Implementation of a Trauma-Specific,Evidence-Informed Treatment for Adolescents: Two Cases Highlighting How to and How Not to Integrate

The clinical team at an urban trauma clinic sought to evaluate a protocol representing an integration of empirically validated treatment components to address trauma sequelae among female adolescents with a history of physical and/or sexual abuse. PARTNERS with teens is an exposure-based, trauma-specific cognitive-behavioral therapy protocol. Specifically, PARTNERS integrates engagement strategies, cultural sensitivity, and elements of motivational interviewing, dialectical behavior therapy, and family-based parent and communication training in order to reduce symptoms of posttraumatic stress disorder (PTSD) and depression and improve affect regulation among economically disadvantaged, multiracial/ethnic adolescents. This paper describes two cases that represent both treatment success and failure in treatment integration, specifically in negotiation of caregiver resistance, adolescent safety concerns, and ongoing interpersonal crises. Results illustrate how treatment components were emphasized and incorporated differentially throughout treatment as a function of case conceptualization. Successful implementation of treatment resulted in reductions in PTSD, depression, externalizing behaviors, and emotion dysregulation. In contrast, failure to effectively reconcile different philosophies and techniques within the treatment model to address challenges in engagement and motivation, inconsistent caregiver involvement, and trauma-related conflicts in the dyad, contributed to disengagement from treatment and persistence of trauma sequelae. Treatment outcome across these two cases is discussed as a function of how well the philosophies and techniques of different adolescent specific treatment components are integrated; directions for future research and training are discussed.