Abstract
Complex trauma (CT) is the experience, or witness, of prolonged abuse or neglect that negatively affects children’s emotional and psychological health. Youth in residential care experience higher incidences of complex trauma than youth in community-based care, with notable gender differences and presentation of psychological symptoms. This study examined the effects of trauma-informed residential care and the relation between CT and gender. A sample (n = 206) from an evaluation of a youth psychiatric residential facility in the Midwest that transitioned from a traditional care model to a trauma-informed care model was used. A hierarchical regression was used to model the main effects of model of care, gender, CT, length of stay, and crisis response on treatment outcomes; and the moderating effects of gender and CT. The results support the high prevalence of CT in residential care populations. The final model explained 30.2% of the variance with a statistically significant interaction between gender and length of stay in treatment, indicating that longer lengths of stay in treatment are associated with less change in functional impairment for girls than boys. Youth gender and prior trauma are important factors to consider when monitoring experiences and treatment outcomes in youth residential care.
Similar content being viewed by others
References
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., Andres, B., Cohen, C., & Blaustein, M. E. (2011). Treatment of complex trauma in young children: developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34–51. https://doi.org/10.1080/19361521.2011.545046.
Azeem, M. W., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B. (2011). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints ata child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 11–15. https://doi.org/10.1111/j.1744-6171.2010.00262.x.
Bates, M. P., Furlong, M. J., & Green, J. G. (2006). Are CAFAS subscales and item weights valid? A preliminary investigation of the child and adolescent functional assessment scale. Administration and Policy in Mental Health and Mental Health Services Research, 33, 682–695. https://doi.org/10.1007/s10488-006-0052-4.
Boel-Studt, S. M. (2017). A quasi-experimental study of trauma-informed psychiatric residential treatment for children and adolescents. Research on Social Work Practice, 27, 273–282. https://doi.org/10.1177/1049731515614401.
Brady, K. L., & Caraway, S. J. (2002). Home away from home: factors associated with current functioning in children living in a residential treatment setting. Child Abuse & Neglect, 26, 1149–1163. https://doi.org/10.1016/S0145213402003897.
Briggs, E. C., Greeson, J. K., 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 & Adolescent Trauma, 5(1), 1–15. https://doi.org/10.1080/19361521.2012.646413.
Brown, J. D., Barrett, K., Ireys, H. T., Allen, K., Pires, S. A., Blau, G., et al. (2012). Seclusion and restraint practices in residential treatment facilities for children and youth. American Journal of Orthopsychiatry, 82(1), 87–90. https://doi.org/10.1111/j.1939-0025.2011.01128.x.
Child Maltreatment. (2016). Indicators of child and youth well-being. Retrieved from https://www.childtrends.org/wp-ontent/uploads/2016/09/40_Child_Maltreatment.
Chow, W. Y., Mettrick, J. E., Stephan, S. H., & Von Waldner, C. A. (2014). Youth in group home care: youth characteristics and predictors of later functioning. The Journal of Behavioral Health Services & Research, 41, 503–519. https://doi.org/10.1007/s11414-012-9282-2.
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 and Addiction, 9, 577–589. https://doi.org/10.1007/s11469-011-9323-8.
Connor, D. F., Doerfler, L. A., Toscano, P. F., 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. https://doi.org/10.1023/B:JCFS.0000044730.66750.57.
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. https://doi.org/10.3928/00485713-20050501-05.
Eisengart, J., Martinovich, Z., & Lyons, J. S. (2008). Discharge due to running away from residential treatment: youth and setting effects. Residential Treatment for Children & Youth, 24, 327–343. https://doi.org/10.1080/08865710802174418.
Esaki, N., Benamati, J., Yanosy, S., Middleton, J., Hopson, L., Hummer, V., & Bloom, S. (2013). The sanctuary model: theoretical framework. Families in Society: The Journal of Contemporary Social Services, 94(2), 87–95. https://doi.org/10.1606/1044-3894.4287.
Eschenbeck, H., Kohlmann, C. W., & Lohaus, A. (2007). Gender differences in coping strategies in children and adolescents. Journal of Individual Differences, 28(1), 18–26. https://doi.org/10.1027/1614-0001.28.1.18.
Farmer, E. M. Z., Seifert, H., Wagner, H. R., Burns, B. J., & Murray, M. (2017). Does model matter? Examining change across time for youth in group homes. Journal of Emotional and Behavioral Disorders, 25(2), 119–128. https://doi.org/10.1177/1063426616630520.
Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). Thousand Oaks: Sage.
Fox, L. (2004). The impact of restraint on sexually abused children and youth. Residential Group Care Quarterly, 4(3), 1–5.
Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of residential mental health placements for children and youth. Child & Youth Care Forum, 31, 307–339. https://doi.org/10.1023/A:1016826627406.
Greeson, J. K., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., Ko, S. J., et al. (2011). Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91–108.
Handwerk, M. L., Clopton, K., Huefner, J. C., Smith, G. L., Hoff, K. E., & Lucas, C. P. (2006). Gender differences in adolescents in residential treatment. American Journal of Orthopsychiatry, 76, 312–324. https://doi.org/10.1037/0002-9432.76.3.312.
