Home-Based Parent Child Therapy for Young Traumatized Children Living In Poverty: A Randomized Controlled Trial

Abstract

A randomized control trial was used to evaluate the effectiveness of a home-based, parent-and-child therapy program specifically developed for toddlers and preschoolers living in poverty with trauma symptoms. Sixty-four children 5-years of age and younger were referred to a community-based clinic for behavior problems and emotional difficulties. All children had experienced one or more potentially traumatic events and met the DSM-5's criteria for Post-Traumatic Stress Disorder in Children Six Years of Age and Younger. All families received government assistance indicating that their income met the federal definition for poverty. Participants were randomly assigned to either immediate treatment or wait list control groups. Significant between-group differences on all post-treatment measures were found. After the waitlist group completed treatment, significant improvements for both groups were found on all measures at six-weeks follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver adherence to treatment strategies. This study offers support for early intervention of children with trauma symptoms and identifies the clinical challenges and advantages of providing therapy services in a home setting for very young children in poverty.

Assessment of Trauma Symptoms in Toddlers and Preschoolers Living in Poverty

“…As an initial effort to determine whether the PITS-TC scores and subscale scores would be sensitive to change following participation in an in-home, trauma-informed treatment specifically designed for very young children in poverty (Fox, 2018), we conducted a separate pilot study with 93 children referred to our clinic. This treatment program has been analyzed for efficacy through four separate randomized controlled studies (Carassco & Fox, 2012; Fung & Fox, 2014; Harris, Fox, & Love, 2015; Love & Fox, 2019) with similar samples of children. We did not include a control group in this preliminary study.…”

“…The treatment sensitivity of the PITS reported in this study should be considered as only a preliminary finding as no control group was included. However, four previous randomized controlled studies of this evidence-based, trauma-informed treatment program did show that it significantly reduced trauma symptoms compared with a control group using more established trauma measures (Carassco & Fox, 2012; Fung & Fox 2014; Harris et al, 2015; Love & Fox, 2019). Given the paucity of sound screening measures combined with the growing recognition of the critical need to identify, assess, and treat trauma symptoms in very young children (nctsn.org), having a relatively short screening measure with at least the potential to accurately assess trauma symptoms following trauma-informed treatment programs will be a welcome addition to the various welfare and child protective service agencies who routinely serve the population sampled in this study.…”

“…Clinic staff provided treatment to the children of caregivers who exhibited trauma symptoms and had previous exposure to potentially traumatic events. Staff had been trained and regularly supervised in an in-home, evidence-based, trauma-informed program specifically designed for very young children in poverty (Love & Fox, 2019).…”

“…Also, most available measures do not consider the newer diagnostic criteria for Post-Traumatic Stress Disorder in Children 6 years of age and younger in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; APA, 2013). While this diagnosis does not cover the full range of trauma symptoms presented by younger children and may even exclude children in need of trauma-informed care (Love & Fox, 2019), it does include important criteria when considering appropriate diagnoses for reimbursement purposes and to further research on the range of symptoms that may need to be considered in future editions of the DSM.…”

Infant Mental Health Prevention and Treatment: A Systematic Review Examining the Role of Homelessness

“…Early Pathways is a trauma-informed program based in cognitive behavioral therapy, social learning, and child development. Early Pathways has demonstrated moderate to large effect sizes in decreasing behavior problems, emotional problems, trauma symptoms, and overall likelihood to meet diagnostic criteria for a mental health disorder (Fung & Fox, 2014;Harris, Fox, & Love, 2015;Love & Fox, 2019;Nicholson, Anderson, Fox, & Brenner, 2002). However, Early Pathways has yet to be examined in shelter (Leijten et al, 2018;Morpeth et al, 2017;Pearl, 2009;C.…”