An integrative, ecologically informed, and exposure-based program for trauma-exposed adolescents, ages 13-18, who experience co-occurring trauma-related mental health problems (e.g., posttraumatic stress disorder, depression), substance use problems, and other risk behaviors (e.g., risky sexual behavior, non-suicidal self-injury).  The therapy is novel in its integration of these components, given that standard care for trauma-exposed youth often entails treatment of substance use problems separate from treatment of another trauma-related psychopathology. It is individualized to the needs, strengths, developmental factors, and cultural background of each adolescent and family. The pacing and ordering of the therapy components are flexible and determined by the needs of each family and symptom severity in each domain. Substance use (as relevant) and posttraumatic stress (PTS) symptoms are monitored throughout treatment to help track progress and guide clinical decision making. The average frequency and duration of the therapy depends on the symptom level of each youth, but typically involves 18-24 weekly, 60–90 minute sessions with periodic check-ins between scheduled appointments.