Telehealth-Delivered Written Exposure Therapy by Paraprofessional Coaches for Teenagers with Post-Traumatic Stress Disorder: A Feasibility Trial

Abstract

Adolescents with post-traumatic stress disorder (PTSD) face major barriers to evidence-based care. Written Exposure Therapy (WET), a brief exposure-based treatment effective in adults, has not been evaluated in teens, via telehealth, or when delivered by paraprofessionals. This controlled case series tested the feasibility and preliminary outcomes of telehealth WET for adolescents with PTSD. Six participants (ages 13–19) were randomized to immediate WET (n=4) or a waitlist control (n=2). WET was delivered in five weekly sessions by trained paraprofessional coaches via secure videoconference. Feasibility outcomes included recruitment, retention, adherence, and fidelity; clinical outcomes included PTSD, depression, anxiety, and functioning. Retention was 83%, with no treatment dropouts. Coaches demonstrated high protocol fidelity, and all WET participants with post-treatment data improved in at least one domain, while waitlist participants remained stable or worsened. Results support the feasibility and acceptability of paraprofessional-delivered telehealth WET, justifying larger trials to test clinical effectiveness and implementation.