Access to therapy for child sexual abuse survivors: Preliminary dialogue of barriers and facilitators between caregivers.

BACKGROUND: Difficulties in access to therapy were highlighted by COVID-19 measures restricting in-person gatherings. Additional challenges arise when focusing on caregivers of child sexual abuse (CSA) survivors in particular, which are a population that has been historically difficult to engage with due to issues of stigma and confidentiality. OBJECTIVES: To present preliminary qualitative results from caregivers of CSA survivors. METHODS: This study was conducted with caregivers of CSA survivors. Two hybrid webinar/focus groups were conducted using a video conferencing platform in fall of 2021 with two groups of stakeholders (11 caregivers and 5 moderators/clinical staff at Little Warriors, an intensive episodic treatment facility). Sessions were recorded, transcribed, and thematically-analyzed using standard qualitative methodology. RESULTS: A total of 11 caregivers contributed to the data. Themes include: (1) Challenges of starting and maintaining treatment (i.e., emotional impact of intake day, challenges of enrolling), (2) Therapeutic benefits of specialized treatment (i.e., feeling safe and supported and the importance of trauma-informed care), and (3) Barriers and facilitators of treatment (i.e., avenues to scale-up and self-care). CONCLUSION: The importance of a strong therapeutic alliance was highlighted by both caregivers/clinical staff and further support is needed for families post-treatment. The present hybrid webinar/focus group also achieved engagement goals in a population that is typically difficult to reach. Overall, the response rate (12%) was equivalent to reported registrant attendance rates for general business to consumer webinars and the recommended focus group size. This preliminary approach warrants replication in other populations outside our clinical context.

Early Mental Health Foundations: A Scoping Review of Reflective Functioning in Caregiver-Child Dyads.

International public health strategies indicate a need for equitable resources for wellness in younger children and their caregivers. Reflective functioning, a proxy for emotional regulation abilities, is a key area in this domain. As an emerging area, reflective functioning has not been mapped comprehensively and requires systematic investigation. This review examines "what qualitative and quantitative evidence is there for the value of reflective functioning assessment and intervention studies in caregiver-child dyads?" This scoping review focused on data published to September 2021, focusing on caregivers of children ≤36 months of age (including Medline, PsycINFO, CINAHL, ERIC, Scopus, Web of Science, and Embase). Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed. From 5162 initial articles, 608 papers were screened for full text yielding a final 181 papers. Only 69 studies included multiple ethnicities. Seven of the 69 studies included at least 1 Indigenous person. No studies were conducted in low- to middle-income countries, and no studies reported data on gender identity. This review comprises a novel and comprehensive mapping of the reflective functioning literature in terms of both assessment and intervention studies. The present mapping of the reflective functioning literature indicates the importance of health disparities in caregiver-child dyads (these include gaps and needs for future research). In relation to gaps, studies of adverse childhood experience, consideration of equity, diversity, and inclusion, and global mental health are underrepresented. Future research is needed to provide information on the relevance of gender identity and low- to middle-income countries in relation to the impact on reflective functioning in this context.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts.

BACKGROUND: Child sexual abuse (CSA) is a form of early-life trauma that affects youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative to investigate the potential impact of added stress on already vulnerable populations. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a multimodal treatment program on mental health outcomes for youth CSA survivors aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 on treatment outcomes. PARTICIPANTS AND SETTING: Participants of this study were children and youth aged 8-17 who were engaged in a complex multimodal treatment program specifically designed for youth CSA survivors. METHODS: Participants were asked to complete self-report surveys at baseline and at the end of two subsequent treatment rounds. Surveys consisted of measures pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and (5) self-esteem. RESULTS: Median scores improved for all groups at all timepoints for all five domains. For the pre-Covid participants, the largest improvements in the child program were reported in depression (36.6 %, p = 0.05); in the adolescent program anxiety showed the largest improvement (-35.7 %, p = 0.006). Improvements were generally maintained or increased at the end of round two. In almost every domain, the improvements of the pre-COVID group were greater than those of the COVID-I group. CONCLUSIONS: A complex multimodal treatment program specifically designed for youth CSA survivors has the capacity to improve a number of relevant determinants of mental health and well-being. The COVID-19 pandemic may have retraumatized participants, resulting in treatment resistance.

Five year cost savings of a multimodal treatment program for child sexual abuse (CSA): a social return on investment study.

