Examining Written Exposure Therapy Delivered to Adolescents

The Kiddie Schedule for Affective Disorders and Schizophrenia, which is a psychometrically strong tool to assess diagnoses for a wide variety of mental health conditions among adolescents, will be used to assess Posttraumatic Stress Disorder (PTSD) symptoms present and diagnostic criteria over the course of the longitudinal period. Higher scores indicate greater likelihood of meeting diagnostic criteria for PTSD.

The Child and Adolescent Trauma Screen (CATS) youth and caregiver reports (ages 7-17) assess exposure to 15 different types of potentially traumatic events followed by 20-items assessing PTSD symptoms. It is a widely used psychometrically validated tool and will be used to assess the adolescent's trauma exposure history and PTSD symptoms per self and caregiver report. Total scores on this measure range from 0 to 60; scores of 21 or higher indicate elevated symptoms of posttraumatic stress disorder (PTSD). Higher scores indicate greater PTSD symptom severity.

The Cognitive Emotion Regulation Questionnaire - Adolescent Version is a 36 item psychometrically strong measure of cognitive and emotion regulation strategies and has been used widely with trauma-exposed adolescents. The rumination subscale of the CERQ will be used to examine changes in ruminative thinking, a proposed mechanism of WET's action to be tested in the study, over the course of treatment. Total scores on this measure range from 36 to 180. Several subscales are included on this measure: Self-blame, Other-blame, Rumination, Catastrophizing, Putting into perspective, Positive refocusing, Positive reappraisal, Acceptance, and Planning. Higher scores indicate higher levels of experiencing each symptom area measured (e.g., higher scores on the self blame subscale indicate greater self-blame; higher scales on the positive re-focusing indicate greater ability to positively refocus).

The Acceptability of Intervention Measure is a 4-item measure used to assess patient perceptions of new interventions, including whether they believe the new treatment is agreeable, palatable, or satisfactory on a five-point Likert scale. This measure will be administered to adolescents and their caregivers to gauge acceptability of the experimental intervention for meeting the needs of the adolescent population. Scores are averaged; total scores on this measure range from 1 to 5. Higher scores indicate greater acceptability of the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

The Feasibility of Intervention Measure is a 4-item measure to assess perceptions of whether an intervention will be able to be successfully implemented within a given agency or setting to a certain population of interest. This measure will be administered to adolescents and caregivers to gauge perceptions of feasibility of WET for delivery with adolescents. Scores are averaged; total scores on this measure range from 1 to 5. Higher scores indicate greater perceived feasibility of the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

The Intervention Appropriateness Measure is a 4-item measure to assess perceptions of whether an intervention is perceived as appropriate for addressing the needs/symptoms of a population. This measure will be administered to adolescents and caregivers to gauge perceptions of the appropriateness of WET delivered to 12 to 18 year olds. Scores are averaged; total scores on this measure range from 1 to 5. Higher scores indicate greater perceived feasibility of the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

Questions will include probes about how to enhance the intervention to elicit impressions of the un-adapted content (e.g., written prompt wording, relevance of psychoeducational content, helpfulness), areas in need of adaptation, gaps missing in the manual, and recommendations for adaptations (e.g., wording alterations, content adaptations). Interviews will also inquire about barriers and facilitators to traditional trauma-focused treatment and whether WET meets or does not meet priorities and needs of adolescents with PTSD and their caregivers.

Revised Children's Anxiety and Depression Scale caregiver and child surveys are 25-item scales assessing for depression and anxiety symptoms among youth. The full subscales from the RCADS-47 for social phobia and obsessive compulsive disorder symptoms will also be administered to youth. The RCADS-25 is psychometrically strong scales for use with adolescents and caregivers and therefore will be used to assess participant self-reported symptoms of depression and anxiety. Scores range from 0 to 75 and raw scores are converted to T scores in relation to normed data based on same aged peers. Higher scores on this measure indicate greater levels of depression and anxiety.

The Kiddie Schedule for Affective Disorders and Schizophrenia, which is a psychometrically strong tool to assess diagnoses for a wide variety of mental health conditions among adolescents. Screeners and, full modules when indicated following screens, will be used to facilitate accurate screening and diagnosis of comorbidities to identify whether participants meet inclusion or exclusion criteria at baseline (i.e., active psychosis, active suicidal plan and intent, anorexia nervosa, severe substance use withdrawal symptoms, active psychosis). This interview has several subscales that allow for a diagnostic interview to assess common psychiatric conditions among youth and does not have a standardized range of scores. The Mania, schizophrenia, eating disorder, and suicide screeners and full modules when screeners are positive will be used.

