1 - (IOP 4) Exploring Neighborhood Risk: Youth Trauma Symptom Severity, Treatment Engagement, and Treatment Outcomes

More than half of children and adolescents under 18 have experienced traumatic events. Exposure to those traumatic events is associated with an increased risk of developing posttraumatic stress disorder (PTSD), mood and anxiety and disorders, behavioral issues, and socioemotional difficulties. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment widely used to treat youth who have experienced post-traumatic symptoms. However, the effect of neighborhood risk factors (e.g., poverty, crime, or environmental stressors) on treatment implementation and outcomes remains understudied. Therefore, this study investigates how neighborhood risk impacts pre-treatment symptom severity, treatment completion, and treatment outcomes.
Using a single-group longitudinal design and a quasi-experimental design, de-identified data from a statewide implementation of TF-CBT in a Midwestern state will be analyzed. In collaboration with the state’s Department of Human Services (DHS), an implementation collaborative provided TF-CBT training to over 1,000 providers from 2006 to 2022. As part of the training, providers gathered de-identified client demographic information and standardized clinical assessments at intake (n = 8,435) and at treatment completion (n = 2,007). Youth posttraumatic stress symptoms were measured by the UCLA PTSD Reaction Index for the DSM-IV or DSM-5, and psychosocial adjustment was measured by the Strengths and Difficulties Questionnaire (SDQ). The study integrates geocoded clinic-level neighborhood risk indices, including poverty rate, crime rate, unemployment, median income, green space access, population density, and neighborhood health insurance coverage. Multilevel regression models will be used to assess whether neighborhood risk is related to baseline symptom severity, treatment completion rate, and treatment response, controlling for demographic factors. A quasi-experimental propensity score-matching approach will compare TF-CBT recipients with a statewide dataset of youth receiving other treatments.
Findings will enhance our understanding of social determinants of mental health treatment outcomes, potentially informing policies and interventions that optimize TF-CBT for trauma-exposed youth in diverse communities. This study addresses a critical gap in research by exploring how environmental contexts influence therapeutic engagement and effectiveness, ultimately contributing to more equitable mental health care solutions.