Victims of child abuse dropping out of trauma‑focused treatment: A meta‑analysis of risk factors

A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children’s trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the “Demographic and Family” risk domain (r=.121), with factors including being male, child protective services involvement or placement, and minority status, and for the “Youth Alliance” risk domain (r=.207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the “Demographic and Family” domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Care for children who have experienced child abuse & neglect:The relevance of innovative and integrative prevention and treatment programs

This thesis aimed to examine reasons why children who experienced child abuse and neglect (CAN) drop out of trauma treatment and to investigate how innovative interventions with integrative, multidisciplinary approaches and techniques can contribute to the existing body of interventions for children who experienced CAN. We provide an overview of risk factors identified in literature for children dropping out of evidence-based trauma therapy after CAN; we evaluate a trauma-informed drama therapeutic program (‘Time for Tony the Turtle’) in domestic violence shelters by exploring the experiences of mothers, children, and professionals involve; we conduct a first experimental study into the effectiveness of Integratieve Gehechtheidsbevorderende Traumabehandeling voor Kinderen (IGT-K) on attachment problems, posttraumatic stress symptoms, behavioral problems, and emotion regulation difficulties in children who experienced CAN in the past. Given the severity of symptomatology after CAN, it is important to develop a continuum of adequate care that is suitable to target and engage all children who are at risk for developing CAN-related symptomatology or are already struggling with it. For certain groups of children, this requires integrating (existing) interventions or innovating techniques to better match their needs. Our findings show that efforts, both in the field of research and in the clinical field, can contribute to the improvement of knowledge and foster insight in factors that influence the risk for evidence-based trauma-focused treatment dropout. Besides, our results show that through further developing and examining treatments, more children can be engaged in either prevention or specialized treatments

De discussie over de Eerste Kamer: over onduidelijke agenda's en evenwicht van machten

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