Skip to main content

Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents

Abstract

It is consistently recognized that children and adolescents who have repeatedly experienced or witnessed violence are at significant risk for a multitude of lasting difficulties across many domains of functioning. Adolescents in residential settings often have extensive trauma histories and experience profound behavioral, emotional, and interpersonal difficulties. Unfortunately, there are few structured trauma-informed treatments that have been implemented in residential settings, and even fewer that have been evaluated. This article describes the core components of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a manually-guided trauma-informed group treatment, and provides clinical examples within residential facilities for adolescents with emotional and behavioral difficulties and extensive victimization histories. Preliminary data on self-reported emotional, behavioral, and posttraumatic stress symptoms are presented.

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

References

  • Abramovitz, R., & Bloom, S. L. (2003). Creating sanctuary in residential treatment for youth: from the “well-ordered asylum” to a ” living-learning environment. Psychiatric Quarterly, 74, 119–135.

    PubMed  Article  Google Scholar 

  • Allen, K. D., Pires, S. A., & Brown, J. (2010). System of care approaches in residential treatment facilities serving children with serious behavioral health needs. Hamilton: Center for Health Care Strategies, Inc.

    Google Scholar 

  • Amaya-Jackson, L., & DeRosa, R. R. (2007). Treatment considerations for clinicians in applying evidence-based practice to complex presentations in child trauma. Journal of Traumatic Stress, 20, 379–390.

    PubMed  Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text rev.) (4th ed.). Washington: Author.

    Google Scholar 

  • Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competence. New York: Guilford Press.

    Google Scholar 

  • Boyer, S. N., Hallion, L. S., Hammell, C. L., & Button, S. (2009). Trauma as a predictive indicator of clinical outcome in residential treatment. Residential Treatment For Children & Youth, 26, 92–104.

    Article  Google Scholar 

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

    Article  Google Scholar 

  • Burlingame, G. M., Mosier, J. I., Wells, M. G., Atkin, Q. G., Lambert, M. J., Whoolery, M., et al. (2001). Tracking the influence of mental health treatment: the development of the Youth Outcome Questionnaire. Clinical Psychology and Psychotherapy, 8, 361–379.

    Article  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guildford Press.

    Google Scholar 

  • Connor, D. F., Miller, P., Cunningham, J. A., & Melloni, R. H. (2002). What does getting better mean? Child improvement and measure of outcome in residential treatment. American Journal of Orthopsychiatry, 72, 110–117.

    PubMed  Article  Google Scholar 

  • Connor, D., Doerfler, L., Toscano, P., Volungis, A., & Steingard, R. (2004). Characteristics of children and adolescents admitted to a residential treatment center. Journal of Child and Family Studies, 13, 497–510.

    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, 390–398.

    Google Scholar 

  • Drais-Parrillo, A., Baker, A., Fojas, S., Gunn, S., Kurland, D., & Schnur, E. (2005). The odyssey project: A descriptive and prospective study of children and youth in residential group care and therapeutic foster care. Final report. Washington: Child Welfare League of America.

    Google Scholar 

  • Farragher, B., & Yanosy, S. (2005). Creating a trauma-sensitive culture in residential treatment. Therapeutic Communities, 26, 93–109.

    Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19, 149–166.

    PubMed  Article  Google Scholar 

  • Ford, J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21, 365–384.

    Article  Google Scholar 

  • Ford, J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: trauma adapative recovery group education and therapy (TARGET). American Journal of Psychotherapy, 60, 335–355.

    PubMed  Google Scholar 

  • Greenbaum, P. E., Dedrick, R. F., Friedman, R. M., Kutash, K., Brown, E. C., Lardieri, S. P., et al. (1998). National adolescent and child treatment study (NACTS): Outcomes for children with serious emotional and behavioral disturbance. In M. H. Epsteing, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families (pp. 21–54). Austin: Pro-Ed.

    Google Scholar 

  • Guterman, N. B., Cameron, M., & Hahm, H. C. (2003). Community violence exposure and associated behavior problems among children and adolescents in residential treatment. Journal of Aggression, Maltreatment & Trauma, 6, 111–135.

    Article  Google Scholar 

  • Habib, M., & Labruna, V. (2006). The adolescent trauma history checklist and interview. Unpublished measure.

  • Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: a review of research from 1993 to 2003. Journal of Child and Family Studies, 14, 551–575.

    Article  Google Scholar 

  • Hodgdon, H., Kinniburgh, K., Gabowitz, D., Blaustein, M., & Spinazzola, J. (2013, this issue). Development and implementation of trauma-informed programming in residential schools using the ARC framework. Journal of Family Violence, 27(8).

