Identifying and addressing barriers to treatment for child sexual abuse survivors and their non-offending caregivers

Mental health treatment is a critical part of an effective and compassionate response to the disclosure of child sexual abuse (CSA). Given the vast negative consequences for children and families following CSA, engagement in treatment can benefit youth and their non-offending caregivers. Yet, these families face unique barriers to treatment initiation, adherence, and effectiveness. The identification of these barriers allows clinicians, researchers, and policy makers to increase treatment utilization, engagement, and value. The current review and its recommendations derive from the existing literature combined with knowledge gained from a clinical research team with more than 20 years of experience offering a treatment program for CSA survivors and their non-offending family members. The review organizes barriers around factors related to individual characteristics of children and caregivers, perceptions and beliefs commonly held following CSA, and challenging family interactions in the context of individual and group treatment for CSA. Finally, barriers related to systemic and societal factors are examined given the importance of understanding the legal and cultural context in which families seek and engage in treatment. Recommendations for further research, suggestions for clinicians, and considerations for policy change to decrease the identified treatment barriers for families impacted by CSA are provided

Adverse Childhood Experiences among Adolescent Girls in Residential Treatment: Relationship with Trauma Symptoms, Substance Use, and Delinquency

Adverse childhood experiences (ACEs) refer to negative events during childhood or adolescence including abuse, maltreatment, and exposure to household dysfunction (Kalmakis & Chandler, 2014). ACEs are associated with negative outcomes including mental and behavioral health concerns and offending (Fox et al., 2015). The risk of negative outcomes associated with ACEs increases when an individual experiences polyvictimization (experiencing multiple types of adverse events; Felitti et al., 1998; Finkelhor et al., 2011). A majority of adolescents served by residential treatment programs (RTPs) have experienced polyvictimization (Briggs et al., 2013). Research examining juvenile offending and youth delinquency has focused on boys. Thus, research is warranted to understand adolescent girls in residential treatment to improve treatment, prevent recidivism, and prevent first encounters with juvenile justice systems. This study addressed some of these gaps by characterizing ACEs and mental and behavioral health concerns among adolescent girls within an RTP utilizing a person-centered approach. Data were coded from archived psychological assessment records for girls who entered an RTP between 2017 and 2021 (N = 256). Psychological assessments consisted of results from a clinical interview, youth self-reported measures, and collateral information. Girls reported experiencing an average of 5.08 ACEs (SD = 2.47). Among the sample, 13.7% reported clinical levels of posttraumatic stress, 17.8% reported clinical levels of alcohol use, and 51.4% reported clinical levels of other substance use. Four distinct classes were identified through the latent class analysis (i.e., low adversity, household dysfunction, abuse and non-support, and polyvictimization). The polyvictimization and abuse and non-support classes reported higher levels of trauma symptoms compared to the low adversity class. Youth in the polyvictimization and household dysfunction classes reported higher scores of substance use compared to the low adversity class. Youth in the household dysfunction class displayed higher delinquent behaviors compared to the low adversity class. These findings provide a deeper understanding of adolescent girls’ experiences of ACEs and mental and behavioral concerns when entering residential treatment. These efforts may help to inform prevention and intervention efforts that reduce burden to children, families, and the systems that serve these youth. Additional clinical and policy implications of these findings are discussed. Advisor: David J. Hanse

Identifying and addressing barriers to treatment for child sexual abuse survivors and their non-offending caregivers

Mental health treatment is a critical part of an effective and compassionate response to the disclosure of child sexual abuse (CSA). Given the vast negative consequences for children and families following CSA, engagement in treatment can benefit youth and their non-offending caregivers. Yet, these families face unique barriers to treatment initiation, adherence, and effectiveness. The identification of these barriers allows clinicians, researchers, and policy makers to increase treatment utilization, engagement, and value. The current review and its recommendations derive from the existing literature combined with knowledge gained from a clinical research team with more than 20 years of experience offering a treatment program for CSA survivors and their non-offending family members. The review organizes barriers around factors related to individual characteristics of children and caregivers, perceptions and beliefs commonly held following CSA, and challenging family interactions in the context of individual and group treatment for CSA. Finally, barriers related to systemic and societal factors are examined given the importance of understanding the legal and cultural context in which families seek and engage in treatment. Recommendations for further research, suggestions for clinicians, and considerations for policy change to decrease the identified treatment barriers for families impacted by CSA are provided