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access this issue brief online.

ISSUE BRIEF

August 2012

Trauma-Focused Cognitive 

Behavioral Therapy for 

Children Affected by 

Sexual Abuse or Trauma

What’s Inside:

• Features of TF‐CBT

• Key components

• Target population

• Effectiveness of TF‐CBT

• What to look for in a therapist

• Considerations for child 

welfare agency administrators

• Resources for further 

information

Trauma-focused cognitive behavioral therapy (TF-CBT) is an 

evidence-based treatment approach shown to help children, 

adolescents, and their caregivers overcome trauma-related 

difficulties. It is designed to reduce negative emotional 

and behavioral responses following child sexual abuse, 

domestic violence, traumatic loss, and other traumatic 

events.1

 The treatment—based on learning and cognitive 

theories—addresses distorted beliefs and attributions related 

to the abuse and provides a supportive environment in 

which children are encouraged to talk about their traumatic 

experience. TF-CBT also helps parents who were not abusive 

to cope effectively with their own emotional distress and 

develop skills that support their children.

1	 While TF-CBT is effective in addressing the effects of traumatic events (e.g., the

loss of a loved one, domestic or community violence, accidents, hurricanes, terrorist

attacks, etc.), the main focus of this issue brief is the treatment of child sexual abuse

and exposure to other trauma.
Trauma-Focused Cognitive Behavioral Therapy 

for Children Affected by Sexual Abuse or Trauma http://www.childwelfare.gov

2 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

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This issue brief is intended to build a better 

understanding of the characteristics and 

benefits of TF-CBT. It was written primarily 

to help child welfare caseworkers and other 

professionals who work with at-risk families 

make more informed decisions about when to 

refer children and their parents and caregivers 

to TF-CBT therapists. This information also 

may help biological parents, foster parents, 

and other caregivers understand what they 

and their children can gain from TF-CBT and 

what to expect during treatment. In addition, 

this issue brief may be useful to others with 

an interest in implementing or participating 

in effective strategies for the treatment of 

children who have suffered from sexual abuse 

or multiple traumatic events.2

Researchers and providers continue to 

develop and refine trauma treatment 

approaches and determine how to 

incorporate them into child welfare 

services. In September 2011, the Children’s 

Bureau awarded 5-year cooperative 

agreements to five organizations to focus 

on integrating trauma-informed and 

trauma-focused practice in child protective 

service (CPS) delivery. The grantees will 

implement TF-CBT and several other 

therapies demonstrating some evidence of 

effectiveness with children and families who 

have experienced trauma.2

2 The Children’s Bureau does not endorse any specific

treatment or therapy. Before implementing a specific type of

therapy in your community, consider its appropriateness based

on families’ needs, resource availability, and fit within the current

service delivery system. Read the section Considerations for

Child Welfare Agency Administrators to determine if TF-CBT

is right for your agency, and consult the section Resources for

Further Information to identify and select therapies for the

families you serve.

Features of TF-CBT

TF-CBT addresses the negative effects of 

sexual abuse, exposure to domestic violence 

and other traumatic events by integrating 

several therapeutic approaches and treating 

both child and parent in a comprehensive 

manner.

TF-CBT Addresses the Effects 

of Sexual Abuse and Trauma

In the immediate as well as long-term 

aftermath of exposure to trauma, children are 

at risk of developing significant emotional 

and behavioral difficulties (see, for example, 

Berliner & Elliott, 2002; Briere & Elliott, 2003; 

Chadwick Center, 2004). For example, victims 

of sexual abuse often experience:

•	 Maladaptive or unhelpful beliefs and

attributions related to the abusive events, 

including:

○ A sense of guilt for their role in the abuse

○ Anger at parents for not knowing about 

the abuse

○ Feelings of powerlessness

○ A sense that they are in some way 

“damaged goods”

○ A fear that people will treat them 

differently because of the abuse

•	 Acting out behaviors, such as engaging in 

age-inappropriate sexual behaviors

•	 Mental health disorders, including major 

depression

•	 Posttraumatic stress disorder (PTSD)

symptoms, which are characterized by:
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for Children Affected by Sexual Abuse or Trauma

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○ Intrusive and reoccurring thoughts of the 

traumatic experience

○ Avoidance of reminders of the trauma 

(often places, people, sounds, smells, 

and other sensory triggers)

○ Emotional numbing

○ Irritability

○ Trouble sleeping or concentrating

○ Physical and emotional hyperarousal 

(often characterized by emotional 

swings or rapidly accelerating anger or 

crying that is out of proportion to the 

apparent stimulus)

These symptoms can impact the child’s daily 

life and affect behavior, school performance, 

attention, self-perception, and emotional 

regulation.

