Adolescents In Residential Care Research Articles

Traumatic Experiences and High-Risk Behaviors Among Runaway Youth in Residential Care Centers: The Influence of Sensation Seeking and Impulsivity

ABSTRACT Running away from a residential care center is a worrying reality due to high-risk behaviors adopted by many youths such as delinquency, substance abuse, risky sexual behavior and risky driving. Because youth in residential care may have been exposed to a variety of traumatic experiences (e.g. emotional, physical, and sexual abuse, emotional and physical neglect), the purpose of this study is first, to examine the association between these experiences and high-risk behaviors in adolescents in residential care. Second, this study aims to explore the explanatory mechanisms (impulsivity and sensation-seeking) behind the adoption of high-risk behaviors in runaway and non-runaway youth in residential care. To this end, 125 adolescents aged 15–17 who had run away at least once and 75 who had never run away from their residential care center completed self-report questionnaires about traumatic experiences, high-risk behaviors, sensation seeking and impulsivity. To address the study objectives, correlation and conditional mediation analyses were conducted. Results indicate that sensation seeking influences the relationship between traumatic experiences and delinquency, as well as drug and alcohol use. Thus, addressing sensation seeking tendencies could reduce the risks inherent in the adoption of certain high-risk behaviors among youth in residential care centers.

Suicidal behavior and deliberate self-harm: A major challenge for youth residential care in Spain

The aim of this study was to characterize and determine the incidence of suicidal behavior and deliberate self-harm among youth in residential care in Spain, and to explore the perceived knowledge and competence of direct care professionals with regard to recognizing and managing suicide risk. The sample comprised 185 adolescents aged between 12 and 18 years (M = 15.41, SD = 1.58; 49.7 % male, 49.2 % female, and 1.1 % non-binary) and 225 direct care professionals (Mage = 34.58, SD = 13.72). We found a high rate of suicidal behavior (36.2 % of adolescents reported suicidal ideation and 26.5 % had made a lifetime suicide attempt), and only a third of young people who had thoughts about suicide had sought help. Half of the adolescent sample had engaged in deliberate self-harm. Among direct care professionals, there was a perceived lack of knowledge with respect to recognizing and managing suicide risk behavior. Adolescents in residential care are a risk population that should be targeted with specific interventions aimed at preventing suicidal behavior. Training for professionals is also needed to ensure they have the skills required to ask young people about suicidal thoughts or intentions and to engage them with appropriate support services.

Affective relationships with caregivers, self-efficacy, and hope of adolescents in residential care

The transition to residential care (RC) is often experienced with fear and distrust, which, associated with a feeling of punishment and abandonment, may result in pejorative attributions and self-depreciation. These feelings may reveal a greater difficulty for youth to invest in social relationships and be open to reorganizing affective bonds with alternative significant figures. Developing quality affective relationships with caregivers in residential care may work as a protective factor for the biopsychosocial development of youth. The present study aims to analyze the associations between affective relationships with caregivers and self-efficacy, and future expectations of youth in residential care, as well as to test the mediating effect of hope on the previous association. The sample included 249 youth living in residential care, aged between 12 and 18 years. The results show that the quality of affective relationships with caregivers is associated with youth self-efficacy and hopes. A partial positive mediation of hope is also found. The results are discussed considering attachment theory and its contribution to relational mechanisms to promote self-efficacy and expectations of the future of youth living in residential care. The contributions of this study to the implementation of intervention guidelines will also be discussed.

Psychological adjustment of children and adolescents in residential care with Collaborating Families: A multi-informant assessment

