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Improving Health and Behavioral Outcomes
among Sexually Victimized Male Youth:
A Qualitative Investigation among Treatment...
Presentation
Overview
Introduction
Study Rationale/ Objectives
Methodology
Preliminary Findings
Implications
Next Steps
Overview
Sexually victimized youth are at
an increased risk for deleterious
behavioral and health
outcomes1,2
Approximatel...
Treatment Practices for Youth Sexual Abuse
Evidence-based treatment programs are available to mitigate mental
health probl...
TF-CBT Components “PRACTICE”4-7
Psychoeducation, parenting skills
Relaxation skills
Affective expression and modulation
Co...
Additional Trauma-Based Interventions
•Cognitive Behavioral Therapy
•Cognitive Processing Therapy
•Eye Movement Desensitiz...
Gaps In Research and Practice
No known published studies on:
◦ Types of trauma-based services offered across
Ontario
◦ Gen...
Study Objectives
Using qualitative inquiry:
1. To understand what trauma-based services for youth victims of sexual
abuse ...
Procedure
17 agencies contacted (inpatient/ outpatient settings, child advocacy
centers, homeless shelters)
Eligibility: O...
Interview Guide- Question Categories
•Agency & Provider Roles
•Treatment Provision and Decision-Making Process
•Youth Enga...
Study Participants- Providers
•Number of sites: 9
•Current number of interviews completed
• Focus groups (n=3), Joint Inte...
Study Participants-Providers
Currently work with:
• Males: 87%
• Females: 100%
• Transgender: 82%
• Other: 21% (non-binary...
Services Currently Offered
◦ TF-CBT*
◦ Narrative Therapy
◦ DBT*
◦ Prolonged Exposure
◦ Play Therapy
◦ Family Counseling
◦ ...
(Ongoing) Qualitative Analyses
Qualitative Analyses
•NVivo 12
•Three coders
•Content analysis
•For today: transcripts openly coded for thematic elements
Preliminary Findings- Services Offered
•Service providers offer mix of broad-based services as treatment for
youth
“It’s q...
Preliminary Findings- Services Offered
◦ Decision making process: youth influence treatment delivery
“It’ll be a collabora...
Preliminary Findings- Gender Adaptations
•Non-specific gender modalities delivered to all youth
•Youth discussions on gend...
Emerging Themes and Additional
Considerations
•Gender presentation of symptomology
•Caregivers of youth have own mental he...
Next Steps
Continue data collection
◦ Northern Ontario
◦ Indigenous communities
Data analyses
◦ Transcribing
◦ Coding
◦ In...
Long-term Goal
Pilot program evaluation study assessing feasibility and acceptability
adapted (?) TF-CBT intervention for ...
THANK YOU!
Ashwini Tiwari: tiwari.as1@gmail.com/
tiwara3@mcmaster.ca
Additional Members of The
Research Team:
❖ Ms. Natash...
1. Barth J, Bermetz L, Heim E, Trelle S, Tonia T. The current prevalence of child sexual abuse worldwide: a systematic rev...
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ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers

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Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers

Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)

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ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers

