Skip to main content

Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework

Abstract

This project describes application of an evidenced-based, trauma-informed treatment framework, Attachment, Regulation and Competency (ARC), with complexly traumatized youth in residential treatment. The processes of implementing the ARC model into clinical and milieu programming at two residential treatment programs are described. Particular attention is paid to system-level processes and strategies for embedding ARC in a sustainable manner. Pilot data demonstrated a significant relation between use of ARC and reductions in PTSD symptoms, externalizing and internalizing behaviors, and the frequency of restraints used across programs. Preliminary findings contribute to an emerging empirical basis for the ARC model and are supportive of its clinical utility as a practice in the residential context. Next steps include: a) expanding the study findings by conducting controlled efficacy research, b) examining system level variables as mediators of change, and c) describing the full operation stage of implementation of the ARC framework.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Centre for Children, Youth and Families.

    Google Scholar 

  • Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., et al. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in applications of the ARC intervention model. Journal of Child and Adolescent Trauma, 4, 34–51.

    Article  Google Scholar 

  • Asmundson, G. J. G., Stapleton, J. A., & Taylor, S. (2004). Are avoidance and numbing distinct PTSD symptom clusters? Journal of Traumatic Stress, 17, 467–475.

    PubMed  Article  Google Scholar 

  • Blaustein, M. E., & Kinniburgh, K. J. (2010). Treating traumatic stress in children and adolescents: How to Foster Resilience through Attachment, Regulation and Competency (ARC). New York, NY: The Guilford Press.

    Google Scholar 

  • Briggs, E. C., Fairbank, J. A., Greeson, J. K., Layne, C. M., Merrill, C., Steinberg, A. M., et al. (2012a). Links between child and adolescent trauma exposure and service use histories in a national clinic-referred sample. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 101–109.

    Article  Google Scholar 

  • Briggs, E. C., Greeson, J. K. P., Layne, C. M., Fairbank, J. A., Knoverek, A. M., & Pynoos, R. S. (2012b). Trauma exposure, psycholosocial functioning, and treatment needs of youth in residential care: Preliminary findings from the NCTSN Core Data Set. Journal of Child & Adolescent Trauma, 5, 1–15.

    Article  Google Scholar 

  • Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390–398.

    Google Scholar 

  • DeRosa, R., Habib, M., Pelcovitz, D., Rathus, J., Sonnenklar, J., Ford, J., et al. (2005). Structured Psychotherapy for Adolescents Responding to Chronic Stress: A treatment guide. Manhasset, NY: North Shore University Hospital.

    Google Scholar 

  • Doyle, J. S., & Bauer, S. K. (1989). Post-traumatic stress disorder in children: Its identification and treatment in a residential setting for emotionally disturbed youth. Journal of Traumatic Stress, 2, 275–288.

    Article  Google Scholar 

  • Eyberg, S. M., Boggs, S., & Algina, J. (1995). Parent–child Interaction Therapy: A psychosocial model for the treatment of young children with conduct problem behavior and their families. Psychopharmacology Bulletin, 31, 83–91.

    PubMed  CAS  Google Scholar 

  • Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., Wallace, R. M. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  • Ford, J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group attendance is associated with reduced disciplinary incidents and sanctions in juvenile detention facilities. Journal of Aggression, Maltreatment, and Trauma, 21, 365–384.

    Article  Google Scholar 

  • Habib, M., Labruna, V., & Newman, J. (2013). Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents. Journal of Family Violence, 28(7).

  • ICF International. (2010). Evaluation of the national child traumatic stress initiative: FY 2010 Annual Progress Report, Executive Summary.

  • Kendall, P. C., & Beidas, R. S. (2007). Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity. Professional Psychology: Research & Practice, 38(1), 13–20.

    Article  Google Scholar 

  • Kinniburgh, K. J., Blaustein, M. E., Spinazzola, J., & van der Kolk, B. (2005). Attachment, self-regulation & competency. Psychiatric Annals, 35, 424–430.

    Google Scholar 

  • Knoverek, A. M., Briggs, E. C., Underwood, L. A., & Hartman, R. L. (2013). Clinical considerations for the treatment of latency age children in residential care. Journal of Family Violence, 28(7).

  • Levant, R. F. (2005). Report of the 2005 presidential task force on evidence-based practice. American Psychological Association. http://www.apa.org/practice/resources/evidence/evidence-based-report.pdf.

  • Lewis, D. O., & Shanok, S. S. (1979). A comparison of the medical histories of incarcerated delinquent children and a matched sample of non-delinquent children. Child Psychiatry and Human Development, 9, 210–214.