To date, numerous studies have documented 

the effectiveness of TF-CBT in helping 

children overcome these and other symptoms 

following child sexual, domestic violence, and 

similar traumatic experiences (see Empirical 

Studies at end of paper). This treatment 

helps children to process their traumatic 

memories, overcome problematic thoughts 

and behaviors, and develop effective coping 

and interpersonal skills (see Effectiveness of 

TF-CBT, below). 

TF-CBT Treats Nonoffending 

Parents in Addition to the Child

Recognizing the importance of parental 

support in the child’s recovery process, 

TF-CBT includes a treatment component 

for parents (or caregivers) who were not 

abusive. Treatment sessions are divided into 

individual meetings for the children and 

parents, with about equal amounts of time 

for both. The parent component teaches 

stress management, parenting and behavior 

management skills, and communication skills. 

As a result, parents are better able to address 

their own emotional distress associated with 

the child’s trauma, while also supporting their 

children more effectively.

TF-CBT Integrates Several 

Established Treatment Approaches 

TF-CBT combines elements drawn from:

• Cognitive therapy, which aims to change 

behavior by addressing a person’s thoughts 

or perceptions, particularly those thinking 

patterns that create distorted or unhelpful 

views

• Behavioral therapy, which focuses on 

modifying habitual responses (e.g., anger, 

fear) to identified situations or stimuli

• Family therapy, which examines patterns 

of interactions among family members to 

identify and alleviate problems

TF-CBT uses well-established cognitivebehavioral therapy and stress management 

procedures originally developed for the 

treatment of fear, anxiety, and depression 

in adults (Wolpe, 1969; Beck, 1976). These 

procedures have been used with adult 

rape victims with symptoms of PTSD (Foa, 

Rothbaum, Riggs, & Murdock, 1991) and have 

been applied to children with problems with 

excessive fear and anxiety (Beidel & Turner, 

1998). The TF-CBT protocol has adapted 

and refined these procedures to target the 

specific difficulties exhibited by children 

who are experiencing PTSD symptoms in 

response to sexual abuse, domestic violence, 

or other childhood traumas. In addition, 

well-established parenting approaches (e.g., 
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Patterson, 2005; Forehand & Kotchick, 2002) 

also are incorporated into treatment to 

guide parents in addressing their children’s 

behavioral difficulties.

TF-CBT Shows Results in 

Various Environments and 

Cultural Backgrounds

TF-CBT has been implemented in urban, 

suburban, and rural environments and in 

clinics, schools, homes, residential treatment 

facilities, and inpatient settings. TF-CBT has 

demonstrated effectiveness with children 

and families of different cultural backgrounds 

(including Caucasian, African-American, and 

Hispanic children from all socioeconomic 

backgrounds) (e.g., Weiner, Schneider, & 

Lyons, 2009). Therapy has been adapted for 

Latino, Native American, and hearing-impaired 

populations. It is a highly collaborative therapy 

approach in which the therapist, parents, and 

child all work together to identify common 

goals and attain them.

TF-CBT Is Appropriate 

for Multiple Traumas

Recent research findings suggest that TF-CBT 

is more effective than nondirective or clientcentered treatment approaches for children 

who have a history of multiple traumas (e.g., 

sexual abuse, exposure to domestic violence, 

physical abuse, as well as other traumas) and 

those with high levels of depression prior to 

treatment (Deblinger, Mannarino, Cohen, 

& Steer, 2006). The model also has been 

tested with children who are experiencing 

traumatic grief after the death of a loved one 

(Cohen, Mannarino, & Knudsen, 2004; Cohen, 

Mannarino, & Staron, 2006).

Key Components

TF-CBT is a short-term treatment typically 

provided in 12 to 18 sessions of 50 to 90 

minutes, depending on treatment needs. The 

intervention is usually provided in outpatient 

mental health facilities, but it has been used 

in hospital, group home, school, community, 

residential, and in-home settings.

