University of Central Florida Undergraduate Research Journal - A Practicality Analysis Pertaining to Minimally <br/> Invasive Robot-Assisted Urologic Surgery
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Discussion

We found a significant difference in that more counseling appointments were cancelled with the biological mother as primary caregiver than with the biological father. A number of factors might contribute to this finding. Research indicates that cohabiting boyfriends and male partners of mothers perpetrate many incidents of child abuse (Berger, Paxson, & Waldfogel 2009; Daly & Wilson 2008; Lee, Lightfoot, & Edleson 2008). Additionally, some women remain with the abuser, which can complicate aspects of treatment (Alaggia 2001; Lipovsky 1991) such as attendance. The abuser may control the actions of the mother and child and create barriers such as removing their method of transportation, controlling their funds, or threatening harm. Another potential consideration is the difficulty women encounter when leaving their abuser, which might require relocation resulting in inconsistencies in treatment attendance and premature treatment cessation. Although limitations exist, which will be presented below, there were non-significant findings in this study that have relevance in identifying demographic characteristics that might not influence treatment attendance. Researchers investigating factors influencing treatment attendance can now ask more sophisticated questions related to victim or caregiver age and caregiver income along with more qualitative areas of inquiry. However, it is important to note the center that contributed data served a low resource, uninsured, or minimally insured population. Thus, additional investigations could identify potential influence of income, controlling for insurance status, or between private practice and agency clients.

Limitations in this study include examining demographic variables available, which possibly impacted treatment attendance. However, a number of other variables demonstrate the potential to impact treatment attendance not collected by the NCAtrak. Although a difference between the biological mother and father in the number of sessions canceled was noted, we did not examine contributions to this difference. Additionally, we analyzed data from a community social service agency with no private practice representation. Thus, any conclusions would be limited to agency populations. Finally, the small effect size found with the significant finding suggests the need for some caution with these findings and what they suggest. Nonetheless, research demonstrates the positive impact of treatment attendance and completion in child abuse victims, so additional contributions help complete the picture needed to address and mitigate the problem on treatment non-completion.

Implications of this study include delving further, particularly through qualitative approaches, into why biological mothers may cancel more sessions and how this data affects the child advocacy center's retention rate, organization, and overall effectiveness. Qualitative approaches are recommended because they allow for the clients to discuss their experiences subjectively at a more intimate level than quantitative approaches can provide (Crisma, Bascelli, Paci, & Romito, 2004). An abundance of research offers various reasons for low session attendance, including the mother being a victim of abuse, the parent being the abuser, the abuser living in the household, the mother feeling guilt or shame for not properly protecting her child, and the mother's cultural or religious beliefs (Alaggia 2001; Baker 2001; Boroughs 2004; Plummer & Eastin 2007b; Lippert, Favre, Alexander, & Cross 2008). This data will help counselors identify strategies to increase retentions with clients whose biological mother is their primary caregiver. Other common causes of low retention include lack of transportation, inability to pay for services, and the caregiver not feeling supported by the center (Meddin & Hansen 1985; Plummer & Eastin 2007a; Thompson 2005). Centers need to collect additional data, quantitative and qualitative, to better identify potential factors for greater or lower levels of treatment attendance. For example, gathering data on potential barriers to treatment—such as transportation, financial distress, stability of residence, and self-report of perceived barriers—provides counselors with additional data to help them mitigate barriers. This process also provides researchers more data to investigate which barriers prove more challenging for different clients.

Prior research on demographic factors of family and victims is slim and the focus of the studies differed slightly. Age of child, type and frequency of abuse, ethnicity, level of law enforcement involvement, and caregiver perspective on therapy are examples of factors investigated in previous research (Cohen & Mannarino 1998; Lippert et al. 2008; McPherson et al. 2012; Tingus, Heger, Foy, & Leskin 1996). Only two articles examined the relationship between these demographic factors and treatment completion and the results from both studies are similar (Lippert et al. 2008; McPherson et al. 2012). The researchers of this study did not have access to the caregivers or the children to ask them their thoughts on the treatment; therefore, they could only infer about the cancellation of sessions based on the results from similar, published research.

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