Engagement in Trauma-Specific CBT for Youth Post-9/11

Abstract

Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income ethnically diverse population were trained to deliver CBT and structured engagement strategies. Four hundred and forty-five youth ages 5-19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children's mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at where services were delivered in schools. However, sites, demographic factors and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests structured engagement strategies, linked to evidence-based treatments may improve treatment participation for youth.

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

“…Predisposing and need factors identified in the EBMVP model were not associated with treatment initiation or treatment completion in our sample. Our results are partially consistent with a past study that found demographic variables added only a small amount variance that explained pretreatment show rates and dose in a sample of trauma-exposed youth offered TIC interventions (Rodriguez et al, 2013). Our results contradict the literature that suggests greater symptom severity or greater need is an important predictor of mental health service use (Miller et al, 2008).…”

“…Only 43.0% of the total sample of youth actually completed treatment, consistent with research suggesting between 20 and 75% of youth prematurely drop out of therapy (Olfson et al, 2009; Wamser-Nanney & Steinzor, 2017). Previous studies found treatment initiation rates among low-income, urban populations ranging from 72% (McKay, Lynn, & Bannon, 2005) to 95% (Rodriguez et al, 2013) and treatment completion rates of 59% (McKay et al, 2005). Several plausible explanations for high rates of initiation and completion among those who initiated our TIC interventions exist.…”

“…Youth with greater externalizing problems (e.g., oppositional, aggressive, and disruptive behaviors) tend to use more mental health services compared with youth with internalizing problems (e.g., depression ;Miller, Southam-Gerow, & Allin, 2008). Yet other research has found that higher symptomology was not a significant predictor of treatment access or participation rates (Rodriguez et al, 2013). Type of trauma (i.e., physical and sexual abuse) has been associated with more sessions of outpatient therapy attended compared with children with no reported history of child abuse (Walrath, Ybarra, Sheehan, Holden, & Burns, 2006).…”

“…Although prior work has investigated determinants of mental health service utilization in youth, few studies have focused specifically on trauma-exposed youth in real-world settings. Of this work, prior research has suggested girls tend to attend more treatment sessions than boys (Rodriguez et al, 2013), while ethnic and racial minority youth tend to be less likely to initiate treatment and more likely to drop out of treatment compared with White Americans (Atdjian & Vega, 2005). Youth with greater externalizing problems (e.g., oppositional, aggressive, and disruptive behaviors) tend to use more mental health services compared with youth with internalizing problems (e.g., depression; Miller, Southam-Gerow, & Allin, 2008).…”

“…We sought to utilize the EBMVP to understand predictors of treatment initiation, completion, and selection among impoverished youth who experienced a traumatic event (e.g., crime, violence) and were offered a TIC intervention. Both initiation and completion of treatment are critical to consider as each represents a distinct form of service engagement (Rodriguez et al, 2013; Staudt, 2007). Drawing from prior research, we explored the following questions: (a) are predisposing factors, specifically age (older), sex (female), race/ethnicity (White), and trauma characteristics (physical and sexual abuse), or need factors, such as symptom severity, associated with initiation of TIC treatment?…”