Capacitación de la fuerza laboral puertorriqueña de salud mental en un tratamiento basado en evidencia para trauma: Resultados de la implementación de la terapia cognitiva-conductual enfocada en trauma (TF-CBT) en colaboración con ASSMCA
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Publicado
2025-12-30
Rosaura Orengo Aguayo
Inés Cano-González
Miriam K. Avilés López
Regan W. Stewart
https://orcid.org/0000-0002-1195-1085
Resumen
El objetivo de este proyecto fue capacitar a profesionales proveedores de salud mental en la Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA) en la terapia cognitiva conductual enfocada en trauma (TF-CBT) y realizar una evaluación de programa. Dieciséis profesionales de la salud mental recibieron capacitación en TF-CBT utilizando un modelo de aprendizaje colaborativo. Las personas terapeutas implementaron TF-CBT con 59 jóvenes, de 4 a 17 años, y sus personas cuidadoras. Todas las personas proveedoras (N = 16; 100%) completaron los requisitos de la certificación. Quince (93%) obtuvieron una certificación nacional. Cuarenta y nueve de 59 jóvenes (83.1%) completaron todos los componentes de TF-CBT. Los resultados indican reducciones de gran magnitud en síntomas de estrés postraumático (d = 1.70, joven; d = 1.10, persona cuidadora), síntomas depresivos (d = 1.14, joven) y efectos medios para síntomas de ansiedad (d = 0.78, joven; d = 0.76, persona cuidadora). Fue posible capacitar a las personas proveedoras en TF-CBT, pero requirió capacitación, apoyo y tiempo adicional. TF-CBT fue eficaz en el tratamiento de TEPT en la juventud puertorriqueña, pero la flexibilidad en la implementación fue fundamental (p. ej., uso de telesalud y sesiones en las escuelas y el hogar fueron esenciales para abordar barreras de acceso).
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Keywords
trauma, TEPT, TF-CBT, población hispana, Puerto Rico
References
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https://doi.org/10.1037/tra0000444
Bunger, A. C., Hanson, R. F., Doogan, N. J., Powell, B. J., Cao, Y., & Dunn, J. (2016). Can learning collaboratives support implementation by rewiring professional networks? Administration and Policy in Mental Health and Mental Health Services Research, 43, 79–92. https://doi.org/10.1007/s10488-014-0621-x
Carliner, H., Keyes, K. M., McLaughlin, K. A., Meyers, J. L., Dunn, E. C., & Martins, S. S. (2016). Childhood trauma and illicit drug use in adolescence: A population-based national comorbidity survey replication–adolescent supplement study. Journal of the American Academy of Child & Adolescent Psychiatry, 55(8), 701-708. https://doi.org/10.1016/j.jaac.2016.05.010
Carlson, J. S., Yohannan, J., Darr, C. L., Turley, M. R., Larez, N. A., & Perfect, M. M. (2019). Prevalence of adverse childhood experiences in school-aged youth: A systematic review (1990–2015). International Journal of School & Educational Psychology, 8(1), 2–23. https://doi.org/10.1080/21683603.2018.1548397
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). The Guilford Press.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2024). The trauma-focused cognitive behavioral therapy (TF-CBT): At-A-Glance [Fact sheet]. National Center for Child Traumatic Stress.
https://www.nctsn.org/sites/default/files/interventions/trauma-focused-cognitive-behavioral-therapy-2024.pdf
Deblinger, E., Pollio, E., Cooper, B., & Steer, R. A. (2020). Disseminating trauma-focused cognitive behavioral therapy with a systematic self-care approach to addressing secondary traumatic stress: PRACTICE What You Preach. Community Mental Health Journal, 56, 1531–1543. https://doi.org/10.1007/s10597-020-00602-x
Departamento de Salud (2023). Boletín estadístico de violencia sexual, año 2023.
https://observatoriopvg.salud.pr.gov/Principal/Download/14186#:~:text=Seg%C3%BAn%20datos%20reportados%20por%20el,4.0%25)%20(Gr%C3%A1fica%2010).&text=Fuente%3A%20Departamento%20de%20la%20Familia%2C%202024.
Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., Higa-McMillan, C., & Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-short version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24(4), 833–845. https://doi.org/10.1037/a0027283
Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Yeh, R. (2018). Psychometrics of the child PTSD symptom scale for DSM-5 for trauma-exposed children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 38–46. https://doi.org/10.1080/15374416.2017.1350962
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. (2001). The child PTSD symptom scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376–384.
https://doi.org/10.1207/S15374424JCCP3003_9
Government Accountability Office (2024). Puerto Rico disasters: Progress made, but the recovery continues to face challenges. https://www.gao.gov/assets/gao-24-105557.pdf
Hanson, R. F., Saunders, B. E., Ralston, E., Moreland, A. D., Peer, S. O., & Fitzgerald, M. M. (2019). Statewide implementation of child trauma-focused practices using the community-based learning collaborative model. Psychological Services, 16(1), 170–181. https://doi.org/10.1037/ser0000319
Hasson, R. G. III, Easton, S. D., Díaz-Vald´es Iriarte, A., O’Dwyer, L. M., Underwood, D., & Crea, T. M. (2021). Examining the psychometric properties of the child PTSD symptom scale within a sample of unaccompanied immigrant children in the United States. Journal of Loss and Trauma, 26(4), 323–335.
https://doi.org/10.1080/15325024.2020.1777760
Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global prevalence of past-year violence against children: A systematic review and minimum estimates. Pediatrics, 137(3), e20154079.
https://doi.org/10.1542/peds.2015-4079
Instituto del Desarrollo de la Juventud (2019, January 31). A future of child poverty in Puerto Rico: how much it costs us and what we can do about it. https://www.juventudpr.org/publicaciones/un-futuro-de-pobreza-infantil-en-puerto-rico-cuanto-nos-cuesta-y-que-podemos-hacer
Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 311–318. https://doi.org/10.1097/00004583-200303000-00011
Lai, B. S., Lewis, R., Livings, M. S., La Greca, A. M., & Esnard, A-M. (2017). Posttraumatic stress symptom trajectories among children after disaster exposure: A review. Journal of Traumatic Stress, 30(6), 571–582.
https://doi.org/10.1002/jts.22242
O’Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited war affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359–369.
https://doi.org/10.1016/j.jaac.2013.01.013
Orengo-Aguayo, R., Dueweke, A. R., Nicasio, A., de Arellano, M. A., Rivera, S., Cohen, J. A., Mannarino, A. P., & 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, 105671.
https://doi.org/10.1016/j.chiabu.2022.105671
Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after hurricane Maria. JAMA Network Open, 2(4), e192619.
https://doi.org/10.1001/jamanetworkopen.2019.2619
Park, A. L., Ebesutani, C. K., Bose, D., & Chorpita, B. F. (2016). Psychometric properties of a Spanish translation of the Revised Child Anxiety and Depression Scale-parent version. Journal of Psychopathology and Behavioral Assessment, 38, 307–319.
https://doi.org/10.1007/s10862-015-9517-7
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), Article 21.
https://doi.org/10.1186/s13012-015-0209-1
Rubin, A., Washburn, M., & Schieszler, C. (2017). Within-group effect size benchmarks for trauma-focused cognitive behavioral therapy with children and adolescents. Research on Social Work Practice, 27(7), 789–801. https://doi.org/10.1177/1049731515620016
Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N., Risch, E., Rosner, E., & Goldbeck, L. (2017). International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). Journal of Affective Disorders, 210, 189-195.
https://doi.org/10.1016/j.jad.2016.12.040
Sandin, B., Chorot, P., Valiente, R. M., & Chorpita, B. F. (2010). Development of a 30-item version of the Revised Child Anxiety and Depression Scale. Revista de Psicopatología y Psicología Clínica, 15(3), 165–178.
https://doi.org/10.5944/rppc.vol.15.num.3.2010.4095
Schincariol, A., Orrù, G., Otgaar, H., Sartori, G., & Scarpazza, C. (2024). Posttraumatic stress disorder (PTSD) prevalence: An umbrella review. Psychological Medicine, 54(15), 4021–4034. https://doi.org/10.1017/S0033291724002319
Serrano-Ibáñez, E. R., Ruiz-Parraga, G. T., Esteve, R., Ramírez-Maestre, C., & López-Martínez, A. E. (2018). Validation of the child PTSD symptom scale (CPSS) in Spanish adolescents. Psicothema, 30(1), 130–135.
