Many Trauma-affected Youth Face Long Waits for Therapy, Worsening Stress, and Avoidance. CISS, a 90-minute Session Based on Stanford's Cue-Centered Therapy, Offers Coping Tools and Psychoeducation During This Gap. This Pilot Tests CISS's Feasibility, Acceptability, and Impact on 30-40 Adolescents.

CISS: CCT-Informed Single Session Intervention

Many young people who have experienced traumatic events such as sexual assault, domestic violence, serious accidents, or natural disasters face long waits before they can begin full trauma-focused therapy. During this waiting period, symptoms such as avoidance, anxiety, and distress may worsen, and many youth lose motivation or confidence to start treatment. The Cue-Centered Therapy (CCT)-Informed Single Session Intervention (CISS) was designed to bridge this gap by offering a one-time, 90-minute session that teaches coping and self-understanding skills while youth are still on the waiting list.

This study is a pilot feasibility trial conducted in partnership between Stanford University and the University of Auckland. The purpose of the study is to evaluate whether CISS is a practical, acceptable, and safe intervention for young people aged 13-18 who have been exposed to trauma and are currently waiting for or hesitant to begin full-length therapy within New Zealand Hapai Ora Clinics.

Youth participants will meet once with a trained Hapai Ora clinician who will deliver the 90-minute CISS session. The session combines psychoeducation about trauma cues with skill-building strategies to improve coping, confidence, and readiness to engage in future treatment. Participants will complete short questionnaires before and after the session, and again at 3- and 6-month follow-ups. Measures will assess coping self-efficacy, treatment readiness, posttraumatic stress symptoms, and whether participants eventually begin full-length therapy.

The study will recruit approximately 30-40 adolescents across Hapai Ora clinical sites in Auckland, New Zealand. All clinicians providing the intervention are qualified mental-health professionals trained in both CISS and child-safety protocols. Participation involves minimal risk-similar to discussing difficult topics in a supportive therapy session.

Findings from this pilot study will help researchers understand whether CISS can be feasibly and safely delivered within public mental-health services, and whether it shows promise in helping young people build coping skills, reduce avoidance, and increase readiness to start therapy. The results will guide future larger-scale trials and inform the development of single-session, early-intervention approaches for trauma-exposed youth worldwide.

Trauma-exposed youth often face months-long waits before beginning comprehensive trauma-focused therapy, leaving them without structured support during a critical period of need. During these waiting periods, symptoms such as avoidance, anxiety, and hyperarousal may worsen, and many young people lose motivation or confidence to begin care. Brief, single-session interventions (SSIs) have emerged as a promising approach to strengthen coping and treatment engagement among youth unable or unwilling to access longer-term therapy.

The Cue-Centered Therapy (CCT)-Informed Single Session Intervention (CISS) is a 90-minute, structured, one-on-one session derived from the evidence-based Cue-Centered Therapy model developed at Stanford University's Early Life Stress and Resilience Program. CISS distills key CCT components-psychoeducation about trauma cues, development of insight into avoidance patterns, and flexible coping skill practice-into a single, accessible format designed to serve as a "bridge-to-care" for youth awaiting therapy.

This pilot feasibility trial will evaluate whether CISS can be feasibly and safely delivered to adolescents (ages 13-18) who have been exposed to trauma and are currently on Hapai Ora waitlists in New Zealand. The study is a collaboration between Stanford University and the University of Auckland.

Primary objectives:

• Assess the feasibility and acceptability of CISS delivery within routine Hapai Ora workflows.
• Examine pre- to post-intervention changes in coping self-efficacy, treatment readiness, and posttraumatic stress symptoms (PTSD symptoms).
• Explore treatment uptake and engagement in full-length trauma therapy following participation.

Approximately 30-40 adolescents will be recruited through collaborating Hapai Ora sites. After informed consent or assent, participants will complete baseline questionnaires, attend a single 90-minute CISS session with a trained clinician, and complete post-session, 3-month, and 6-month follow-up assessments. All measures are brief, self-reported, and non-invasive. Core instruments include:

• Children's Revised Impact of Event Scale (CRIES-8): measuring posttraumatic stress symptom severity (primary PTSD outcome)

• Motivation for Youth Treatment Scale - Readiness Subscale (MYTS-R): measuring treatment readiness

  -.Credibility and Expectancy Questionnaire - Youth, Trauma-Focused (CEQ-Y-TF): measuring perceived credibility and expectancy of benefit

• General Help-Seeking Questionnaire (GHSQ): measuring coping self-efficacy and help-seeking intentions

The study uses a single-group, pre-post feasibility design. Sessions are delivered by licensed Hapai Oraclinicians (e.g., psychologists, psychiatrists, nurses, or social workers) trained in CISS through Stanford- and Auckland-led workshops. Fidelity is monitored through checklists and optional video review for supervision. Data will be stored securely on Stanford Medicine's Qualtrics and Box servers, with all identifiable information removed prior to analysis.

Risks are minimal and limited to temporary emotional discomfort when discussing past trauma. All clinicians follow standard crisis-management and child-safety procedures, and participants have access to ongoing clinical support through Hapai Ora. No invasive procedures or medications are involved.

The anticipated study duration is from December 2025 to November 2028. Primary data collection (including 6-month follow-ups) is expected to conclude by May 2028. Findings will inform the design of a larger randomized controlled trial and contribute to international efforts to improve early trauma intervention accessibility within youth mental-health systems.

Inclusion Criteria:

• Age: 13 to 18 years old (adolescents).

Trauma Exposure: History of chronic or single-event trauma (e.g., interpersonal violence, serious accidents, natural disaster) as documented in Child and Adolescent Mental Health Services (CAMHS) intake records.

Service Status: Currently on a CAMHS waitlist for trauma-focused therapy, or self-referred but hesitant to begin multi-session treatment.

Capacity and Consent: Ability to provide informed assent (ages 13-15 with parental permission) or informed consent (ages 16-18).

Exclusion Criteria:

Current Trauma Treatment: Actively engaged in any form of trauma-focused psychotherapy (e.g., TF-CBT, EMDR, CCT) at the time of enrollment.

Severe Cognitive Impairment: Intellectual disability or cognitive impairment (e.g., IQ < 70) that precludes comprehension of psychoeducational material or completion of self-report questionnaires.

Acute Suicidality: Endorsement of imminent self-harm or suicide risk (e.g., PHQ-9 item 9 ≥ 2) during screening that necessitates immediate crisis management rather than study participation.