Abstract
A randomized control trial was used to evaluate the effectiveness of a home-based, parent-and-child therapy program specifically developed for toddlers and preschoolers living in poverty with trauma symptoms. Sixty-four children 5-years of age and younger were referred to a community-based clinic for behavior problems and emotional difficulties. All children had experienced one or more potentially traumatic events and met the DSM-5’s criteria for Post-Traumatic Stress Disorder in Children Six Years of Age and Younger. All families received government assistance indicating that their income met the federal definition for poverty. Participants were randomly assigned to either immediate treatment or wait list control groups. Significant between-group differences on all post-treatment measures were found. After the waitlist group completed treatment, significant improvements for both groups were found on all measures at six-weeks follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver adherence to treatment strategies. This study offers support for early intervention of children with trauma symptoms and identifies the clinical challenges and advantages of providing therapy services in a home setting for very young children in poverty.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.
Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic. American Journal of Orthopsychiatry, 64, 577–585. doi:10.1037/h0079571.
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., … & Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4, 34–51. doi:10.1080.19361521.2011.545046.
Barkham, M., Connell, J., Stiles, W. B., Miles, J. N., Margison, F., Evans, C., & Mellor-Clark, J. (2006). Does-effect relations and responsive regulation of treatment duration: The good enough level. Journal of Consulting and Clinical Psychology, 74, 160–167. doi:10.1037/0022-006x.74.1.160.
Bernard, K., Dozier, M., Bick, J., Lewis-Morrarty, E., Lindhiem, O., & Carlson, E. (2012). Enhancing attachment organization among maltreated infants: Results of a randomized clinical trial. Child Development, 83, 623–636. doi:10.1111/j.14678624.2011.01712.x.
Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: Guilford Press.
Briere, J., & Scott, C. (2012). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). Thousand Oaks: Sage.
Briggs-Gowan, M. J., Ford, J. D., Fraleigh, L., McCarthy, K., & Carter, A. S. (2010). Prevalence of exposure to potentially traumatic events in a healthy birth cohort of very young children in the northeastern United States. Journal of Traumatic Stress, 23, 725–733. doi:10.1002/jts.20593.
Chadwick Center for Children and Families. (2008). Assessment-based treatment for traumatized children: A trauma assessment pathway (TAP). Retrieved from http://www.taptraining.net
Chu, A., & Lieberman, A. (2010). Clinical implications of traumatic stress from birth to age five. Annual Review of Clinical Psychology, 6, 469–494. doi:10.1146/annualrev.clinpsy.121208.131204.
Cohen, J. (1998). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford.
Collins, K., Connors, Il, Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, … & Thompson, E. (2010). Understanding the impact of trauma and urban poverty on family systems: Risks, resilience, and interventions. Baltimore: Family Informed Trauma Treatment Center. Retrieved from http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar or http://fittcenter.umaryland.edu/WhitePaper.aspx
Eyberg, S., & Pincus, D. (1999). Eyberg Child Behavior Inventory & Sutter-Eyberg Student Behavior Inventory-Revised: Professional Manual. Odessa: Psychological Assessment Resources.
Finkelhor, D., Ormond, R. K., & Turner, H. A. (2009). Lifetime assessment of poly-victimization in a national sample of children and youth. Child Abuse & Neglect, 33, 403–411. doi:10.1016/j.chigbu.2008.09.102.
Ford, J., & Rogers, K. (1997). Empirically based assessment of trauma and PTSD with children and adolescents. Montreal: Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies.
Ford, J. D., Courtois, C. A., Steele, K., Hart, O. V. D., & Nijenhuis, E. R. (2005). Treatment of complex posttraumatic self-dysregulation. Journal of Traumatic Stress, 18, 437–447. doi:10.1002/jts.20051.
Fox, R. A. (2017). Early Pathways: Home-Based Mental Health Services for Very Young Children in Poverty. Unpublished manuscript, Marquette University (Available for free download at www.marquette.edu/education/early-pathways.
Fox, R. A., & Holtz, C. A. (2009). Treatment outcomes for toddlers with behavior problems from families in poverty. Child and Adolescent Mental Health, 14, 183–189. doi:10.1111/j.1475-3588.2009.00527.x.
Fox, R. A., & Nicholson, B. C. (2003). Parenting young children: A facilitator’s guide. Longmont: Sopris West.
Fox, R. A., Keller, K. M., Grede, P. L., & Bartosz, A. M. (2007). A mental health clinic for toddlers with developmental delays and behavior problems. Research in Developmental Disabilities, 28, 119–129. doi:10.1016/j.ridd.2006.02.001.
Frederick, C. (1985). Children traumatized by catastrophic situations. In S. Eth & R. S. Pynoos (Eds.), Posttraumatic stress disorder in children (pp. 73–99). Washington, DC: American Psychiatric Press.
Fung, M. P., & Fox, R. A. (2014). The culturally-adapted early pathways program for young Latino children in poverty: A randomized controlled trial. Journal of Latina/o Psychology, 2, 131–145. doi:10.1037/lat0000019.
Fung, M. P., Fox, R. A., & Harris, S. E. (2014). Treatment outcomes for at-risk young children with behavior problems: Toward a new definition of success. Journal of Social Service Research, 40, 623–641. doi:10.1080/01488376.2014.915283.
Garner, A.S., Shonkoff, J. P., Siegel, B.S., Dobbins, M. I., Earls, M. F., Garner, A. S., … & Wood, D. L. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: Translating developmental science into lifelong health. Pediatrics, 129, e224-e231. doi:10.1542/peds.2011-2662.
