Journal of Family Violence

, Volume 28, Issue 7, pp 639–652 | Cite as

Traumatized Youth in Residential Treatment Settings: Prevalence, Clinical Presentation, Treatment, and Policy Implications

  • Amanda D. Zelechoski
  • Ritu Sharma
  • Kari Beserra
  • Jennifer L. Miguel
  • Mia DeMarco
  • Joseph Spinazzola


Children and adolescents with histories of traumatic exposure comprise a substantial portion of youth in residential treatment programs. However, until recently, little has been known about this specific population. Given the well-documented unique treatment considerations for traumatized youth, it is important to understand how the distinct needs of this population factor into the particular residential treatment setting approach. This paper presents a comprehensive overview of the current understanding of this vulnerable youth population, the impact trauma exposure can have on their clinical presentation and response to treatment, and the available empirical research regarding effective intervention strategies. In addition, policy implications specific to traumatized youth receiving treatment in residential settings are discussed.


Complex trauma Residential treatment Posttraumatic stress Developmental trauma Continuum of care 


  1. Ackerman, P. T., Newton, J. E., McPherson, W. B., Jones, J. G., & Dykman, R. A. (1998). Prevalence of posttraumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Child Abuse and Neglect, 22, 759–774.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. Avinger, K. A., & Jones, R. A. (2007). Group treatment of sexually abused adolescent girls: a review of outcome studies. The American Journal of Family Therapy, 35, 315–326.CrossRefGoogle Scholar
  4. Baker, A. J. L., & Curtis, P. (2006). Prior placements of youth admitted to therapeutic foster care and residential treatment centers: the Odyssey Project population. Child & Adolescent Social Work Journal, 23, 38–60.CrossRefGoogle Scholar
  5. Baker, A. J. L., Gries, L., Schneiderman, M., Parker, R., Archer, M., & Friedrich, B. (2001). Children with problematic sexualized behaviors in the child welfare system. Child Welfare, 87, 5–27.Google Scholar
  6. Baker, A. J. L., Wulczyn, F., & Dale, N. (2005). Covariates of length of stay in residential treatment. Child Welfare: Journal of Policy, Practice, and Program, 84, 363–386.Google Scholar
  7. Baker, A. J. L., Curtis, P. A., & Papa-Lentini, C. (2006). Sexual abuse histories of youth in child welfare residential treatment centers: analysis of the Odyssey Project population. Journal of Child Sexual Abuse, 15, 29–49.PubMedCrossRefGoogle Scholar
  8. Baker, A. J. L., Kurland, D., Curtis, P., Alexander, G., & Papa-Lentini, C. (2007). Mental health and behavioral problems of youth in the child welfare system: residential treatment centers compared to therapeutic foster care in the Odyssey Project population. Child Welfare: Journal of Policy, Practice, and Program, 86, 97–123.Google Scholar
  9. Baker, A. J., Ashare, C., & Charvat, B. J. (2009). Substance use and dependency disorders in adolescent girls in group living programs: prevalence and associations with milieu factors. Residential Treatment for Children & Youth, 26, 42–57.CrossRefGoogle Scholar
  10. Bates, B. C., English, D. J., & Kouidou-Giles, S. (1997). Residential treatment and its alternatives: a review of the literature. Child and Youth Care Forum, 26, 7–52.CrossRefGoogle Scholar
  11. Bebout, R. R. (2001). Trauma-informed approaches to housing. In M. Harris & R. D. Fallot (Eds.), Using trauma theory to design service systems (pp. 47–55). San Francisco: Jossey-Bass.Google Scholar
  12. Bettmann, J. E., Lundahl, B. W., Wright, R., Jasperson, R. A., & McRoberts, C. H. (2011). Who are they? A descriptive study of adolescents in wilderness and residential programs. Residential Treatment for Children & Youth, 28, 192–210.CrossRefGoogle Scholar
  13. Biswas, B., & Vaughn, M. G. (2011). Really troubled girls: gender differences in risky sexual behavior and its correlates in a sample of juvenile offenders. Children & Youth Services Review, 33, 2386–2391.CrossRefGoogle Scholar