The treatment involves individual sessions 

with the child and parent (or caregiver) 

separately and joint sessions with the child 

and parent together. Each individual session is 

designed to build the therapeutic relationship 

while providing education, skills, and a 

safe environment in which to address and 

process traumatic memories. Joint parentchild sessions are designed to help parents 

and children practice and use the skills they 

learned and for the child to share his/her 

trauma narrative while also fostering more 

effective parent-child communication about 

the abuse and related issues.

Goals

Generally, the goals of TF-CBT are to:

• Reduce children’s negative emotional and 

behavioral responses to the trauma

• Correct maladaptive or unhelpful beliefs 

and attributions related to the traumatic 

experience (e.g., a belief that the child is 

responsible for the abuse)

• Provide support and skills to help 

nonoffending parents cope effectively with 

their own emotional distress

• Provide nonoffending parents with skills 

to respond optimally to and support their 

children
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Protocol Components

Components of the TF-CBT protocol can be 

summarized by the word “PRACTICE”:

• P - Psychoeducation and parenting 

skills—Discussion and education about 

child abuse in general and the typical 

emotional and behavioral reactions to 

sexual abuse; training for parents in child 

behavior management strategies and 

effective communication

• R - Relaxation techniques—Teaching 

relaxation methods, such as focused 

breathing, progressive muscle relaxation, 

and visual imagery

• A - Affective expression and regulation—

Helping the child and parent manage their 

emotional reactions to reminders of the 

abuse, improve their ability to identify and 

express emotions, and participate in selfsoothing activities

• C - Cognitive coping and processing—

Helping the child and parent understand 

the connection between thoughts, feelings, 

and behaviors; exploring and correcting of 

inaccurate attributions related to everyday 

events

• T - Trauma narrative and processing—

Gradual exposure exercises, including 

verbal, written, or symbolic recounting 

of abusive events, and processing of 

inaccurate and/or unhelpful thoughts about 

the abuse

• I - In vivo exposure—Gradual exposure to 

trauma reminders in the child’s environment 

(for example, basement, darkness, school), 

so the child learns to control his or her own 

emotional reactions

• C - Conjoint parent/child sessions—Family 

work to enhance communication and create 

opportunities for therapeutic discussion 

regarding the abuse and for the child to 

share his/her trauma narrative

• E - Enhancing personal safety and future 

growth—Education and training on personal 

safety skills, interpersonal relationships, and 

healthy sexuality and encouragement in the 

use of new skills in managing future stressors 

and trauma reminders

Target Population

TF-CBT is appropriate for use with sexually 

abused children or children exposed to trauma 

ages 3 to 18 and parents or caregivers who 

did not participate in the abuse. 

Appropriate Populations 

for Use of TF-CBT

Appropriate candidates for this program 

include:

• Children and adolescents with a history 

of sexual abuse and/or exposure to 

trauma who:

○ Experience PTSD

○ Show elevated levels of depression, 

anxiety, shame, or other dysfunctional 

abuse-related feelings, thoughts, or 

developing beliefs

○ Demonstrate behavioral problems, 

including age-inappropriate sexual 

behaviors
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• Children and adolescents who have been 

exposed to other childhood traumas (e.g., 

exposure to community violence, traumatic 

loss of a loved one) and show symptoms of 

depression, anxiety, or PTSD

• Nonoffending parents (or caregivers) 

Meaningful assessment is important in 

selecting which children may benefit 

from TF-CBT and to inform the focus of 

the intervention. The assessment should 

specifically address PTSD, depressive and 

anxiety symptoms, and sexually inappropriate 

behaviors and other behavior problems, as 

these have been found to be most responsive 

to TF-CBT in multiple studies.

Limitations for Use of TF-CBT

TF-CBT may not be appropriate or may need 

to be modified for:

• Children and adolescents whose primary 

problems include serious conduct problems 

or other significant behavioral problems that 

existed prior to the trauma and who may 

respond better to an approach that focuses 

on overcoming these problems first.

• Children who are acutely suicidal or who 

actively abuse substances. The gradual 

exposure component of TF-CBT may 

temporarily worsen symptoms. However, 

other components of TF-CBT have 

been used successfully to address these 

problems. It may be that, for these children, 

the pace or order of TF-CBT interventions 

needs to be modified (as has been done in 

the Seeking Safety model; Najavits, 2002), 

rather than that TF-CBT is contraindicated 

for these populations.

