Risk Factors for Attrition From Pediatric Trauma-Focused Treatment

Abstract

Rates of attrition from pediatric trauma-focused treatments are high, yet few studies have examined predictors of dropout. The aim of the study was to investigate whether higher levels of caregiver- and child-reported pretreatment difficulties predicted attrition from trauma-focused therapy. One hundred seventy-two children aged 6–18 ( M = 10.53, SD = 3.36; 64% female, 64% Black) and their caregivers were included in the study. Two operational definitions of attrition were utilized: (1) clinician-rated dropout and (2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Rates of clinician-rated attrition were high (76.2%); however, 73.8% received an adequate dose. Despite expectations, higher levels of rule-breaking and aggressive behavior were related to clinician-rated dropout ( d = 0.59, .63, respectively) but were not significant predictors in a logistic regression model. Child-reported symptoms were unrelated to clinician-rated attrition. Higher levels of caregiver-reported anxiety/depression, somatic complaints, and trauma-related difficulties corresponded with adequate dose ( ds = 0.52–1.06). Yet only caregiver-reported sexual concerns predicted adequate dose in a regression model ( OR = 1.09). Caregiver- and child-reported symptoms may be unrelated to clinician-rated treatment completion and appear to play a small role in understanding whether the child received an adequate dose of treatment.

Maternal Support and Attrition from Child Trauma‐Focused Therapy

“…Evidence‐based treatments help combat the negative impact of trauma exposure among children; yet, over one third to three fourths of children may prematurely terminate from trauma‐focused treatment (Cohen et al., 2011; Gillies et al., 2013; Scheeringa et al., 2011; Wamser‐Nanney & Steinzor, 2016, 2017; Wamser‐Nanney, 2019). Risk and protective factors for attrition from child trauma‐focused therapy are continuing to be identified.…”

“…In this population, in particular, children may be in child protective services (CPS) custody and brought to treatment by a nonparent caregiver. Interestingly, in two previous studies, children who were accompanied to therapy by their biological parent were no more likely to complete treatment than those who were brought by someone other than their biological parents (Wamser-Nanney, 2019;Wamser-Nanney & Steinzor, 2016. However, caregivers with fewer resources may be at increased risk for premature termination-specifically unmarried caregivers, those with lower levels of educational attainment, and those with lower household incomes (Wamser-Nanney & Steinzor, 2016.…”

“…Children who report exhibiting more impaired functioning have also been shown to be more likely to terminate treatment early (Fraynt et al., 2014). However, there has been considerable between‐study variability regarding which symptoms are tied to attrition, and in research that has examined multiple forms of difficulties, some work has found only a few types of symptoms, such as aggressive behavior or sexual behavior problems, to be tied to dropout (Wamser‐Nanney & Steinzor, 2017; Wamser‐Nanney 2019). At the present time, the literature is still emerging, and it seems premature to make conclusions regarding specific types of symptoms and attrition; yet, higher levels of symptoms may increase dropout risk.…”

“…Nonetheless, it is notable that caregiver‐ and family‐level variables have not consistently corresponded with dropout (Celano et al., 2018; Yasinski et al., 2018). Involvement with CPS has been shown to be a risk factor for attrition in some studies (Sprang et al., 2013; Wamser‐Nanney & Steinzor, 2016) but not others (Wamser‐Nanney, 2019; Wamser‐Nanney & Steinzor, 2017), and in one sample of Medicaid‐eligible children, placement in CPS custody was a protective factor against dropout (Yasinski et al., 2018). The nature and the degree of involvement with CPS may be important aspects in understanding attrition.…”

The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people

“…Observations from adult-focused literature indicate that dropout amongst patients with post-traumatic stress is common and is highest amongst those who received trauma-focused treatments (Imel, Laska, Jakupcak, & Simpson, 2013 ; Lewis, Roberts, Gibson, & Bisson, 2020 ). Equivalent research is less exhaustive for youth; however, there is some evidence indicating that retaining youth in treatment is also challenging (de Haan, Boon, de Jong, Hoeve, & Vermeiren, 2013 ; Wamser-Nanney, 2019 ). Tern has been explicitly designed to anticipate and accommodate engagement issues for CT youth with flexibility around attendance times and missed appointments.…”