Personal Trauma and Risk Behaviors Among Youth Entering Residential Treatment

The focus of this study was to determine the prevalence and types of traumas experienced by adolescents prior to admission to long term mental health residential care and the impact of these traumas on their risk behaviors. The research was conducted at a state-supported residential mental health treatment facility functioning under the authority of the Department of State Health Services. Client level data was extracted from social assessment forms (N = 457) in case records of clients. Results confirmed that exposure to trauma was pervasive among adolescents admitted to the facility. Findings also revealed a link between trauma and risk behaviors among youth entering residential treatment facilities. Increased trauma exposure significantly impacted the risk behaviors of youths entering the residential treatment facility. The results indicate that the total number of traumas experienced was a greater predictor of risk behaviors among these youth than the specific traumas experienced. Internalizing behaviors such as self-harm and suicide attempts also increased with the number of traumas experienced by the adolescent. The study demonstrates the need for further exploration of the complex relationship between personal trauma, mental health, and social development in adolescents.     

Placement type matters: Placement experiences in relation to justice system involvement among child welfare-involved youth and young adults

Out-of-home placement in the child welfare system is related to justice system involvement. Yet, few studies address the similarities and differences of child welfare placement types in relation to justice system involvement within the same sample of youth, which can provide a more nuanced understanding of the relationship between the two. Utilizing a sample of child welfare youth with substantial out-of-home placements (N = 794), we investigate trajectory group experiences on each of three child welfare placement types, and cross-tabulate each with justice system trajectory groups to examine subgroups. The five-group model fits best for foster homes and group homes; four groups for residential facilities. Relationships between justice system groups and placement types were significant. Youth with chronic justice system involvement had more experiences in group homes and residential facilities; youth with less justice system contact tended to have foster home experiences. Implications for policy and practice are presented.     

Addressing the impact of trauma before diagnosing mental illness in child welfare

Congress set requirements for child welfare agencies to respond to emotional trauma associated with child maltreatment and removal. In meeting these requirements, agencies should develop policies that address child trauma. To assist in policy development, this study analyzes more than 14,000 clinical assessments from child welfare in Illinois. Based on the analysis, the study recommends child welfare agencies adopt policies requiring that (1) mental health screenings and assessments of all youth in child welfare include measures of traumatic events and trauma-related symptoms; (2) evidence-based, trauma-focused treatment begin when a youth in child welfare demonstrates a trauma-related symptom; and (3) a clinician not diagnose a youth in child welfare with a mental illness without first addressing the impact of trauma. The study also raises the issue of treatment reimbursement based on diagnosis.     

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

Barriers and facilitators for access to mental health services by traumatized youth

Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.     

A Survey of Problematic Sexualized Behaviors of Children in the New York City Child Welfare System: Estimates of Problem,Impact on Services,and Need for Training

ABSTRACT

Forty-eight of 52 (92%) agencies contracted with the New York City Administration for Children's Services (ACS) responded to a survey about problematic sexualized behaviors (PSB) of children in different levels of care within the child welfare system. Results revealed that almost all agencies reported PSB within their foster boarding home and residential treatment centers. A majority of agencies perceived PSB to be a significant problem for which staff and families were not sufficiently trained. These findings highlight many avenues for advocacy, clinical intervention, and staff development.     

Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.     

Needs assessment of youths in residential child care in Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal / Evaluación de necesidades de jóvenes en acogimiento residencial en Portugal

Residential child care in Portugal is the most common protection measure in cases of family separation, since family foster care is still very rare. However, little is known about the needs of these children and young people. The purpose of this study is to describe the profile of adolescents close to legal adulthood who are in residential care, comparing it with a Spanish sample. The sample is composed of 345 young people aged 16 to 17 on whom information has been collected regarding their history of protection, family background, schooling, mental health and offending behaviour. A Spanish sample was selected as a comparison group (N = 384). The results reveal the complexity and special seriousness of the profile of young people in residential care in Portugal compared to a Spanish sample, highlighting a high presence of mental health problems and especially suicidal behaviours. Given these results, efforts should be focused on developing specialized residential care programmes adapted to the specific needs of these young people.     

Developmental Outcomes of Vulnerable Youth in the Child Welfare System

Abstract

Adolescent development of youth in foster care holds great interest for society. This article examines a random sample of 200 adolescents currently placed in foster care on developmental outcomes. Using face-to-face interviews, the present study found that a majority of foster youth have biological families experiencing multiple problems and experience many developmental difficulties. A large percentage of the sample youth experience mental illness, school failure, substance abuse, and other antisocial behaviors. This paper considers implications from the study findings for policy and interventions designed to foster better developmental outcomes among youth in the child welfare system.     

