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November 19, 2003

School-Based Interventions for Children Exposed to Violence

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(19):2541. doi:10.1001/jama.290.19.2541-a

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