Trauma is only part of the story: Strengths moderate the relationship between trauma and needs for older youth in foster care.

INTRODUCTION: Many youth in foster care endure traumatic experiences (TE) that can lead to lasting negative outcomes. However, the identification of strengths may mitigate the impact of TE. METHODS: This study examines the frequency and distribution of identified strengths; whether strengths moderate the association between TE and various outcomes; and whether certain strengths have a larger moderation effect on the association between TE and life domain functioning. Administrative and clinical data, including the Child and Adolescent Needs and Strengths (CANS) assessment, were examined for 3324 transition age youth and emerging adults in out-of-home foster care in the United States. Participants were males and females between 14.5 and 21 years old. Pearson's chi-square tests of association were conducted to determine whether identification of strengths varied significantly by sex or race/ethnicity. Negative binomial regressions were used to determine whether strengths modified the association between TE and needs domains. RESULTS: Of 11 measured strengths, 56% of youth had 7 or more strengths identified as centerpiece strengths, and 20% had all 11. No significant differences in identification of strengths were found across sex or race/ethnicity. All strengths significantly moderated the association of TE and outcomes across CANS domains tested. While cumulative strengths had the largest overall moderation effects, identification of education setting, coping and savoring skills, and interpersonal strengths as centerpiece strengths had the largest moderation effect among specific strengths. CONCLUSIONS: Findings suggest assessing, identifying, and bolstering strengths may help to promote well-being after trauma exposure.

Treatment Engagement Among Children Exposed to Violence: A Systems Perspective.

Childhood exposure to violence is a major public health issue. Effective treatment can reduce the impact of violence exposure on child outcomes. However, disparities in treatment engagement can interfere with effective treatment. This study reviews data collected from 2,546 children referred to community-based mental health services from 2001 to 2015 after exposure to violence. Children were categorized into three groups: those who attended intake but never started treatment, referred to as the Nonengager group; those who started but discontinued treatment prior to meeting treatment goals, referred to as the Attriter group; and those who completed treatment as rated by the treating therapist, referred to as the Completer group. The three groups were analyzed for differences in behavioral and emotional problems, racial identity, child social support, household income, number of people living in the home, parent stress, parent social support, community violence exposure, and neighborhood-level child opportunity. Analyses demonstrated that the Completer group were more likely to: live in neighborhoods with higher levels of childhood opportunity, identify as White, have an annual household income of $40,000 or greater, have significantly fewer people living in the home, report lower levels of parental stress, report higher levels of parental social support, report higher levels of child social support, and have significantly lower scores of emotional and behavioral problems after treatment. Overall, our study supports the importance of considering multiple ecological levels when targeting treatment engagement for children after exposure to violence. Results indicate that children from more advantaged environments are more likely to complete treatment, which leads to better outcomes. This can exacerbate existing disparities. Findings highlight the need for systems change and advocacy for children in less advantaged environments and meeting families in their specific context, to combat treatment disparities.

Understanding trauma experiences and needs through a comprehensive assessment of transition age youth in child welfare.

BACKGROUND: In the context of child welfare, Transition Age Youth (TAY) have high rates of trauma experiences (TEs) and are more likely to exhibit negative outcomes as they transition into adulthood. OBJECTIVE: This study describes the frequency and distribution of TEs among TAY in child welfare, as a whole and across sex and race/ethnicity. This study also examines the relationship between TEs and Child and Adolescent Needs and Strengths (CANS) needs. PARTICIPANTS AND SETTING: Participants included 3324 TAY (14.5 to 21-year-olds) who were under the care of the Illinois Department of Child and Family Services (IDCFS) and in out-of-home care for at least one year. METHODS: The CANS was the primary measure for this study. Administrative and clinical data were examined for youth who met the identified criteria. Pearson's chi-square tests of association were conducted to determine differences in TEs across race/ethnicity and sex. Negative binomial regressions were used to determine the association between TEs and needs. RESULTS: Most TAY had at least one TE (91%) and the majority had four or more TEs (52%). Significant differences occurred in relation to sex and race/ethnicity. Furthermore, TEs were significantly associated with needs across all CANS domains examined (e.g., behavioral/emotional needs, life domain functioning). CONCLUSIONS: This is one of the few empirical studies to examine TEs and related functional, behavioral, and emotional needs of TAY in child welfare. Overall, findings suggest a need for improving trauma-informed approaches and interventions that serve TAY.

Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network.

Many children in the child welfare system (CWS) have histories of recurrent interpersonal trauma perpetrated by caregivers early in life often referred to as complex trauma. Children in the CWS also experience a diverse range of reactions across multiple areas of functioning that are associated with such exposure. Nevertheless, few CWSs routinely screen for trauma exposure and associated symptoms beyond an initial assessment of the precipitating event. This study examines trauma histories, including complex trauma exposure (physical abuse, sexual abuse, emotional abuse, neglect, domestic violence), posttraumatic stress, and behavioral and emotional problems of 2,251 youth (age 0 to 21; M = 9.5, SD = 4.3) in foster care who were referred to a National Child Traumatic Stress Network site for treatment. High prevalence rates of complex trauma exposure were observed: 70.4% of the sample reported at least two of the traumas that constitute complex trauma; 11.7% of the sample reported all 5 types. Compared to youth with other types of trauma, those with complex trauma histories had significantly higher rates of internalizing problems, posttraumatic stress, and clinical diagnoses, and differed on some demographic variables. Implications for child welfare practice and future research are discussed.