In 2020, DC experienced 198 homicides, a growth of 19% from the prior year. These community traumas can impact mental health and wellbeing. Cognitive Behavioral Therapy (CBT) is a therapeutic approach that has positive effects in managing PTSD, anxiety, and depression. From 2020-2021, we collaborated with the DC Office of Neighborhood Safety and Engagement (ONSE) to pilot CBT for residents impacted by trauma. The pilot’s case study identifies who used services, and the barriers that kept some from thriving in therapy.
Why is this issue important in DC?
Violence can have devastating effects across communities, impacting residents’ health and well-being.1 Many of the DC residents served by ONSE have frequent or ongoing exposure to violence and personal, familial, or community trauma. This can profoundly affect mental health, in the form of PTSD, anxiety, and depression.
What did we do?
In late 2020 and early 2021, ONSE piloted one-on-one CBT sessions with residents dealing with trauma stemming from poverty, crime, and violence. Participants met virtually, twice a week for eight weeks with a dedicated therapist. The pilot was designed as a randomized controlled trial but due to undersubscription, ONSE and The Lab shifted our research to a case study.
What have we learned?
Pilot participants had significant challenges to their mental health and well-being. For example, 96% of participants reported at least one traumatic exposure in their life. These were things like witnessing someone being killed or seriously injured, fearing they themselves would die or be seriously injured, or having a disagreement involving a gun. These experiences point to a need for therapeutic services and the potential benefits of CBT to the community. But we also learned that there were significant barriers to getting the most out of therapy. For example, participants struggling to meet basic needs like housing or not having a private space for virtual therapy. These and other barriers are detailed in the case study.
What comes next?
Since the pilot, ONSE integrated best practices from Roca’s Rewire CBT: A Trauma-Informed Approach to Change. This is an adaptation of cognitive behavioral theory designed for high-risk young people impacted by trauma, violence, and justice system involvement. Unlike traditional clinical therapy, Rewire CBT is a simplified, non-clinical, skills-based model delivered in real-world settings—on the streets, in classrooms, or wherever participants are. Read more in the ONSE Pathways Program FY25 Annual Report.
What happened behind the scenes?
Recruitment of participants proved to be much harder than we anticipated. Relationships with ONSE priority communities were fragile and trust building took time. Explaining CBT to a resident, normalizing therapy with them, and securing their informed consent was time consuming and challenging. As a result, we fell short of our anticipated study population. Given the undersubscription, we did not believe it was ethical to withhold CBT services just for purposes of a randomized evaluation. So, we discontinued the evaluation and offered services to all who were eligible.