  1. 1. Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation among Treatment Providers in Ontario ASHWINI TIWARI, PHD, NATASHA VAN BOREK, MSCPPH, MELISSA KIMBER, PHD, CHRIS WEKERLE, PHD, SAVANAH SMITH, ANDREA GONZALEZ, PHD MCMASTER UNIVERSITY
  2. 2. Presentation Overview Introduction Study Rationale/ Objectives Methodology Preliminary Findings Implications Next Steps
  3. 3. Overview Sexually victimized youth are at an increased risk for deleterious behavioral and health outcomes1,2 Approximately 22.1% of female youth and 8.3% of male youth ages 12-18 years of age are sexually abused annually in Ontario, Canada3
  4. 4. Treatment Practices for Youth Sexual Abuse Evidence-based treatment programs are available to mitigate mental health problems associated with youth trauma ◦ “Gold Standard” treatment among sexually abused youth: Trauma- Focused Cognitive Behavioral Therapy (TF-CBT)4-7
  5. 5. TF-CBT Components “PRACTICE”4-7 Psychoeducation, parenting skills Relaxation skills Affective expression and modulation Cognitive Coping and processing Trauma Narration In vivo mastery of trauma reminders Conjoint child-parent sessions Enhancing future safety and development Phase 1 Stabilization Phase 2 Trauma Narrative Phase 3 Integration / Consolidation
  6. 6. Additional Trauma-Based Interventions •Cognitive Behavioral Therapy •Cognitive Processing Therapy •Eye Movement Desensitization and Reprocessing •Dialectical Behavior Therapy •Prolonged Exposure •Brief Eclectic Psychotherapy •Play Therapy •Narrative Therapy •Risk Reduction through Family Therapy
  7. 7. Gaps In Research and Practice No known published studies on: ◦ Types of trauma-based services offered across Ontario ◦ Gender adaptations made to services ◦ Service delivery in community settings ◦ Do providers delivery adhere to treatment services as intended?
  8. 8. Study Objectives Using qualitative inquiry: 1. To understand what trauma-based services for youth victims of sexual abuse are offered in Ontario, Canada and their delivery 2. To learn of gender-adaptations (if any) that are made by service providers during delivery in community settings
  9. 9. Procedure 17 agencies contacted (inpatient/ outpatient settings, child advocacy centers, homeless shelters) Eligibility: Ontario service provider of trauma-based treatment for youth victims of sexual abuse ◦ All levels of experience and training In-person / phone individual or group interviews (5-6 persons) with trained interviewer
  10. 10. Interview Guide- Question Categories •Agency & Provider Roles •Treatment Provision and Decision-Making Process •Youth Engagement and Retention in Treatment •Youth Social Support and Caregiver Involvement •Treatment Barriers and Facilitators Gender-context*
  11. 11. Study Participants- Providers •Number of sites: 9 •Current number of interviews completed • Focus groups (n=3), Joint Interviews (n=2), Individual Interviews (n=7) •Education: ~30% with Bachelors/ College; 50% Master’s; 21% Doctorate •Ethnicity: 82% Caucasian, 13% Black, 5% Asian •Age: 39.2 years (SD=10.8); Range: 26-63 years •Managers (7), Psychologists (6), Social Workers (3), Clinical Therapists (6), Clinical Leads (2)
  12. 12. Study Participants-Providers Currently work with: • Males: 87% • Females: 100% • Transgender: 82% • Other: 21% (non-binary) Youth age: •2-5 years: 20.8% •6-11 years: 41.7% •12-17 years: 95.8% •18-25 years: 54.2% •25+: 12.5%
  13. 13. Services Currently Offered ◦ TF-CBT* ◦ Narrative Therapy ◦ DBT* ◦ Prolonged Exposure ◦ Play Therapy ◦ Family Counseling ◦ Mindfulness ◦ Art Therapy ◦ Psychodynamic Therapy ◦ ITTM ◦ CPT ◦ Emotion Focused Therapy
  14. 14. (Ongoing) Qualitative Analyses
  15. 15. Qualitative Analyses •NVivo 12 •Three coders •Content analysis •For today: transcripts openly coded for thematic elements
  16. 16. Preliminary Findings- Services Offered •Service providers offer mix of broad-based services as treatment for youth “It’s quite eclectic… I have training in that [narrative therapy], I also do CBT, trauma focused CBT, I have some DBT training, Jack of all trades master of none sort of thing…It makes me flexible.. I am not stuck with one type of modality. I wish I could, I would like to do some more training on EMDR perhaps, but I’m definitely not rigid in my treatment style.”
  17. 17. Preliminary Findings- Services Offered ◦ Decision making process: youth influence treatment delivery “It’ll be a collaborative process so like what do you want, what do we recommend, how does that fit together, where do we start, where do you want to start, where do you not want to start...that kind of stuff.” “ I don’t follow a manual per say, I meet the client where there at and depending on what they bring to session that particular day determines what art directive we would work on and how we would process the emotions or feelings that are connected to it.”
  18. 18. Preliminary Findings- Gender Adaptations •Non-specific gender modalities delivered to all youth •Youth discussions on gender identify is important during therapy “I think there is a difference between you know, what the identities of clients are coming in with, and I don’t always know if that is recognized by every clinician. And so, I think like the plan is the same across the gender spectrum. The needs are the same. The modality can even be the same, but the stories might be different, and we just need to acknowledge that.”
  19. 19. Emerging Themes and Additional Considerations •Gender presentation of symptomology •Caregivers of youth have own mental health problems •Importance of building therapeutic alliance
  20. 20. Next Steps Continue data collection ◦ Northern Ontario ◦ Indigenous communities Data analyses ◦ Transcribing ◦ Coding ◦ Interpretation
  21. 21. Long-term Goal Pilot program evaluation study assessing feasibility and acceptability adapted (?) TF-CBT intervention for sexually victimized youth across all gender identities ▪Assess effects of TF-CBT on behavioral and physiological outcomes ▪Gender differences, trajectories over treatment Baseline Assessment TF-CBT (adapted?) Post Assessment
  22. 22. THANK YOU! Ashwini Tiwari: tiwari.as1@gmail.com/ tiwara3@mcmaster.ca Additional Members of The Research Team: ❖ Ms. Natasha Van Borek ❖ Dr. Melissa Kimber ❖ Dr. Christine Wekerle ❖ Ms. Savanah Smith ❖ Dr. Andrea Gonzalez
  23. 23. 1. Barth J, Bermetz L, Heim E, Trelle S, Tonia T. The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. International journal of public health. 2013;58(3):469-83. doi: 10.1007/s00038-012-0426-1. 2. Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American journal of public health. 2001;91(5):753-60. Epub 2001/05/10. PubMed PMID: 11344883; PMCID: PMC1446666. 3. MacMillan, H.L. et al.. (2013). Child physical and sexual abuse in a community sample of young adults: results from the Ontario Child Health Study. Child Abuse & Neglect, 37, 14- 21. 4. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). New York: The Guilford Press 5. de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., ... & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence. Psychiatric Services, 65(5), 591-602. 6. Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Heflin, A. H. (2015). Child sexual abuse: A primer for treating children, adolescents, and their nonoffending parents (2nd ed.). New York: Oxford University Press 7. Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393–402. http://dx.doi.org/10.1097/00004583-200404000-00005

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