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Treatment Engagement Among Children Exposed to Violence: A Systems Perspective
Linzy M Pinkerton1, Cassandra L Kisiel1, Heather J Risser1
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Children exposed to violence who complete mental health treatment have better outcomes. However, disparities in treatment engagement, influenced by socioeconomic factors, can worsen these outcomes.
Area of Science:
- Public Health
- Child Psychology
- Mental Health Services Research
Background:
- Childhood exposure to violence is a significant public health concern with lasting impacts on child development.
- Effective mental health treatments exist, but disparities in engagement hinder their reach and efficacy for vulnerable children.
- Understanding factors influencing treatment completion is crucial for addressing these disparities.
Purpose of the Study:
- To analyze differences in demographic, social, and environmental factors among children exposed to violence based on their mental health treatment engagement.
- To identify predictors of treatment completion versus non-engagement or attrition in community-based mental health services.
- To explore the relationship between treatment engagement and child outcomes following violence exposure.
Main Methods:
- Retrospective analysis of data from 2,546 children referred to community mental health services between 2001 and 2015.
- Categorization of children into Nonengager, Attriter, and Completer groups based on treatment participation.
- Comparison of groups across variables including behavioral/emotional problems, race, socioeconomic status, social support, and neighborhood opportunity.
Main Results:
- Treatment completers were more likely to be White, from households earning $40,000+, and live in neighborhoods with higher child opportunity.
- Completers reported lower parental stress, higher parental and child social support, and fewer co-habitants.
- Children who completed treatment showed significantly lower emotional and behavioral problems post-intervention.
Conclusions:
- Treatment completion for children exposed to violence is strongly associated with socioeconomic and environmental advantages, potentially exacerbating existing disparities.
- Addressing disparities requires a multi-level approach, considering ecological factors and tailoring interventions to specific family contexts.
- Systemic changes and advocacy are needed to ensure equitable access to effective mental health treatment for all children exposed to violence.
Abstract:
Childhood exposure to violence is a major public health issue. Effective treatment can reduce the impact of violence exposure on child outcomes. However, disparities in treatment engagement can interfere with effective treatment. This study reviews data collected from 2,546 children referred to community-based mental health services from 2001 to 2015 after exposure to violence. Children were categorized into three groups: those who attended intake but never started treatment, referred to as the Nonengager group; those who started but discontinued treatment prior to meeting treatment goals, referred to as the Attriter group; and those who completed treatment as rated by the treating therapist, referred to as the Completer group. The three groups were analyzed for differences in behavioral and emotional problems, racial identity, child social support, household income, number of people living in the home, parent stress, parent social support, community violence exposure, and neighborhood-level child opportunity. Analyses demonstrated that the Completer group were more likely to: live in neighborhoods with higher levels of childhood opportunity, identify as White, have an annual household income of $40,000 or greater, have significantly fewer people living in the home, report lower levels of parental stress, report higher levels of parental social support, report higher levels of child social support, and have significantly lower scores of emotional and behavioral problems after treatment. Overall, our study supports the importance of considering multiple ecological levels when targeting treatment engagement for children after exposure to violence. Results indicate that children from more advantaged environments are more likely to complete treatment, which leads to better outcomes. This can exacerbate existing disparities. Findings highlight the need for systems change and advocacy for children in less advantaged environments and meeting families in their specific context, to combat treatment disparities.
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