Trauma-Informed Care in Inpatient and Residential Settings

Abstract

A history of exposure to traumatic events is the norm in youth utilizing residential care, whether it be acute or subacute inpatient care or longer-term residential placement. Studies of youth in inpatient psychiatric settings reveal traumatic exposures in over 90 % of admitted youth and rates of post-traumatic stress disorder (PTSD) from 25 to 33 % (Adam et al. 1992; Craine et al. 1988; Gold 2008; Havens et al. 2012a, b; Allwood et al. 2008; Lipschitz et al. 1999). By definition, youth placed within the child welfare system have been exposed to abuse and/or neglect. Studies in this population reveal rates of PTSD from 19 to 40 % (Kolko et al. 2010; Famularo et al. 1996). Despite these realitites, inpatient psychiatricand residential treatment settings often struggle to adeqautely identify and address trauma exposure and its mental health consequences in youth, leading to inadeqaute treatmetn planning and milieu management problems. This chapter describes the features of trauma-informed milieu settings and outlines the steps in implementing four essential component: 1) youth trauma screening processes; 2) multi-disciplinarystaff trauma training; 3) trauma skills groups for youth, and; 4) strategies for sustainability of trauma practices. Examples are provided from the authors’ experiences in implementing trauma-informed care in inpatient child and adolescent psychiatry and juvenile detneion settings