Predictors of treatment initiation, completion, and selection among youth offered trauma-informed care.

Abstract

Objective: Few studies have investigated determinants of trauma-informed care (TIC) in vulnerable youth populations. The purpose of the present study was to investigate factors associated with initiation, completion, and selection of type of TIC treatment among a sample of 128 treatment-seeking youth who experienced crime or violence. Method: This retrospective medical record review study used data collected through routine clinical care at an outpatient, no-cost community mental health clinic. Results: We found that 69.5% of treatment-seeking youth (n ϭ 89) initiated treatment, defined as attending at least 1 TIC session. Among youth who initiated treatment, 61.8% (n ϭ 55) completed a TIC treatment. Predisposing and need characteristics were not significantly associated with initiating or completing treatment in adjusted models. Youth assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) were more likely to complete treatment compared with those assigned to child-centered therapy (CCT) approaches (odds ratio [OR] ϭ 4.48, 95% CI [1.35, 14.91], p ϭ .014). Logistic regression analyses suggested therapists were less likely to select TF-CBT for children with higher externalizing symptoms (OR ϭ 0.92, 95% CI [0.85, 0.99], p ϭ .035). Conclusions: Findings suggest among youth who called in for treatment, many successfully initiated treatment, and of those who initiated, most completed treatment. Empirically supported treatments such as TF-CBT may further promote treatment completion. Clinical Impact StatementVulnerable youth populations who have experienced trauma may benefit from emerging best practices in TIC. These practices may include attending to clinical issues, such as using a structured treatment protocol and multiple attempts to schedule appointments, that have the potential to improve engagement with mental health services. Since low-income populations often have difficulty initiating and engaging in mental health treatment, Masked Manuscript without Author Information INITIATION, COMPLETION AND TREATMENT SELECTION IN YOUTH 2 findings suggest TF-CBT may help address such challenges in this population. Training community-based clinicians in TF-CBT and other TIC is imperative to meet the needs of this vulnerable population.

Comparing trauma-focused cognitive-behavioral therapy to commonly used treatments in usual care for children with posttraumatic stress disorder.

“…Also, females were more likely to receive TF-CBT, although this finding may be due in part to the greater rates of sexual victimization reported in females. Children with a presenting problem of disruptive behaviors were less likely to receive TF-CBT, which is consistent with a finding from a community-based trauma recovery center serving low-income children (Ghafoori et al, 2019). It may be that clinicians use behavioral EBTs (e.g., parent management training) to address disruptive behaviors; however, TF-CBT includes a component on parenting skills to address behavior problems resulting from trauma exposure (Cohen et al, 2017).…”

“…In this study, non-Hispanic White children were most likely to receive TF-CBT and Hispanic children were less likely to receive TF-CBT. Prior research on race/ethnicity predictors of types of traumatic stress treatment received in community settings is mixed (Ghafoori et al, 2019; Urban et al, 2020). In a state-funded dissemination of trauma-focused EBTs for diverse foster care youth in Illinois, 57% of the sample of children who received TF-CBT were White and 0% were Hispanic, which was in contrast to the samples for the other trauma-focused EBTs disseminated in the same system of care (21%–25% White children and 12%–18% Hispanic children; Weiner et al, 2009).…”

“…Overall, it appears that some children receive evidence-based practices for traumatic stress but many receive treatments that are not evidence-based. Preliminary evidence suggests that levels of externalizing symptoms, race/ethnicity, and trauma type may contribute to the likelihood that a clinician uses a trauma-informed EBT with a particular child (Ghafoori et al, 2019; Urban et al, 2020). For example, Ghafoori et al (2019) found that children with externalizing problems and Black children were less likely to receive TF-CBT than child-centered therapy.…”

“…Preliminary evidence suggests that levels of externalizing symptoms, race/ethnicity, and trauma type may contribute to the likelihood that a clinician uses a trauma-informed EBT with a particular child (Ghafoori et al, 2019; Urban et al, 2020). For example, Ghafoori et al (2019) found that children with externalizing problems and Black children were less likely to receive TF-CBT than child-centered therapy. More research is needed to understand the use of TF-CBT in community mental health clinics across large systems of care.…”