title: Barriers to successful treatment completion in child sexual abuse survivors.
abstract: Child sexual abuse (CSA) often requires psychological treatment to address the symptoms of victim trauma. Barriers to entry and completion of counseling services can compromise long-term well-being. An integrated medical and mental health evaluation and treatment model of a child advocacy center (CAC) has the potential to reduce barriers to mental health treatment.
  
  
  OBJECTIVE
  (a) to describe characteristics between CSA patients who engage versus those who do not engage in mental health treatment and (b) to identify factors associated with successful completion of mental health treatment goals. For design/setting, a retrospective cohort study was conducted of CSA patients (ages 3-16 years) referred to mental health services following a CAC assessment. Outcome variables included linkage with treatment and completion of treatment. Independent variables included demographics, abuse characteristics, and therapist characteristics. Data were abstracted from the CAC and billing databases.
  
  
  RESULTS
  Four hundred ninety subjects were evaluated. Subjects were as follows: predominately female (74%), White (60%), and more than half received Medicaid (56%). Mean age was 8.4 years. About 52% linked with mental health services and 39% of patients that successfully linked with mental health services completed therapy. Successful linkage was independently associated with referrals to other counseling services (AOR 8.4 [2.5, 27.7]). Successful completion of therapy was independently associated with caregiver participation in therapy (AOR 3.2 [1.8, 6.0]) and if the patient was referred to other counseling services (AOR 4.1 [1.9, 8.5]). There were no differences between subjects that linked and/or completed therapy and those that did not with regard to demographic characteristics or abuse severity.
  
  
  CONCLUSIONS
  In contrast to previous reports, efforts at our CAC seem to overcome linkage barriers in this population. However, there remain challenges in achieving successful completion of treatment goals in this population. Engaging caregivers' involvement in therapy services had a positive effect with successfully achieving treatment goals.
authors.affiliation: Akron Children's Hospital, Akron, OH 44504, USA. pmcpherson@chmca.org
authors.forename: Paul
authors.initials: P
authors.lastname: McPherson
authors.forename: Philip
authors.initials: P
authors.lastname: Scribano
authors.forename: Jack
authors.initials: J
authors.lastname: Stevens
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000628:therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008485:Medical Audit; D009820:Ohio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017741:Survivors