CBITS At-a-Glance
The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is a school-based, group and individual intervention. It is designed to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems, and to improve functioning, grades and attendance, peer and parent support, and coping skills.
CBITS has been used with students from 5th grade through 12th grade who have witnessed or experienced traumatic life events such as community and school violence, accidents and injuries, physical abuse and domestic violence, and natural and man-made disasters.
CBITS uses cognitive-behavioral techniques (e.g., psychoeducation, relaxation, social problem solving, cognitive restructuring, and exposure).
Access our Free Resources
Professionals can register with our website for training and implementation information.
By registering, you'll gain access to a host of free resources, including everything you'll need to implement CBITS in your school:
- Our interactive online training course that will prepare you to implement CBITS*
- Sample materials and forms to help you deliver the CBITS intervention
- A robust online community where you can engage with discussion boards, "ask the experts," and collaborate on documents
- Video clips of experts providing practical advice on CBITS implementation
- And more!
*NOTE: While the course is free, you'll need to purchase the course manual at a minimal cost.
Take a CBITS Training Course
CBITS offers both online and in-person training. To learn more about our online training or to take the online course, register with our website. For more information about our in-person training, contact us at info@cbitsprogram.org or 703-413-1100, ext. 5118.
How is CBITS implemented?
CBITS is designed for delivery by mental health professionals in a school setting. The program consists of:
- 10 group sessions
- 1-3 individual sessions
- 2 parent psychoeducational sessions
- 1 teacher educational session
Is CBITS evidence-based?
Yes. Extensive research since 2000 has shown that students who participate in the program have significantly fewer symptoms of post-traumatic stress, depression, and psychosocial dysfunction.
CBITS is cited as a recommended practice by several national agencies that assess the quality of mental health interventions, including:
- CDC Prevention Research Center
- SAMHSA's National Registry of Evidence-Based Programs and Practices
- U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention
Where has CBITS been implemented?
Since 2001, CBITS has been implemented widely across the United States and abroad and is also being actively disseminated through SAMHSA’s National Child Traumatic Stress Network. Implementation settings have included:
- In the US: California, Colorado, District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, Montana, New Jersey, New Mexico, Tennessee, Washington, and Wisconsin
- Abroad: Australia, China, Japan, and Guyana
How has CBITS been adapted for different settings and populations?
CBITS has been adapted for use with Spanish-speaking populations, low-literacy groups, and children in foster care.
CBITS has also been modified for delivery by nonclinicians and in a variety of settings (urban, rural, suburban, and tribal).
CBITS Staff
CBITS was developed by a team of clinician-researchers from the RAND Corporation, the University of California at Los Angeles (UCLA), and the Los Angeles Unified School District (LAUSD).
| M. Alejandra Acuña, LCSW CBITS Trainer |
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| maria.a.acuna@lausd.net | |
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Ms. Acuña is a full-time social welfare PhD student at UCLA and a part-time psychiatric social worker with School Mental Health Services of LAUSD. She has worked in health and human services for over 20 years. As a school social worker, her professional efforts have been focused on providing universal, targeted, and intensive interventions aligned with the Response to Instruction and Intervention (RtI2) model for elementary and high school students. As a team leader for the South Los Angeles Resiliency Project, a federally funded counseling demonstration grant, she examined and reported on the mental health and academic outcomes of project services. She has won local and national awards for supervising social work interns. She has taught social work courses at California State University, Los Angeles and UCLA. Her research interests include evidence-based school mental health services, attachment, family engagement, and resilience (individual, family, community, and professional). In the last few years, Ms. Acuña has been involved in the implementation of CBITS as a group facilitator in elementary and high schools, as a Reflective Learning Group facilitator providing ongoing CBITS training and supervision to LAUSD social workers, and as a trainer for the Los Angeles County Department of Mental Health. She has engaged in local and national efforts to develop products and provide professional development training on RtI2, trauma and resiliency awareness, and psychological first aid. She is currently partnering with Dr. Sheryl Kataoka, one of the CBITS developers, to study how the Learning Collaborative model impacts the implementation effectiveness of evidence-based interventions such as CBITS in school settings. |
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| Pia Escudero, LCSW Intervention Developer |
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| pia.escudero@lausd.net | |
