Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Stein and colleagues1 found that a 10-session, school-based cognitive-behavioral
treatment (CBT) program was effective for reducing the levels of posttraumatic
stress disorder (PTSD) and depression among children exposed to violence.
I am concerned that the authors did not find a significant difference
in classroom behavior after the intervention. Schools have limited mental
health resources and need to prioritize how they choose to provide them for
students, whether they emphasize preventive interventions or focus resources
on the more disruptive, demanding students.2,3 Thus,
the decrease in PTSD and depression might have been due to increased support
of the teachers and administrators, rather than to the CBT program itself.
The authors stated that they provided "frequent consultations with school
staff about implementation issues" and made "efforts to educate teachers and
administrators about how violence affects children" that "helped to make the
program acceptable and relevant to schools." This is an important point, as
such standardized curricula may be ineffective without the infrastructure
to modify the behavior of staff.4
Rappaport N. School-Based Interventions for Children Exposed to Violence. JAMA. 2003;290(19):2541. doi:10.1001/jama.290.19.2541-a