Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)

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. Presentation
Overview
Introduction
Study Rationale/ Objectives
Methodology
Preliminary Findings
Implications
Next Steps

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. (Ongoing) Qualitative Analyses

15. Qualitative Analyses
•NVivo 12
•Three coders
•Content analysis
•For today: transcripts openly coded for thematic elements

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. 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. 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. Emerging Themes and Additional
Considerations
•Gender presentation of symptomology
•Caregivers of youth have own mental health
problems
•Importance of building therapeutic alliance

20. Next Steps
Continue data collection
◦ Northern Ontario
◦ Indigenous communities
Data analyses
◦ Transcribing
◦ Coding
◦ Interpretation

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. 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

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