Evidence in Action

A quarterly research brief from the Center on Trauma and Children

Volume 2, Issue 4 
October 2014 

The Center on Trauma and Children (CTAC) is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

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www.uky.edu/CTAC

 

  

 

 

 

 

Child and Caregiver Dropout in

Child Psychotherapy for Trauma

 

The reference for this paper is:

Eslinger, J.G., Sprang, G., & Otis, M.D. 

(2014). Child and caregiver dropout in

child psychotherapy for trauma. Journal of Loss and

Trauma, 19(2), 121-136.

 

Why is the prevention of treatment dropout important in treatment for trauma?

The completion of a treatment protocol helps ensure that an individual has received the essential components of a given intervention.  Evidence-based practices for trauma-exposed children involve helping a child manage distressing emotional content related to traumatic experiences (National Child Traumatic Stress Network, 2005).  Addressing the barriers that  lead to treatment dropout can help make sure children and their caregivers receive the full benefit of treatment.        

 

What did we study?

In the July 2013 issue of our Evidence in Action research brief, we examined factors affecting treatment completion using data from the National Child Traumatic Stress (NCTSN) Core Dataset (CDS).  This month, we examine predictors to treatment dropout in a study conducted with data from our Child and Adolescent Trauma Treatment and Training Institute (CATTTI).  Our study focused on the examination of variables collected at baseline assessment that can predict children and caregivers at risk for dropout.  We used a sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress related problems.  The average age of children in the study was 10 years of age (M = 9.67, SD = 4.36), 56.5% were female, and 84% identified as Caucasian.  Forty-two percent of children in the study were living with biological or adoptive parents, 33% resided in foster care, 22% lived with other relatives, and 3% lived in other care situations.  We used bivariate analyses and multinomial logistic regression to examine whether child and caregiver age and gender, the primary type of trauma exposure, distance traveled to sessions, child trauma symptom scores, parenting stress scores, and child externalizing behavior scores predicted whether a child and caregiver would drop out of treatment. 

 

 

SUMMARY OF FINDINGS

  • Children living with their biological or adoptive parents were more likely to drop out of treatment than children residing in foster care.  Of children living in foster care, 74% fully completed treatment compared to only 42% of children living with biological or adoptive parents. 
  • Younger caregivers were found to be at greater risk of dropout compared to their older counterparts. 
  • Older caregivers with younger children were found to be more likely to fully complete treatment and older caregivers who identified higher levels of post-traumatic stress symptoms for their child were more likely to receive at least a moderate dose of treatment.  This may be because older caregivers may have access to more established systems of support and other resources which may help them remain in treatment. 
  • No significant differences in parenting stress scores were found for the completion and dropout groups. 
  • Although the distance traveled varied substantially across the sample (with some families driving up to 235 miles to attend sessions), distance traveled to session was not found to be a significant predictor of treatment dropout.
  • Findings suggest that children with primary exposure to domestic violence may be at increased risk of treatment dropout compared to children with other types of exposures.
 

How Can We Increase the
Completion of Treatment? 
  

  • Communicating the rationale for treatment and providing psychoeducation about how trauma exposure can affect a child's emotional and behavioral functioning can help caregivers understand the purpose of the treatment and expectations related to attendance and participation.  Psychoeducation is recommended throughout treatment as the family progresses through the treatment protocol. 
  • Children in trauma treatment may experience intense and overwhelming thoughts and feelings related to their trauma histories.  An early focus on symptoms of avoidance is recommended to help children develop and implement coping skills for managing distressing emotional content. This appears to be especially important for older children who may present with more complex symptom profiles. 
  • Pay attention to those who may be at risk (younger caregivers, children exposed to domestic violence, etc.) and utilize dropout management techniques such as participant feedback, motivational interviewing, and reminders to increase the completion rate. 
  
Funding for this project was made possible in part from the Substance Abuse and Mental Health Services Administration, USDHHS, 36795M054284-SM-11-OL1 (Sprang- PI)