(PS6-33) Association Between Parenting Practices and Attrition in Alternative for Families: A Cognitive Behavioral Therapy

Abundant research documents the relationship between child maltreatment and a range of adverse outcomes (McLaughlin et al., 2013). As such, trauma-specific treatments, like Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT; Kolko et al., 2011), have been developed to mitigate the effects of child maltreatment and prevent future victimization. Outcome research has demonstrated significant advantages for children who complete treatment, including reductions in trauma-related symptomatology (Kolko et al., 2012). Despite their documented efficacy, between 33% and 77% of maltreated children drop out of trauma-specific therapies (Wamser-Nanney, 2023). Thus, advancing our understanding of the mechanisms of dropout may help increase treatment retention and improve treatment efficiency for trauma-exposed youth.

Studies of children in general outpatient care have found a positive association between baseline reports of physical discipline and attrition (e.g., Kazdin & Mazurick, 1994; McCabe, 2002). For maltreated children, McWey et al. (2014) found that baseline reports of inconsistent discipline were positively associated with attrition, but Tebbett (2013) found no association for families in trauma therapy. Unique to AF-CBT, offending caregivers participate in treatment, and children brought to therapy by their perpetrating caregiver are more likely to drop out (Lau & Weisz, 2003). Thus, we aim to examine the relationship between parenting and attrition in AF-CBT. We hypothesize that problematic parenting at baseline is predictive of decreased odds of treatment completion and that positive parenting at baseline is predictive of increased odds of treatment completion.

Data were drawn from an OJJDP-funded (PI: E. Brown) randomized controlled trial evaluating the effectiveness of AF-CBT versus waitlist control. AF-CBT was delivered in community settings to 56 children (aged 4-17) exposed to family violence and their perpetrating caregivers. Eligible children identified as African American, Caribbean, and/or Latine. Caregiver- and child-reported parenting practices were collected at baseline using the Alabama Parenting Questionnaire (Frick, 1991). Positive parenting comprises Involvement and Positive Parenting, and problematic parenting comprises Corporal Punishment and Inconsistent Discipline. Completion status was coded dichotomously (completion vs. attrition) and determined by completion of all AF-CBT components.

A logistical regression was conducted to assess the effects of baseline Involvement, Positive Parenting, Corporal Punishment, and Inconsistent Discipline on Treatment Completion. Results indicate that Involvement and Positive Parenting significantly predict Treatment Completion, χ²(4, N = 56) = 10.54, p = .032, whereas Corporal Punishment and Inconsistent Discipline did not, χ²(4, N = 56) = 3.14, p = .534. Results suggest that problematic parenting may not impact attrition, but positive parenting may protect against dropout. Reported use of Corporal Punishment (M = 9.46, SD = 3.18) was lower than expected and may indicate underreporting. Future research should further explore how caregiver factors may relate to dropout from trauma-specific therapy.