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Ms. Escudero is director of LAUSD School Mental Health, which was established in 1933 to promote the mental health, well-being, and academic achievement of all LAUSD students. She oversees more than 300 school mental health professionals, including psychiatric social workers, psychiatrists, and clinical psychologists. School Mental Health staff facilitate student development and the ability to successfully deal with problems, crises, or traumatic experiences. Ms. Escudero directs a range of comprehensive services, including prevention, early intervention, and treatment. She provides local and national leadership to assist in the development, implementation, evaluation, and dissemination of trauma-informed and trauma-specific services for children and families under the LAUSD Trauma Services Adaptation (TSA) Center for Resiliency, Hope, and Wellness in Schools. Ms. Escudero has also participated in the development of the California Mental Health Services Act and represented LAUSD, students, and school stakeholders in several local and state workgroups. Previously, Ms. Escudero was a field coordinator for LAUSD Crisis Counseling and Intervention Services and served as program manager for TSA Center for Schools and Communities, a member of the National Child Traumatic Stress Network funded by SAMSHA, where she coordinated district projects such as Crisis Counseling and Intervention Services, Threat Assessment and Management, Robert Wood Johnson Bienestar, and the Mental Health Immigrant Intervention Program. Ms. Escudero was one of the original contributors to the development of the Emergency Immigrant Education Program, which was an early version of CBITS targeting immigrant students. |
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| Lisa Jaycox, PhD Intervention Developer |
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| jaycox@rand.org | |
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Dr. Jaycox is a senior behavioral scientist at RAND Corporation and a clinical psychologist. She has wide-ranging clinical and research expertise in the areas of child, adolescent, and adult mental health problems with a special emphasis on reactions to trauma exposure. Prior to joining RAND, Dr. Jaycox conducted clinical trials of psychotherapy treatment and prevention programs for post-traumatic stress disorder in adult female assault survivors and also developed and evaluated a depression prevention program for school children. At RAND, her work has focused on mental health services research as well as evaluations of clinical trials, with an emphasis on dissemination of proven treatments into community settings. Her focus on the mental health consequences of traumatic life experiences includes work related to the September 11th terrorist attacks, hurricanes Katrina and Rita, California fire storms, recovery from traumatic injuries resulting in hospitalization, evaluation work related to young children’s exposure to violence, as well as work related to deployment in Iraq and Afghanistan. Her work on the CBITS program began with intervention development with collaborators at UCLA and LAUSD, and continues today with an emphasis on national training and dissemination. |
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| Sheryl Kataoka, MD, MSHS Intervention Developer |
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| skataoka@ucla.edu | |
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Dr. Kataoka is an associate professor in the UCLA Division of Child and Adolescent Psychiatry, where she also serves as the training director of the Child Psychiatry Fellowship. As a clinician and health services researcher, she has been devoted to improving the access to and quality of mental health care for ethnic minority children and their families through school-based services. As co-chairperson of the American Academy of Child and Adolescent Psychiatry’s Schools Committee, Dr. Kataoka has been committed to expanding and improving mental health services in schools nationally. She has been investigating methods of delivering evidence-based mental health care in schools to students in both general and special education. Her research has led to a greater understanding of the role of schools in decreasing disparities in mental health care for ethnic minority children and their families. Dr. Kataoka was one of the original investigators who evaluated CBITS. Through a community-academic partnership, she collaborated with colleagues at LAUSD and RAND in developing the CBITS program to be culturally sensitive for the multiethnic students in Los Angeles. Dr. Kataoka has piloted the CBITS program in faith-based communities, in collaboration with QueensCare Health and Faith Partnership and their parish nurses and promotoras. She and her colleagues conducted a year-long CBITS Learning Collaborative sponsored by the National Child Traumatic Stress Network, which led to five sites across the country implementing CBITS for hundreds of students with post-traumatic stress symptoms. With NIMH funding, Dr. Kataoka is now studying how the Learning Collaborative model impacts the implementation effectiveness of evidence-based interventions such as CBITS in school settings. |
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| Joshua Kaufman, LCSW CBITS Trainer |
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| joshua.kaufman@lausd.net | |
