(PS4-C68) Pre-treatment Resilience as a Predictor of Attrition for Trauma-focused Cognitive-behavioral Therapy

In the United States, more than 60% of children are exposed to trauma (McLaughlin et al., 2013), and at least 50% of those develop at least one symptom of posttraumatic stress disorder or other anxiety disorder (Alisic et al., 2014; Hamby et al., 2020). Evidence-based trauma treatments, such as Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2017), have been found to decrease trauma-related symptoms (Deblinger et al., 2011). However, retention in TF-CBT is a concern, with attrition rates ranging from 11-40% (Cohen et al., 2004; Cohen et al., 2011). Persisting through certain treatment components (e.g., gradual exposure) can be challenging for children and their families. Nevertheless, completion of all phases of TF-CBT is associated with the largest decreases in trauma-specific distress (Deblinger et al., 2011), highlighting the need to complete treatment. Resilience, defined as the capacity to quickly adapt to and recover from adversity (Garmezy, 1991), may play a crucial role in helping individuals undertake and better engage with difficult parts of treatment. This pattern was exhibited in a sample of adults entering substance abuse treatment, such that high levels of resilience at baseline predicted treatment completion (Harrison, 2013). To date, research has not yet considered if this same pattern is exhibited in traumatized youth receiving TF-CBT. The goal of the proposed study is to examine whether high level of pre-treatment resilience is predictive of completing TF-CBT.

Participants are drawn from an ongoing study of TF-CBT being provided free-of-charge at an urban mental health clinic for maltreated youth (ages 4-17) and their caregivers. Participants have completed pre-treatment assessment and attended at least one session of TF-CBT.  Resilience is assessed using the Behavior Assessment for Children, third edition, Parent Rating Scale (BASC-III-PRS; Reynolds & Kamphaus, 2004) Resiliency subscale, which assesses adaptive strength and “the ability of to access both internal and external support systems to alleviate stress and adversity” (Reynolds & Kamphaus, 2004, p. 4). Attrition is categorized as a binary response based on whether children completed or failed to complete all components of TF-CBT.

We conducted a logistic regression with BASC-III-PRS Resilience at baseline as the predictor and completion status (yes/no) as the criterion variable. Level of child resilience at baseline was not a statistically significant predictor of completing all components of TF-CBT, χ²(1) = 1.288, p = .256. Results suggest that children's level of resilience at the start of treatment may not impact treatment completion of trauma interventions. The poster will compare baseline resilience levels of children with caregivers to examine whether caregiver resiliency plays a role in treatment completion. Further clinical implications and future directions will be discussed.