Caregiver’s Maltreatment History Influences Treatment Outcomes for Their Maltreated Children Receiving Trauma-Focused Cognitive Behavioral Therapy

• In Event: Poster Session 03
  In Poster Session: PS 03 Topic - Developmental Psychopathology

Abstract

Child maltreatment is a significant threat to normative development, which often influences the next generation. For example, mother’s history of child maltreatment is significantly associated with their children’s emotional and behavioral difficulties (Plant et al., 2018). Other caregiver characteristics (e.g., depression) may also influence children’s treatment outcomes (Martin et al., 2019). However, there is limited research on whether caregiver’s trauma history interferes with their children’s response to treatment. Results from one study suggested that caregiver trauma history may impede improvement in functioning for their children being treated in the community (Swartz et al., 2018). Additionally, there is only one known study that investigates predictors of dropout from Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the most well-established treatment for PTSD and other trauma-related symptomatology in maltreated children (Silverman et al., 2008). Using a sample of 41 caregiver-youth dyads, researchers found that caregiver trauma history predicted higher enrollment and completion rates among caregivers with less favorable attitudes towards treatment. They suggested that caregivers’ past experiences could heighten awareness and recognition of their children’s mental health needs, which could promote help-seeking attitudes (Lai et al., 2019).

The current study investigates how caregiver maltreatment history influences treatment outcomes of their maltreated children participating in TF-CBT. We predicted that caregiver maltreatment history will be: (1) significantly associated with children’s baseline mental health symptoms; (2) be associated with treatment outcomes (e.g., number of sessions attended, treatment completion). Furthermore, similarities in maltreatment history between caregivers and children will moderate the relationship between caregiver maltreatment history and treatment outcomes; and (3) Caregiver characteristics (i.e., depression, parenting stress, and attachment style) will moderate the relationship between caregiver maltreatment history and treatment outcomes.

A total of 209 maltreated youth (mean age = 10.78 years; Range = 3-17 years; 67.9% female) who participated in TF-CBT through an outpatient treatment clinic were eligible for this study. Caregiver maltreatment history was assessed using the Childhood Trauma Questionnaire. Children’s baseline mental health symptoms were measured using the Strengths and Difficulties Questionnaire. Additional caregiver characteristics were assessed using the PHQ-9, Parenting Stress Index, and Experiences in Close Relationships Scale.

Preliminary analyses are presented for 113 participants. Number of maltreatment subtypes (Range = 0-5) experienced by caregivers significantly predicted children’s baseline internalizing (t = 2.64; p <.01), but not externalizing, symptoms. Caregiver maltreatment history also positively predicted number of treatment sessions attended (t = 2.09; p = .04), but not treatment completion. However, examination of moderators revealed that the positive relationship between caregiver maltreatment history and number of treatment sessions attended was limited to caregivers who did not have a similar maltreatment history to their children (see Table 1 and Figure 1). In other words, children of caregivers with more extensive maltreatment histories attended more TF-CBT sessions, but only if children and their caregivers did not experience the same subtype of maltreatment (e.g., sexual abuse). Other caregiver characteristics did not influence findings. Results will be discussed in terms of utilizing information about caregiver maltreatment history to identify potential barriers to effective treatment for maltreated children.

Authors

• Michelle P Brown, University of South Carolina
  Presenting Author

• Rachel Brettler, The Pennsylvania State University College of Medicine
  Non-Presenting Author

• Brian Allen, Penn State College of Medicine
  Non-Presenting Author

• Ashley Bucher, Pennsylvania State University
  Non-Presenting Author