https://doi.org/10.7334/psicothema2017.144
Shea, C. M. (2021). A conceptual model to guide research on the activities and effects of innovation champions. Implementation Research & Practice, 2, 1-13. https://doi.org/10.1177/2633489521990443
Sigel, B. A., Kramer, T. L., Conners-Burrow, N. A., Church, J. K., Worley, K. B., & Mitrani, N. A. (2013). Statewide dissemination of trauma-focused cognitive-behavioral therapy (TF-CBT). Children and Youth Services Review, 35(6), 1023–1029.
https://doi.org/10.1016/j.childyouth.2013.03.012
Stewart, R. W., Orengo-Aguayo, R. E., Gilmore, A. K., & de Arellano, M. (2017). Addressing barriers to care among Hispanic youth: Telehealth delivery of trauma-focused cognitive behavioral therapy. The Behavior Therapist, 40(3), 112.
Stewart, R. W., Orengo-Aguayo, R., Young, J., Wallace, M. M., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2020). Feasibility and effectiveness of a telehealth service delivery model for treating childhood posttraumatic stress: A community-based, open pilot trial of trauma-focused cognitive–behavioral therapy. Journal of Psychotherapy Integration, 30(2), 274-289.
https://doi.org/10.1037/int0000225
Stewart, R. W., Orengo-Aguayo, R., Villalobos, B. T., Nicasio, A. V., Dueweke, A., Alto, M., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2021). Implementation of an evidence-based psychotherapy for trauma-exposed children in a lower-middle income country: The use of trauma-focused cognitive behavioral therapy in El Salvador. Journal of Child & Adolescent Trauma, 14, 433-441. https://doi.org/10.1007/s40653-020-00327-9
Tamir, T. T., Tekeba, B., Mekonen, E. G., Deresse, A. G., & Alabachew, F. Z. (2025). Shadows of trauma: An umbrella review of the prevalence and risk factors of post-traumatic stress disorder in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 19, 48.
https://doi.org/10.1186/s13034-025-00879-4
Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child abuse & neglect, 134, 105899. https://doi.org/10.1016/j.chiabu.2022.105899
Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., Lynde, D., & Drake, R. E. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. https://doi.org/10.1176/ps.2008.59.7.732
Young, J., Ramachandran, S., Stewart, R. W., Orengo-Aguayo, R., & Chorpita, B. F. (2020). Psychometric properties of the Spanish Revised Child Anxiety and Depression Scale short version in El Salvador. Journal of Psychopathology and Behavioral Assessment, 38(2), 307–319.
https://doi.org/10.1007/s10862-020-09843-2
https://doi.org/10.1037/tra0000444
Bunger, A. C., Hanson, R. F., Doogan, N. J., Powell, B. J., Cao, Y., & Dunn, J. (2016). Can learning collaboratives support implementation by rewiring professional networks? Administration and Policy in Mental Health and Mental Health Services Research, 43, 79–92. https://doi.org/10.1007/s10488-014-0621-x
Carliner, H., Keyes, K. M., McLaughlin, K. A., Meyers, J. L., Dunn, E. C., & Martins, S. S. (2016). Childhood trauma and illicit drug use in adolescence: A population-based national comorbidity survey replication–adolescent supplement study. Journal of the American Academy of Child & Adolescent Psychiatry, 55(8), 701-708. https://doi.org/10.1016/j.jaac.2016.05.010
Carlson, J. S., Yohannan, J., Darr, C. L., Turley, M. R., Larez, N. A., & Perfect, M. M. (2019). Prevalence of adverse childhood experiences in school-aged youth: A systematic review (1990–2015). International Journal of School & Educational Psychology, 8(1), 2–23. https://doi.org/10.1080/21683603.2018.1548397
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). The Guilford Press.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2024). The trauma-focused cognitive behavioral therapy (TF-CBT): At-A-Glance [Fact sheet]. National Center for Child Traumatic Stress.
https://www.nctsn.org/sites/default/files/interventions/trauma-focused-cognitive-behavioral-therapy-2024.pdf
Deblinger, E., Pollio, E., Cooper, B., & Steer, R. A. (2020). Disseminating trauma-focused cognitive behavioral therapy with a systematic self-care approach to addressing secondary traumatic stress: PRACTICE What You Preach. Community Mental Health Journal, 56, 1531–1543. https://doi.org/10.1007/s10597-020-00602-x
Departamento de Salud (2023). Boletín estadístico de violencia sexual, año 2023.
https://observatoriopvg.salud.pr.gov/Principal/Download/14186#:~:text=Seg%C3%BAn%20datos%20reportados%20por%20el,4.0%25)%20(Gr%C3%A1fica%2010).&text=Fuente%3A%20Departamento%20de%20la%20Familia%2C%202024.
Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., Higa-McMillan, C., & Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-short version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24(4), 833–845. https://doi.org/10.1037/a0027283
Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Yeh, R. (2018). Psychometrics of the child PTSD symptom scale for DSM-5 for trauma-exposed children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 38–46. https://doi.org/10.1080/15374416.2017.1350962
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. (2001). The child PTSD symptom scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376–384.
https://doi.org/10.1207/S15374424JCCP3003_9
Government Accountability Office (2024). Puerto Rico disasters: Progress made, but the recovery continues to face challenges. https://www.gao.gov/assets/gao-24-105557.pdf
Hanson, R. F., Saunders, B. E., Ralston, E., Moreland, A. D., Peer, S. O., & Fitzgerald, M. M. (2019). Statewide implementation of child trauma-focused practices using the community-based learning collaborative model. Psychological Services, 16(1), 170–181. https://doi.org/10.1037/ser0000319
Hasson, R. G. III, Easton, S. D., Díaz-Vald´es Iriarte, A., O’Dwyer, L. M., Underwood, D., & Crea, T. M. (2021). Examining the psychometric properties of the child PTSD symptom scale within a sample of unaccompanied immigrant children in the United States. Journal of Loss and Trauma, 26(4), 323–335.
https://doi.org/10.1080/15325024.2020.1777760
Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global prevalence of past-year violence against children: A systematic review and minimum estimates. Pediatrics, 137(3), e20154079.
https://doi.org/10.1542/peds.2015-4079
Instituto del Desarrollo de la Juventud (2019, January 31). A future of child poverty in Puerto Rico: how much it costs us and what we can do about it. https://www.juventudpr.org/publicaciones/un-futuro-de-pobreza-infantil-en-puerto-rico-cuanto-nos-cuesta-y-que-podemos-hacer
Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 311–318. https://doi.org/10.1097/00004583-200303000-00011
Lai, B. S., Lewis, R., Livings, M. S., La Greca, A. M., & Esnard, A-M. (2017). Posttraumatic stress symptom trajectories among children after disaster exposure: A review. Journal of Traumatic Stress, 30(6), 571–582.
https://doi.org/10.1002/jts.22242
O’Callaghan, P., McMullen, J., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited war affected Congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359–369.
https://doi.org/10.1016/j.jaac.2013.01.013
Orengo-Aguayo, R., Dueweke, A. R., Nicasio, A., de Arellano, M. A., Rivera, S., Cohen, J. A., Mannarino, A. P., & 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, 105671.
https://doi.org/10.1016/j.chiabu.2022.105671
Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after hurricane Maria. JAMA Network Open, 2(4), e192619.
https://doi.org/10.1001/jamanetworkopen.2019.2619
Park, A. L., Ebesutani, C. K., Bose, D., & Chorpita, B. F. (2016). Psychometric properties of a Spanish translation of the Revised Child Anxiety and Depression Scale-parent version. Journal of Psychopathology and Behavioral Assessment, 38, 307–319.
https://doi.org/10.1007/s10862-015-9517-7
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), Article 21.
https://doi.org/10.1186/s13012-015-0209-1
Rubin, A., Washburn, M., & Schieszler, C. (2017). Within-group effect size benchmarks for trauma-focused cognitive behavioral therapy with children and adolescents. Research on Social Work Practice, 27(7), 789–801. https://doi.org/10.1177/1049731515620016
Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N., Risch, E., Rosner, E., & Goldbeck, L. (2017). International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). Journal of Affective Disorders, 210, 189-195.
https://doi.org/10.1016/j.jad.2016.12.040
Sandin, B., Chorot, P., Valiente, R. M., & Chorpita, B. F. (2010). Development of a 30-item version of the Revised Child Anxiety and Depression Scale. Revista de Psicopatología y Psicología Clínica, 15(3), 165–178.
