Abstract
_Clara is a 16-year-old adolescent female who was removed from parental care at age 4 following extreme neglect and physical abuse by her primary caregivers. Previously, an older sibling was removed and placed into foster care. Constant psychiatric crises due to mood dysregulation and behavioral disinhibition prevented reunification or alternative family placement. As a result, and over the course of a decade, Clara transitioned through all levels of care in the child welfare and mental health system, including inpatient hospitalization, residential care, multiple group homes, therapeutic foster care, and partial hospitalization. During her journey, she continued to experience different forms of trauma, including sexual and physical abuse, neglect, unstable caregiving, and a significant number of restraints and seclusions.
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