Lay Counselor Delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): A Systematic Review

Lay counselor delivery of trauma-focused cognitive behavioral therapy (TF-CBT) may be a promising strategy to increase access to trauma-focused care and prevent trauma-related health disparities among youth in low-resource settings in the United States. This pre-registered systematic review sought to synthesize how TF-CBT has been tailored for lay counselor delivery globally, which can inform broader dissemination. Specifically, we examined (1) the modification process, (2) treatment modifications, and (3) implementation strategies (e.g., training and supervision) to support lay counselor delivery of TF-CBT. In May 2024, a literature search was conducted across PsycINFO, PubMed, MEDLINE, and PILOTS. Grey literature was identified through Google Scholar and ProQuest. A narrative synthesis summarized findings by research question. Ten trials (21 articles) met inclusion criteria and described modifications or implementation strategies for lay counselor-delivered TF-CBT. All trials implemented culturally tailored versions of TF-CBT, with most (90%) conducted in low- and middle-income countries. The modification process relied on input from local experts through community-researcher collaborations. TF-CBT modifications were contextual (e.g., modality) or surface-level (e.g., language), with no trials reporting modifications to core components. Implementation strategies included enhancing training and supervision, addressing implementation barriers, and preserving counselor wellbeing. Findings suggest that TF-CBT can be successfully delivered by lay counselors with peripheral modifications, enhanced counselor supports, and strong community partnerships. This review provides a foundation for future research aimed at disseminating lay counselor-delivered TF-CBT in low-resource settings – a critical direction to close the mental health treatment gap and promote health equity in the United States and globally.