Childhood maltreatment — assessment, reporting and TF-CBT (MEQ)

(i) Reporting framework and risk. In Australia, mandatory reporting of child abuse and neglect was first introduced in Tasmania in 1974 and most other states followed to varying degrees, so name the statutory pathway of your own jurisdiction.^[10] Her exposure matters for prognosis: exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences.^[3]

(ii) Assessment. Trauma-informed practice uses a strengths-based approach to encourage engagement, built on five principles: safety, trustworthiness, choice, collaboration and empowerment.^[9] The AACAP practice parameter highlights early identification of PTSD, gathering information from parents and children, and the assessment and treatment of comorbid disorders.^[2] Maltreatment is still missed through provider bias or lack of experience with proper evaluation approaches.^[11]

(iii) Formulation. The ACE study found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.^[4] Child maltreatment has long-lasting effects on mental health, drug and alcohol misuse, risky sexual behaviour, obesity and criminal behaviour, which persist into adulthood.^[3]

(iv) Psychological plan. TF-CBT is a flexible, components-based model that gives children and parents stress management skills before direct discussion and processing of the traumatic experience. Its components are summarised by PRACTICE: Psychoeducation, Parenting skills, Relaxation skills, Affective modulation skills, Cognitive coping skills, Trauma narrative and cognitive processing, In vivo mastery of trauma reminders, Conjoint child-parent sessions, and Enhancing safety and future developmental trajectory.^[8] In a multisite RCT of 229 children aged 8-14 with sexual-abuse-related PTSD symptoms, TF-CBT gave more improvement than child-centred therapy in PTSD, depression, behaviour problems, shame and abuse-related attributions.^[1] In children aged 4-11 referred for sexual abuse with PTSD symptoms, TF-CBT was effective regardless of 8 or 16 sessions or inclusion of the trauma narrative.^[7]

(v) Medication. The AACAP practice parameter presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.^[2] The sertraline RCT was in outpatients with PTSD (mean age 40), using 25 mg/d for 1 week then flexible 50 to 200 mg/d; paediatric dosing is per local formulary and specialist guidance.^[6]