• Adolescents who have a history of running 

away, serious cutting behaviors, or 

engaging in other parasuicidal behavior. For 

these teens, a stabilizing therapy approach 

such as dialectical behavior therapy (Miller, 

Rathus, & Linehan, 2007) may be useful 

prior to integrating TF-CBT into treatment.

Effectiveness of TF-CBT

The effectiveness of TF-CBT is supported 

by outcome studies and recognized on 

inventories of model and promising treatment 

programs.

Demonstrated Effectiveness 

in Outcome Studies

To date, at least 11 empirical investigations 

have been conducted evaluating the impact of 

TF-CBT on children who have been victims of 

sexual abuse or other traumas (see Empirical 

Studies at end of paper). In addition, there 

have been studies specifically showing the 

effectiveness of TF-CBT with children exposed 

to domestic violence (Cohen, Mannarino, & 

Iyengar, 2011; Weiner, Schneider, & Lyons, 

2009). The findings consistently demonstrate 

TF-CBT to be useful in reducing symptoms of 

PTSD as well as symptoms of depression and 

behavioral difficulties in children who have 

experienced sexual abuse and other traumas. 

In randomized clinical trials comparing TF-CBT 

to other tested models and services as usual 

(such as supportive therapy, nondirective 

play therapy, child-centered therapy), TF-CBT 

resulted in significantly greater gains in fewer 

clinical sessions. Follow-up studies (up to 2 

years following the conclusion of therapy) 

have shown that these gains are sustained 

over time.
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Children showing improvement typically:

• Experience significantly fewer intrusive 

thoughts and avoidance behaviors

• Are able to cope with reminders and 

associated emotions

• Show reductions in depression, anxiety, 

disassociation, behavior problems, sexualized 

behavior, and trauma-related shame

• Demonstrate improved interpersonal trust 

and social competence

• Develop improved personal safety skills

• Become better prepared to cope with 

future trauma reminders (Cohen, Deblinger, 

Mannarino, & Steer, 2004)

Research also demonstrates a positive 

treatment response for parents (Cohen, 

Berliner, & Mannarino, 2000; Deblinger, 

Lippmann, & Steer, 1996). In TF-CBT studies, 

parents often report reductions in depression, 

emotional distress associated with the child’s 

trauma, and PTSD symptoms. They also report 

an enhanced ability to support their children 

(Deblinger, Stauffer, & Steer, 2001; Cohen, 

Deblinger, et al., 2004; Mannarino, Cohen, 

Deblinger, Runyon, & Steer, in press).

Recognition as an EvidenceBased Practice

Based on systematic reviews of available 

research and evaluation studies, several 

groups of experts and Federal agencies have 

highlighted TF-CBT as a model program or 

promising treatment practice. This program is 

featured in the following sources:

• Closing the Quality Chasm in Child Abuse 

Treatment: Identifying and Disseminating 

Best Practices (Chadwick Center, 2004) at 

http://www.chadwickcenter.org/kauffman/

kauffman.htm

• The National Child Traumatic Stress 

Network’s (2005) Empirically Supported 

Treatments and Promising Practices,

supported by the Substance Abuse and 

Mental Health Services Administration 

(SAMHSA), at http://www.nctsn.org/

resources/topics/treatments-that-work/

promising-practices

• Child Physical and Sexual Abuse: 

Guidelines for Treatment (Saunders et al., 

2004) at http://academicdepartments.

musc.edu/ncvc/resources_prof/OVC_

guidelines04-26-04.pdf

• The California Evidence-Based 

Clearinghouse for Child Welfare (2011) at 

http://www.cebc4cw.org

• SAMHSA Model Programs: National 

Registry of Evidence-Based Programs and 

Practices at http://nrepp.samhsa.gov

• Journal of Clinical Child and Adolescent 

Psychology (Silverman et al., 2008).