BACKGROUND: Specialized mental health services for the treatment of Child Sexual Abuse (CSA) are generally expensive and labour intensive. They require a trauma-informed approach that may involve multiple services and therapeutic modalities, provided over the course of several months. That said, given the broad-ranging, long term negative sequelae of CSA, an evaluation of the cost-benefit analysis of treatment is clearly justified. METHODS: We performed a Social Return on Investment (SROI) analysis of data gathered as part of the treatment program at the Be Brave Ranch in Edmonton, Canada to determine the value-for-money of the services provided. We endeavoured to take a conservative, medium-term (5 year) perspective; this is in contrast to short term (1-2 year) effects, which may rapidly dissipate, or long term (15-20 year) effects, which are likely diffuse and difficult to measure. As such, our analysis was based on an average annual intake of 100 children/adolescents (60:40 split) and their families, followed over a five-year timeframe. Financial proxies were assigned to benefits not easily monetized, and six potential domains of cost savings were identified. RESULTS: Our analyses suggest that each dollar spent in treatment results in an average cost savings of $11.60 (sensitivity analysis suggests range of 9.20-12.80). The largest value-for-money was identified as the domain of crisis prevention, via the avoidance of rare but costly events associated with the long term impacts of CSA. Somewhat surprisingly, savings related to the area of criminal justice were minimal, compared to other social domains analysed. Implications are discussed. CONCLUSIONS: Our results support the cost effectiveness of the investment associated with specialized, evidence-based early interventions for CSA. These approaches alleviate severe, negative outcomes associated with CSA, resulting in both economic savings and social benefits. These findings rest upon a number of assumptions, and generalizability of these results is therefore limited to similar programs located in comparable areas. However, the SROI ratio achieved in this analysis, in excess of $11:1, supports the idea that, while costly, these services more than pay for themselves over time.

A Novel 2-week Intensive Multimodal Treatment Program for Child Sexual Abuse (CSA) Survivors is Associated with Mental Health Benefits for Females aged 13-16.

OBJECTIVE: The aim of this study was to evaluate the psychiatric outcomes for the first cohorts of adolescent female Child Sexual Abuse (CSA) survivors after two-weeks in an intensive multimodal treatment program designed for this population. METHODS: Baseline data was collected at intake and again immediately prior to discharge. Data collected included demographic information, as well as measurement of standardized scales for PTSD, depression, anxiety, quality of life, self-esteem, and resilience. Mean scores at baseline and discharge were statistically analyzed to assess for changes following the treatment program on these measures. RESULTS: From the first twenty-seven (27) adolescent female CSA survivors, who completed two-weeks of the multimodal treatment program, all three symptomatic scales showed statistically significant improvements from baseline. There were decreases in mean questionnaire scores for Depression (-23.8%, p = 0.001), Anxiety (-20.6%, p = 0.006), and PTSD (-20.3%, p = 0.002), as well as decrease of nearly 50% in the number of participants who were having active suicidal thoughts. In keeping with this, there were also statistically significant improvements in ratings for Quality of Life (17.6%, p = 0.022), Self-Esteem (22.9%, p = 0.010), and Resilience (6.9%, p = 0.019). CONCLUSION: This study presents preliminary findings from an intensive two-week multimodal treatment program specifically designed to help survivors of child sexual abuse (CSA). The highly positive short-term findings suggest that further longer-term follow-up in larger groups is appropriate. These preliminary results also support ongoing research for such intensive multimodal programs.

OBJECTIF: La présente étude visait à évaluer les résultats psychiatriques des premières cohortes d'adolescentes survivantes d'abus sexuels sur des enfants (ASE) après deux semaines d'un programme de traitement multimodal intensif conçu pour cette population. MÉTHODES: Les données de base ont été recueillies à l'admission et de nouveau, immédiatement avant le congé. Les données recueillies comprenaient l'information démographique ainsi que les mesures aux échelles normalisées du trouble de stress post-traumatique (TSPT), de la dépression, de l'anxiété, de la qualité de vie, de l'estime de soi et de la résilience. Les scores moyens à la base et au congé ont été statistiquement analysés pour évaluer les changements suite au programme de traitement sur ces mesures. RÉSULTATS: Pour les vingt-sept (27) premières adolescentes survivantes d'ASE qui ont suivi les deux semaines du programme de traitement multimodal, les trois échelles symptomatiques indiquaient des améliorations statistiquement significatives par rapport à la base. Il y a eu diminution des scores moyens aux questionnaires pour la dépression (−23,8 %, p = 0,001), l'anxiété (−20,6 %, p = 0,006), et le TSPT (−20,3 %, p = 0,002), ainsi qu'une réduction de près de 50 % du nombre de participantes qui avaient une idéation suicidaire active. Dans le même ordre d'idées, il y a aussi eu des améliorations statistiquement significatives des scores de la qualité de vie (17,6 %, p = 0,022), de l'estime de soi (22,9 %, p = 0,010), et de la résilience (6,9 %, p = 0,019). CONCLUSION: Cette étude présente les résultats préliminaires d'un programme de traitement multimodal intensif de deux semaines spécifiquement conçu pour aider les survivants d'abus sexuel sur les enfants (ASE). Les résultats à court terme très positifs suggèrent qu'un suivi à plus long terme pour de grands groupes est approprié. Ces résultats préliminaires suggèrent aussi la poursuite des recherches de tels programmes multimodaux intensifs.