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and a previous TF-CBT deconstructive study (Deblinger et al., 2011) suggest the possibility of matching treatments to individual children’s presenting problems. It is difficult to untangle the question of how to treat complicated PTSD from the issue of how to address co-occurring psychiatric conditions such as substance abuse, violence and risk behaviors. Two important studies address these questions. The first study evaluated the efficacy of Risk Reduction through Family Therapy (RRTF), a modification of TF-CBT for youth with substance abuse. Danielson and colleagues randomized 30 adolescents with comorbid sexual assault history and substance abuse history to RRTF or TAU (Danielson et al., 2012). Multiple instruments assessed substance abuse, family and mental health outcomes in addition to PTSD. Mixed effects regressions showed that the RRTF group experienced significantly greater improvement in PTSD, depression, substance use, and internalizing symptoms than the WL group, but because of baseline differences in symptom severity we need to be cautious before drawing conclusions about effectiveness from this pilot study. The second study evaluated a collaborative care model targeting violence risk behaviors, substance abuse, PTSD and depression in youth who were hospitalized after acute physical injuries (Zatzick et al., 2014). The intervention included motivational interviewing targeting risk behaviors and substance use as well as medication and CBT targeting PTSD and depression. At a level 1 trauma center, 120, 12 to 18-year-olds were randomized VOLUME 26/NO. 3 • 2015 PAGE 3 to the collaborative care intervention or a no-treatment control. Follow-ups at 2, 5, and 12 months used standard instruments for violence risk behaviors, substance use, PTSD and depression. At baseline, a third of the youth endorsed carrying a weapon. The intervention group experienced significantly greater reductions in weapon carrying compared to controls during the year after injury. Other outcomes were not significantly different. The lack of significant differences on other outcomes may have been due to the fact that reported baseline symptoms were low relative to weapon carrying. Since most children and adolescents attend school, providing trauma screening and treatment in these settings offers and important opportunity for meeting the needs of children who otherwise would not receive services (Kataoka et al., 2012). A study by Foa et al. (2013) highlights the value of embedding existing evidence based treatments in usual community provider organizations and shows the effectiveness of one such treatment, Prolonged Exposure, for adolescents. Empirical evidence from the few well controlled, scientifically rigorous studies conducted to date has failed to support the efficacy of any pharmacologic agent in improving PTSD symptoms in children an excellent review is provided in Wilkinson & Carrion (2012). Despite this, psychotropic medications are often used to treat traumatized children; particularly those involved in the child welfare and juvenile justice systems. The following study is important because it offers potentially promising data. Scheeringa & Weems (2014) provided children ages 7-18 with PTSD with a 12 session CBT manualized treatment. Those remaining in treatment at session 5 (N = 57) were randomized to CBT + D-Cycloserine (DSC) or CBT+ Placebo. DSC may enhance exposure-based therapies for anxiety as a partial NDMA agonist. Results showed no significant differences between the two groups, however, there was a trend toward DSC speeding recovery during the exposure sessions of CBT and evidence that the CBT+DSC group sustained greater improvement in inattention than the CBT + Placebo group at 3-month follow-up. This finding is of potential significance for children with comorbid PTSD and Attention Deficit Hyperactivity Disorder, or for those with PTSD-related inattention. More research into the use of DSC for augmenting CBT treatment in children and adolescents is warranted. Finally, therapists can only provide face-to-face treatment for a small fraction of the traumatized children around the world. Web-based treatment offers the possibility of greatly magnifying the reach of therapist-delivered evidence-based treatment. Marsac and colleagues (2013) describe an ongoing RCT to test a game for preventive intervention following acute injury. No doubt more tablet, smart phone, and computer-assisted options are coming for children to access trauma treatment. For example, the TF-CBT Triangle of Life, for implementing TF-CBT cognitive processing, is now available from Google+ and Apple stores. From promising new preventive interventions for acute trauma to the growing number of evidence-based treatments for complex trauma presentations across the developmental spectrum, to technological applications to assist in treatment implementation, the future of child trauma treatment looks bright. Barron, I. G., Abdallah, G., & Smith, P.A. (2013). Randomized control trial of a CBT trauma recovery program in Palestinian schools. Journal of Loss and Trauma, 18, 306-321. doi:10.1080/15325024.20 12.688712 The current study aimed to assess the TRT trauma recovery program within the context of ongoing violence. Utilizing a randomized controlled trial, 11-14-year-old students in Nablus, Palestine
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