Frequency and impact of childhood sexual and physical abuse on people using IAPT services

Abstract

Objectives This study explored the prevalence of childhood sexual/physical abuse (CSA/CPA) as identified by practitioners in Improving Access to Psychological Therapies (IAPT) services and clarified differences in clients’ characteristics with and without a history of CSA/CPA. Methods A retrospective analysis of a large dataset comprised of IAPT routine data and data from a local service evaluation reporting on clients’ presenting problems. Results 14% of IAPT clients (n = 1,315) were identified with a record of CSA/CPA. CSA/CPA history was associated with longer duration and earlier age of onset of condition(s), greater number of presenting problems and post‐traumatic stress disorder co‐occurrence, higher intensity treatment delivery, and lower recovery rates. Conclusions CSA/CPA history appears as an important feature in a sizable minority of IAPT clients; further work is required to meet clients’ trauma‐related needs. Practitioner points A sizable minority of IAPT clients (14%) present with a history of CSA/CPA as recorded in clinical notes. CSA/CPA history is associated with more complex and enduring presentations in IAPT clients. The reported CSA/CPA frequency is likely to be underestimates of the actual prevalence and impact of adverse childhood experiences in IAPT clients. Trauma‐informed inquiry and trauma‐specific screening tools would help practitioners to meet clients’ trauma‐related needs.

Evaluating referral pathways to a specialist trauma service

“…A stepped care approach may effectively extend the reach of trauma-focused interventions to non-specialist settings, improve access to early interventions (Zatzick et al , 2011) and increase the number of mental health services they receive (Belsher et al , 2016); however, such an approach may present specific challenges for traumatised clients.. For example, an IAPT service evaluation showed that those clients who reported childhood sexual and/or physical abuse were more likely to experience greater complexity and PTSD co-occurrence, higher intensity of treatment received and poorer clinical outcomes compared to those without such history (Verbist et al , 2021). Complex clients who do not benefit from lower intensity interventions may find themselves receiving “revolving door” care, with repeated referrals, assessments and treatments (Cotton, 2019).…”

Predicting treatment outcomes in improving access to psychological therapy (IAPT) services

“…Conversely, clinical improvement has been associated with higher number of treatment sessions (Clark et al, 2018;Green et al, 2015;Vaillancourt et al, 2015), seniority of therapists, self-referral and greater step-up rate (Gyani et al, 2013). Although comorbidity with personality disorders (Goddard et al, 2015), psychological trauma (Thomlinson et al, 2017) and childhood abuse (Verbist et al, 2021), have been linked with poorer treatment outcomes, minimal evidence exists showing the impact of multiple comorbidity (i.e. total number of presenting problems) on recovery (Hepgul et al, 2016).…”