In residential care, programs such as Collaborating Families have been developed so that children and adolescents can experience periods of cohabitation in a positive family environment, which generates benefits for them and complements their residential care. The present study used the Strengths and Difficulties Questionnaire (SDQ) to study the psychological adjustment of 37 children and adolescents in residential care with collaborating families, comparing the assessments of 185 informants: the children themselves, their collaborating families, their caregivers at the protection center, as well as a comparison group of peers without collaborating families and their caregivers. In addition, this study analyzed whether the psychological adjustment of these children is related to some of their personal variables and their experience in family collaboration. The results showed significant differences between the psychological adjustment assessed by the different informants. Also, children with collaborating families tended to present a better psychological adjustment compared to the comparison group, with considerable effect sizes. Moreover, significant relationships were found between psychological adjustment and the children’s ratings about their family collaboration. Finally, some practical implications for the development of the program are discussed. En el marco del acogimiento residencial, se ha desarrollado el programa Familias Colaboradoras con el fin de que los niños, niñas y adolescentes tutelados puedan disfrutar de períodos de convivencia en un ambiente familiar positivo, que les genere beneficios y complemente su atención residencial. En este trabajo, a través del instrumento Strengths and Difficulties Questionnaire (SDQ), estudiamos el ajuste psicológico de 37 menores de edad en acogimiento residencial con familias colaboradoras, contrastando las valoraciones de 185 informantes: los propios menores de edad, sus familias colaboradoras, los profesionales de referencia del centro, así como un grupo de comparación de iguales sin familias colaboradoras y sus profesionales de referencia. Además, analizamos si el ajuste psicológico de estas personas menores se relaciona con variables personales y la valoración que hacen de la colaboración familiar. Los resultados mostraron diferencias significativas entre el ajuste psicológico valorado por los distintos informantes. Además, los menores de edad con familias colaboradoras tendieron a mostrar un mejor ajuste psicológico frente al grupo de comparación, con tamaños de efecto considerables. Se encontraron también relaciones significativas entre el ajuste psicológico y la valoración de los menores sobre la colaboración familiar. Finalmente, se discuten algunas implicaciones prácticas para el desarrollo del programa.

Adolescents' personhood and the effects of their institutionalization

This paper aims to make a comparison of personality disorders in adolescents in residential care versus adolescents raised in natural families. The aim is to identify differences in personality traits and personal autonomy between adolescents living in residential care and those living in natural families, and to compare personality traits between the two groups, including by gender and age.

How Adolescents in Residential Care Perceive their Skills and Satisfaction with Life: Do Adolescents and Youth Workers Agree?

Adolescents in residential care display a self-perception of their own skills that may differ from how their youth workers perceive them. This difference in perceptions may influence the way youth workers see the adolescents they serve and can have an impact on the development of these children. Moreover, how adolescents perceive their own skills may also influence other aspects, such as the degree of satisfaction they have in different areas of their lives. This article analyses perceptions of cognitive, emotional and social skills and their relationship with life satisfaction in a sample of adolescents in residential care in different European countries (Spain, Poland and Germany). At the same time, the relationships these adolescents establish within the residential setting, both with other peers and with the youth workers involved in their education, have also been used to assess their satisfaction. The research has collected quantitative data through 2 questionnaires, one for the children (N = 238) and one for their youth workers (N = 217). The results show that, in most aspects, the adolescents’ self-perceptions and evaluations are higher than those attributed to them by their youth workers. Another important finding is that the average scores for satisfaction with aspects of life are low, many of them below 7 points (out of 10). Regression analyses indicate that higher skill ratings are associated with higher well-being. This article highlights the importance of changing the perspective of youth workers to a more positive one that supports, empowers and accompanies adolescents in residential care.

Adverse childhood experiences and residential care environment: The mediating role of trauma-related symptoms and psychological maladjustment in adolescents

BackgroundResearch has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects. ObjectiveTo analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment. Participants and settingThe sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12–18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain. MethodsThis study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions. ResultsDifferential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems. ConclusionsMental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs.

Common elements to reduce seclusion in child and adolescent residential care settings: A synthesis of literature and semi-structured interviews

In the past decades, awareness of the harmful effects of seclusion has led to a strong desire to reduce its use in child and adolescent residential care settings. As a response, various seclusion reduction interventions have been developed and implemented in practice. These interventions consist of both methods as well as more practice-based and ad hoc actions. Identification of common elements within this wide variety of seclusion reduction interventions would be beneficial for the further understanding and implementation of these interventions, training of staff, and research aimed at the reduction of seclusion. Therefore, the objective of this study was to identify the common elements of both methods and practice-based actions to reduce seclusion in child and adolescent residential care settings. A literature review and semi-structured interviews with experienced professionals involved in child and adolescent residential care were used to determine the common elements of seclusion reduction interventions. In total, 21 studies and 11 interviews were assessed. This led to the identification of two domains with six common elements each. Further investigation of how these common elements influence the reduction of seclusion could potentially build strong universal methods and training modules for the reduction of seclusion in a broad range of child and adolescent residential care settings.

