Play to the Whistle: A Pilot Investigation of a Sports-Based Intervention for Traumatized Girls in Residential Treatment

Adolescents in residential treatment settings have symptoms that prevent them from participation in normal youth activities, which in turn prevent development of social skills and competencies. A sports-based intervention called “Do the Good” (DtG) was designed for this population using trauma-informed treatment principles. This paper describes the intervention model and presents outcome data. A total of 88 female residential students aged 12 to 21 participated, including 62 students voluntarily enrolled in the sports league and 26 treatment-as-usual (TAU) comparisons. Positive behaviors (e.g., helping peers, perseverance) during games were observed and coded for sports league participants and their coaches. Mental health charts of DtG and TAU participants were reviewed for behavior and symptoms prior to program participation, and again post-program. Girls in the sports league exhibited reductions in restraints and time-outs, as well as internalizing and externalizing symptoms. These data provide evidence that sports-based interventions present a promising adjunctive approach for traumatized youth.     

Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Although abundant evidence exists indicating the prevalence of trauma exposure among youth in residential care, few models exist for creating trauma-informed milieu treatment. This article outlines the problem and describes the implementation of Trauma Systems Therapy (TST) in three residential centers. TST is unique in emphasizing youth emotions and behaviors as well as the role a distressed or threatening social environment may play in keeping a traumatized youth in a dysregulated state. This dual emphasis makes TST specifically appropriate to implementation in congregate care, focusing assessment and intervention strategies on both clinical treatment and the functioning of the therapeutic milieu itself. Data are reported on incidents of the use of physical restraint; numbers of disrupted foster care placements following discharge from residential treatment; and scores on psychometric measures of children’s functioning and emotion regulation capacity. Knowledge gained through TST implementation in these three residential centers has important implications for developing a model of trauma-informed congregate care.     

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

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.     

Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Implications for a Developmental Trauma Framework

Patterns of trauma exposure and symptoms were examined in a sample of 16,212 children in Illinois child welfare. Data were collected on trauma histories, child and caregiver needs and strengths, and analyzed in light of the proposed Developmental Trauma Disorder diagnostic criteria. Youth exposed to both interpersonal violence and attachment-based (“non-violent”) traumas within the caregiving system had significantly higher levels of affective/physiological, attentional/behavioral, and self/relational dysregulation in addition to posttraumatic stress symptoms compared to youth with either type of trauma alone or in relation to other trauma experiences. These complexly traumatized children exhibited higher levels of functional impairment and were more likely to have placement disruptions and psychiatric hospitalizations. Findings suggest a developmental trauma framework can more adequately capture the spectrum of needs of these multiply traumatized youth than existing diagnostic formulations. Utilizing this framework for assessment, treatment planning, and intervention can lead to more targeted and effective services for these children.     

PROTECTING YOUTH PLACED IN UNLICENSED,UNREGULATED RESIDENTIAL “TREATMENT” FACILITIES

Throughout the country, there is considerable inconsistency in how states regulate residential treatment programs for youth. In states with little oversight, the health and safety of youth are unprotected and they may be subject to substandard treatment, rights violations, and/or abuse. Three initiatives to address this issue are reported: (1) an Internet survey of youth who are former residents, (2) a four‐state pilot study of how states regulate and monitor residential programs, and (3) a bridge‐building conference between residential treatment providers and mental health leaders. Recommendations address the next steps for lawmakers, lawyers, judges, mental health and education professionals, and parents.     

Predicting successful outcomes for serious and chronic juveniles in residential placement

In the past decade, juvenile justice agencies have become more reliant on objective risk scales based on an actuarial approach to assessing risk. Risk assessment scales are used as decision-making guides at multiple points in the juvenile justice system. However, little research has focused on assessment of more serious offenders facing removal from the community. Enormous benefits can be derived, both in public safety and cost savings, from successful interventions with these offenders. Identifying offenders most amenable to intervention and at lowest risk for offending upon leaving placement represents a significant challenge. In this study, a placement risk screen was developed that assesses amenability to treatment in a residential treatment program and later risk for adult criminality. The relationship between suspected risk factors, success in a residential treatment program, and adult offending was assessed in a population of 81 male delinquent youths. Many factors are believed to have a bearing on success in treatment and later offending behavior, but only a small number of these were statistically significant. The results suggest that success in residential placement can reduce future offending, but that youth should first be screened for amenability to the program so scarce resources can be conserved. The proposed placement risk screen can assist juvenile court judges, officers, and residential treatment staff in identifying youth most suitable for treatment and who represent a lower risk to the community.     

