Perceptions of Trauma-Focused Mental Health Services for Adolescent Girls in Child Welfare

Background and Purpose. Child welfare-involved adolescent girls are a highly traumatized population at heightened risk for numerous negative outcomes including interpersonal violence, mental health problems, and difficulties forming healthy relationships. Despite widespread promotion of trauma-informed child welfare practice and mounting evidence about the effectiveness of trauma-focused interventions (TFIs) in other populations to reduce PTSD and other trauma-related problems, little is known about child-welfare involved adolescents’ experiences with TFIs. Moreover, according to the Health Belief Model, engagement with mental health services is more likely when perceived effectiveness is high and psychological barriers are minimal. However, few studies have examined perceptions of the benefits of, or potential barriers to engaging with trauma-focused services in child welfare populations. To address this, the current study answered the following questions: 1) What did girls involved in child welfare and their caregivers consider to be most beneficial elements of the services received for addressing trauma, 2) What were the perceived facilitators and barriers to engagement?  

Methods. Qualitative semi-structured interviews were conducted with 16 adolescent girls involved in child welfare and their caregivers (n=6). Data were derived from girls assigned to a usual care condition for a trauma-focused CBT intervention study. Adolescent participants were aged 13 to 19 (mean=16.1, SD=1.42); and self-identified as non-Hispanic, Caucasian, (n=8), African American (n=7), and mixed race (n=1). Caregivers were foster parents (n=2), biological parents (n=3), and grandparents (n=1); four were non-Hispanic Caucasian, and two were African American. Interview guides included questions about services received in the last six months and the relevance for dealing with negative consequences of trauma. Data were analysed through an inductive process involving initial open coding and the subsequent formation of more abstract categories (Miles & Huberman, 1994). Each transcript was independently coded by two team members using NVivo 10.

Results. Four themes emerged about beneficial service elements. Participants valued the provision of knowledge and skills in relation to: emotion regulation, aggression and conflict, processing difficult experiences, and forming healthy relationships. In each case, adolescents provided examples of successfully incorporating these skills into their lives. For example, one girl believed newly acquired emotion regulation skills had prevented the breakdown of her foster placement. Perceived facilitators to engagement included freedom of expression and being shown care by professional staff. Barriers to engagement included beliefs about the irrelevance of services and negative perceptions of service providers. Fear of re-experiencing traumatic events also led to avoidance of services; for example, one caregiver reported that her daughter “sometimes wouldn’t even come home” when she knew the therapist would be there.

Conclusions and Implications. The service elements identified as beneficial by adolescent girls and their caregivers correspond with many core components of evidence-based TFIs. However, girls did not engage with services if other elements of trauma-informed practice were missing, such as a positive therapeutic relationship or a sense of safety. Trauma-informed child welfare service delivery requires provision of evidence-based TIFs in a manner that minimizes psychological barriers to engagement for traumatized adolescent girls.