  14. Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self- regulation, and competency. New York: Guilford Press.Google Scholar
  15. Bloom, S. (1997). Creating sanctuary: Toward the evolution of sane societies. New York: Routledge.Google Scholar
  16. Bloom, S. L., & Farragher, B. (2010). Destroying sanctuary: The crisis in human service delivery systems. New York: Oxford University Press.CrossRefGoogle Scholar
  17. Bloom, S. L., & Reichert, M. (1998). Bearing witness: Violence and collective responsibility. Binghamton: Haworth Press.Google Scholar
  18. 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.CrossRefGoogle Scholar
  19. Briggs, E. C., Greeson, J. K. P., Layne, C. M., Fairbank, J. A., Knoverek, A. M., & Pynoos, R. S. (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.CrossRefGoogle Scholar
  20. Brown, S. M., Baker, C. N., & Wilcox, P. (2012a). Risking Connection trauma training: A pathway toward trauma-informed care in child congregate settings. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 507–515.Google Scholar
  21. Brown, J. D., Barrett, K., Ireys, H. T., Allen, K., Pires, S. A., Blau, G., et al. (2012b). Seclusion and restraint practices in residential treatment facilities for children and youth. American Journal of Orthopsychiatry, 82, 87–90.PubMedCrossRefGoogle Scholar
  22. Brown, A. D., McCauley, K., Navalta, C. P., & Saxe, G. N. (2013, this issue). Trauma Systems Therapy in residential settings: Improving emotion regulation and the social environment of traumatized children and youth in congregate care. Journal of Family Violence, 28(7). doi: 10.1007/s10896-013-9542-9.
  23. Child Welfare League of America. (2005). The Odyssey Project: A descriptive and prospective study of children and youth in residential group care and therapeutic foster care. Washington, DC: Author.Google Scholar
  24. Cohen, J. A., & Mannarino, A. P. (1997). A treatment study of sexually abused preschool children: outcome during 1-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228–1235.PubMedCrossRefGoogle Scholar
  25. Cohen, J., Deblinger, E., Mannarino, A., & Steer, R. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 393–402.CrossRefGoogle Scholar
  26. Cohen, J. A., Mannarino, A. P., & Navarro, D. (2012). Residential treatment. In J. A. Cohen, A. P. Mannarino, & E. Deblinger (Eds.), Trauma-focused CBT for children and adolescent: Treatment applications (pp. 73–104). New York: Guilford Press.Google Scholar
  27. Collin-Vézina, D., Coleman, K., Milne, L., Sell, J., & Daigneault, I. (2011). Trauma experiences, maltreatment-related impairments, and resilience among child welfare youth in residential care. International Journal of Mental Health & Addiction, 9, 577–589.CrossRefGoogle Scholar
  28. Connor, D. F., McIntyre, E. K., Miller, K., Brown, C., Bluestone, H., Daunais, D., et al. (2003). Staff retention and turnover in a residential treatment center. Residential Treatment for Children & Youth, 20, 43–53.CrossRefGoogle Scholar
  29. Connor, D. F., Doerfler, L. A., Toscano, P. F., Jr., Volungis, A. M., & Steingard, R. J. (2004). Characteristics of children and adolescents admitted to a residential treatment center. Journal of Child and Family Studies, 13, 497–510.CrossRefGoogle Scholar
  30. Conte, C., Snyder, C., & McGuffin, R. (2008). Using self-determination theory in residential settings. Residential Treatment for Children & Youth, 25, 307–318.CrossRefGoogle Scholar
  31. 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
  32. D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82, 187–200.PubMedCrossRefGoogle Scholar
  33. Dale, N., Baker, A., Anastasio, E., & Purcell, J. (2007). Characteristics of children in residential treatment in New York State. Child Welfare, 86, 5–27.PubMedGoogle Scholar
  34. Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreatment, 1, 310–321.CrossRefGoogle Scholar