The Mental Health Statistics Improvement Program (MHSIP) Youth Survey is a standardized tool to assess youth and caregiver's perceptions of mental health services they received including treatment satisfaction and appropriateness of the intervention to meet one's mental health needs. It has been used among adolescent and caregiver populations and has strong psychometric properties. Total scores on this measure range from 25 to 125. Higher scores indicate greater satisfaction with the intervention (either Written Exposure Therapy or Trauma-focused Cognitive Behavior Therapy).

The Therapeutic Alliance Scale for Children (TASC) - Revised is a 12 item measure designed to assess therapeutic alliance between therapists and patients as perceived by the patient and by their caregiver. This will be administered during the follow up phase to assess perceptions of the therapeutic alliance. Total scores on this measure range from 12 to 48. Higher scores indicate greater levels of therapeutic alliance.

Youth who endorse traumatic loss will complete the thirteen item Prolonged Grief Scale to assess for symptoms of traumatic grief. Total scores on this measure range from 11 to 55; scores of 30 or higher indicate elevated symptoms of prolonged grief. Higher scores indicate higher levels of prolonged grief disorder symptoms.

The Rosenberg Self Esteem Scale is comprised of 10 items assessing self esteem among youth. Responses range from 0 to 30 and lower scores indicate lower levels of self esteem.

The Multidimensional Scale of Perceived Social Support will be administered to youth and their caregivers to assess perceptions of their current social support. This twelve item scale has a potential score range of 12 to 84; higher scores indicate higher levels of perceived social support.

The Posttraumatic Stress Disorder (PTSD) Checklist - 8 will be used to assess caregiver symptoms of PTSD. Total range of potential scores is from 8 to 32 and higher scores indicate greater PTSD symptomatology among caregivers. Scores over 12 indicate likelihood of PTSD symptoms.

The Alabama Parenting Questionnaire, nine item short form, will be used to assess parenting approaches and strategies among caregivers who participate in the trial over the course of the study. Three subscales are assessed in the measure: Positive parenting (possible score range: 6-30), inconsistent discipline (possible score range: 6-30), and poor supervision (possible score range: 9-45). Higher scores on each subscale indicate greater levels of each of the subscale categories assessed.

The Parental Self Efficacy Scale 5 item measure will be used to assess Parental Self Efficacy among caregivers who participate in the study. Total score responses range from 5 to 25 and higher scores indicate higher levels of perceived self efficacy as a parent.

The DSM-5-TR Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure is a 25 item measure will be used to assess caregiver perceptions of their child mental health with regard to several domains (Depression, Anger and Irritability, Mania, Anxiety, Somatic symptoms, Inattention, Suicidal ideation/attempt, Psychosis, Sleep disturbance, Repetitive thoughts and behaviors, and Substance use). The measure will be administered to assess caregiver perceptions of these symptoms among youth as perceived by caregivers over the course of the study as well as will be used at baseline to screen for the presence of potential comorbid symptoms that could indicate a need to further assess for potential exclusion criteria

Select items from the Accountable Health Communities Health Related Social Needs Screening Tool will be used to assess for factors related to social determinants of health, such as food insecurity, housing insecurity, and other basic needs. Questions are administered to caregivers and youth to characterize the sample and to connect families to resources, as needed.

Adolescent participants will complete the Adverse Childhood Events Scale - Youth Version at baseline to assess for a wide range of adverse childhood events that are not captured on the CATS 2.0 including emotional abuse, divorce, familial incarceration, parental substance use, and neglect. Findings will be used to inform comprehensive trauma assessment.

Adolescent participants will complete the Measure of Adolescent Relationship Harassment and Abuse - Short Form at baseline to assess for exposure to Teen Dating Violence, some of which may not otherwise be captured on the CATS 2.0. Findings will be used to inform comprehensive trauma assessment.

The HARK will be used to screen for lifetime and past year Intimate Partner Violence among caregivers in the study at baseline.

Caregivers will complete the 24 item trauma history questionnaire to assess for trauma history among caregivers who participate in the study.