Objective: This study explored the feasibility of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) relative to TF-CBT with children (aged 8--12). Method: Children (N = 33) with post-traumatic stress symptoms (PTSS) were randomly assigned (2:1) to SC-TF-CBT or TF-CBT. SC-TF-CBT consisted of Step 1, parent-led therapist-assisted treatment, and Step 2 (nine TF-CBT sessions). TF-CBT consisted of 12 therapist-directed sessions. Baseline, post-Step 1, posttreatment, and 3-month follow-up assessments occurred. Cost-related data were collected throughout the treatment. Results: In all, 64% (intent-to-treat) to 82% (completers) responded to Step 1. Group × Time interactions were not statistically significant for PTSS (p = 0.888), severity (p = 0.576), and internalizing (p = 0.862)/externalizing (p = 0.974) symptoms, indicating comparable improvements in outcomes across both conditions. There were no significant differences in parental treatment credibility (p = 0.440), expectations (p = 0.664), and satisfaction (p = 0.768). SC-TF-CBT total costs were significantly lower than TF-CBT (Effect Size [ES] = 1.61, confidence interval [CI] = [0.65, 2.59], p < 0.0001). Conclusion: Step 1 may be a viable service delivery approach although further research is needed.