  35. Deblinger, E., Steer, R., & Lippmann, J. (1999). Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering posttraumatic stress symptoms. Child Abuse Neglect, 23, 1371–1378.PubMedCrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. Dvir, O., Weiner, A., & Kupermintz, H. (2012). Children in residential group care with no family ties: facing existential aloneness. Residential Treatment for Children and Youth, 29, 282–304.CrossRefGoogle Scholar
  38. Esaki, N., & Larkin, H. (2013). Prevalence of adverse childhood experiences (ACEs) among child service providers. Families in Society, 94, 31–37.CrossRefGoogle Scholar
  39. Farragher, B. (2002). A system-wide approach to reducing incidents of therapeutic restraint. Residential Treatment for Children & Youth, 20, 1–14.CrossRefGoogle Scholar
  40. Farro, S. A., Clark, C., & Eyles, C. H. (2011). Assessing trauma-informed care readiness in behavioral health: an organizational case study. Journal of Dual Diagnosis, 7, 228–241.CrossRefGoogle Scholar
  41. Ford, J. D. (2005). Treatment implications of altered affect regulation and information processing following child maltreatment. Psychiatric Annals, 35, 410–419.Google Scholar
  42. Ford, J.D., & Blaustein, M.E. (2013, this issue). Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs. Journal of Family Violence, 28(7). doi: 10.1007/s10896-013-9538-5.
  43. 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, & Trauma, 21, 365–384.CrossRefGoogle Scholar
  44. Garland, E., Pettus-Davis, C., & Howard, M. (2013). Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress. Journal of Behavioral Medicine, 36, 175–185.PubMedCrossRefGoogle Scholar
  45. Gillen, P. (2012). Trauma-informed care: a look at residential treatment. Brown University Child & Adolescent Behavior Letter, 28, 1–7.Google Scholar
  46. Griffin, G., Martinovich, Z., Gawron, T., & Lyons, J. S. (2009). Strengths moderate the impact of trauma on risk behaviors in child welfare. Residential Treatment for Children & Youth, 26, 105–118.CrossRefGoogle Scholar
  47. Griffith, A. K., Ingram, S. D., Barth, R. P., Trout, A. L., Hurley, K. D., Thompson, R. W., et al. (2009). The family characteristics of youth entering a residential care program. Residential Treatment for Children & Youth, 26, 135–150.CrossRefGoogle Scholar
  48. Habib, M., Labruna, V., & Newman, J. (2013, this issue). Complex histories and complex presentations: Implementation of a manually-guided group treatment for traumatized adolescents. Journal of Family Violence, 28(7). doi: 10.1007/s10896-013-9532-y.
  49. Harned, M. S., Jackson, S. C., Comtois, K. A., & Linehan, M. M. (2010). Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with borderline personality disorder. Journal of Traumatic Stress, 23, 421–429.PubMedCrossRefGoogle Scholar
  50. Hillary, B. E., & Schare, M. L. (1993). Sexually and physically abused adolescents: an empirical search for PTSD. Journal of Clinical Psychology, 49, 161–165.PubMedCrossRefGoogle Scholar
  51. 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, 28(7). doi: 10.1007/s10896-013-9531-z.
  52. Hussey, D. L., & Guo, S. (2002). Profile characteristics and behavioral change trajectories of young residential children. Journal of Child and Family Studies, 11, 401–441.CrossRefGoogle Scholar
  53. James, S., Alemi, Q., & Zepeda, V. (2013). Effectiveness and implementation of evidence-based practices in residential care settings. Children and Youth Services Review, 35, 642–656.PubMedCrossRefGoogle Scholar
  54. Jarero, I., Roque-López, S., & Gomez, J. (2013). The provision of an EMDR-based multicomponent trauma treatment with child victims of severe interpersonal trauma. Journal of EMDR Practice and Research, 7, 17–28.CrossRefGoogle Scholar
  55. Jaycox, L. H., Ebener, P., Damesek, L., & Becker, K. (2004). Trauma exposure and retention in adolescent substance abuse treatment. Journal of Traumatic Stress, 17, 113–121.PubMedCrossRefGoogle Scholar
  56. Julian, D. A., Julian, T. W., Mastrine, B. J., & Wessa, P. (1992). Residential and community treatment services utilized by a sample of youth with severe emotional disturbances. American Journal of Community Psychology, 20, 799–809.PubMedGoogle Scholar
  57. 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, 28(7). doi: 10.1007/s10896-013-9537-6.
