Factors Associated with Caregiver Involvement In Young Children’s Mental Health Treatment for Trauma: A Descriptive Exploratory Study

Background and Purpose: Rates of child trauma in South Carolina far exceed national averages, yet there exists a shortage of mental health providers, especially in rural communities where poverty is high. While a number of evidence-based practices and interventions (EBPIs) exist to support treatment for trauma, use in real-world settings remains limited. In particular, while caregiver involvement is necessary, factors influencing caregiver involvement in trauma treatment for children is not known. This study explored the factors related to caregiver involvement in young children’s treatment for trauma in a sample of real-world service providers in the state of SC.

Method: In a university-community partnership with the SC Department of Social Services, an online, anonymous landscape survey assessed implementation of evidence-based mental health interventions across the state. The survey was broadly distributed to behavioral health providers, working in a range of service settings, from January-April 2026. Data was collected via RedCap and analyzed using JASP software. The current descriptive study focused on a subsample of respondents providing mental health services for children (3-11 years) who have experienced trauma.

Results: To date, n=523 providers responded to the survey; 81 met study inclusion criteria. Most providers identified as White (66.7%), professional counselors (56.5%), and were licensed (84.6%). A majority were parents themselves (72.7%), 35-54 years of age (64.5%), averaging 15 years of work experience. Over one-third (35%) were not receiving clinical supervision through their primary employer. The majority of providers worked in outpatient settings (81.3%) and accepted Medicaid (68.8%). Consistent with state data, the most prevalent child presenting problem was trauma-related (92.5%). On a scale from 1-7 (1 low, 7 high), providers rated levels of confidence in delivering mental health services (M=6.0) and parenting interventions (M=5.5). On a scale from 1-7 (1 not at all, 7 very great extent), providers rated their agency’s level of effectiveness in using EBPIs (M=4.6). Some agencies offered training in EBPIs (M=3.2) but provided little financial incentive to use EBPIs (M=1.4). The majority of respondents (48.1%) cited difficulty engaging families as the most prevalent barrier to using EBPIs. However, based on a scale from 0-3 (0 not at all, 3 great extent), they reported frequent involvement of caregivers in services (M=2.8).

Conclusions and Implications: A majority of mental health service agencies in SC are not offering essential supports—training, financial incentives, and consistent clinical supervision. Even experienced providers require these resources to create a sustainable work environment. High turnover threatens the mental health workforce and can be damaging to children who suffer frequent attachment disruption. Difficulty involving socioeconomically marginalized caregivers is another barrier to delivery of EBPIs. Providers conveyed difficulty engaging families, yet reported high levels of caregiver involvement. Limitations may include item nonresponse rate, unknown quality of involvement, and social desirability bias. Efforts to reform policies are needed to influence reimbursement, supervision, and training, thereby increasing access to EBPIs, including caregiver involvement in trauma treatment for young children. Future analyses will examine the relationships between provider characteristics, child and organization-related factors, and caregiver involvement in services.