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November 2016Vol. 17, No. 8Fidelity of Trauma Treatment in Under-Served Communities

A comprehensive service model for treating trauma-affected children and families points to the need for reliable and low-cost tools to improve the fidelity of evidence-based practices and the challenges of doing so in community-based settings. Improving Service Delivery for Children Affected by Trauma—An Implementation Study of Children's Institute, Inc. is a recent project of MDRC, a nonprofit, nonpartisan social and education policy research group that seeks to improve the well-being of low-income populations.

The August 2016 MDRC report explores recent work by the Los Angeles-based Children's Institute, Inc. (CII), a multiservice organization that offers an array of supportive and therapeutic services for children affected by trauma, including physical or sexual abuse, domestic violence, or violence in the community. CII relies on evidence-based practices to treat children's mental health needs, provides classes for parents and caregivers to help them care for their children, offers early child care and Head Start programs, and sponsors youth activities to create protective factors in its communities.

The study was designed to evaluate CII's service model and its delivery of evidence-based practices, including a fidelity study of its Trauma-Focused Cognitive Behavior Therapy (TF-CBT). The study concluded that:

  • CII engages holistically with clients in multiple services.
  • A third of children receiving clinical services were treated with evidence-based practices.
  • Treatment recipients were shown to have at least a 50 percent chance of receiving half of the practice's required therapeutic components.

The fact that CII therapists were not able to offer all of TF-CBT's required treatment components—consistent with findings from other community-based studies—leads the study authors to point to the need for "robust and low-cost tools to help providers deliver evidence-based treatments with fidelity." MDRC President Gordon L. Berlin writes in the preface that the report "adds to the understanding of the challenges of implementing evidence-based practices in community-based settings, where the highly specified protocols of these practices meet the realities of providing services in high-needs and under-sourced communities."

The report is available at