Date of Award

2026

Document Type

Thesis

Degree Name

MA in Psychology

Department

Psychology

First Advisor

Elissa J Brown

Second Advisor

William Chaplin

Abstract

In the United States, more than 60% of youth experience at least one trauma by age 16, and about one-third develop a trauma-related disorder. Evidence-based trauma-specific cognitive behavioral therapies (TS-CBTs) exist, yet fewer than 20% of trauma-exposed youth receive trauma-focused treatment, with dropout rates as high as 75% after treatment initiation. Referral sources are gatekeepers to TS-CBTs and may be a key system-level factor shaping barriers to starting and staying in treatment. This study examined whether referral source was associated with entry into and completion of a full TS-CBT service delivery pathway in a community-based trauma clinic. Participants were 346 children aged 4–17 referred between 2007 and 2024 to the PARTNERS Clinic in Queens, New York. All entered the clinic at the pre-treatment assessment stage. The sample was racially and ethnically diverse, with child sexual abuse the most commonly reported trauma type. Referral sources included child advocacy centers (CACs), child protective services (CPS), hospital-affiliated and community mental health providers, and self-referrals. Service delivery phases included pre-treatment assessment, treatment start, completion of TS-CBT Phases 1–3, and overall TS-CBT completion. Data came from the PARTNERS Referral Form, Treatment Monitoring Records, and Therapy Attendance Logs. Analyses used chi-square tests of independence, goodness-of-fit tests, and Holm-adjusted Fisher’s exact tests to evaluate associations between referral source and service delivery phase completion. Results showed that referral source significantly influenced treatment start and later phase completion. Youth referred by CPS were less likely to start treatment than those referred by CACs and had significantly lower odds of completing TS-CBT Phases 2 and 3. Differences between CPS- and CAC-referred youth were more pronounced in later trauma-processing phases than during early engagement. CAC referrals represented the largest share of youth and showed stronger progression through service delivery phases. These findings indicate that referral source operates as a systems-level mechanism shaping entry into and ongoing engagement in trauma-specific care. The study highlights the importance of trauma-informed referral practices and phase-based monitoring to improve access to and completion of evidence-based trauma treatment for youth. Clinical implications, policy implications, and recommendations for agency training are offered.

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