The Effectiveness of a Trauma-Informed Approach in Psychiatric Residential Treatment Programs for Children and Adolescents

Purpose: The use of trauma-informed interventions is on the rise across child serving systems despite limited empirical evidence demonstrating the effects of such approaches. National estimates find that as many as 92% of youth served in residential treatment have previously been exposed to multiple traumatic events including maltreatment, family violence, and community violence (Briggs et al., 2011). Given the extensive trauma histories and heightened risk for re-traumatization that characterizes youth served in residential treatment programs, trauma-focused interventions are increasingly being considered as a critical component to effective treatment (LeBuffe et al., 2010; Stewart et al., 2011).  The purpose of this study was to examine the effects of integrating a trauma-informed approach as an enhancement to standard treatment in two psychiatric residential treatment programs (PRT) serving children and adolescent ages 5-17.

Method: The study is being conducted in collaboration with one large child welfare agency in the Midwest that began implementing trauma-informed programming in their residential programs in the 2012.  A quasi-experimental design was used to compare the effects of a trauma-focused PRT (n = 79) with a standard services PRT (n = 100). Outcome measures included: change in functional impairment using the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 1997), length of stay in PRT, number of physical restraints and seclusion room incidents, and discharge placement types. Youths’ age, race, gender, trauma histories, and level of impairment at intake were included as model covariates. ANCOVAs and a logistic regression were used to examine differences in treatment outcomes between groups.

Results: Youth receiving trauma-informed PRT experienced significantly greater reductions in functional impairment from admission to discharge and their length of time in treatment was shorter by an average of four months compared to youth in the standard PRT. Further, youth in the trauma-informed group experienced significantly fewer seclusion room placements. There were no statistically significant differences between groups in the types of placements youth were discharged to or in the number of physical restraint incidents that occurred.   

Conclusion: Taken together, these results suggest that the inclusion of a trauma-informed approach to enhance services in PRT may help youth achieve greater symptom reduction in a shorter amount of time. Emerging evidence from the current study also suggests that trauma-informed PRT may help reduce the need for physically invasive methods of behavior management and subsequent risk for re-traumatizing youth that may result from the use of such approaches, especially among youth with prior exposure to maltreatment and/or family violence. Implications for practice and policy, particularly as it relates to funding for inpatient treatment will be discussed. In addition, plans for future research focused on further understanding the effects of trauma-informed approaches for helping youth in residential placements recover from experiences of interpersonal and extrapersonal trauma will be outlined.