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Researchers are evaluating a preventive intervention called Condensed Internet-delivered Prolonged Exposure (CIPE) for people who have symptoms of post-traumatic stress disorder (PTSD) about one month after experiencing a traumatic event. The study aims to test the effectiveness and cost-effectiveness of CIPE in Norwegian municipal psychosocial crisis services, comparing it to usual treatment. This research addresses the lack of evidence-based preventive options available for trauma victims in Norway and explores how CIPE may reduce PTSD symptoms, depression, insomnia, prolonged grief, and the need for specialized mental health care. CIPE is a therapist-supported program delivered online through four modules. It includes education about normal trauma reactions, exposure techniques to confront reminders of trauma both in real life and imagination, and a breathing exercise. Participants receive CIPE alongside treatment as usual (TAU), which varies but generally involves psychological first aid, psychoeducation, social support activation, and practical help. The study compares outcomes between those receiving CIPE plus TAU and those receiving only TAU. Participants are involved for at least 6 weeks after starting treatment, with follow-ups at 6 and 12 months post-trauma. Researchers assess symptoms using the PTSD Checklist for DSM-5 (PCL-5) and measure depression, insomnia, prolonged grief, treatment satisfaction, and referrals to specialized care. The study also evaluates quality of life and cost-effectiveness of adding CIPE to usual care. Participants must complete questionnaires and provide informed consent, with language requirements for English or Norwegian speakers aged 16 to 99 years.

Childhood trauma is a major public health challenge and affects a substantial number of children. Trauma impacts psychological and physical development, as well as long term mental and physical health and behaviour. These adverse outcomes can be prevented through appropriate treatment. Unfortunately, there is a substantial gap between the need for treatment and access to evidence-based care. Low-intensive treatments that utilize and strengthen family resources could contribute to bridging this gap and contribute to improving long-term public health and quality of life. The Stepped Care Cognitive Behavioral Therapy for Children after Trauma (SC-CBT-CT; Salloum et al. .2014) is a promising intervention for traumatized children that consists of two steps: 1) Stepping Together for Children after Trauma (Stepping Together CT, ST-CT), which is a parent-led, therapist-assisted treatment that takes advantage of and strengthens parent resources; and 2) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al. 2017) which is a therapist-led treatment provided when Stepping Together CT does not sufficiently help the child. Results from a recent randomized control trial (RCT) conducted in the United States, show that SC-CBT-CT is as effective as standard therapist-led TF-CBT in reducing post-traumatic symptoms, depression, sleep disturbance and parental distress, while simultaneously reducing treatment-related costs by 50% (Salloum et al. 2022). In Norway, a recent pilot study found that the first step, ST-CT, is well accepted by children, parents, and therapists, and is feasible as a first-line intervention in the municipal services (ClinicalTrials.gov Identifier: NCT04073862). The current study is an RCT with a hybrid effectiveness-implementation design where ST-CT will be implemented to municipal first-line service centers. Participants will be randomized to either the ST-CT or usual care (UC). We will recruit 160 child-parent dyads through 30 participating municipalities from 2023-2025. This will be the first RCT of ST-CT from an independent research group, with the potential for wider implementation which will greatly impact the resources and tools the municipalities have in facing challenges related to childhood trauma. Aims and data collection: 1\) Assess the effectiveness of the parent-led intervention in reducing symptoms on post-traumatic stress, depression, somatic pain and quality of life from both children and caregivers compared to UC. In addition, an objective assessment of quality of sleep will be recorded with a sensor that registers the child's sleep patterns; 2) Evaluate the cost-effectiveness and cost-utility of the ST-CT model; 3) Assess the potential preventive effect of the intervention through long-term follow-up data on use of health services from the Norwegian Patient Registry (NPR), the Norwegian Prescribed Drug Registry (NorPD), and Statistics Norway (SSB); and 4) Investigate barriers and facilitator for implementation, develop culturally adapted treatment material, and an implementation guideline. Assessments of the children and parents will be conducted by an independent assessor at five time points: T1 = baseline, T2 = after completion of the workbook (ST-CT)/9 weeks (UC); T3 = after the maintenance phase (ST-CT)/ 15 weeks (UC); T4 = 6 months after baseline; T5 = 12 months after baseline. A secondary aim is to investigate the change-processes within the ST-CT arm, including when during the treatment change in PTSS occurs and how change is related to parenting practices and the child's perceived relationship to their parent. Assessments related to change-processes will take place in the first 6-9 weeks of treatment, between T1 and T2, for participants in the ST-CT arm only. Specifically, we will collect a short post-traumatic stress symptom assessment (at each parent-child meeting at home, and the first four sessions with the therapist, altogether 15 times), and assess parenting practices and the child's perceived relationship to the parent (the first four sessions with the therapist).