Risk factors for mental health diagnoses among children adopted from the public child welfare system

Children awaiting adoption through the child welfare system often have “special needs,” or characteristics that make securing an adoptive home for them challenging. A subset of these youth experiences significant psychiatric symptomatology, which may pose a problem for the stability of the adoptive placement. Clinicians and policymakers require information about precursors to mental health difficulties in order to plan effectively for the placement of these children.This study examines potential child and biological family risk factors for the presence of a DSM-IV mental health diagnosis among 368 children placed for adoption by a special needs adoption program between February 1997 and April 2005 using logistic regression within the Generalized Estimating Equations (GEE) framework. A significant proportion of the children and biological parents in our study experienced serious adversity prior to adoptive placement. Older age at adoptive placement, white race, male gender, having more than one placement, and a history of sexual abuse are significant predictors of the presence of a mental health diagnosis in the logistic regression model. Biological parent incarceration is significantly associated with the absence of a mental health diagnosis.Adoptive placement is a key transition for youth who have often experienced significant loss and trauma prior to placement. Support of the adoptive family and youth can be critical to ensuring placement stability and may be especially salient for youth with documented mental health diagnoses and corresponding behavioral problems, which put children at increased risk for placement disruption. More work is needed to understand the interplay of risk and protective factors for mental health difficulties among youth adopted from the child welfare system, including how these are affected by child welfare policies, informal procedures, and resources to produce varying outcomes for children in peril.     

Sexual risk behaviors among youth in the child welfare system

This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to provide estimates of sexual risk behaviors for 877 youth, age 11–14 at baseline, in the child welfare system. It examines the association between baseline psychosocial risk and protective factors on engagement in sexual risk behaviors after 36 months. It further compares rates of sexual risk behaviors between youth placed in out-of-home care and those who remained with their biological family. Key findings include a high rate of pregnancy, a high percentage of youth who initiated sexual activity at or before age 13 as well as a limited role of protective factors in moderating sexual risk behaviors. A history of placement into out-of-home care is not significantly associated with greater engagement in sexual risk behaviors. Implications for intervention development and child welfare policy for this population are discussed.     

Educational risk,recidivism, and service access among youth involved in both the child welfare and juvenile justice systems

Dually-involved youth represent a population of youth who receive some level of supervision from both the child welfare and juvenile justice systems concurrently. The current study examined education-related risk factors, recidivism, referrals for services, and service access among dually-involved youth in Los Angeles County. Specifically, whether increased educational risk was associated with referrals to, and access of, educational services and supports and whether higher receipt of educational services reduced recidivism approximately six months post-disposition. Data for this study consisted of a sample of dually-involved youth (N = 131) who were adjudicated delinquent and also had a child welfare case open. An Educational Risk Index (ERI) was developed and included school attendance, credit deficiency, problem school behavior, and current grades. Results indicate that educational risk was negatively associated with mental health services accessed, demonstrating that those with higher educational risk accessed less mental health services. Educational risk, however, was not associated with increased educational service referrals or access, suggesting a possible mismatch in educational need and service referrals. Lastly, there were no significant differences between those that recidivated and those that did not recidivate in service access and educational risk.     

Prior Placements of Youth Admitted to Therapeutic Foster Care and Residential Treatment Centers: The Odyssey Project Population

Two samples of youth in the child welfare system were compared—youth entering residential treatment centers (RTCs) and youth entering therapeutic foster care (TFC). Three questions were addressed: (1) Where were youth living prior to the current placement? (2) Had youth been treated in other systems of care? (3) How many prior placements did youth have? Time 1 data of the national “Odyssey Project” developed by the Child Welfare League of America were used. The^.measure utilized was the child and family characteristics form (CFC). Results revealed that youth admitted to RTCs were more likely to be entering from other systems of care and stepping down to the RTC while youth entering TFCs were more likely to be entering from within the child welfare system and stepping up to a higher level of care. The results have implications for improving clinical practice and for the development of a cross-system perspective on serving troubled youth.     

