauma treatment before TF-CBT training | 13 (49%) | 4 (15%) | 4 (15%) | 6 (22%) |
| 11. Skills | Extent to which you have the skills you feel you need to actually implement TF-CBT | 13 (49%) | 6 (22%) | 6 (22%) | 2 (7%) |
| 12. Expected outcome** | Level of confidence that TF-CBT will work | 13 (50%) | 4 (15%) | 8 (31%) | 1 (4%) |
| 13. Learning style | How well TF-CBT training and consultation calls fit with my learning style | 8 (30%) | 8 (30%) | 8 (30%) | 3 (11%) |
| 14. Emotions | My emotional experience when providing trauma treatment | 6 (22%) | 3 (11%) | 8 (30%) | 10 (37%) |
| 15. Capacity to plan change | My capacity to make changes in my schedule to provide TF-CBT | 2 (7%) | 11 (41%) | 10 (37%) | 4 (15%) |
| Team Processes | |||||
| 16. Team processes | Extent to which your school team worked together on TF-CBT screening, enrollment and implementation | 4 (15%) | 13 (48%) | 3 (11%) | 7 (26%) |
| 17. Referral to enrollment processes | Processes for referring students, connecting to families, and screening students for TF-CBT enrollment | 5 (19%) | 14 (52%) | 6 (22%) | 2 (7%) |
| Client Factors | |||||
| 18. Student needs | How good of a fit TF-CBT was with student’s actual needs | 10 (37%) | 6 (22%) | 11 (41%) | 0 |
| 19. Student preferences** | How good of a fit TF-CBT was with student preferences | 6 (23%) | 9 (19%) | 10 (38%) | 1 (4%) |
| 20. Parent preferences | How good of a fit TF-CBT was with parent/guardian preferences | 1 (4%) | 12 (44%) | 10 (37%) | 4 (15%) |
| Organizational Factors | |||||
| 21. Capable leadership | Extent to which your supervisor or administrator supported your use of TF-CBT | 12 (44%) | 1 (4%) | 5 (19%) | 9 (33%) |
| 22. Priority | How important TF-CBT was compared to other new initiatives or requirements | 5 (19%) | 8 (30%) | 6 (22%) | 8 (30%) |
| 23. Monitoring and feedback** | Extent to which my supervisors or managers collected information on my progress with TF-CBT cases and provided feedback | 6 (23%) | 6 (23%) | 5 (19%) | 9 (19%) |
| Social, Political and Legal Factors | |||||
| 24. Payment/ reimbursement* | Extent to which students’ insurance or other funding sources covered TF-CBT | 5 (19%) | 0 | 1 (4%) | 21 (78%) |
| 25. Liability | Extent to which providing TF-CBT introduced a possible liability concern for you, your agency, school or district | 1 (4%) | 2 (7%) | 2 (7%) | 22 (81%) |
*
All factors are from the TICD Checklist (Flottorp et al., 2013) with the exception of “payment/reimbursement”, which was developed to represent “payer or funder policies” in the original checklist but more clearly named and defined for this study.
**
N=26 instead of 27 due to missing data from one participant on these items.