Symposia
Dissemination & Implementation Science
Briana S. Last, M.A.
Doctoral Candidate
University of Pennsylvania
Philadelphia, Pennsylvania
Briana S. Last, M.A.
Doctoral Candidate
University of Pennsylvania
Philadelphia, Pennsylvania
Christina Johnson, BA
Clinical Research Coordinator
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA
Chynna Mills, BA
Research Coordinator
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Natalie Dallard, MA
Child Trauma Operations Specialist
Community Behavioral Health
Philadelphia, PA
Sara Fernandez-Marcote, MEd, LPC
Project Manager
Community Behavioral Health
Philadelphia, Pennsylvania
Rinad Beidas, PhD
Associate professor of Psychiatry
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Background: Philadelphia is an economically unequal and racially segregated city, with 68% of its youth insured by Medicaid. To address the high rates of trauma faced by youth, in 2012, the city began training clinicians serving publicly insured youth in the evidence-based intervention trauma-focused cognitive behavioral therapy (TF-CBT). This study aims: 1) to evaluate TF-CBT effectiveness for publicly insured youth from 2013-2021, and 2) to assess whether social inequities predict caregiver engagement or moderate treatment outcomes.
Methods: Data collection occurred in two waves. Wave 1 (n = 114) occurred between 2013-2016 and Wave 2 (n = 91) occurred from 2016-2021. Youth receiving TF-CBT in Philadelphia’s public clinics were diagnostically evaluated every 6 months. The following symptom measures were used: the Trauma Symptom Checklist for Young Children, the Child PTSD Symptom Scale, and the PTSD Symptom Scale. The Parent Participation Engagement Measure assessed caregiver treatment engagement. Social inequities were measured using primary and secondary data. Wave 2 participants completed the Accountable Health Communities Health-Related Social Needs Screening Tool and the Urban Life Stressor Scale. For both waves, Census-tract level measures of socioeconomic status were extracted from the American Community Survey.
Analysis: For Aim 1, multilevel linear models will assess youth treatment outcomes accounting for nested observations. For Aim 2, multilevel linear models will evaluate whether social inequities predict caregiver engagement or moderate treatment outcomes.
Results: Data collection is complete, and analysis will be completed by May 2022. Wave 1’s 114 youth participants ranged in age from 5-19 years-old (M = 12.01, SD = 3.93). Most youth identified as female (n = 64, 56.7%), non-Hispanic/Latinx (n = 71, 62.3%), and half (n = 55, 48.3%) identified as Black/African American. Of the 114 youth who completed a baseline assessment, 72 (63.2%) completed at least one follow-up assessment. Wave 2’s 91 youth ranged in age from 4-20 years-old (M = 11.71, SD = 4.0). Most youth identified as female (n = 62; 68.1%), Black/African American (n = 49; 53.8%), and non-Hispanic/Latinx (n = 59; 64.8%). Fifty-nine youth (64.8%) completed at least one follow-up assessment.
Conclusion: A well-documented “voltage drop” in effect sizes exists when treatments move from efficacy trials to community settings. It is important to measure whether social inequities create structural barriers to caregivers engaging in or youth improving from treatment.