AMERICAN BAR ASSOCIATION POLICY REQUIRING LICENSURE,REGULATION, AND MONITORING OF PRIVATELY OPERATED RESIDENTIAL TREATMENT FACILITIES FOR AT‐RISK CHILDREN AND YOUTH

Well‐meaning parents send an estimated 10,000 to 14,000 at‐risk children each year to unregulated private residential treatment facilities, which for as much as $3,000 to $5,000 per month promise to modify troublesome behaviors and make bad kids good. The facilities that compose this booming, billion‐dollar business are generally not regulated, licensed, or monitored by state or federal governments; too many aspects of this alternative care system for youth are rife with mistreatment, including physical, sexual, and mental abuse by facility staff. This American Bar Association policy resolution urges state, territorial, and tribal legislatures to pass laws that require the licensing, regulating, and monitoring of residential treatment facilities that are not funded by public or government systems but offer treatment to at‐risk children and youth for emotional, behavioral, educational, or other problems or issues.     

WHAT'S GOOD FOR THE GAYS IS GOOD FOR THE GANDER: MAKING HOMELESS YOUTH HOUSING SAFER FOR LESBIAN,GAY, BISEXUAL,AND TRANSGENDER YOUTH

Across the United States, lesbian, gay, bisexual, and transgender (LGBT) youth are grossly overrepresented in the homeless youth population. These youth are at an increased risk of being victims of violence in homeless youth housing facilities. This Note examines the causes of the overrepresentation of LGBT youth in the homeless youth population. Additionally, this Note suggests the following changes to the regulation of homeless youth housing programs to make them safer for these youth: (1) placing low maximum limits on the occupancy capacity at which these programs may operate, (2) requiring that all showering facilities provide individual privacy, (3) prohibiting anti‐LGBT discrimination in the provision of services, (4) requiring nondiscrimination and sensitivity training, and (5) promoting the creation of LGBT‐specific homeless youth housing programs.     

Clinical Considerations for the Treatment of Latency Age Children in Residential Care

Children in the United States are exposed to alarmingly high rates of violence and trauma. Notable are the rates of maltreatment among children and the heightened risk for both out of home placement and an array of developmental, behavioral, and psychosocial sequelae. Despite these risks, little information is available on effective interventions and services designed to address the complex needs of youth in residential treatment settings. To effectively respond to their unique developmental, behavioral, and emotional needs, trauma-informed interventions and services must be provided to support optimal outcomes. To this end, this paper delineates the prevalence of children in residential care secondary to chronic maltreatment and other trauma exposures, identifies behavioral and emotional issues through the theoretical framework of complex trauma, highlights the importance of organizational capacity to deliver trauma-informed services, and describes effective clinical interventions that are often used in residential treatment. Clinical considerations and recommendations are also provided.     

Does Treatment Quality Matter?

Research Summary

The Florida Department of Juvenile Justice has implemented a process to evaluate the treatment quality of interventions provided statewide in all long‐term residential programs. In the current study, we examine the predictive validity of this treatment quality component in the prediction of recidivism of youth (N = 2,397) who completed juvenile justice residential programs from July 1, 2013 to June 30, 2014. We use hierarchical linear modeling to assess the effects of treatment quality (as youth are nested within programs), controlling for demographic and criminal history factors. The results indicate that higher average treatment quality scores of interventions received within a residential program decreased the likelihood of subsequent arrest, conviction, and reincarceration, whereas the highest treatment quality score of any specific intervention provided within the program decreased the odds of reincarceration only.

Policy Implications

In this study, we confirm the importance of fidelity and implementation quality in the provision of crime prevention treatment interventions to serious, deep‐end juvenile offenders. Additionally, our results shed light on the ability of a juvenile justice agency to measure treatment quality in a substantively meaningful way with the use of limited additional resources. The services provided to keep communities safe, prevent future offending, and rehabilitate juvenile offenders must be held accountable for producing such outcomes, and one method of measuring such compliance is to evaluate the quality of the interventions with respect to staff training, fidelity adherence, evaluation, and corrective action processes.     