What to Look for in a Therapist

Caseworkers should become knowledgeable 

about commonly used treatments before 

recommending a treatment provider to 

families. Parents or caregivers should receive 

as much information as possible about the 

treatment options available to them. If TF-CBT 

appears to be an appropriate treatment model 

for a family, the caseworker should look for a 

provider who has received adequate training, 

supervision, and consultation in the TF-CBT 

model. If feasible, both the caseworker and 

the family should have an opportunity to 

interview potential TF-CBT therapists prior to 

beginning treatment.
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Questions to Ask 

Treatment Providers

In addition to appropriate training and 

thorough knowledge of the TF-CBT model, 

it is important to select a treatment provider 

who is sensitive to the particular needs of 

the child, caregiver, and family. Caseworkers 

recommending a TF-CBT therapist should ask 

the treatment provider to explain the course 

of treatment, the role of each family member 

in treatment, and how the family’s specific 

cultural considerations will be addressed. 

The child, caregiver, and family should feel 

comfortable with and have confidence in the 

therapist with whom they will work.

Some specific questions to ask regarding 

TF-CBT include:

• What is the nature of the therapist’s TF-CBT 

training (when trained, by whom, length of 

training, access to follow-up consultation, 

etc.)? Is this person clinically supervised by (or 

did he or she participate in a peer supervision 

group for private practice therapists with) 

others who are TF-CBT trained?

• Is there a standard assessment process 

used to gather baseline information on the 

functioning of the child and family and to 

monitor their progress in treatment over time?

• What techniques will the therapist use to 

help the child manage his or her emotions 

and related behaviors?

• How and when will the therapist ask the 

child to describe the trauma?

• Will the therapist use a combination of 

individual and joint child-parent sessions?

• Is the practitioner sensitive to the cultural 

background of the child and family?

• Is there any potential for harm associated 

with treatment?

TF-CBT Training

TF-CBT training sessions are appropriate 

for therapists and clinical supervisors with 

a master’s degree or higher in a mental 

health discipline, experience working with 

children and families, and knowledge of child 

sexual abuse dynamics and child protection. 

Therapists may benefit from sequential 

exposure to different types of training:

• Completing the 10-hour web-based training 

on TF-CBT on the Medical University of South 

Carolina website (http://tfcbt.musc.edu)

• Reading the program developer’s treatment 

book(s) and related materials

• Participating in intensive skills-based 

training (2 days)

• Receiving ongoing expert consultation from 

trainers for 6 to 12 months

• Participating in advanced TF-CBT training 

for 1 to 2 days

See Training and Consultation Resources, 

below, for contact information.

Considerations for Child 

Welfare Agency Administrators

Agency administrators considering promoting 

the use of TF-CBT with children who have 

suffered trauma and their families will want to 

research several variables:
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for Children Affected by Sexual Abuse or Trauma

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• Agency-level adjustments to support 

successful TF-CBT with families, such as 

modifications in policy, practice, and 

data collection 

• Identification of therapists or mental health 

agencies with experience offering TF-CBT 

and who can work with children from child 

welfare populations (see above)

• Projected costs

When introducing TF-CBT as a referral option 

that child welfare workers may consider 

for children and families in their caseload, 

administrators will want to ensure that workers 

have a clear understanding of how TF-CBT 

works, the values that drive it, and its efficacy. 

Training for child welfare staff on the basics of 

TF-CBT, how to screen for trauma, and how 

to make appropriate referrals can expedite 

parent and child’s access to effective treatment 

options (see the National Child Traumatic 

Stress Network’s Child Welfare Trauma Training 

toolkit at http://www.nctsn.org/products/

child-welfare-trauma-training-toolkit-2008). 

Research has shown that TF-CBT works best 

under the following organizational conditions:

• Organizational leadership that supports the 

use of evidence-based interventions, which, 

in turn, promote acceptance by workers 

and supervisors

• Provision of ongoing supervision to help child 

welfare workers make informed referrals to 

trauma-informed services and supervision for 

trained clinicians providing treatment

Conclusion

TF-CBT is an evidence-based treatment 

approach for children who have experienced 

sexual abuse, exposure to domestic violence, 

or similar traumas. Despite the impressive 

level of empirical support for TF-CBT and 

an established publication track record, 

many professionals remain unaware of its 

advantages, and many children and parents 

who could benefit do not receive such 

treatment. Further, in many communities 

around the nation, there may not yet be 

any TF-CBT trained therapists. The current 

demand for such evidence-based treatments, 

however, will encourage other professionals to 

acquire the needed training and to implement 

the TF-CBT model. Increased availability 

of TF-CBT, along with increased awareness 

among those making treatment referrals, can 

offer significant results in helping children to 

process their trauma and overcome emotional 

and behavioral problems following sexual 

abuse and other childhood traumas.
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Resources for Further Information

