Caregiver Barriers to Engagement and Completion of an Evidence-Based Practice, TF-CBT, among Youth Victims of Abuse and Trauma: A Mixed Methods Approach

Youth trauma exposure increases the risk for negative health outcomes, re-victimization, and perpetration of violence.  Evidence-based practices are available to assist traumatized youth and improve youth trajectories; however, limited research has examined how to engage and retain families in these services within community settings.  The current study examined caregiver barriers to youth enrollment and completion of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in a community setting that minimized logistical barriers (e.g. providing transportation, after-hours services, and free services).  Forty-one parent-youth dyads recently referred to therapy following youth trauma exposure were recruited.  A mixed methods approach was utilized to examine how parent age, education level, trauma exposure, stress, and mental health influenced youth utilization of TF-CBT. Exploratory analyses suggest important trends, including that parents with higher education were twice as likely to enroll their youth in therapy (p=.06)  and parents with a PTSD diagnosis were 24 times more likely to have youth complete therapy (p=.08). Qualitative analyses further supported that parents with personal trauma experiences express positive opinions of therapy sessions for trauma victims.  

In contrast to prior research, study results suggest that parental mental health, particularly trauma-exposure related symptoms, may increase the likelihood that traumatized youth complete therapeutic services. Parents with personal traumatic experience may view therapy as important and may be more committed to their child receiving therapy.  Clinical applications of these findings suggest that therapists need to offer additional parental psychoeducation about therapy benefits when parents have not experienced trauma and related mental health symptomatology.