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Symposium

Child and adolescent mental health
Symposium

Symposium 38 - Evaluating the Implementation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Children and Adolescents in Puerto Rico

Saturday, June 27, 2026
11:00 AM - 12:00 PM PDT
Location: Yerba Buena Salon 12, B3 Level
CE: 1

Keywords: Trauma , Treatment , Hispanic American/Latinx
Level of Familiarity: All
Recommended Readings: Orengo-Aguayo, R., Dueweke, A. R., Nicasio, A., de Arellano, M. A., Rivera, S., Cohen, J. A., ... & Stewart, R. W. (2022). Trauma-focused cognitive behavioral therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes. Child Abuse & Neglect, 129, https://doi.org/105671.,   Wamser‐Nanney, R., & Walker, H. E. (2023). Attrition from pediatric trauma‐focused cognitive behavioral therapy: A meta‐analysis. Journal of Traumatic Stress, 36(1), 17-30.,   D’Amico, P. J., Vogel, J. M., Mannarino, A. P., Hoffman, D. L., Briggs, E. C., Tunno, A. M., Smith, C. C., Hoover, D., & Schwartz, R. M. (2022). Tailoring trauma-focused cognitive behavioral therapy (TF-CBT) for youth with intellectual and developmental disabilities: A survey of nationally certified TF-CBT therapists. Evidence-Based Practice in Child and Adolescent Mental Health, 7(1), 112–124. https://doi.org/10.1080/23794925.2021.1955639,   Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (Second Edition). New York.,  

Trauma exposure is a global public health concern for minors, particularly in low-resource and culturally diverse settings (Tamir et al., 2025). Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is an evidence-based treatment for pediatric PTSD, yet gaps remain in its implementation, effectiveness, and equitable access for underserved groups, including Latino youth, neurodivergent children, and those at risk for treatment non-completion (Cohen et al., 2018). This symposium, based on data from a SAMHSA-funded project, examines the impact, adaptation, and implementation of TF-CBT across diverse youth populations and real-world service contexts in Puerto Rico. The presentations collectively address three interconnected levels of inquiry. First, outcome data from children and adolescents receiving TF-CBT in Puerto Rico demonstrate significant pre- to post-treatment reductions in PTSD symptoms as well as internalizing and externalizing problems, with most minors falling within non-clinical ranges after treatment. These findings extend the TF-CBT evidence base to a Latin American context, supporting its clinical utility beyond predominantly mainland U.S. samples. Second, a pilot investigation focuses on TF-CBT delivery for children with autism spectrum disorder, an understudied and highly vulnerable population. Results highlight both promising symptom reductions and substantial variability in treatment response, underscoring the complexities of assessment, informant discrepancies, and the potential need for extended treatment duration or tailored implementation strategies for neurodivergent youth. Third, implementation-focused analyses examine sociodemographic characteristics and pretreatment psychopathology symptom profiles of youth who either did or did not complete all TF-CBT components. Our findings suggest that enrollment in private schools, living in urban zones, and presenting at baseline with normal-range (non-PTSD) overall psychopathology symptoms, particularly anxious and depressive symptoms, are associated with treatment non-completion. This emphasizes the importance of identifying and addressing systemic, personal, familial, and contextual barriers to engagement and retention. Taken together, the symposium illustrates how TF-CBT functions as an effective and adaptable intervention when delivered within culturally responsive, community-based care systems. The integration of outcome research, pilot innovation with special populations, and implementation science perspectives advances understanding of how evidence-based trauma treatments can be equitably disseminated and sustained. Implications for clinical practice, training, and policy include the importance of culturally grounded assessment, flexible pacing, and proactive strategies to reduce barriers to treatment completion. The discussant will synthesize findings and highlight future directions for expanding trauma-informed, evidence-based care across Latin America and other underserved global contexts, directly aligning with global CBT goals of equity, access, and health for all.

Learning Objectives:

  • Strengthen future clinical practice by integrating outcome data and implementation science into TF-CBT decision-making.
  • Explain pre-post changes in PTSD, internalizing, and externalizing symptoms following TF-CBT in Puerto Rican youth with ASD.
  • Improve clinicians’ understanding of implementation barriers, predictors of non-completion, and strategies to boost engagement.
  • Enhance clinicians’ ability to implement TF-CBT using culturally responsive and context-sensitive practices with diverse youth.
  • Identify potential benefits and challenges of implementing TF-CBT with Latino children with ASD.
  • Identify common barriers to TF-CBT retention and link them to targeted engagement strategies.
  • Summarize implementation-relevant findings from a SAMHSA-funded NCTSI project to inform clinical decision making.

Presentations:

  • 11:03 AM - 11:22 AM PDT
    (SYM 38) Impact of Trauma-focused Cognitive Behavioral Therapy on Internalizing, Externalizing, and Posttraumatic Stress Symptoms in Children and Adolescents in Puerto Rico

    Speaker: Emily Sáez-Santiago, Ph.D. (she/her/hers) – University of Puerto Rico, Rio Piedras Campus

  • 11:22 AM - 11:41 AM PDT
    (SYM 38) Evaluating Trauma-focused Cognitive Behavioral Therapy for Puerto Rican Children with Autism Spectrum Disorder and Trauma: A Pilot Study

    Speaker: Camile Borja, B.S. (she/her/hers) – University of Puerto Rico, Río Piedras Campus

    Co-Author: Emily Sáez-Santiago, Ph.D. (she/her/hers) – University of Puerto Rico, Rio Piedras Campus

    Co-Author: Eduardo Cumba-Avilés, Ph.D. (he/him/his) – University of Puerto Rico, Río Piedras Campus

  • 11:41 PM - 12:00 PM PDT
    (SYM 38) Sociodemographic and Psychological Factors Related to Non-completion of Trauma-focused Cognitive-behavioral Therapy Among Puerto Rican Children and Adolescents

    Speaker: Eduardo Cumba-Avilés, Ph.D. (he/him/his) – University of Puerto Rico, Río Piedras Campus

    Co-Author: Emily Sáez-Santiago, Ph.D. (she/her/hers) – University of Puerto Rico, Rio Piedras Campus