No abstract

No abstract

BACKGROUND Background: Childhood sexual abuse (CSA) is a key health area that needs new and innovative treatment options for both caregivers and children. Although there are few existing treatment options for the CSA survivors, there have been studies targeting inventions for children’s mental health issues as well as for caregiver-child dyads. For CSA survivors, there is some recent evidence for the effectiveness of multimodal treatment. However, no prior study has identified long term findings over the full year of programming in a multimodal program and there has been no analysis of the role of caregivers in treatment outcomes. OBJECTIVE Objective: The aim of this study was to evaluate the effectiveness of a complex multimodal treatment program for child sexual abuse (CSA) survivors. The secondary aim was to qualitatively evaluate the attitudes and opinions of caregivers. METHODS Methods: Children (CSA survivors) completed quantitative self-report surveys before and after each of the four treatment rounds in a comprehensive year long program (n=15). 86.7% identified as female and 13.3% identified as transgender (mean age 10.2 ± 1.6). Measures included validated self-report surveys related to anxiety, depression, PTSD, quality of life, and self-esteem. Changes in mean outcome scores were analyzed for statistical significance. Caregivers of CSA survivors participated in two innovative hybrid webinar focus groups with staff at a residential treatment facility (n=11). Sessions were recorded, transcribed, and thematically analyzed. RESULTS Results: For CSA survivors, statistically significant improvements were observed on PTSD, depression, anxiety, and quality of life. For caregivers of CSA survivors, 20 participants contributed to the data and three themes arose from our thematic analysis: (1) Challenges of starting and maintaining treatment, (2) Therapeutic benefits of specialized treatment, and (3) Barriers and facilitators of treatment. CONCLUSIONS Conclusions: The present mixed methods study supports effectiveness of a complex multimodal program designed for CSA survivors in terms of improving children’s mental health outcomes as well as supporting caregiver well-being. Future studies are warranted with a larger sample size to replicate these preliminary long-term findings. Several benefits and gaps in wellness support arose during our thematic analysis.

Background Specialized mental health services for the treatment of Child Sexual Abuse (CSA) are generally expensive and labour intensive. They require a trauma-informed approach that may involve multiple services and therapeutic modalities, provided over the course of several months. That said, given the broad-ranging, long term negative sequelae of CSA, an evaluation of the cost-benefit analysis of treatment is clearly justified. Methods We performed a Social Return on Investment (SROI) analysis of data gathered as part of the treatment program at the Be Brave Ranch in Edmonton, Canada to determine the value-for-money of the services provided. We endeavoured to take a conservative, medium-term (5 year) perspective; this is in contrast to short term (1–2 year) effects, which may rapidly dissipate, or long term (15–20 year) effects, which are likely diffuse and difficult to measure. As such, our analysis was based on an average annual intake of 100 children/adolescents (60:40 split) and their families, followed over a five-year timeframe. Financial proxies were assigned to benefits not easily monetized, and six potential domains of cost savings were identified. Results Our analyses suggest that each dollar spent in treatment results in an average cost savings of $11.60 (sensitivity analysis suggests range of 9.20–12.80). The largest value-for-money was identified as the domain of crisis prevention, via the avoidance of rare but costly events associated with the long term impacts of CSA. Somewhat surprisingly, savings related to the area of criminal justice were minimal, compared to other social domains analysed. Implications are discussed. Conclusions Our results support the cost effectiveness of the investment associated with specialized, evidence-based early interventions for CSA. These approaches alleviate severe, negative outcomes associated with CSA, resulting in both economic savings and social benefits. These findings rest upon a number of assumptions, and generalizability of these results is therefore limited to similar programs located in comparable areas. However, the SROI ratio achieved in this analysis, in excess of $11:1, supports the idea that, while costly, these services more than pay for themselves over time.