(PS4-D89) Targeting Traumatic Stress Does Not Predict Functioning at Discharge Among Community Sample of Youth with Posttraumatic Stress Disorder

Estimates of the proportion of children and adolescents who have experienced one or more potentially traumatic events vary from 25% of youth in the general population to 90% of youth receiving services through public mental health care (Saunders & Adams, 2014). Among these youth, a subset experiencing persistent and impairing symptoms carry a diagnosis of posttraumatic stress disorder (PTSD). PTSD is a severe and complex mental health problem that can negatively affect the cognitive, emotional, and behavioral development of youth. Research supports the use of traumatic stress focused treatment as being effective and efficacious in decreasing PTSD symptoms among such youth (e.g., Cohen & Mannarino, 2015; Foa et al., 2013). Current public community mental health (PCMH) research, however, has shown that most youth with elevated scores of traumatic stress do not go on to receive treatment targeting traumatic stress (Starace, 2012). This comports with research that suggests a diagnosis of PTSD does not affect the type of PCMH treatment that youth receive. Little research to date has examined the extent to which treatment focused on traumatic stress is associated with positive treatment outcomes (e.g., improved functioning) within a PCMH sample. Indeed, findings in community mental health settings do not always comport with those from randomized control studies. There is growing literature suggesting that practices associated with positive outcomes in community-based mental health systems for children do not always follow those patterns observed in efficacy and effectiveness studies (e.g., Garland et al., 2010).  

Data from youth who received services from the Hawaiʻi state public mental health system between July 1, 2006 and June 30, 2017 and met certain criteria (carried a PTSD diagnosis and received in-home services) were analyzed (N = 428). The sample was approximately 50% male (n = 216), mostly multiethnic (n = 273), and had a mean age of 13.65 years (SD = 2.97). Youth functional impairment was measured using the Child and Adolescent Functional Assessment Scale (Hodges, 1998), a provider-report measure typically scored at the beginning and end of a treatment episode. Of the 428 youth in the sample, 43% (n= 184) received treatment targeting traumatic stress at any point. Surprisingly, multiple regression analyses revealed that among youth carrying a diagnosis of PTSD and receiving PCMH services, a treatment focus of traumatic stress was not a significant predictor of these youth’s functional impairment at treatment discharge.

Such research in PMHC is particularly important given that clients in these settings often are underrepresented in the current treatment research literature, come from diverse and disadvantaged backgrounds, often do not have access to private mental health services, and are particularly at-risk of developing complex mental health concerns in crisis events. Results from this study elucidate current treatment outcomes for a subset of these youth that are also reporting significant impairment following traumatic events and could help to spur PCMH research on effective implementation of cognitive behavioral therapies for such youth. Further findings and implications for effective treatment will be discussed.