  58. Kagan, R., Douglas, A. N., Hornik, J., & Kratz, S. L. (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.CrossRefGoogle Scholar
  59. Kinniburgh, K., Blaustein, M., Spinazzola, J., & van der Kolk, B. (2005). Attachment, self-regulation, and competency: a comprehensive intervention framework for children with complex trauma. Psychiatric Annals, 35, 424–430.Google Scholar
  60. Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., et al. (2008). Creating trauma-informed systems: child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39, 396–404.CrossRefGoogle Scholar
  61. Kugler, B., Bloom, M., Kaercher, L., Truax, T., & Storch, E. (2012). Somatic symptoms in traumatized children and adolescents. Child Psychiatry & Human Development, 43, 661–673.CrossRefGoogle Scholar
  62. Leichtman, M., & Leichtman, M. L. (2001). Facilitating the transition from residential treatment into the community: I. The problem. Residential Treatment for Children & Youth, 19, 21–27.CrossRefGoogle Scholar
  63. Levin, E. C. (2009). The challenges of treating Developmental Trauma Disorder in a residential agency for youth. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 37, 519–538.PubMedCrossRefGoogle Scholar
  64. Little, S., & Akin-Little, A. (2009). Trauma-focused cognitive behavior therapy. In A. Akin-Little, S. Little, M. A. Bray, & T. J. Kehle (Eds.), Behavioral interventions in schools: Evidence-based positive strategies (pp. 325–333). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  65. Lovelle, C. (2005). Dialectical therapy and EMDR for adolescents in residential treatment: a practical and theoretical perspective. Residential Treatment for Children and Youth, 23, 27–43.CrossRefGoogle Scholar
  66. Lyons, J. S., Libman-Mintzer, L. N., Kisiel, C. L., & Shallcross, H. (1998). Understanding the mental health needs of children and adolescents in residential treatment. Professional Psychology: Research and Practice, 29, 582–587.CrossRefGoogle Scholar
  67. Lyons, J. S., Uziel-Miller, N. D., Reyes, F., & Sokol, P. T. (2000). Strengths of children and adolescents in residential settings: prevalence and associations with psychopathology and discharge placement. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 176–181.CrossRefGoogle Scholar
  68. McNamara, P. M. (2010). Staff support and supervision in residential youth justice: an Australian model. Residential Treatment for Children and Youth, 27, 214–240.CrossRefGoogle Scholar
  69. Miele, D., & O’Brien, E. J. (2010). Underdiagnosis of posttraumatic stress disorder in at risk youth. Journal of Traumatic Stress, 23, 591–598.PubMedCrossRefGoogle Scholar
  70. Nickerson, A. B., Colby, S. A., Brooks, J. L., Rickert, J. M., & Salamone, F. J. (2007). Transitioning youth from residential treatment to the community: a preliminary investigation. Child and Youth Care Forum, 36, 73–86.CrossRefGoogle Scholar
  71. Perry, B. D. (1994). Neurobiological sequelae of childhood trauma: Post-traumatic stress disorders in children. In M. Murberg (Ed.), Catecholamine function in Posttraumatic Stress Disorder: Emerging concepts (pp. 233–256). Washington, DC: American Psychiatric Press.Google Scholar
  72. Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221–238). Washington, D.C.: American Psychiatric Press, Inc.Google Scholar
  73. Pynoos, R. S., Steinberg, A. M., Ornitz, E. M., & Goenjian, A. K. (1997). Issues in the developmental neurobiology of traumatic stress. Annals of the New York Academy of Sciences, 821, 176–193.PubMedCrossRefGoogle Scholar
  74. 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 & Youth, 25, 167–185.Google Scholar
  75. 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 and Adolescent Social Work Journal, 21, 529–550.CrossRefGoogle Scholar