A Clinical-Corrections Approach: The Failure of a Residential Juvenile Delinquency Treatment Center

Abstract With the incidence of violent juvenile crime and the increasingly limited funds for residential treatment of the adolescent offender, one court jurisdiction (16th Judicial Circuit, Kane County, Illinois) attempted to develop and administer its own residential treatment facility within the walls of its detention facility. This article documents the problems encountered in this endeavor and provides recommendations for other jurisdictions which might be tempted to try to balance the fiscal and rehabilitative demands of this growing population by administering their own residential treatment facilities. The problems addressed in this article pertain to the following areas of difficulty: developing a therapeutic milieu; attracting, training, and evaluating a competent child care staff; and implementing a consistent philosophy of change designed to drive all decision-making within the center.     

Treatment Profiles of Troubled Female Adolescents: Implications for Judicial Disposition

Increasing numbers of girls are entering the juvenile justice system. This growing number of females creates a dilemma for judges concerned with appropriate disposition to treatment and diversion: since current intervention methodologies were developed primarily for males, how effective are they for females? The current paper describes a research process that addressed this issue. A sample of troubled adolescents was selected from a residential treatment facility. Data were collected from 137 youth between the ages of 12 and 17 (65 female [47%] and 72 male [52%]) regarding variables related to twenty-three behavioral and psychosocial problems. These data were then subjected to a cluster analysis. Two distinct treatment profiles were formed, each differing in composition by gender. Based on the results of the cluster analysis, the researchers conducted a literature review to determine the implications of those profiles for successful disposition and treatment.     

WHEN IT HAPPENS IN A FAMILY: AIDING PARENTS OF SUBSTANCE‐ABUSING ADOLESCENTS*

This article first summarizes key data on the scope of teen substance abuse and the lack of teen access to needed treatment services. It then describes how and why attorneys may be helpful to parents who discover their teen's drug or alcohol problem and seek advice and counsel about the legal implications of various actions that can or may be taken. The article explores such issues as parents finding illegal drugs in the house or on their teen's person, various modalities of treatment and how family members are involved, how parents might secure residential evaluations for their youth without the necessity of juvenile court involvement (and why this is important), concerns about placing youth in unlicensed residential treatment facilities, health insurance coverage issues, home drug testing, and how past American Bar Association (ABA) policy on youth drug and alcohol abuse is being followed up with a new ABA project to aid parents of substance‐abusing teenagers and their families.     

Exploring the Impacts of Racial Disparity Within the American Juvenile Justice System

The racial disparity in the American juvenile justice system impacts the lives of many youth of color. Youth of color constitute 34% of the U.S. population, however, they make up 62% of the youth charged in the juvenile justice system. The cycle of racial inequality and imprisonment are factors influenced by residential segregation and policing practices. Juvenile justice involvement leads to poorer physical and mental health in youth, stymied social outcomes, poorer familial relationships, decreased graduation and employment rates, increased rates in violence, and long-term negative future outcomes. The article advocates for mental health treatment and family services to be incorporated within incarcerated settings. Clinical strategies and future direction are discussed to begin to combat these various adverse impacts.     

Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs

Most youth detained in juvenile justice facilities have extensive histories of exposure to psychological trauma. Traumatic stress plays a key role in their mental health and behavioral problems and needs, and in their safety and rehabilitation and the security and effectiveness of detention facilities. We provide an overview of the barriers to successful provision of mental health services for youths in juvenile justice facilities, including those involving youth, parents, and juvenile justice residential facility staff and administrators. Next, we discuss the relevance and potential utility of approaching mental health needs using posttraumatic stress disorder (PTSD), and more broadly posttraumatic dysregulation, as an organizing framework. Examples of how a posttraumatic dysregulation perspective can enhance juvenile justice residential facility milieus and services are presented, with an overview of traumatic stress intervention models that have shown promise, or potentially could be deployed, in developing and sustaining trauma-informed juvenile justice facilities.     