    PubMed  Article  CAS  Google Scholar 

  • Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D. (2001). Dimensions of child maltreatment and children’s adjustment: Contributions of developmental timing and subtype. Development and Psychopathology, 13, 759–782.

    PubMed  CAS  Google Scholar 

  • National Association of Psychiatric Health Systems. (2011). 2010 Annual Survey.

  • Pearl, E. (2008). Child Adult Relationship Enhancement (CARE). Models for developing trauma-informed behavioral health systems and trauma-specific services. National Association for State Mental Health Program Directors (NASMHPD).

  • Pynoos, R., Fairbank, J., Steinberg, A., Amaya-Jackson, L., Gerrity, E., Mount, M., & Maze, J. (2008). The National Child Traumatic Stress Network: Collaborating to improve the standard of care. Professional Psychology Research & Practice, 39, 389–395.

    Article  Google Scholar 

  • Raudenbush, S., Bryk, A., Cheong, Y. F., & Congdon, R. (2005). HLM 6: Hierarchical Linear and Nonlinear Modeling. Lincolnwood, IL: Scientific Software International.

    Google Scholar 

  • Rivard, J. C., McCorkle, D., Duncan, M. E., Pasquale, L. E., Bloom, S. L., & Abramovitz, R. (2004). Implementing a trauma recovery framework for youths in residential treatment. Child & Adolescent Social Work Journal, 21, 529–550.

    Article  Google Scholar 

  • Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families.

    Google Scholar 

  • Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Spinazzola, J., Ford, J. D., Zucker, M., van der Kolk, B. A., Silva, S., Smith, S. F., & Blaustein, M. (2005). Survey evaluates complex trauma exposure, outcome, and intervention among children and adolescents. Psychiatric Annals, 35, 433–439.

    Google Scholar 

  • Steinberg, A. M., Brymer, M., Decker, K., & Pynoos, R. S. (2004). The UCLA PTSD Reaction Index. Current Psychiatry Reports, 6, 96–100.

    PubMed  Article  Google Scholar 

  • Steinberg, A. M., Brymer, M. J., Kim, S., Ghosh, C., Ostrowski, S. A., Gulley, K., et al. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part 1. Journal of Traumatic Stress, 26, 1–9.

    PubMed  Article  Google Scholar 

  • The National Child Traumatic Stress Network (NCTSN). (2008). Trauma informed interventions, CARE: General information. Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/promising_practices/CARE_General.pdf.

  • U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2012). Child maltreatment 2011. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

  • Van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35, 401–408.

    Google Scholar 

  • Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J., DeMarco, M., & Spinazzola, J. (2013). Traumatized youth in residential treatment settings: Prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 28(7).

  • Zucker, M., Villaflor, E.B., Holden, J., Jones, R., & Spinazzola, J. (2006). Urban Improv for the classroom, 4th grade reacher curriculum. The Trauma Center at Justice Resource Institute. Available at http://www.traumacenter.org/products/pdf_files/UITeacherStand-Alone.pdf.

Download references

Acknowledgments

This project was funded in part by grant number 5U79SMO56175 from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. The authors thank the National Child Traumatic Stress Network’s Core Data Set team at Duke Clinical Research Institute for their seminal work in developing the database from which data for the present study were drawn; Johanna Greeson and Ernestine Briggs from the National Center for Child Traumatic Stress at Duke University for assistance with data coding and extraction; and Dr. Michael Suvak for assistance with statistical analyses and consultation. We acknowledge the staff of Glenhaven Academy, Cohannet Academy, Walden Street School and the Susan Wayne Center for their collaboration in developing, implementing, evaluating and refining trauma-focused residential programming for youth impacted by complex trauma. We express our special gratitude to Kari Beserra, Douglas Brooks, Liz Carrigan, Mia DeMarco, Stacey Forrest, Rick Granahan, Brian Lary, Jenn Miguel, Sean Rose, and above all to Andrew Pond, for their unwavering openness, ingenuity, insight, and perseverance in partnering with us to advance trauma-focused residential systems of care.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hilary B. Hodgdon.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hodgdon, H.B., Kinniburgh, K., Gabowitz, D. et al. Development and Implementation of Trauma-Informed Programming in Youth Residential Treatment Centers Using the ARC Framework. J Fam Viol 28, 679–692 (2013). https://doi.org/10.1007/s10896-013-9531-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10896-013-9531-z

Keywords

  • Traumatized youth
  • Trauma-informed care
  • Residential services
  • Complex trauma
  • Evidence-based treatment