Exploring Barriers to Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) Treatment Completion

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for children impacted by trauma. Despite decades of empirical support for its efficacy, many children do not complete the full course of TF-CBT as designed. Up to 27% of children do not receive the full dose of treatment, limiting treatment effectiveness. Number of traumatic experiences, avoidance, post-traumatic stress symptoms, and foster care show mixed associations with treatment completion across evidence-based treatments overall, and it remains unknown if these same factors contribute to early termination of TF-CBT. Given documented barriers to participation (e.g., lack of parental involvement), further analysis using TF-CBT data is warranted. Thus, this study sought to identify client characteristics (e.g., residence status [living with parents versus not], number of trauma types [not including number of experiences], UCLA PTSD RI-5 scores and symptomology, and demographics [white, male, age]) associated with premature dropout or treatment transfer compared with treatment completion. The study used secondary baseline data from a statewide implementation of TF-CBT (N = 562 children). Multinomial logistic regression analyses revelated that children with a greater number of trauma types were significantly more likely to drop out of treatment or have their treatment transferred than complete TF-CBT. Under PTSD symptoms, children with higher arousal were more likely to transfer but children with higher re-experiencing symptoms were more likely to complete. This suggests that TF-CBT treatment may not be as accomplishable for children with multiple trauma types and tailoring based on these symptoms early may lead to less treatment transfer or dropout.