(PS6-57) Relation Between Referral Source and Completion of Trauma Therapy in a Community Setting

In the United States, over 60% of children experience at least one traumatic event by age 16 (SAMHSA, 2023), and childhood trauma is associated with posttraumatic stress disorder (PTSD) (Cloitre & Beck, 2017). Trauma-specific evidence-based interventions (EBIs) for childhood trauma are well established, but treatment completion is a challenge. Attrition rates range from 11-40% (Cohen et al., 2004; Cohen et al., 2011) when non-offending caregivers are involved in treatment. Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT; Kolko et al., 2011), is an EBI for physically abused children and their offending caregivers. Kolko (1996) reported a dropout rate of 20% for AF-CBT.

 AF-CBT was enhanced for Latinx and African/Caribbean youth victims of violence. Bilingual (Spanish/English) staff provided care in a trusted community site (Queens Library branches) at no cost, and on Saturday and evenings with childcare provided. Trusted community figures, such as faith-based leaders, were utilized as mental health advisors. Despite these efforts, retention rates were low. Thus, we considered factors that may influence caregivers’ comfort with trauma-specific therapy. Gould et al. (1985) found school-referred children at a psychiatry clinic were significantly more likely to drop out of treatment compared to those with parent-involved referrals. Yasinski et al. (2018) found that high levels of caregiver avoidance, a common symptom of PTSD, predicted dropout. This project aims to examine what factors predict attrition in AF-CBT; we specifically consider 1) referral source and 2) caregiver PTSD at baseline. We hypothesized that children with parent-involved referrals had higher odds of completing AF-CBT compared to those with non parent-involved referrals. We also hypothesized that as the severity of caregiver PTSD increases their odds of completing AF-CBT decreases. 

Data used were from an OJJDP-funded (PI: E. Brown) randomized controlled trial that compared AF-CBT to a waitlist control group delivered in a community setting. Participants (N = 46) were children, aged 4-17, who experienced physical abuse and/or family violence. During pre-treatment phone screening with a referred caregiver, referral source, informed consent, and study eligibility was collected. Referral sources included Family Advocacy Center, Place of Worship, Child Protective Services, Educational Center, and Non-trauma mental health provider. Attrition was categorized as a binary response (completer, non-completer) based on completion of all components of AF-CBT. Caregiver PTSD was assessed using the PTSD Symptom Scale-Self Report DSM-5 (PSS-SR5; Foa et al., 2016).

To examine the impact of referral source and baseline caregiver PTSD on attrition, we conducted a logistic regression with referral source and baseline caregiver PTSD severity as predictors, and completion status (yes/no) as the criterion variable. Referral source and baseline caregiver PTSD severity were significant predictors of Completion Status, χ² (4, N = 46) =11.381, p = .023. Cox & Snell R² = .219 and the Nagelkerke R² = .315. Results suggest that caregiver PTSD and referral source may affect treatment completion when trauma interventions are implemented in community settings.