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Mr. Kaufman is a psychiatric social worker with School Mental Health of LAUSD, and is currently the program manager of the Trauma Service Adaptation (TSA) Center for Resilience, Hope, and Wellness in Schools. Mr. Kaufman's professional efforts are focused on the implementation and dissemination of evidence-based, trauma-informed and trauma-specific practice models, and the provision of clinical consultation and training both within LAUSD and nationally. He has provided trainings focused on response and emergency management for schools, school-based screening and assessment, and trauma awareness in schools, and CBITS for the U.S. Dept of Education, George Washington University, and various community-based organizations and school districts across the country. In addition to his work with TSA for Schools, Mr. Kaufman was until recently the project manager for Bienestar: Trauma Services for Immigrant Students, a Caring Across Communities grantee-site funded by the Robert Wood Johnson Foundation. He has also been active in promoting a transition toward trauma-informed services and CBITS for School Mental Health, a unit of more than 300 psychiatric social workers serving the students, families, and schools of LAUSD. Recently, Mr. Kaufman developed a reflective learning model of training, supervision, and fidelity monitoring of CBITS. Following the completion of his graduate studies in social welfare at the University of California, Berkeley, Mr. Kaufman began his career with the San Francisco County Department of Mental Health, where he specialized in treating trauma-related disorders and working with the mentally ill, indigent adults, and transitional youth. |
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| Audra Langley, PhD Director of Training |
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| alangley@mednet.ucla.edu | |
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Dr. Langley is an assistant clinical professor in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior. She is also the director of training for the Trauma Services Adaptation Center for Resiliency, Hope, and Wellness in Schools and serves as chair of the National Child Traumatic Stress Network School Committee. Dr. Langley is a clinician and researcher who specializes in cognitive-behavioral treatment for children and adolescents with PTSD, anxiety, and related disorders, and her work seeks to increase school-based access to evidence-based interventions for underserved populations of children. Dr. Langley received her PhD in clinical child psychology from Virginia Tech. She went on to specialize in cognitive-behavioral therapy with children and adolescents during her internship at the UCLA Neuropsychiatric Institute and postdoctoral research fellowship in the clinical evaluation of evidence-based treatments for childhood anxiety disorders through the UCLA Child OCD, Anxiety, and Tic Disorders Program, where she continues as a faculty member. She was the recipient of an NIMH-funded Career Development Award and is currently developing a school-based intervention for elementary-school children exposed to traumatic events. Dr. Langley has served as investigator, trainer, clinician, and clinical supervisor on several clinic and school-based studies and trials treating ethnically and socioeconomically diverse children and adolescents with PTSD, anxiety, and OCD, and has presented and published treatment manuals and research papers on her work. |
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| Bradley Stein, MD, PhD Intervention Developer |
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| stein@rand.org | |
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Dr. Stein is a health services and policy researcher at the RAND Corporation and an associate professor of psychiatry at the University of Pittsburgh. A child and adolescent psychiatrist, he serves as the dissemination director for Trauma Services Adaptation Center for Schools and Communities. His major research interests combine child mental health services, improving the quality of mental health care in community settings, school mental health, and trauma services. Dr. Stein is one of the originators of the CBITS program and was a co-principal investigator in the evaluation of the effectiveness of CBITS in LAUSD. Dr. Stein has extensive clinical and research experience in the areas of trauma and disaster. He has been involved in the mental health response to multiple disasters and has served as a consultant to schools and government agencies providing crisis intervention services after a disaster. He is a member of the American Academy of Child and Adolescent Psychiatry Schools Committee and serves on the editorial board of Psychiatric Services and the Journal of the American Academy of Child and Adolescent Psychiatry. He previously directed the University of Southern California Division of Child Psychiatry School Consultation Program and served as a psychiatric expert for the LAUSD Mental Health Services Unit. |
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| Ailleth Tom, MSW CBITS Trainer |
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| ailleth.tom@lausd.net | |
