Unaccompanied Migrant Children in the United States: Implementation and Effectiveness of Trauma-Focused Cognitive Behavioral Therapy

Objective: The number of unaccompanied children (UC) arriving in the United States (U.S.) from other countries has increased significantly over the past decade. UC report high trauma exposure and greater posttraumatic stress symptoms compared with youth who immigrate with caregivers. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has demonstrated preliminary effectiveness with UC. However, few studies have treated U.S.-based samples of UC, who emigrate primarily from Central America. Method: One hundred thirty-eight UC were referred for treatment and 129 completed a pretreatment assessment including the Child and Adolescent Trauma Screen (CATS) and the Strengths and Difficulties Questionnaire (SDQ). Most UC were from Central America (n = 109; 79.0%) and resided in government facilities (n = 76; 55.1%). One hundred twenty-two youth began TF-CBT, had an average of 9.71 sessions (SD = 9.3, range: 1-48), and 41.8% (n = 51) completed treatment. One hundred four youth completed a brief, six-item progress monitoring measure of trauma symptoms, for which 84 had at least two observations during treatment. Results: UC endorsed 3.80 traumatic events on average (SD = 2.38). High rates of violence, physical and sexual abuse, and serious injury were reported. There were significant improvements on most self-report rating scales (p < .05); within-subjects Cohen's d's ranged from .07 to 1.03 for pre- to posttreatment assessments and was d = .44 for the progress monitoring measure. Therapists reported on TF-CBT modifications for UC, including discussing mental health beliefs, navigating roles and relationships, tailoring treatment examples, exploring coping strategies, and addressing immigration factors. Conclusion: Preliminary findings support the utility of TF-CBT with UC. Implications for implementation and cultural modifications are discussed. Clinical Impact Statement Unaccompanied children (UC) experience significant trauma prior to and during their journey to the United States. Trauma-informed treatment for UC is a public health concern, yet there are limited data on the effectiveness of evidence-based trauma treatment (EBT) for UC. This study examined the effectiveness of an EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), in a community sample of UC and found that posttraumatic stress symptoms decreased after treatment. Preliminary findings suggest that with modifications (e.g., reducing jargon, using culturally relevant examples) TF-CBT may be a useful treatment for UC.