Children with problematic sexualized behaviors in the child welfare system

This study assessed the utility of the Child Sexual Behavior Inventory (CSBI) in a child welfare sample. In this study, 97 children from ages 10 to 12 from either foster boarding homes or a residential treatment center participated. Researchers interviewed foster parents or primary therapists about children's sexual behavior, traumatic events, clinical symptoms, and their attitudes toward the child. Findings revealed that problematic sexualized behaviors were more prevalent in the residential treatment center (RTC) sample than they were in a normative sample. The pattern of associations between sexual behavior problems, traumatic events, and clinical syndromes in both the RTC and the foster boarding home (FBH) samples was similar to what has been found in samples in which biological custodial parents were the respondents. Analyses comparing youth who met the criterion for having problematic sexualized behaviors and youth who did not meet the criterion revealed that the two groups differed on clinical symptoms, prior traumatic events, and negative reports by caregivers. Results confirm the utility of the CSBI measure for this population and highlight several important clinical and programmatic concerns for addressing problematic sexual behavior in children in the child welfare system.     

Adolescents in residential treatment: The prevalence of ACEs,substance use and justice involvement

Abstract

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.     

Psychological Symptoms of Sexually Victimized Children and Adolescents Compared With Other Maltreatment Subtypes

The differential effects of sexual victimization and other forms of maltreatment on psychological functioning are not well understood. A sample of sexually victimized children and adolescents (N = 70; 6.3–17.9 years) and a group of youth with a history of nonsexual maltreatment (N = 108; 6.7–16.9 years) were compared using measures of mental health and psychosocial functioning. Assessments included standardized clinical interviews on individual maltreatment history and current psychopathology as well as questionnaires on behavioral and emotional symptoms, including posttraumatic stress symptoms. The results from this study suggest that the risk of experiencing any current mental disorders was independent of type of maltreatment. The risk of meeting the criteria for a current diagnosis of major depression, however, is greater among youth with a history of maltreatment that includes sexual victimization. The significant impact of sexual victimization on posttraumatic stress symptoms was found to be nonsignificant after controlling for age and gender effects. The results indicate that the outcomes of child maltreatment depend on type of maltreatment, but age and gender must be taken into account.     

Instability in patchworks of child care when moving from welfare to work

We use longitudinal, qualitative interview data collected from 38 initially welfare‐reliant women in Cleveland, Ohio to examine the factors driving instability in child‐care arrangements when women transitioned from welfare to work. Grounded theory analysis revealed that decisions about care were circumscribed by scarce social and economic resources, women went to extraordinary lengths to patch together arrangements that typically involved multiple providers, relative care was central to patchworks of care, and patchworks of child care were often highly unstable. These complex arrangements and their instability were influenced by mothers’ desires to find the most suitable arrangements for their children within resource and job constraints, dissatisfaction with providers, difficulties accessing subsidies, and changes in provider availability. Findings suggest that policymakers must consider instability in patchworks of multiple child‐care providers as they consider alternatives for meeting low‐wage working women's and children's needs for safe, affordable, accessible, and enriching nonmaternal child care.     

Job-strain and well-being among Finnish social workers: exploring the differences in occupational well-being between child protection social workers and social workers without duties in child protection

Work-related mental distress and its impact on employees’ working life is a mounting issue among Finnish social workers. This article focuses on identifying the factors associated with child welfare social workers’ occupational well-being. The occupational well-being of Finnish child welfare social workers (N?=?364) and social workers whose duties do not include child protection work (N?=?524) was explored and compared with each other using t-test statistics and logistic regression analysis. The data, collected in 2014/2015, were obtained from an ongoing longitudinal cohort study on work-related well-being among Finnish public sector employees. A multi-dimensional and holistic approach to occupational well-being was used as the outline for the analysis and comparison of the two groups. Child protection social workers reported higher levels of burnout and secondary traumatic stress than social workers without child protection duties. Despite these burdens, both groups showed a similar level of general health, compassion satisfaction and overall occupational well-being. Individual and organizational factors associated with high occupational well-being were identified. Supervision was found to be an important supporting element. This study identified multiple determinants related to social workers’ occupational well-being, comprising positive and negative elements with regard to organizational and individual factors.     

Safer recruitment? Protecting children,improving practice in residential child care

In the wake of a number of high‐profile cases of the abuse of children and young people in residential child care, there have been repeated calls for the improvement of recruitment and selection of residential child care staff. This paper describes the findings from a survey, undertaken in 2005, of operational and human resource managers who have responsibility for the recruitment and selection of residential child care staff in the voluntary and statutory sectors in Scotland. This research was commissioned by the Scottish Executive to identify which elements of safer recruitment procedures had been implemented following the countrywide launch of a Toolkit for Safer Recruitment Practice in 2001. Research findings show that although local authorities were more likely than voluntary organisations to have gone some way toward implementing safer recruitment procedures, the recruitment process lacked rigour and commitment to safer procedures in some organisations. The article discusses the current barriers to the introduction of safer recruitment methods and proposes some possible solutions for the future. Copyright © 2007 John Wiley & Sons, Ltd.