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Ms. Tom is an organization facilitator with School Mental Health of LAUSD and has worked in health and human services for 9 years. As a social worker, her professional efforts have been focused on crisis/threat response and intervention, suicide prevention, trauma recovery and resiliency, the Mental Health Services Act, and Response to Instruction and Intervention (RtI2). She has provided trainings to staff and local agencies on threat assessment, substance abuse, trauma, and psychological first aid. As one of the leading experts of inhalant abuse prevention and education within LAUSD, Ms. Tom contributed to the development of an Inhalant Abuse Prevention Kit and continues to support schools by providing education and information about inhalant abuse through presentations and crisis response. In addition, her work with the Inhalant Prevention Committee contributed to changes in policy within the district regarding inhalants and has provided support for changing legislation regarding nitrous oxide within the state of California. Ms. Tom has also been involved in the implementation of CBITS as a group facilitator in middle and high schools, as a Reflective Learning Group facilitator, and as a trainer for the Los Angeles County Department of Mental Health. Ms. Tom began her professional social work career working in the Adoptions Unit for the Los Angeles County Department of Children and Family Services, following the completion of her graduate studies in social welfare at the University of California, Los Angeles. She is an advocate for the wellness of children and their families and promotes their right to safe and nurturing homes, schools, and communities so that they may achieve their greatest potential. |
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| Marleen Wong, PhD Intervention Developer |
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| marleenw@usc.edu | |
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Dr. Wong is assistant dean, clinical professor, and director of field education at the University of Southern California School of Social Work. She is also director and principal investigator for the Trauma Services Adaptation Center for Resiliency, Hope, and Wellness in Schools and one of the original developers of CBITS. Formerly the director of mental health services, crisis intervention, and suicide prevention at LAUSD, she is identified by the White House as one of the "pre-eminent experts in school crisis and recovery" and the "architect of school safety programs" by the Wall Street Journal. In response to the tragic school shootings across the country and acts of terrorism in Oklahoma City and New York, she developed mental health recovery programs; crisis and disaster training for school districts, law enforcement, and Department of Defense personnel in the United States, Canada, Israel, Europe, and Asia; and is frequently a consultant for the U.S. Department of Education to assist with recovery programs for schools impacted by violence, school shootings, terrorism, and natural disasters. In addition to books and peer-reviewed journal articles, she co-authored "Psychological First Aid for Students and Teachers: Listen, Protect, Connect, Model, and Teach" which is available on the public websites of the U.S. Department of Homeland Security, the U.S. Department of Education, and the state of California Department of Mental Health. Dr. Wong served on the Institute of Medicine Board on Neuroscience and Behavioral Health, and in 2009, she was appointed to the American Psychological Association’s Presidential Task Force on Post-Traumatic Stress Disorder and Trauma in Children and Adolescents and the Education Subcommittee of the National Commission on Children and Disasters. Dr. Wong has been identified as a subject matter expert in the area of at-risk populations by the Disaster Mental Health Subcommittee of the National Biodefense Science Board and tasked with providing expert advice and guidance to the Secretary of the US Department of Health and Human Services on scientific, technical, and other matters regarding chemical, biological, nuclear, and radiological agents, whether naturally occurring, accidental, or deliberate. |
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CBITS Dissemination and Sustainability
Dissemination and sustainability of CBITS rests on several factors, including program funding, community collaboration, and leadership support. Our Success Stories provide information about types of funding, models for dissemination, and examples of sites that have successfully sustained CBITS in schools.
Madison, Wisconsin
The Mental Health Center of Dane County successfully implemented CBITS in local public schools as part of their Adolescent Trauma Treatment Program. In 2004, the center and the Madison Metropolitan School District were looking for a screening and intervention program to treat exposure to community violence, post-traumatic stress disorder symptoms, and depression. They selected CBITS because of its evidence- and skill-based curriculum.
They found numerous positive outcomes as a result of implementation, including a significant reduction in symptoms of PTSD and depression. They also reported qualitative improvements, such as an increased awareness of the effects of trauma, and positive feedback from children, parents, and providers. In response, the center and school district sought to expand CBITS throughout the district as well as to neighboring districts. Originally funded by the Substance Abuse and Mental Health Services Administration, the program continues with support from the United Way and other sources.
Baltimore, Maryland
Since 2004, the University of Maryland has been implementing CBITS in schools throughout the state with great success. The Center for School Mental Health and the School Mental Health Program, both in the School of Medicine, initially received funding from the Maryland Department of Health and Mental Hygiene to implement CBITS in two Baltimore city schools as part of a trauma-informed framework for HIV prevention.
