Exploring relationships as mediators of treatment outcomes among commercially sexually exploited youth.

BACKGROUND: Research indicates that youth exposed to commercial sexual exploitation tend to have extensive histories of trauma, including physical abuse, sexual abuse, and neglect, which increases their vulnerability to exploitation. Trauma literature finds youth who present to treatment with greater behavioral health needs tend to have higher trauma scores than youth with fewer behavioral health needs (Copeland et al., 2007; Finkelhor et al., 2007). OBJECTIVE: There is, however, limited research on the role of youth strengths as a buffer against the outcomes associated with trauma. With this in mind, the purpose of this study was to examine the relationship between Adverse Childhood Experiences (ACE scores) and youth outcomes such as risk behaviors, behavioral needs, and impairment in functioning across major life domains. Secondly, we explored how this relationship might be better explained by examining youth strengths as mediators-specifically, peer relationships and the stability of significant relationships in the youth's life. PARTICIPANTS AND SETTING: Data on clients served in a treatment program specialized for commercially sexually exploited youth were used for this research. RESULTS: Results indicated that youth with higher ACE scores had a greater number of risk behaviors, behavioral needs, and impairment in functioning across major life domains. Findings of the mediation analysis provide some support that peer relationships and relationship stability, at least in part, mediates the relationship between ACEs and youth outcomes. Post hoc analyses indicated youth strengths mediated 9-18% of the total effect of ACE scores on youth outcomes. CONCLUSIONS: Developing peer relationships and sustaining significant relationships can mitigate some of the adverse effects of trauma experienced by exploited youth.

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

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.

The association between type of out-of-home mental health treatment and juvenile justice recidivism for youth with trauma exposure.

BACKGROUND: High rates of mental health disorders and exposure to trauma among the juvenile justice population highlight the importance of understanding whether and how mental health services can help prevent further justice system involvement as well as provide treatment. AIMS: We had two principal questions: Is out-of-home mental health treatment after arrest associated with reduced recidivism among young people who have been exposed to trauma? Are particular types of out-of-home treatment associated with better outcomes? We hypothesised that type of residential setting would affect outcomes among those with histories of serious trauma. METHODS: Primary data sources included Florida Juvenile Justice, Child Welfare and Medicaid data from July 2002 through June 2008. We identified all Florida Juvenile Justice cases with a record of 'severe emotional disturbance'. Two groups were identified - one for whom an arrest was followed within 90 days by out-of-home placement for mental health treatment and the other for whom there was some other out-of-home placement. Generalised estimating equations (GEE) were used to calculate associations with likelihood of re-arrest during a 12 month at risk period. RESULTS: Young people who had experienced severe trauma and were sent to out-of-home treatment settings after conviction for a criminal offence had lower recidivism rates when receiving treatment in foster care than other out-of-home placements, while those with less severe or no trauma histories had lower recidivism rates with any out-of-home placement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: We believe that this is the first study to have considered how trauma histories may mediate outcomes for young people in out-of-home placements after arrest or conviction for a criminal offence. Findings suggest that case managers and clinicians should consider the trauma histories when making decisions about the appropriate treatment setting in these circumstances. Copyright © 2017 John Wiley & Sons, Ltd.

Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed.

Arrests among youth after out-of-home mental health treatment: comparisons across community and residential treatment settings.

BACKGROUND: There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments. AIMS: To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type. METHODS: Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003-2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates. RESULTS: Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care.

Predictors for readmission into children's inpatient mental health treatment.

The goal of this study was to examine factors associated with time to first and subsequent readmissions of youth (N = 1,432) to one of Florida's residential mental health treatment programs, known as State Inpatient Psychiatric Program (SIPP). Results of multivariate Cox regression analysis indicated that greater maltreatment severity, shorter length of time spent in SIPP during the initial episode, and longer time to provision of targeted case management services were associated with earlier readmission. When time to subsequent readmission was examined, results of multivariate Cox regression analysis indicated that shorter length of stay during the second hospitalization and having more than one mental health diagnosis increased the odds of experiencing subsequent readmission. One consistent finding across initial and subsequent readmissions was that the timing of service provision but not the amount of services was crucial for preventing readmissions to inpatient residential programs.

After out-of-home mental health treatment: atypical antipsychotic medication use and the probability of returning to treatment.

Florida Medicaid claims data were used to assess antipsychotic medication use among children after therapeutic out-of-home mental health treatment. Fifty percent of youth received antipsychotics after the treatment episode, but differences exist across age, gender, and racial groups. Utilization was higher among males and youth ages 6-12, while blacks were less likely to be prescribed antipsychotics than whites. Youth receiving antipsychotics were less likely to return to out-of-home treatment within 6 months. However, among youth receiving antipsychotic medications, a higher medication possession ratio was not associated with the likelihood of returning to treatment. Such patterns require further investigation to determine whether they indicate inadequate treatment for some youth.

Innovations in implementation of trauma-informed care practices in youth residential treatment: a curriculum for organizational change.

Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and children in the child welfare system and discusses a study of trauma-informed practices in OOH treatment programs and the curriculum Creating Trauma-Informed Care Environments, which resulted from study findings.