Subculture,Gang Involvement,and Delinquency: A Study of Incarcerated Youth in China

The purpose of this study is to examine youth gang phenomena in China employing a two-step approach. The first step is to apply the delinquent subculture perspective to the explanation of variation in gang involvement; the second is to investigate the relationship between youth gang involvement and self-reported delinquency. The data for the study were collected from face-to-face interviews conducted with adjudicated youth offenders incarcerated in a province-run juvenile prison. Structural equation modeling is used to assess the direct and indirect effects of delinquent subculture exposure and gang involvement on three outcome variables of delinquency. The primary finding is that exposure to a subculture of violence is indeed a significant predictor of gang involvement. Importantly, gang involvement is significantly correlated with both violent offending and drug offending.     

The relationship between childhood traumatic events,social support,and mental health problems in prisoners

This study examined the prevalence of childhood traumatic events (CTE), social support levels as well as mental health problems (MHP), to test for differences between traumatized and non-traumatized individuals, and to investigate the relationship among the aforementioned parameters in a sample of 49 prisoners in Switzerland. This cross-sectional study used standardized self-report measurements. In line with expectations, prisoners reported a high rate of traumatic events. Furthermore, results indicated that those traumatized differed from those non-traumatized regarding the level of social support, interpersonal sensitivity, and depression. However, no relationship between CTE and social support as well as MHP was found. This points to specific therapeutic needs of those traumatized, and to the necessity of a trauma-informed correctional care. Moreover, these study results are a further step into more integrated models of criminal behavior.     

A Call for Help: Women Offenders' Reflections on Trauma Care

Female prisoners have extensive trauma histories and complex treatment needs that contribute to their criminality, yet trauma screening and treatment is not widespread in prisons. This article examines qualitative data gathered from face-to-face interviews with 31 female offenders in Canadian prisons. Using a grounded theory approach we demonstrate an unmet need for trauma-specific services for female offenders. These services go beyond trauma-informed practice and treat the psychological and behavioral sequelae of trauma exposure (e.g., mental illness and addictions) to facilitate recovery. The findings suggest that women in prison want and need specific treatment for trauma exposure. Integrating trauma-specific services involves a cultural shift within the prison environment that might be achieved by positioning trauma within the risk–need–responsivity model as an additional risk factor for criminality. Although counter to the public health perspective that trauma is a health concern, it is a way to ensure that trauma becomes part of the battery of care in corrections so that the needs of traumatized women are addressed while they are in custody. This was a unique opportunity to learn about what women would like to help deal with their experiences of trauma.     

Cumulative experiences of violence among high-risk urban youth

This study examines type-specific and cumulative experiences of violence among a vulnerable population of youth. Sixty high-risk, shelter-dwelling, urban youth were interviewed regarding their history of childhood maltreatment, exposure to community violence (ECV), and experience with intimate partner violence (IPV). Results show a high prevalence and high degree of overlap among multiple types of violence exposure. Childhood physical, sexual (CSA), and emotional (CEA) abuse were interrelated and were associated with ECV. Cumulative experiences of childhood abuse (CCA) had a graded association with IPV victimization. In multivariate analyses, CCA and ECV were independently associated with IPV victimization. Gender moderated the effect of one association: CEA raised the risk of IPV victimization for girls but not for boys. Only CSA predicted IPV perpetration. Findings suggest that cumulative exposures to violence create cumulative risk for experiencing more violence. Shelter-dwelling, urban youth may be particularly vulnerable to this additive effect.     

The Importance of the Caregiver and Adolescent Relationship for Mental Health Outcomes Among Youth in Foster Care

Youth in foster care have often been exposed to in-home violence and violence exposure is associated with higher mental health concerns. This study used multiple regression mediation analyses with bootstrapping to identify specific current foster caregiver-adolescent relationship factors and their mediating qualities between in-home violence exposure and adolescent internalizing, externalizing, and trauma symptoms. Using a national dataset of adolescents in foster care (n?=?175), the results of this study suggested that an adolescent’s perception of feeling emotionally secure in their relationship with their caregiver mediated the relationships between exposure to violence and youth internalizing, externalizing, and trauma symptoms. Additionally, current foster caregiver involvement and structure mediated the associations between exposure to violence and adolescent internalizing and externalizing outcomes, but not trauma symptoms. Further discussion of the results is included. Findings have important implications for mental health interventions aimed towards youth in foster care.