Which of the following is NOT a problem to be managed before starting TF-CBT?

The correct answer is that significant academic problems are not typically considered a problem that must be managed before starting Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). While academic difficulties can impact a child's overall well-being and functioning, they do not pose an immediate threat to safety or well-being in the same way that other issues on the list do.

TF-CBT focuses on addressing the trauma-related symptoms and their immediate effects on a child's mental health. Safety concerns, such as risk of self-harm or harm to others, must be prioritized and managed before therapy can begin. Severe behavioral issues and immediate safety risks also require urgent attention to ensure the child can engage in therapy in a safe environment.

Academic problems, while important and potentially addressed later within the therapeutic process, do not need to be resolved before starting TF-CBT—making this the correct choice in the context of the question.