https://doi.org/10.5944/rppc.vol.15.num.3.2010.4095
Schincariol, A., Orrù, G., Otgaar, H., Sartori, G., & Scarpazza, C. (2024). Posttraumatic stress disorder (PTSD) prevalence: An umbrella review. Psychological Medicine, 54(15), 4021–4034. https://doi.org/10.1017/S0033291724002319
Serrano-Ibáñez, E. R., Ruiz-Parraga, G. T., Esteve, R., Ramírez-Maestre, C., & López-Martínez, A. E. (2018). Validation of the child PTSD symptom scale (CPSS) in Spanish adolescents. Psicothema, 30(1), 130–135.
https://doi.org/10.7334/psicothema2017.144
Shea, C. M. (2021). A conceptual model to guide research on the activities and effects of innovation champions. Implementation Research & Practice, 2, 1-13. https://doi.org/10.1177/2633489521990443
Sigel, B. A., Kramer, T. L., Conners-Burrow, N. A., Church, J. K., Worley, K. B., & Mitrani, N. A. (2013). Statewide dissemination of trauma-focused cognitive-behavioral therapy (TF-CBT). Children and Youth Services Review, 35(6), 1023–1029.
https://doi.org/10.1016/j.childyouth.2013.03.012
Stewart, R. W., Orengo-Aguayo, R. E., Gilmore, A. K., & de Arellano, M. (2017). Addressing barriers to care among Hispanic youth: Telehealth delivery of trauma-focused cognitive behavioral therapy. The Behavior Therapist, 40(3), 112.
Stewart, R. W., Orengo-Aguayo, R., Young, J., Wallace, M. M., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2020). Feasibility and effectiveness of a telehealth service delivery model for treating childhood posttraumatic stress: A community-based, open pilot trial of trauma-focused cognitive–behavioral therapy. Journal of Psychotherapy Integration, 30(2), 274-289.
https://doi.org/10.1037/int0000225
Stewart, R. W., Orengo-Aguayo, R., Villalobos, B. T., Nicasio, A. V., Dueweke, A., Alto, M., Cohen, J. A., Mannarino, A. P., & de Arellano, M. A. (2021). Implementation of an evidence-based psychotherapy for trauma-exposed children in a lower-middle income country: The use of trauma-focused cognitive behavioral therapy in El Salvador. Journal of Child & Adolescent Trauma, 14, 433-441. https://doi.org/10.1007/s40653-020-00327-9
Tamir, T. T., Tekeba, B., Mekonen, E. G., Deresse, A. G., & Alabachew, F. Z. (2025). Shadows of trauma: An umbrella review of the prevalence and risk factors of post-traumatic stress disorder in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 19, 48.
https://doi.org/10.1186/s13034-025-00879-4
Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child abuse & neglect, 134, 105899. https://doi.org/10.1016/j.chiabu.2022.105899
Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., Lynde, D., & Drake, R. E. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. https://doi.org/10.1176/ps.2008.59.7.732
Young, J., Ramachandran, S., Stewart, R. W., Orengo-Aguayo, R., & Chorpita, B. F. (2020). Psychometric properties of the Spanish Revised Child Anxiety and Depression Scale short version in El Salvador. Journal of Psychopathology and Behavioral Assessment, 38(2), 307–319.
https://doi.org/10.1007/s10862-020-09843-2
Cómo citar
Capacitación de la fuerza laboral puertorriqueña de salud mental en un tratamiento basado en evidencia para trauma: Resultados de la implementación de la terapia cognitiva-conductual enfocada en trauma (TF-CBT) en colaboración con ASSMCA. (2025). Revista Puertorriqueña De Psicologia, 36(2), 270-284. https://doi.org/10.55611/reps.3602.10
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Cómo citar
Capacitación de la fuerza laboral puertorriqueña de salud mental en un tratamiento basado en evidencia para trauma: Resultados de la implementación de la terapia cognitiva-conductual enfocada en trauma (TF-CBT) en colaboración con ASSMCA. (2025). Revista Puertorriqueña De Psicologia, 36(2), 270-284. https://doi.org/10.55611/reps.3602.10