A Five-Year Window on the Mental Health of Maltreated Children: Development, Age, and Early Intervention

• In Event: 3-199 - Toward a More Nuanced Understanding of Child Abuse and Neglect: Timing, Type, and Intervention Effectiveness

Integrative Statement

Child maltreatment constitutes a threat to physical and emotional well-being during childhood and into adulthood (e.g., Chapman et al., 2004; Norman et al., 2012). Although there are interventions for reducing children’s trauma symptoms, improving attachment security, and enhancing the quality of parent-child relationships, research primarily focuses on immediate outcomes of treatment and extending out a few years (e.g., Toth et al, 2006). A recent meta-analysis suggested that 3 year effects of parenting interventions were heterogeneous, fading or even increasing over time (sleeper effects), but could not identify the reasons for heterogeneity (van Aar et al., 2017). We propose that effects of maltreatment on children’s mental health may fade or increase depending on the child’s age at treatment participation, which may contribute to the intervention’s effectiveness over time (Fraley et al., 2013), and that 3 years might not be a long enough period to detect effects. The purpose of this study is to explore the effects of maltreatment history and participation in Parent-Child Interaction Therapy (PCIT) on the likelihood of receiving a referral for mental health services in the 5 years post participation in PCIT.
Method
Eligible participants were 375 children and their biological mothers who were referred to PCIT for disruptive behavior problems and had terminated PCIT at least 5 years earlier. Children ranged from 2-8 years, with 42% in the 2-4 age range; 61% were male. Children and caregivers were ethnically diverse. Approximately 70% of children had some history of maltreatment. Approximately 34% of children completed PCIT, 55% ended services early, and 12% never began PCIT.
Mothers completed demographic questionnaires and standardized assessments before beginning treatment. Maltreatment exposure was obtained from file review. Information was collected regarding mental health referrals made during the 5 years following their episode in PCIT: 27.5% had been referred for some mental health services in the first 2 years and 42% had been referred in the five years following PCIT participation.
Results
Results of a stepwise logistic regression of the likelihood of a mental health referral in the 2 years following PCIT showed that maltreatment history and having clinical levels of behavior problems at pre-treatment increased the likelihood of a new mental health referral; being 2-4 years old during PCIT decreased the likelihood of referral. Treatment participation decreased the likelihood of a mental health referral only for 2-4 year olds. Results of a stepwise logistic regression of the likelihood of a mental health referral in 5 years following PCIT showed that only maltreatment history was associated with a higher likelihood of referral. Results of a Cox regression with a time-dependent covariate predicting the rate of receiving a new mental health referral in 5 years following PCIT showed that while younger children were initially less likely to be re-referred than older children, this effect tended to fade.
Conclusion
Analyses suggest that parenting interventions for maltreated children may reduce their likelihood of mental health re-referrals for two years post participation, but their influence may fade over time, with different implications for younger and older children.

Authors

• Susan G Timmer, UC Davis CAARE Center
  Presenting Author

• Brandi N Hawk, UC Davis CAARE Center
  Non-Presenting Author

• Maria Usacheva, UC Davis
  Non-Presenting Author