Hoagwood, K., & Cunningham, M. (1992). Outcomes of children with emotional disturbance in residential treatment for educational purposes. Journal of Child and Family Studies, 1(2), 129–140. https://doi.org/10.1007/BF01321281.
Hussey, D. L., & Guo, S. (2002). Profile characteristics and behavioral change trajectories of young residential children. Journal of Child and Family Studies, 11, 401–410. https://doi.org/10.1023/A:1020927223517.
Joiner, V. C., & Buttell, F. P. (2018). Investigating the usefulness of trauma-focused cognitive behavioral therapy in adolescent residential care. Journal of Evidence-Informed Social Work, 1–16. https://doi.org/10.1080/23761407.2018.1474155.
Kinniburgh, K. J., Blaustein, M., Spinazzola, J., & Van der Kolk, B. A. (2005). Attachment, self-regulation, and competency: a comprehensive intervention framework for children with complex trauma. Psychiatric Annals, 35, 424–430. https://doi.org/10.3928/00485713-20050501-08.
Knorth, E. J., Harder, A. T., Zandberg, T., & Kendrick, A. J. (2008). Under one roof: a review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review, 30, 123–140. https://doi.org/10.1016/j.childyouth.2007.09.001.
Larzelere, R. E., Dinges, K., Schmidt, M. D., Spellman, D. F., Criste, T. R., & Connell, P. (2001). Outcomes of residential treatment: a study of the adolescent clients of Girls and Boys Town. Child & Youth Care Forum, 30, 175–185. https://doi.org/10.1023/A:1012236824230.
Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: evidence-based practice in clinical settings. Journal of Clinical Psychology, 69, 497–509. https://doi.org/10.1002/jclp.21990.
Loughran, T. A., Mulvey, E. P., Schubert, C. A., Fagan, J., Piquero, A. R., & Losoya, S. H. (2009). Estimating a dose-response relationship between length of stay and future recidivism in serious juvenile offenders. Criminology, 47, 699–740. https://doi.org/10.1111/j.1745-9125.2009.00165.x.
Maschi, T., Morgen, K., Bradley, C., & Hatcher, S. S. (2008). Exploring gender differences on internalizing and externalizing behavior among maltreated youth: implications for social work action. Child and Adolescent Social Work Journal, 25, 531–547.
Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: a review of the literature. International Journal of Mental Health Nursing, 23(1), 51–59. https://doi.org/10.1111/inm.12012.
Pfeiffer, S. I., & Strzelecki, S. C. (1990). Inpatient psychiatric treatment of children and adolescents: a review of outcome studies. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 847–853. https://doi.org/10.1097/00004583-199011000-00001.
Phillips, E. L., Phillips, E. A., Fixsen, D. L., & Wolf, M. M. (1974). The teaching-family handbook (2nd ed.). Lawrence: University Press of Kansas.
Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 201–269. https://doi.org/10.1002/1097-0355(200101/04)22:1<201::AID-IMHJ8>3.0.CO;2-9.
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. https://doi.org/10.3928/00485713-20050501-09.
Sunseri, P. A. (2001). The prediction of unplanned discharge from residential treatment. In Child and youth care forum (Vol. 30, no. 5, pp. 283-303). Kluwer Academic Publishers-Plenum Publishers.
Sunseri, P. A. (2004). Family functioning and residential treatment outcomes. Residential Treatment for Children & Youth, 22(1), 33–53. https://doi.org/10.1300/J007v22n01_03.
U.S. Department of Health and Human Services, Administration for Children and Families, Administration of Children, Youth, and Families, Children’s Bureau. (2018). The AFCARS Report: Preliminary FY 2017 Estimates as of August 10, 2018. Retrieved from https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport25.pdf.
Van der Kolk, B. A. (2005). Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35, 401–408. https://doi.org/10.3928/00485713-20050501-06.
Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Children and Youth Services Review, 31, 1199–1205. https://doi.org/10.1016/j.childyouth.2009.08.013.
Whittaker, J. K., Del Valle, J. F., & Holmes, L. (Eds.). (2014). Therapeutic residential care with children and youth: Developing evidence-based international practice. London and Philadelphia: Jessica Kingsley Publishers.
Winokur, M. A., Crawford, G. A., Longobardi, R. C., & Valentine, D. P. (2008). Matched comparison of children in kinship care and foster care on child welfare outcomes. Families in Society, 89, 338–346. https://doi.org/10.1606/1044-3894.3759.
Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013). Traumatized youth in residential treatment settings: prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 28, 639–652. https://doi.org/10.1007/s10896-013-9534-9.
Acknowledgments
Lauren H. K. Stanley would like to thank Dr. Boel-Studt for her support and guidance during this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Authors Lauren H. K. Stanley and Shamra Boel-Studt declare they have no conflict of interests to report.
Ethical Standards and Informed Consent
This study was approved by the Florida State University Institutional Review Board and followed the ethical standards applied to de-identified secondary data.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Stanley, L.H.K., Boel-Studt, S. The Influence of Youth Gender and Complex Trauma on the Relation Between Treatment Conditions and Outcomes in Therapeutic Residential Care. Journ Child Adol Trauma 14, 93–101 (2021). https://doi.org/10.1007/s40653-019-00285-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-019-00285-x