The program was received with such enthusiasm from participants and providers that the center has continued to provide annual trainings for their clinicians, who find the group format of CBITS to be a critical addition to individual services. They've also conducted trainings for school psychologists and mental health therapists, many of whom are actively implementing CBITS at the request of the Maryland State Department of Education and other government agencies.
Los Angeles, California
School Mental Health, an office of the Los Angeles Unified School District, used a reflective learning group model (a weekly training and supervision process from preimplementation to outcome evaluation) to implement CBITS during 2008-2010. They trained 107 staff, offered 117 groups, and served more than 700 students in approximately 100 schools.
After treatment, 81% of CBITS participants across grade levels 5-10 reported improvement in post-traumatic stress disorder symptoms with 63% falling below clinical range. Students showed even greater improvement at the two- to four-month follow-up. Of the clinicians surveyed during the 2008-2009 school year, 98% said they felt comfortable implementing CBITS, were able to treat traumatized students effectively, and planned to use CBITS again.
CBITS is now an approved Evidenced-Based Intervention under the Prevention and Early Intervention component of California's Mental Health Services Act. The County of Los Angeles Department of Mental Health and many other counties have adopted it via their implementation plans.
New Orleans, Louisiana
In response to Hurricane Katrina, Mercy Family Center created Project Fleur-de-lis, a collaborative partnership among schools, social service agencies, and national experts to provide mental health services within New Orleans-area schools. This school-based program was specifically designed to address the mental health issues of youth exposed to disaster.
Project Fleur-de-lis selected CBITS as the second tier of its three-tiered model of care. CBITS "was a natural choice given its proven efficacy with diverse populations and the relative ease of its dissemination and implementation." The program continues with funding from several sources, including Baptist Community Ministries and the Substance Abuse and Mental Health Services Administration.
An Implementation Strategy for Delivering a School-Based Mental Health Program
In recent years a large number of evidence-based treatments for youth have been developed; however, few such treatments have become routinely practiced in community settings. One possible reason for this disparity is the lack of attention paid to how treatments are implemented in organizations providing services to youth.
With funding from the National Institute of Mental Health, we will investigate the issue of implementation effectiveness by evaluating how the CBITS intervention has been implemented in school systems and comparing the efficacy of different implementation models. One recently piloted approach, the Learning Collaborative (LC) model, encourages clinicians and administrators across organizations to share how they’ve overcome implementation barriers.
Over the course of this project we aim to: 1) modify the CBITS LC implementation strategy based on feedback from clinicians that have participated in the model; 2) develop and pilot an implementation effectiveness measure for use in assessing CBITS implementation in schools; and 3) compare the CBITS LC implementation model to the CBITS implementation as usual strategy for feasibility and acceptability. The long-term objectives of this work are to identify key strategies to improve the implementation of evidence-based mental health services in schools generally and to determine how implementation can best be accomplished within the school system and culture.
Support for Students Exposed to Trauma (SSET): A CBITS Adaptation
During the rollout of CBITS, many school districts asked what to do if they did not have access to clinicians for delivery of the program. In response, we obtained funding from the National Institute of Mental Health to adapt CBITS for use by teachers and school counselors without clinical training. The result is Support for Students Exposed to Trauma (SSET), a series of ten lessons with a structured approach that aims to reduce distress resulting from exposure to trauma. Designed to be implemented by teachers or school counselors in groups of 8 to 10 middle-school students, the program includes a wide variety of skill-building techniques geared toward changing maladaptive thoughts and promoting positive behaviors. It is also intended to increase levels of peer and parent support for affected students.
Created for SSET group leaders, the Group Leader Training Manual introduces the SSET concept and provides detailed information on selecting student participants, scheduling lessons, assuring confidentiality, coordinating with clinical backup, managing difficult situations and issues, and conducting group meetings. The "Lesson Plans" section supplies group leader preparation information and in-depth plans for each lesson, including agendas, example scenarios, suggestions for troubleshooting specific problems, homework assignment instructions, and cross-references to other program documentation. Take-home worksheets, letters to parents, forms, and other program materials are supplied in the section entitled "Lesson Worksheets and Materials." These materials are available from RAND.
Research on the program showed it to be feasible for delivery and acceptable to implementers, parents, and students. Results of a small pilot study show the program has promise, though a larger scale evaluation is still needed.
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