Cognitive Behavioral Therapy–Plus for Youth in Out-of-Home Care: A Quasi-Experimental Evaluation

Abstract

Cognitive Behavioral Therapy–Plus (CBT+) has emerged as a promising intervention to address the myriad emotional and behavioral health needs of youth in the child welfare system. Existing CBT+ research has shown reductions in target clinical symptoms, but child welfare placement outcomes have not yet been assessed. The current study tested the effects of CBT+ on placement stability and psychiatric inpatient treatment use among youth in out-of-home care at one countywide CBT+ site. This study used a quasi-experimental design that compared three inverse probability-weighted groups: (1) 40 youth who received CBT+, (2) 38 youth referred for CBT+ but not served, and (3) 90 youth screened in as clinically eligible for CBT+ but not referred because they were receiving other services. Difference-in-differences estimates found that CBT+ significantly improved placement stability. Further, youth served by CBT+ had a greater reduction in psychiatric inpatient treatment use than those referred but not served, although this difference did not reach statistical significance. Findings from this study provide preliminary evidence for CBT+ effects on placement outcomes for youth in out-of-home care, contributing to the growing evidence for CBT+ as a promising intervention for child welfare–involved youth. Methodological limitations and considerations for further investigation are discussed.