Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

David Schuldberg

Commitee Members

Cameo Borntrager, Gyda Swaney, James Caringi, Rick van den Pol


CBITS, CBT, Mixed Methods research, Native American, PTSD, Treatment outcomes


University of Montana


Very few studies have addressed treatment outcomes for Native American youth, and none have qualitatively explored factors that may differentiate children in this population who benefit from intervention and children whose symptoms appear to remain unchanged or worsen. One area of particular interest is the treatment of PTSD, as epidemiological studies demonstrate a markedly elevated lifetime risk for trauma exposure and the development of PTSD in Native Americans. Interventions that utilize exposure and response prevention as a primary component have the best empirical evidence for alleviating symptoms of PTSD. One such intervention is Cognitive Behavioral Intervention for Trauma in Schools (CBITS). This mixed methods study explored treatment outcomes for participants from two rural Reservation schools including examining possible influences from children's experiences that differentiate outcome groups and facets of implementation that relate to CBITS in general and delivered to Native American children specifically. While the overall sample experienced significant reductions in symptoms from pre-group to post-group, there were several children who did not benefit or who experienced worsening symptoms of depression and/or traumatic stress. In all there were 9 distinct outcome groups. By using a mixed methods explanatory sequential design it was possible to gather qualitative data regarding a purposive sample to facilitate an exploration of factors that differ by outcome category. Through its design this study expanded the quantitative results from participating children by interviewing teachers and counselors who served as CBITS facilitators and qualitatively identifying and exploring factors that appeared to help or hinder child participants in benefiting from treatment. These factors fell into three main domains, each of which included several unique items that clustered into identifiable themes. There were some notable differences between groups. Some of these results supported current literature, including highlighting salient risk and protective factors in children's lives that varied by outcome group. In addition there were several institutional factors identified that supported the success of a CBITS program within the school.



© Copyright 2013 Kathrine Irene Butler Hepler