Predictors of Attrition Among Young Children Receiving Trauma-Focused Therapy

Holistic Approach to Gun Violence

The purpose of this manuscript is to provide holistic practice strategies for the care of victims of gun violence. Gun violence is a public health crisis with a significant increase following the pandemic. The impact of Covid-19 restrictions placed an increase burden on some communities already overwhelmed with poverty, crime, and deteriorating homes. The overrepresentation of African American males as victim of gun violence indicates a health care disparity which needs to be addressed. The Theory of Reasoned Action and Theory of Planned Behavior are a theoretical framework that provides insight to the social behaviors associated with gun violence. The holistic approach recognizes the interconnection between individuals and environment, in order to facilitate the healing process for victims of gun violence, social factors and environment must be incorporated into their care.

Attrition from pediatric trauma-focused cognitive behavioral therapy: A meta-analysis

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the leading interventions for trauma-exposed children and adolescents and is associated with significant improvements in a variety of trauma-related symptoms. Nonetheless, attrition from TF-CBT is quite common, and children who do not receive the full intervention may continue to suffer from trauma-related symptoms. Rates of premature termination have varied across studies, and to date, no meta-analyses have been conducted regarding dropout from TF-CBT. The objective of the present study was to conduct a meta-analysis of the rates of attrition from TF-CBT, as well as review factors related to premature termination from this intervention. A total of 22 studies were available for inclusion in this meta-analysis. The prevalence of attrition was 33.9% (95% CI [26.2%, 42.5%]) from 2,059 children receiving TF-CBT. Clinician-rated attrition was 38.5%, and 17.5% did not receive an adequate dose of TF-CBT (e.g., 12+ sessions). Further, the study type was related to differing rates of dropout, with randomized controlled trials having a much lower attrition rate. Regarding risk factors for premature termination, the emerging literature suggests that a child's age, racial-ethnic minority status, and symptom levels may evince some ties to attrition. Caregiver, family, therapist, and treatment factors remain underexplored in relation to premature termination; however, preliminary work suggests that lack of caregiver attendance and difficulty in the child-therapist relationship may be related to attrition. A substantial number of children prematurely terminate from TF-CBT, underscoring the need to better prevent dropout.