Targeting Trauma in Treatment for Youth with Posttraumatic Stress Disorder: Predictors and Outcomes
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2023
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Abstract
Youth in public mental health care (PMHC) settings often have been exposed to a disproportionate amount of trauma, and some such youth carry a diagnosis of posttraumatic stress disorder (PTSD). Despite research supporting the use of traumatic stress focused treatment, studies show that the implementation of such interventions is not as common as expected. This study examined whether a comorbid externalizing diagnosis or concerns about suicidality during treatment might account for low targeting of trauma in treatment for youth with PTSD. Based on clinical records of a sample of youth (N = 594) diagnosed with PTSD and provided intensive in-home services within a statewide PMHC system, the current study investigated whether and to what extent the presence of one or more comorbid externalizing disorders or the targeting of suicidality at any point in treatment was associated with a lower likelihood of traumatic stress targeting. Additionally, this study compared youth clients for whom traumatic stress was and was not targeted to examine whether treatment that included at least some focus on traumatic stress for youth with PTSD was associated with youth functioning status at the end of treatment after controlling for initial functioning.Multiple logistic regression analyses revealed that the presence of a comorbid externalizing disorder was not significantly related to whether traumatic stress was targeted during treatment. Additionally, even when accounting for initial impairment, endorsement of suicidality as a treatment focus predicted higher, not lower, likelihood of traumatic stress targeting. Other significant predictors of traumatic stress targeting included youth clients being female, younger at the start of treatment, and having longer treatment durations. Regarding treatment outcomes, linear regression analyses indicated that targeting traumatic stress in treatment was unrelated to final functional impairment (bivariately or after controlling for initial impairment). Furthermore, the overall variance accounted for by the final linear regression model was limited, suggesting that there might be other factors outside the scope of this study that contribute to treatment outcomes for PTSD youth receiving PMHC treatment. Future research, including the investigation of sex-based treatment differences among youth with PTSD, would advance our understanding of how treatment decisions are made for youth diagnosed with PTSD, and how these decisions relate to clinical outcomes.
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Clinical psychology, Therapy, Public health, posttraumatic stress disorder, public mental health care, treatment decision making, treatment outcomes, treatment targets, youth
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59 pages
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