Training providers at Children's Advocacy Centers to treat early childhood trauma: Perspectives on barriers, facilitators, and sustainability

Nearly half of child maltreatment victims are under the age of six, yet mental health providers are rarely trained in evidence-based treatments for this population. As interdisciplinary agencies that coordinate responses to child maltreatment, Children's Advocacy Centers (CACs) are well-positioned to facilitate access to trauma-focused treatment for an early childhood population, provided the proper training. The present study was a qualitative evaluation of the implementation of Child-Parent Psychotherapy (CPP), a treatment that addresses traumatic stress and child-parent attachment in children ages 0-5, in a statewide network of seventeen CACs. Participants were 17 clinicians, supervisors, and senior leaders from ten CACs who completed qualitative interviews about their experiences with implementation of CPP and their plans for sustainment of CPP. They were interviewed after approximately 8 months of an 18-month CPP training initiative and again approximately 2 months after the training initiative ended. Interview transcripts were coded using a conventional content analysis approach. We identified 11 major themes related to barriers and facilitators in the implementation and sustainment of CPP in CACs. Facilitators included meaningful expansion of services and certain aspects of the training process (e.g., group supervision). Barriers included difficulties with caregiver engagement and clinicians feeling "lost" during the extended learning process for CPP. Factors anticipated to affect future sustainment of CPP included staff turnover at CACs and the availability of CPP training in the future. Our results have implications for clinicians, administrators, and policymakers interested in the use of evidence-based treatments for specialty populations in multidisciplinary settings like CACs.