Adolescents in therapeutic residential care: treatment needs and characteristics

ABSTRACT Despite the growing body of literature examining the complex needs of adolescents in residential care populations, few studies have investigated the specific treatment needs and characteristics of adolescents in therapeutic residential care (TRC). This study aimed to describe and compare risk, need and responsivity factors in a national sample of 737 juveniles (63% males, mean age = 16.2) who displayed serious behavioural problems. The study utilised comprehensive assessment data, including demographic information, clinical variables, and risk factors assessed with the Youth Level of Service/Case management Inventory (YLS/CMI). Sample characteristics were explored, and three subgroups were compared: adolescents with serious substance abuse, adolescents with a high risk of continued delinquency and adolescents with low/moderate risk. The sample showed complex needs in multiple criminogenic domains and substantial mental health problems. Subgroups were clearly differentiated by the YLS/CMI risk profile and several demographic attributes; however, most clinical variables concerning mental health overlapped between groups. The findings suggest that TRC interventions should be aimed at reducing the risk of persistent delinquency and structured according to the principles of risk, need and responsivity. The study has important clinical implications for how differentiated services can tailor interventions to group-based needs and characteristics.

The Effectiveness of Game-Based Meditation Therapy for Adolescents with Posttraumatic Symptoms in Residential Care: A Randomized Controlled Trial

ABSTRACT Many adolescents in residential care have experienced traumatic events and suffer from posttraumatic stress. This study examined the effectiveness of Muse, a game-based meditation intervention played with guidance, as an addition to treatment as usual (TAU) for adolescents with posttraumatic symptoms in residential care. Seventy-seven adolescents with posttraumatic symptoms (10–18 years old) received either Muse and TAU (n = 37) or treatment as usual (n = 40). TAU consisted of evidence-based treatments that did not specifically target posttraumatic symptoms. Outcomes were measured at T1, T2, and two-months follow-up (FU). Primary outcomes were posttraumatic symptoms (self-report and mentor-report) and stress (self-report) at T2. The Muse group showed significantly greater improvements than the control group at T2 regarding self-reported posttraumatic symptoms, stress, anxiety, depression, and aggression. Mentor reports showed marginally significant decreases in posttraumatic stress at T2. There were no differences between the groups at FU, except for a marginally significant difference in self-reported posttraumatic symptoms, where the Muse participants showed larger decreases. This study showed that game-based meditation therapy is a promising intervention that is more effective than TAU alone. Yet, further studies on its immediate and long-term effects, and mechanisms of change are warranted. Implications are discussed.

Does emotion regulation in adolescents in residential care mitigate the association between sexual victimization and poor psychological well-being?

BackgroundChildhood sexual abuse/assault has been linked to mental health problems that affect an individual's psychological well-being. This study explores the facets of emotional regulation as mediating mechanisms in the relationship between sexual victimization and psychological well-being in adolescents in residential care in Eastern Spain. Furthermore, it examines the role of sex assigned at birth and being unaccompanied asylum seeker children as possible moderators of the mediation model. MethodsA total of 346 adolescents (34.1% girls, 65.9% boys) aged between 11 and 19 years old completed a battery of instruments. Parallel multiple mediation paths were tested to determine whether sexual victimization is associated to psychological well-being across emotional regulation dimensions. Moderated mediation models with sex assigned at birth and the condition of unaccompanied asylum seeker children were tested too. ResultsThis study demonstrates that high sexual victimization is associated with poor psychological well-being in adolescents in residential care through the lack of emotional clarity, non-acceptance of emotional responses, and limited access to emotional regulation strategies (β = −0.6, 95%CI = −1.26, −0.09; β = −0.38, 95%CI = −0.9, 0.002; β = −0.39, 95%CI = −0.93, −0.03, respectively). In addition, the latter indirect effect pathway was significantly moderated by the condition of being unaccompanied asylum seeker children (β = 1.46, 95%CI = 0.28, 2.84). Sex assigned at birth was not shown to be a significant moderator. ConclusionsIdentifying which mechanisms of emotional regulation mediate the relationship between sexual victimization and psychological well-being in adolescents in residential care may contribute not only to reducing the psychological distress of these adolescents but also to improving the effectiveness and efficacy of the child welfare system.