  76. Simon, J. B., & Savina, E. A. (2005). Facilitating hospital to school transitions: practices of hospital-based therapists. Residential Treatment for Children & Youth, 22, 49–65.CrossRefGoogle Scholar
  77. Singer, M. I. (2007). Assessment of violence exposure among residential children and adolescents. Residential Treatment for Children & Youth, 24, 159–174.CrossRefGoogle Scholar
  78. Skowron, E., & Reinemann, D. H. S. (2005). Effectiveness of psychological interventions for child maltreatment: a meta-analysis. Psychotherapy: Theory, Research, Practice, Training, 42, 52–71.CrossRefGoogle Scholar
  79. Sng, R. (2009). Family therapy for kids without families: working systemically with children and young people in residential care. The Australian and New Zealand Journal of Family Therapy, 30, 247–259.CrossRefGoogle Scholar
  80. Spinazzola, J., Habib, M., Knoverek, A., Arvidson, J., Nisenbaum, J., Wentworth, R. et al. (2013). The heart of the matter: Complex trauma in child welfare. CW360º: Trauma-Informed Child Welfare Practice (pp. 8–9). CASCS: University of Minnesota.Google Scholar
  81. Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24, 102–106.PubMedCrossRefGoogle Scholar
  82. Streeck-Fischer, A., & van der Kolk, B. (2000). Down will come baby, cradle and all: diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34, 903–918.PubMedCrossRefGoogle Scholar
  83. Thompson, R., Wiley, T. A., Lewis, T., English, D. J., Dubowitz, H., Litrownik, A. J., et al. (2012). Links between traumatic experiences and expectations about the future in high risk youth. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 293–302.CrossRefGoogle Scholar
  84. van der Kolk, B. A. (1994). The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253–265.PubMedCrossRefGoogle Scholar
  85. van der Kolk, B. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics of North America, 12, 293–317.PubMedCrossRefGoogle Scholar
  86. van der Kolk, B. (2005). Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401–408.Google Scholar
  87. Visalli, H., McNasser, G., Johnstone, L., & Lazzaro, C. A. (1997). Reducing high-risk interventions for managing aggression in psychiatric settings. Journal of Nursing Care Quality, 11, 54–61.PubMedCrossRefGoogle Scholar
  88. Warner, L. A., & Pottick, K.J. (2003). Nearly 66,000 youth live in U.S. mental health programs. Latest Findings in Children’s Mental Health: Policy Report submitted to the Annie E. Casey Foundation, 2, 1–2.Google Scholar
  89. Warner, E., Koomar, J., Lary, B., & Cook, A. (2013, this issue). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence, 28(7). doi: 10.1007/s10896-013-9535-8.
  90. Weiner, D., Schneider, A., & Lyons, J. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Children and Youth Services Review, 31, 1199–1205.CrossRefGoogle Scholar
  91. Whittaker, J. K. (2000). Reinventing residential childcare: an agenda for research and practice. Residential Treatment for Children & Youth, 17, 13–30.CrossRefGoogle Scholar
  92. Zappert, L. N., & Westrup, D. (2008). Cognitive processing therapy for posttraumatic stress disorder in a residential treatment setting. Psychotherapy: Research, Theory, Practice, Training, 45, 361–376.CrossRefGoogle Scholar
  93. Zegers, M. A. M., Schuengel, C., Van IJzendoorn, M. H., & Janssens, J. M. A. M. (2008). Attachment and problem behavior of adolescents during residential treatment. Attachment & Human Development, 10, 31–103.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Amanda D. Zelechoski
    • 1
  • Ritu Sharma
    • 2
  • Kari Beserra
    • 3
  • Jennifer L. Miguel
    • 3
  • Mia DeMarco
    • 3
  • Joseph Spinazzola
    • 4
  1. 1.Department of PsychologyValparaiso UniversityValparaisoUSA
  2. 2.Tufts UniversityMedfordUSA
  3. 3.Justice Resource InstituteNeedhamUSA
  4. 4.Trauma Center at Justice Resource InstituteBrooklineUSA

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