Evaluation of Trauma Characteristics as Predictors of Attrition from Cognitive-Behavioral Therapy for Child Victims of Violence

Abstract

Little research has investigated psychotherapy attrition among child victims of violence, and no studies have evaluated the role of trauma characteristics (e.g., level of threat or injury, trauma frequency, perpetrator relationship, victim type, and trauma type). The current study evaluated premature psychotherapy termination with 134 child victims (ages 5-19 years) who were referred for exposure-based cognitive-behavioral therapy. Results indicated that premature treatment termination was associated with children who experienced (a) a single incident of trauma (compared to multiple), (b) neither life threat nor physical injury during the victimization, (c) and an incident that was perpetrated by an older child compared to a parental figure. Certain trauma characteristics may be important factors for identifying children at risk for terminating treatment prematurely.

Risk Factors for Attrition From Pediatric Trauma-Focused Treatment

“…Number of traumatic events was also unrelated to both attrition definitions, in contrast to prior work that reported that a greater number of traumas predicted risk for clinician-rated treatment dropout, but not adequate dose status (Author citation; Author citation). However, one study observed that fewer traumatic events corresponded with attrition (Chasson et al, 2013). It is possible that there are subgroups of trauma-exposed families.…”

“…Aspects of the traumatic event have also been investigated as potential risk factors for attrition. A few studies have observed that experiencing a greater number of traumas was related to increased risk for clinician-rated treatment attrition (Author citation; Author citation; Jensen et al, 2014); however, one study found that exposure to fewer traumas was tied to dropout (Chasson, Mychailyszyn, Vincent, & Harris, 2013). Complex trauma, defined as chronic interpersonal trauma that began early in life, was also unrelated to premature termination (Author citation).…”

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

“…Regression analyses were used in four 482,630,631,633 studies to examine treatment completion. Caregivers' perceptions of the severity of abuse appear to be a common theme relating to treatment completion.…”

“…Chasson et al 482 reported that higher levels of depressive symptoms and feelings of intrusion during treatment were associated with dropout from TF-CBT. In a later study, 630 in which they analysed data from the same group of children augmented with additional cases, the authors found that children who had been abused by another child (not by a parental/adult figure), or had experienced a single event and had not suffered a life-threatening or serious injury, were more likely to drop out than those children exposed to multiple, physical injurious abuse by an adult. Eslinger et al 631 found that the odds of dropout were greater for children with younger parents.…”

“…There were no family characteristic differences identified between treatment completers and non-completers. In Chasson 2013, 630 children who had been abused by an adult figure, had been physically injured, and had been subjected to more than one event, were more likely to complete treatment. Even if true of all studies or interventions, knowing these associations is not sufficient to enable one to know what steps to take to enhance treatment completion.…”