Reflections on Care Experiences Among Early, Middle, and Late Adolescents in Residential Care

Although most youth served in residential group care are adolescents, empirical theories indicate that youth needs vary at different stages of adolescent development. These differences likely impact adolescents’ experiences and, ultimately, responses to treatment; a neglected research topic that may have implications for residential placement and services. This study explored youth experiences in residential care at different stages of adolescence. A descriptive qualitative content analysis from a sample of 103 youths was used to classify open-ended text into categories among early, middle, and late adolescents. Comments showed similarities and differences across developmental stages in six categories—general views on placement, relationships, needs and supports, safety, autonomy and control, and growth and development. Youth in late adolescents were more contemplative about their time in residential care, with comments reflecting a need for more autonomy, while expressing how residential care has helped with future endeavors and goal planning. Middle and early adolescents’ experiences were more varied. Early adolescents focused on relationships outside of care and discussed support needs differently, compared to middle and late adolescents. Our findings suggest that experiences in residential placements differ in important ways across stages of adolescent development.

Sexual Victimization of Adolescents in Residential Care: Self-Reported and Other-Reported Prevalence

ABSTRACT Adolescents in the child welfare system have been exposed to multiple forms of victimization, most notably sexual victimization, many times underreported and misreported. The main aim of this study was to explore the lifetime prevalence of sexual victimization among adolescents in residential care in Eastern Spain, contrasting self-reported information compared to the information reported by the professionals. Sexual abuse/assault characteristics and effects of gender and age were analyzed. Additionally, the association between sexual revictimization and the relationship with the aggressor as well as the age of the first episode of sexual abuse/assault was analyzed. The sample comprised 346 adolescents (34.1% females, 65.9% males) aged between 11 and 19 years old. The prevalence of sexual victimization reported by adolescents was 35.3%, more than double compared to the information reported by professionals (16.9%). Females experienced significantly more sexual victimization than males (OR = 0.23, 95% CI [0.14, 0.37]). The age of the victim at the first episode of sexual abuse/assault and the relationship with the aggressor were explanatory variables of revictimization. Research such as this is crucial to ascertain that these adolescents have very different needs that will influence the design of affective-sexual education initiatives, which are essential to ensure healthy sexual development.

Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care

Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ2 testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.

Behavioral and Emotional Difficulties and Personal Wellbeing of Adolescents in Residential Care.

This work studies the emotional and behavioural difficulties and the personal wellbeing of adolescents under protective measures. The sample is made up of 151 adolescents in residential care between 11 and 17 years of age. The instruments used were the Strengths and Difficulties Questionnaire (SDQ) and the Personal Wellbeing Index (PWI). The results indicate that a high percentage of adolescents have emotional and behavioural difficulties. We found a greater presence of behavioural rather than emotional problems in the adolescents. Similarly, we also found that females showed more emotional difficulties than the males. As for personal wellbeing, the results indicate that the adolescents are dissatisfied in several areas of their life, they feel insecure and have a pessimistic view of their future and of their achievements. Furthermore, those adolescents who were admitted to residential care due to something other than child abuse have a greater prosocial behaviour. It can be concluded that the more difficulties the adolescents experience (emotional, behavioural and with their peers), the lower the perception of their personal wellbeing will be. This study allows us to design interventions aimed at promoting psychological wellbeing among these adolescents.

Therapeutic horseback riding for at-risk adolescents in residential care

BackgroundOver the past two decades, a large body of research has focused on the contribution of equine-assisted therapies to positive psychological changes in at-risk adolescents. The current study aimed to explore the subjective experiences of therapeutic horseback riding (THR, a type of equine-assisted therapy) among at-risk adolescents and examine how they describe the psychological benefits and the mechanisms of change of a THR intervention.MethodsThis qualitative study focused on at-risk adolescents living in residential care. In-depth interviews were conducted with 19 adolescents.ResultsThematic analysis revealed three themes: (a) participants’ presentation, (b) the benefits of riding as a mechanism of change in the THR intervention, and (c) the benefits of the relationship with the horse as a mechanism of change in the THR intervention.ConclusionsThe results of this study emphasize that the riding process and the relationship with the horse are the core mechanisms of THR interventions for at-risk adolescents and provide various psychological, behavioral, and relational benefits. Self-determination theory (SDT) is a relevant framework through which to explore at-risk adolescents’ subjective experiences of THR intervention and reveal its benefits for them.

