Category: Child / Adolescent - Trauma / Maltreatment
Objective: Disparities exist in the utilization of child abuse services, with ethnic minority families being significantly less likely to go on to receive evidence-based services (e.g. forensic interviews, mental health assessments, mental health treatment) despite being at greater risk for trauma exposure (Andrews et al., 2015). Children’s Advocacy Centers (CACs) are part of the acute response after a concern for interpersonal violence to provide services to children and families to help them heal from abuse. Service utilization from children seen at CACs may be different from general outpatient clinics, although this has not been explicitly examined in the literature. Thus, the primary goal of this study is to investigate ethnic differences in service attrition at CACs. Findings will also be presented on qualitative results which explored caregiver and Multidisciplinary Team (MDT) Professionals’ responses to Key Informant Interviews focused on identifying strategies for overcoming barriers to service initiation and engagement at CACs.
Method: Participants include 1,891 youth (52% female) between 2 and 18 years old (M=9.15) who were seen at a CAC in Charleston, SC in 2015. Participants identified as Black (39.8%), White (24.9%), Hispanic (7.7%), Biracial (4.5%), Asian or Pacific Islander (.2%), Other (.9%), or Unknown (22.1%). Treatment attrition was assessed through chart review of families referred to the CAC following suspected abuse or neglect. MDT members (n = 15) involved in the Key Informant Interviews were therapists, forensic interviewers, medical providers, law enforcement detectives, victim advocates, and child protection case managers. Interviewed caregivers (n = 15) were African American or Hispanic.
Results: Black clients missed significantly more assessment sessions (M = .16) than did White (p = .00; M = .05) or Hispanic (p = .02; M = .05) clients [F (6, 1884) = 6.28, p = .00]. White clients (M = .43) were significantly more likely [F (6, 1884) = 2.99, p = .01] to attend their initial assessment than clients of unknown ethnicities (p = .01; M = .3). There were no significant differences seen between ethnicities for the type of mental health treatment assigned (e.g., TF-CBT, AF-CBT, PCIT, CFTSI, abuse clarification, and supportive counseling). However, Black (M = 1.32) clients attended significantly fewer treatment sessions than White (p = .00; M = 2.6) clients [F (6, 1884) = 3.07, p = .01]. Moreover, Black clients (4.7%) were significantly less likely to graduate than White (11.9%) clients [X2 = 27.81, p = .00]. Results from Key Informant Interviews highlighted strategies for reducing treatment attrition (e.g., increasing access to services through offering extending hours) and improving cultural awareness of non-minority practitioners.
Conclusions: Results of the current investigation suggest that CACs should initiate strategies specifically aimed at reducing missed sessions for Black families in need of forensic interviews. Further, given that White clients attended significantly more treatment and were significantly more likely to graduate from treatment than Black clients, findings also have implications for better engaging Black families in mental health treatment following trauma exposure.
Isha Metzger– Postdoctoral Fellow, Medical University of South Carolina, Charleston, South Carolina
Rachael Garrett– Director of Education & Community Services, Dee Norton Child Advocacy Center
Kim Reese– Program Evaluation Manager, Dee Norton Child Advocacy Center
Heather Weimer– Program Evaluator, Dee Norton Child Advocacy Center
Carole Campbell Swiecicki– Executive Director, Dee Norton Child Advocacy Center
Kathy Reid Quinones– Director of Grants and Programs, Dee Norton Child Advocacy Center
Carla Kmett Danielson– Professor, Medical University of South Carolina
Michael de Arellano– Senior Associate Dean for Diversity, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
Medical University of South Carolina
Charleston, South Carolina
Director of Education & Community Services
Dee Norton Child Advocacy Center