  • Holmbeck, G. N., Greenley, R. N., & Franks, E. A. (2003). Developmental issues and considerations in research and practice. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 21–40). New York: Guilford Press.

    Google Scholar 

  • Jacobs, J., & Steele, W. (2007). Structured sensory intervention for traumatized children, adolescents and parents – At-risk adjudicated adolescent treatment program (SITCAP-ART). Grosse Pointe Woods: Trauma and Loss Institute.

    Google Scholar 

  • Kagan, R., & Spinazzola, J. (2013, this issue). Real Life Heroes in residential treatment: Implementation of an integrated model of trauma and resiliency-focused treatment for children and adolescents with complex PTSD. Journal of Family Violence, 27(8).

  • Kagan, R., Douglas, A., Hornik, J., & Kratz, S. (2008). Real life heroes pilot study: evaluation of a treatment model for children with traumatic stress. Journal of Child and Adolescent Trauma, 1, 5–22.

    Article  Google Scholar 

  • Layne, C. M., Saltzman, W. R., Steinberg, A. M., & Pynoos, R. S. (2000). Trauma and grief component therapy for adolescents: Group treatment manual. Sarajevo: UNICEF Bosnia and Herzegovina.

    Google Scholar 

  • Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pašalić, A., Duraković, E., et al. (2008). Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1048–1062.

    Article  Google Scholar 

  • Leichtman, M., Leichtman, M. L., Barber, C. C., & Neese, D. T. (2001). Effectiveness of intensive short-term residential treatment with severely disturbed adolescents. American Journal of Orthopsychiatry, 71, 227–235.

    PubMed  Article  CAS  Google Scholar 

  • Levin, E. (2009). The challenges of treating developmental trauma disorder in a residential agency for youth. Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry, 37, 519–538.

    Article  Google Scholar 

  • Lyons, J. S., & McCulloch, J. R. (2006). Monitoring and managing outcomes in residential treatment: practice-based evidence in search of evidence-based practice. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 247–251.

    Article  Google Scholar 

  • Miller, A. L., Rathus, J. H., & Linehan, M. L. (2006). Dialectical behavioral herapy for suicidal adolescents. New York: Guildford Publications, Inc.

    Google Scholar 

  • Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). The UCLA PTSD Índex for DSM-IV. Los Angeles: UCLA Trauma Psychiatry Program.

    Google Scholar 

  • Raider, M. C., Steele, W., Delillo-Storey, M., Jacobs, J., & Kuban, C. (2008). Structured sensory therapy (SITCAP-ART) for traumatized adjudicated adolescents in residential treatment. Residential Treatment for Children and Youth, 25, 167–185.

    Article  Google Scholar 

  • Rivard, J. C., Bloom, S. L., McCorkle, D., & Abramovitz, R. (2005). Preliminary results of a study examining the implementation and effects of a trauma recovery framework for youths in residential treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations, 26, 83–96.

    Google Scholar 

  • Trieschman, A., Whittaker, J., & Brendtro, L. (1969). The other 23 hours: Child-care work with emotionally disturbed children in a therapeutic milieu. Oxford: Aldine.

    Google Scholar 

  • Wells, M. G., Burlingame, G. M., & Lambert, M. J. (1999). Youth outcome questionnaire (Y-OQ). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 497–534). Mahwah: Lawrence Erlbaum Associates Publishers.

    Google Scholar 

  • Whitaker, J. D. (2004). The re-invention of residential treatment: an agenda for research and practice. Child and Adolescent Psychiatric Clinics of North America, 13, 267–278.

    Article  Google Scholar 

  • Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J., DeMarco, M., & Spinazzola, J. (2013, this issue). Traumatized youth in residential treatment settings: prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 27(8).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mandy Habib.

Additional information

Author Note

The authors wish to acknowledge members of the National Child Traumatic Stress Network and the numerous skilled and dedicated colleagues with whom we have the privilege to work, for sharing their valuable insights and anecdotes regarding their experience working with adolescents in residential settings. In particular, we would like to thank Angel Knoverek and Thomas Donavan for their thoughtful and creative implementation of SPARCS in their work with severely traumatized youth in residential settings.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Habib, M., Labruna, V. & Newman, J. Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents. J Fam Viol 28, 717–728 (2013). https://doi.org/10.1007/s10896-013-9532-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10896-013-9532-y

Keywords

  • Adolescents
  • Residential treatment
  • Complex PTSD
  • Trauma