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Berliner, L., & Elliott, D. M. (2002). Sexual abuse of children. In J. E. B. Myers, L. Berliner, J. Briere, 

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Welfare Information Gateway. Available online at http://www.childwelfare.gov/pubs/trauma

Empirical Studies

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. (2004). A multisite, randomized controlled 

trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy 

of Child & Adolescent Psychiatry, 43, 393-402.

Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool 

children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 

35(1), 42-50.

Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: 

Outcome during one year follow-up. Journal of the American Academy of Child and Adolescent 

Psychiatry 36(9), 1228-1235.

Cohen, J. A., Mannarino, A. P., & Knudsen K. (2005). Treating sexually abused children: One year 

follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-146.

Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic 

stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1(4), 310‐321.

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-Focused 

Cognitive Behavioral Therapy for children: Impact of the trauma narrative and treatment length. 

Depression and Anxiety, 28, 67–75.

Deblinger, E., Mannarino, A. P., Cohen, J. A., & Steer, R. A. (2006). A multisite, randomized 

controlled trial for children with sexual abuse-related PTSD symptoms: Examining predictors of 

treatment response. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 

1474-1484.

Deblinger, E., Stauffer, L., & Steer, R. (2001). Comparative efficacies of supportive and cognitive 

behavioral group therapies for children who were sexually abused and their nonoffending 

mothers. Child Maltreatment 6(4), 332-343.

Deblinger, E., Steer, R. A., & Lippmann, J. (1999). Two year follow-up study of cognitive behavioral 

therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse and 

Neglect, 23(12), 1371-1378.

King, N., Tonge, B. J., Mullen, P., Myerson, N., Heyne, D., Rollings, S., et al. (2000). Treating 

sexually abused children with post‐traumatic stress symptoms: A randomized clinical trial. 

Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1347-1355.

Stauffer, L., & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their 

young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 

1(1), 65-76.
Trauma-Focused Cognitive Behavioral Therapy 

for Children Affected by Sexual Abuse or Trauma

13 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

Welfare Information Gateway. Available online at http://www.childwelfare.gov/pubs/trauma

http://www.childwelfare.gov

Online Resources

Center for Traumatic Stress in Children & Adolescents 

http://www.pittsburghchildtrauma.net

Medical University of South Carolina

Guidelines for Treatment of Physical and Sexual Abuse of Children

http://academicdepartments.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf

Chadwick Center for Children and Families

Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices

http://www.chadwickcenter.org/Kauffman/kauffman.htm

National Child Traumatic Stress Network

Empirically Supported Treatments and Promising Practices

http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices

University of Medicine & Dentistry of New Jersey, School of Osteopathic Medicine

CARES Institute

http://www.caresinstitute.org

SAMHSA Model Programs

National Registry of Evidence-Based Programs and Practices

http://nrepp.samhsa.gov

The California Evidence-Based Clearinghouse for Child Welfare 

http://www.cebc4cw.org/program/trauma-focused-cognitive-behavioral-therapy

Interventions Addressing Child Exposure to Trauma: Part 1 – Child Maltreatment and Family 

Violence Agency for Healthcare Research and Quality, U.S. Department of Health and Human 

Services http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?mode=&page

action=displayproduct&productid=846

Blueprints for Violence Prevention

University of Colorado Boulder’s Center for the Study and Prevention of Violence

http://www.colorado.edu/cspv/blueprints
Trauma-Focused Cognitive Behavioral Therapy 

for Children Affected by Sexual Abuse or Trauma http://www.childwelfare.gov

14 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

Welfare Information Gateway. Available online at http://www.childwelfare.gov/pubs/trauma

Training and Consultation Resources

Web-Based Training

Medical University of South Carolina (MUSC). Distance learning course on TF-CBT

http://tfcbt.musc.edu

Web-based training in TF‐CBT is available as an adjunct or precursor to attending training 

workshops. The website training may be accessed free of charge. Therapists typically benefit 

from a 2-day intensive initial training course, as well as advanced training seminars after some 

experience implementing the model. Access to written resources such as books and treatment 

manuals (listed below), ongoing consultation or clinical mentoring, and regular clinical supervision 

are important complements to any web-based training.