Ghosh-Ippen, C., Ford, J., Racusin, R., Acker, M., Bousquet, K., Rogers, C., … & Edwards, J (2002). Traumatic Events Screening Inventory: Parent report revised. San Francisco: The Child Trauma Research Project of the Early Trauma Network and The National Center for PTSD Dartmouth Child Trauma Research Group.
Gray, M., & Slagle, D. (2006). Selecting a potentially traumatic event screening measure: Practical and psychometric considerations. Journal of Trauma Practice, 5, 1–19. doi:10.1300/J189v05n02-01.
Gresl, B., L., Fox, R. A., & Besasie, L. A. (2016) Development of a barriers scale to predict early treatment success for young children in poverty with behavior problems. Clinical Practice in Pediatric Psychology, 4, 249-262. doi:10.1037/cpp0000124.
Gupta, S. K. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2, 109–112. doi:10.4103/2229-3485.83221.
Harris, S. E., Fox, R. A., & Love, J. R. (2015). Early Pathways therapy for young children in poverty: A randomized controlled trial. Counseling Outcome Research and Evaluation, 6, 3–17. doi:10.1177/2150137815573628.
Harris, S. E., Fox, R. A., & Holtz, C. A. (2016). Screening for significant behavior problems in young children living in poverty. Journal of Child and Family Studies, 25, 1076–1085. doi:10.1007/s10826-015-0300-x.
Herman-Smith, R. (2013). Intimate partner violence exposure in early childhood: An ecobiodevelopmental perspective. Health and Social Work, 38, 232–239. doi:10.1093/hsw/hlt018.
Holtz, C. A., & Fox, R. A. (2012). Behavior problems in young children from low-income families: The development of a new screening tool. Infant Mental Health Journal, 33, 82–94. doi:10.1002/imhj.20341.
Jensen, T. K., Holt, T., Ormhaug, S. M., Egeland, K., Granly, L., Hoaas, L.C., … & Wentzel-Larsen, R. (2014). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. Journal of Clinical Child & Adolescent Psychology, 43, 1–14. doi:10.1080/153744162013.822307.
Kazdin, A. E., & Mazurick, J. L. (1994). Dropping out of child psychotherapy: Distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62, 1069–1074. doi:10.1037/0022-006X.62.5.1069.
Lang, J. M., Ford, J. D., & Fitzgerald, M. M. (2010). An algorithm for determining use of trauma-focused cognitive behavioral therapy. Psychotherapy: Theory, Research, Practice, and Training, 47, 554–569. doi:10.1037/a0021184.
Lieberman, A. F., & Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: The Guilford Press.
Lieberman, A. F., Chu, A., Van Horn, P., & Harris, W. W. (2011). Trauma in early childhood: Empirical evidence and clinical implications. Development and Psychopathology, 23, 397–410. doi:10.1017/S0954579411000137.
Meiser-Stedman, R., Smith, P., Glucksman, E., Yule, W., & Dagleish, T. (2008). The posttraumatic stress disorder in preschool- and elementary school-age children exposed to motor vehicle accidents. American Journal of Psychiatry, 165, 1326–1337. doi:10.1176/appi.ajp.2008.07081282.
National Child Traumatic Stress Network (2012). ABC: Attachment and Biobehavioral Catch-up. Trauma-informed interventions. Retrieved from www.NCTSN.org
Rowan, K., McAlpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care by insurance status, 1999–2010. Health Affairs, 32, 1723–1730. doi:10.1377/hlthaff.2013.0133.
Santiago, C., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low-income adults and children fare in psychotherapy? Journal of Clinical Psychology, 69, 115–126. doi:10.1002/jclp.21951.
Saylor, C. F., Swenson, C. C., Reynolds, S. S., & Taylor, M. (1999). The Pediatric Emotional Distress Scale: A brief screening measure for young children exposed to traumatic events. Journal of Clinical Child Psychology, 28, 70–81. doi:10.1027/S15374424jccp2901-6.
Sheeringa, M. S. (2011). PTSD in children younger than the age of 13: Toward developmentally sensitive assessment and management. Journal of Child & Adolescent Trauma, 3, 181–197. doi:10.1080/19361521.2011.597079.
Sheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three- through six-year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52, 853–860. doi:10.1111/j.1469-7610.2010.02354x.
Shonkoff, J. P., Garner, A. S., & The Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, 232–246 Retrieved from http://aappolicy.aap-publications.org/cgi/content/full/pediatrics;129/1/ e232.
Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice, 5, 439–458. doi:10.1111/j.1468-2850.1998.tb00166.x.
Thompson, R. A. (2014). Stress and child development. The Future of Children, 24, 41–59.
U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2016). Childhood maltreatment 2014. Retrieved from http://www.acf.hhs.gov/programs/cb/research-datatechnology/statistics-research/child-maltreatment
Viera, A. J., & Garret, J. M. (2005). Understanding inter-observer agreement: The Kappa statistic. Research Series, 37, 360–363.
Acknowledgements
This research was supported in part by grants from Charles D. Jacobus Family Foundation, Greater Milwaukee Foundation, Helen Bader Foundation, Hearst Foundation, Roger and Cindy Schaus Family, Substance Abuse and Mental Health Services Administration (Grant SM063056), United Way and the Zilber Family Foundation.
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Love, J.R., Fox, R.A. Home-Based Parent Child Therapy for Young Traumatized Children Living In Poverty: A Randomized Controlled Trial. Journ Child Adol Trauma 12, 73–83 (2019). https://doi.org/10.1007/s40653-017-0170-z
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DOI: https://doi.org/10.1007/s40653-017-0170-z