Poster #48 - The moderating role of childhood adversity on outcomes of a residential treatment program in a diverse sample

• In Event: Poster Session 11

Abstract

Youth who are admitted to residential treatment centers and youth who are involved in the justice system have high incidences of childhood adversity (CA; Duron et al., 2021; Tyler et al., 2019). CA is linked with poor response to treatment in residential settings (Briggs et al., 2012). While the need for trauma-informed care (TIC) in residential treatment is widely recognized, it is not effectively implemented (Berliner & Kolko, 2016). There is a need for a better understanding of how to make TIC more effective (Tyler et al., 2021; Tyler et al., 2019) and how CA pattern and identity factors (i.e., gender, race, ethnicity) impact TIC effectiveness. Unfortunately, there is limited research on how CA pattern influences treatment response and outcomes. The current study utilized a longitudinal design to examine how CA pattern influenced youth’s behavior during treatment (aggression and lethality) and treatment outcomes (emotional and conduct problems) in a residential program.

The sample included 1,343 youth (65.5% males; aged 9.11-18.63 years at intake) in a family-style residential program in the Midwest for maltreated, justice-involved, and/or externalizing youth. The sample racial/ethnic representation was White (47.8%), Black or African American (24.9%), Hispanic or Latino (12.4%), Multi-racial (9.6%), and Other (5.4%). Latent class analysis was used to identify 5 CA patterns: Low exposure, Familial Dysfunction, Neglect/Emotional Abuse, Broad Exposure, and Pervasive Exposure. A mixed, two-factor ANCOVA (i.e., time by CA pattern) was used to explore if CA patterns moderated youth’s emotional problems and aggressive behaviors from intake to discharge. Hierarchical Linear Modeling was performed to explore possible CA pattern differences in the change of youth’s lethality and aggressive behavior incidents during treatment.

Results indicated that youth from all CA patterns experienced parallel decreases in emotional problems; however, youth in the Pervasive Exposure group maintained high levels of emotional problems at intake and discharge (despite improvements). Trends in aggression, conduct problems, and lethality differed by CA pattern: youth in the Neglect/Emotional Abuse group demonstrated more impairment in lethality and aggressive behavior, while youth in the Broad Exposure group demonstrated increased behavioral problems throughout treatment and did not demonstrate decreases in conduct problems at treatment termination. Findings also indicated that girls simultaneously demonstrated more lethality behaviors and greater treatment gains than boys and being Latinx was associated with fewer emotional and conduct problems at intake. Being Black was associated with increased aggressive behaviors during the first month of the program, but fewer lethality and aggressive behaviors over the first 12 months of the program. Additionally, being Black was associated with increases in conduct problems from intake to discharge.

Findings indicate that overall the program is functioning effectively as TIC. However, there is a need for more tailored support for youth in the Pervasive group, Neglect/Emotional Abuse group, and Broad Exposure group as well as for girls, Black youth, and justice involved youth. Findings also suggest a need for a more culturally supportive environment for Black youth, especially as they transition into the program. Additional implications will be discussed.

Authors

• Elizabeth Tampke, Brown University
  Presenting Author

• Chanelle Gordon, Boys Town National Research Hospital

• Patrick Tyler, Boys Town National Research Institute

• Jay Ringle, Boys Town National Research Hospital