Risk and Protective Factors for Treatment Dropout in a Child Maltreatment Population
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ORIGINAL ARTICLE
Risk and Protective Factors for Treatment Dropout in a Child Maltreatment Population Rachel Eirich 1 & Nicole Racine 1,2 & Daniel Garfinkel 3 & Gina Dimitropoulos 1,2 & Sheri Madigan 1,2 Published online: 4 August 2020 # Springer Nature Switzerland AG 2020
Abstract Many children start but do not complete trauma treatment, and there is little knowledge of factors that predict treatment dropout in children who have endured maltreatment. The current study examines the risk and protective factors associated with premature treatment dropout within a sample of 118 children (aged 3–18) referred to a Child Advocacy Centre due to maltreatment, specifically abuse and neglect. In this retrospective chart review, data on risk (i.e., adverse childhood experiences [ACEs] and number of presenting clinical symptoms at intake) and protective factors (e.g., peer support, caregiver support) were extracted from clinical files by two trained coders using a standardized data extraction protocol. Results revealed that, after adjusting for child age, ACEs score, and presenting clinical concerns, children with more protective factors were less likely to drop out of treatment (OR=0.40, 95% CI [0.24, 0.69]). Child age also emerged as a significant predictor of treatment dropout, such that older children were more likely to drop out of treatment prematurely (OR=1.16, 95% CI [1.01, 1.32]). Results suggest that older children and children with fewer protective factors present may benefit from increased retention efforts to reduce treatment dropout. Keywords Child maltreatment . Resilience . Treatment . Dropout . Risk
Introduction Child maltreatment, which includes physical, sexual, and emotional abuse, neglect, and exposure to domestic violence, is a prominent public health concern with approximately 12% of US children experiencing substantiated maltreatment (Wildeman et al., 2014). With an immense economic impact (Bellis et al., 2019; Gelles & Perlman, 2012) and potentially lasting individual consequences for physical and mental wellbeing (Heim, Shugart, Craighead, & Nemeroff, 2010; MacMillan et al., 2001), treatments that mitigate adverse effects and prevent future victimization are essential. While a variety of trauma-focused treatments exist with promising outcomes (Chaffin & Friedrich, 2004; Lenz & Hollenbaugh, * Sheri Madigan [email protected] 1
Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
2
Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
3
Calgary and Area Child Advocacy Centre, Calgary, AB, Canada
2015; Morina, Koerssen, & Pollet, 2016), a high proportion of children that have access to these treatments drop out or intermittently attend treatment sessions. Specifically, studies with children who have experienced maltreatment report dropout rates from trauma-focused treatments ranging from 25 to 69% (Cohen & Mannarino, 2000; Cohen, Mannarino, & Iyengar, 2011; Wamser-Nanney & Steinzor, 2016). Taken together, understanding the factor
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