Future expectations of adolescents in Residential Care: The role of self-perceptions

BackgroundThis study aims to analyze the role of some personal (gender, age, self-perceptions) and contextual variables (living in residential care [RC] vs family) related to developing positive future expectations (FE) among adolescents. MethodParticipants were 758 children aged between 12 and 18 years (46 were in RC, the remaining 712 were their classmates). Self-esteem, life satisfaction, and FE were evaluated. ResultsMost adolescents perceived their future positively. Girls and older children generally had more negative ratings. Children in RC had positive mean levels of self-esteem, life satisfaction, and FE, although significantly lower than those of their peers. Regression analysis showed that age, RC, self-esteem, and life satisfaction explain approximately 30% of global FE. The structural equation model indicated a direct relationship between self-perceptions (self-esteem and life satisfaction) and FE, whereas RC had an inverse relationship with self-perceptions. These relationships accounted for 59.8% of the total variance of FE. ConclusionsThis study identified individual and contextual factors involved in the development of positive FE during adolescence, focusing mainly on children placed in RC. The implications of these results are discussed for the design of interventions with this group.

Assessing the Needs of Victimized Adolescents in Therapeutic Residential Care in Spain

Children and adolescents in residential care often present with emotional and/or behavioral problems associated to previous adverse experiences such as abuse and neglect. Consequently, child welfare systems have developed therapeutic residential care (TRC) programs to address the most complex needs of this population. The aim of this study is to explore the characteristics of youths in TRC comparing them with those of youth in general residential care (GRC), and to detect the factors predicting referral to TRC programs. The sample consisted of 900 adolescents aged 12–17 years old (M = 15.57; SD = 1.33; 66.2% boys), from General Residential Care (n = 554) and Therapeutic Residential Care (n = 346). Profile information was collected through official files and an ad hoc questionnaire. Mental health problems were evaluated using the youth self-report (YSR). Significant sociodemographic differences were found between groups. Also, a higher frequency of emotional abuse and neglect, worse mental health, more breakdowns in child welfare measures and risk behaviors were found among adolescents in TRC. Sociodemographic and familial characteristics, features of the protective process and risk behaviors were associated to referral to TRC programs. Youths in GRC and TRC present with mental and behavioral problems that make it necessary to implement prevention programs and early detection procedures. Screening and evaluation of youth’s mental health and establishment of concrete criteria are suggested to ensure appropriate referral to the most suitable resource according to the individual needs of adolescents.

Giving a voice to adolescents in residential care: Knowledge and perceptions of commercial sexual exploitation and runaway behavior

Commercial sexual exploitation of children (CSEC) is a multifaceted global phenomenon in which adolescents involved in the child welfare system form a high-risk population. However, studies conducted in European countries remain scarce. We recruited a sample of 67 adolescents (50.7% girls and 47.8% boys) aged between 13 and 18 years old (M = 15.8; SD = 2.2) in residential care in the child welfare system in the south-east of Spain, and surveyed them about their runaway behavior, knowledge and perception of CSEC, and possible related preventive measures. Using a mixed-methods approach, we found that 47.8% of the adolescents reported having run away from the residential center and 92.5% knew someone that had run away. A total of 71.6% of the adolescents were aware of the problem of CSEC, and demanded more education and protection. They highlighted various motivations for engaging in this type of behavior. The use of ICT emerged as an important risk factor to take into account in prevention programs.

Stability of self-reported psychopathic traits in at-risk adolescents in youth welfare and juvenile justice institutions

BackgroundThe purpose of this study was to evaluate the self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice placed juveniles) and potential influencing factors.MethodsWe applied the Youth Psychopathic traits Inventory (YPI) in a sample of 162 adolescents (M = 15.0 years, SD = 1.3) over a mean time interval of 11 months (min. 6, max. 21 months, SD = 3.14).ResultsThere was no significant difference in YPI total score nor in the three underlying dimensions Grandiose-Manipulative (GM), Callous-Unemotional (CU), and Impulsive-Irresponsible (II) between t1 and t2. Furthermore, approximately 70% of the adolescents showed no clinically significant reliable change on the YPI total score (as measured with the reliable change index), 15% improved, 15% deteriorated. The strongest predictor for psychopathic traits at t2 were psychopathic traits at t1. Additional predictors for higher levels of general psychopathic traits was male sex, for CU-traits male sex and lower levels of internalizing mental health problems, and for II-traits higher levels of externalizing mental health problems. Generally, the three reliable change groups (increase, no change, decrease) did not seemed to differ on relevant factors.ConclusionsOur results add to the findings that psychopathic traits are relatively stable in this at-risk group over approximately a 1-year time interval. Research with a longer follow-up time and more time points is warranted to better interpret these results.