Medical University of South Carolina (MUSC). Distance Learning course on Child Traumatic Grief

http://ctg.musc.edu

Web-based training is available on the application of TF-CBT principles and interventions to child 

traumatic grief along with presentation of grief-related interventions.

National Child Traumatic Stress Network. Child Welfare Trauma Training Toolkit 

http://www.nctsn.org/products/child-welfare-trauma-training-toolkit-2008

This course is designed to teach basic knowledge, skills, and values about working with children 

in the child welfare system who have experienced traumatic stress. It also teaches how to use this 

knowledge to support children’s safety, permanency, and well-being through case analysis and 

corresponding interventions tailored for them and their biological and resource families.

Web-Based Consultation

Medical University of South Carolina (MUSC). Distance Learning Consultation on TF-CBT

http://etl2.library.musc.edu/tf-cbt-consult/index.php

This web-based consultation tool provides information about frequently asked questions by 

providers implementing TF-CBT.

Implementation Guide

Child Sexual Abuse Task Force and Research & Practice Core, National Child Traumatic Stress 

Network. (2008). How to implement trauma-focused cognitive behavioral therapy.

http://www.nctsnet.org/nctsn_assets/pdfs/TF-CBT_Implementation_Manual.pdf
Trauma-Focused Cognitive Behavioral Therapy 

for Children Affected by Sexual Abuse or Trauma

15 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

Welfare Information Gateway. Available online at http://www.childwelfare.gov/pubs/trauma

http://www.childwelfare.gov

Onsite Training Contacts

Judith Cohen, M.D.

Center for Traumatic Stress in Children & Adolescents 

Allegheny General Hospital

Pittsburgh, PA

Phone: 412.330.4321

Email: JCohen1@wpahs.org

Anthony P. Mannarino, Ph.D.

Center for Traumatic Stress in Children & Adolescents 

Allegheny General Hospital

Pittsburgh, PA

Phone: 412.330.4312

Email: amannari@wpahs.org

Esther Deblinger, Ph.D. 

CARES Institute

University of Medicine & Dentistry of NJ ‐ School of Osteopathic Medicine

Stratford, NJ

Phone: 856.566.7036

Email: deblines@umdnj.edu

Practitioner’s Guides

Cohen, J. A., Mannarino A. P. & Deblinger, E. (2006). Treating trauma and traumatic grief in 

children & adolescents. New York: Guilford Press.

Deblinger, E. & Heflin, A. H. (1996). Treating sexually abused children and their nonoffending 

parents: A cognitive behavioral approach. Newbury Park, CA: Sage Publications.

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012). Trauma-focused CBT for children and 

adolescents: Treatment applications. New York: Guilford Press.

The following children’s books by Stauffer & Deblinger also may be useful in teaching personal 

safety and other coping skills:

Stauffer, L. B., & Deblinger, E. (2003). Let’s talk about taking care of you: An educational book 

about body safety. Hatfield, PA: Hope for Families, Inc.

Stauffer, L., & Deblinger, E. (2005). Let’s talk about coping and safety skills: A workbook about 

taking care of you. Hatfield, PA: Hope for Families, Inc.
Trauma-Focused Cognitive Behavioral Therapy 

for Children Affected by Sexual Abuse or Trauma http://www.childwelfare.gov

16 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

Welfare Information Gateway. Available online at http://www.childwelfare.gov/pubs/trauma

Acknowledgments:

The original (2007) and current versions of this issue brief were developed by Child Welfare 

Information Gateway, in partnership with the Chadwick Center for Children and Families at Rady 

Children’s Hospital San Diego. Contributing Chadwick authors include Cambria Rose Walsh, 

Anthony P. Mannarino, and Charles Wilson.

The conclusions discussed here are solely the responsibility of the authors and do not represent 

the official views or policies of the funding agency. The Children’s Bureau does not endorse any 

specific treatment or therapy.

Suggested Citation:

Child Welfare Information Gateway. (2012). Trauma-focused cognitive behavioral therapy for 

children affected by sexual abuse or trauma. Washington, DC: U.S. Department of Health and 

Human Services, Children’s Bureau. 

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau