Residential Treatment Settings Research Articles

Play Therapy in Residential Treatment Centers for Children

ABSTRACTResidential Treatment Centers (RTCs) serve youth who have suffered extreme abuse and trauma and must reside in 24-hour facilities to receive mental health, medication, and social services. Currently, specific therapeutic interventions utilize talk therapy or cognitive therapies, which may have limited use with children due to developmental considerations, specifically children who have been through trauma that has affected their development. Child-Centered Play Therapy (CCPT) is introduced as an evidence-based expressive therapy modality that emphasizes the child’s natural language of play as a way to support emotional and psychological healing. This article discusses limitations to residential treatment center research as well as ways to implement play therapy into residential treatment settings for children who are in need of such services through the use of brief play therapy, group play therapy, and Child Parent Relationship Therapy (CPRT).

Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas?

BackgroundThe present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. MethodsData were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission. ResultsOnly 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting). ConclusionThis study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes.

Feasibility of Using Short Message Service (SMS) to Collect Outcome Data in an Australian Residential Alcohol and Drug Treatment Service

Objectives: Limited studies have examined the utility of short message service (SMS) for outcome data collection, and none have examined its feasibility within a realistic alcohol and other drug (AoD) treatment environment. The objective of this study was to investigate SMS outcome data collection with limited resources within an Australian residential AoD treatment setting. Methods: A total of 153 clients engaging in residential AoD treatment completed the study; 137 completed feasibility surveys and 19 residents completed a 16-week SMS trial utilizing an automated web-based application, which sent 4 single-items by SMS each week. Feasibility was evaluated by willingness ratings, reasons for nonengagement, proportion of consenting participants, response rates, cost and ease of implementation. The validity of single-item measures was assessed using correlational analyses. Results: Totally, 64.6% of participants were unwilling to engage in SMS monitoring, with the main reasons for not engaging being cost and disinterest in research. Twelve percent of participants engaged in the SMS trial, with 90.5% providing at least 1 SMS response. Although initial responses took up to 6 hours on average, subsequent items were completed within 1 to 5 minutes. Conclusions: In its present form, this method of data collection was not feasible within these AoD residential services. Greater resources are likely required to improve the utility and acceptability of this method.

Measuring Use of Evidence-Based Psychotherapy for PTSD in VA Residential Treatment Settings with Clinician Survey and Electronic Medical Record Templates.

Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15). Therapists self-reported their use of two EBPs, including prolonged exposure delivered in an individual format (PE-I) and cognitive processing therapy delivered in individual and group formats (CPT-I and CPT-G). Using electronic medical record (EMR) templates mandated for EBP documentation in FY15, we measured contemporaneous patient-level receipt of EBPs for PTSD. We assessed the degree of correlation between therapist self-reported EBP delivery and patient receipt of EBT as measured by EMR templates using polychoric correlation coefficients. We determined patient and therapist factors that predicted the receipt of EBPs with multivariable logistic regression, using random effects and robust standard error estimation, and controlling for site. The Veterans IRB of Northern New England provided a waiver of informed consent; as this was a retrospective review, no patients or therapists were contacted, and all data were stored, transmitted, and analyzed on secure VA servers. The VA Connecticut Health Care System Human Research Protection Program approved secondary use of therapist survey data for this project. When EMR template use became mandated in FY15, the proportion of patients in residential PTSD programs who received at least one EBP session that was recorded with an EMR template increased dramatically from 8.8% to 33.9%. There was adequate correlation and between survey-based and EMR-based measures of EBP receipt, with polychoric correlation values of 0.77 for PE-I, 0.69 for CPT-I, and 0.82 for CPT-G. Multiple patient factors were positive (e.g., female gender) and negative (e.g., depressive disorders) predictors of receipt of EBPs, even after controlling for site. Among therapist factors, only EBP consultant or trainer status was a positive predictor of EBP provision and only therapist race was a negative predictor of EBT provision after controlling for site. Following a FY15 mandate, EMR templates documenting EBP delivery were widely used by therapists working in VA residential PTSD programs. EBP receipt measured using EMR templates was consistent with therapist self-report of EBT delivery. There were several patient-level predictors of EBP receipt and therapist-level predictors of EBP delivery. However, therapists most likely to deliver EBPs were clustered at a limited number of sites.

A Complier Average Causal Effect Analysis of the Stimulant Reduction Intervention using Dosed Exercise Study.

ObjectiveExercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise.MethodThe STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results.ResultsThe CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01).ConclusionsThe CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect.

Therapeutic Applications for Integrating Rhythm and Reflection in Support of People with Co-occurring Drug and Alcohol and Mental Health Issues

This article examines the use of rhythmic music in support of people managing co-occuring drug abuse and mental health conditions, and is based on the authors 15 years’ experience as a group counsellor working in this field. Expressive therapies are gaining increasing traction as respected intervention techniques for this client group, as the limits of ‘talk-based’ approaches are exposed. This is particularly true for engaging people in treatment who find discussions confronting or who are uncomfortable with language, including many individuals from minority cultures. Rhythmic music, using hand drums and percussion, is one of the simplest forms of music to introduce into a therapeutic setting and is particularly suited to group therapy. Recent neurological research has showcased the positive impact of rhythmic music for people who have experienced trauma, improving emotional regulation and reducing stress and anxiety associated with relapse. Additionally, experiential therapies such as drumming offer an important balance in residential treatment settings where people may be attending several therapy sessions per day; the result of which can be mental exhaustion. Physical therapies such as drumming can help re-energise clients in these situations, as well as those on sedative medications. Many services resist the introduction of music into their treatment programs due to a perceived lack of expertise or lack of confidence. This article argues that music is too important as a therapeutic healing tool to be left solely to the musical expert, and that many musical exercises, particularly those with a psycho-educational focus that utilise simple rhythmic hand drumming, can be utilised by therapists, with very little musical training, in a fun, empowering and effective way.

Understanding and Serving Adolescent Females with Emotional Disabilities and Executive Dysfunction in a Residential Treatment Setting

Executive functioning has become an important part of helping to understand and serve students with academic and emotional disabilities (EDs). This study sought to understand the profile of female student with ED in a residential treatment center. First, the study investigated the validity of the Behavior Rating Inventory of Executive Function, Parent Rating Scale (BRIEF). The BRIEF is an 86-item checklist that covered eight different aspects of EF. Each item was a statement in which the case manager of each of the 93 students responded never, sometimes, or often. These scales included (1) inhibit, (2) shift, (3) emotional control, (4) initiate, (5) working memory, (6) plan/organize, (7) organization of materials, and (8) monitor. The majority of the 93 participants demonstrated executive dysfunction. Next, divergent validity of the BRIEF was investigated using a principal components analysis. The Basic Academic Skills Inventory (BASI) was used to evaluate the reading and math abilities of participants. The relationship between the BRIEF and the BASI was investigated using a correlation analysis. One factor best explained the structure of the BRIEF and correlated moderately with measures of academics. It is clear that executive functioning is a critical area that we must consider as part of our usual psychological evaluation/intervention tools. Many students with emotional and academic difficulties will benefit from executive functioning interventions such as directing student attention, help in planning, and homework organization management skills. How these findings should relate to the role of school and clinical psychologists will be addressed.

The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial.

To compare outcomes for a behavioral activation group treatment for substance use [life enhancement treatment for substance use (LETS ACT)] versus a time and group size-matched control condition delivered in a residential treatment setting. Single-site two-arm parallel-group randomized clinical trial with follow-up assessment at 3, 6 and 12months post-treatment. Residential substance use treatment facility in the United States. Participants were 263 adults [mean age 42.7 (11.8); 29.5% female; 95.4% African American; 73.2% court mandated] whose insurance dictated 30-day (65.9%) or 90-day (34.1%) treatment duration. LETS ACT (n=142) is a treatment developed originally for depression and modified for substance use. It teaches participants to increase positively reinforcing value-driven activities in order to counter depression and relapse. The control group [supportive counseling (SC); n=121] received time and group size-matched supportive counseling. Treatment was delivered in five or eight 1-hour sessions depending on patient length of stay. Percentage abstinent at follow-up, percentage of substance use days among those reporting use, depressive symptoms [Beck Depression Inventory (BDI)] and adverse consequences of drug use [Short Inventory of Problems-Alcohol and Drug (SIP-AD)]. LETS ACT had significantly higher abstinence rates at 3months [odds ratio (OR)=2.2, 95% confidence interval (CI)=1.3-3.7], 6months (OR=2.6, 95% CI=1.3-5.0) and 12months (OR=2.9, 95% CI=1.3-6.1) post-treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12months post-treatment [B=4.50, standard error (SE)=2.17, 95% CI=0.22-8.78]. Treatment condition had no effect on percentage substance use days among those who resumed use or on change in depressive symptoms; the latter decreased over time only in those who remained abstinent after residential treatment irrespective of condition (B=0.43, SE=0.11, 95% confidence interval=0.22-0.65). A behavioral activation group treatment for substance use (LETS ACT) appears to increase the likelihood of abstinence and reduce adverse consequences from substance use up to 12months post-treatment.

Application of the Teaching-Family Model for Japanese Maltreated Children in a Residential Treatment Setting

Objective: The aim of the present study was to evaluate outcomes of the Teaching-Family Model (TFM) as an intervention for maltreated children who exhibit noncompliance and problematic behavior, in a Japanese residential treatment setting. Methods: The effect of the TFM on 44 children (mean age, 13.6 years; age range, 6–18 years) was assessed using the count data for noncompliance, evaluated by the direct care staff, and problematic behaviors, assessed by the Child Behavior Checklist (CBCL). Data were collected at three time points (at the implementation of the TFM and at 6 months and 1 year after implementation) and compared to assess changes. Results: At 1 year after the TFM, a significant decrease in noncompliance (noncompliance with the rules: F [2, 78] = 4.41, p = .015; noncompliance with following the instructions: df = 2, χ² = 6.31, p = .043) was seen. Significant decreases were also seen in CBCL T-scores at both 6 months and 1 year after the TFM (total problems: F [2, 86] = 361.20, p 〈 .001; internalizing problems: F [2, 86] = 287.26, p 〈 .001; externalizing problems: F [2, 86] = 193.44, p 〈 .001). Conclusion: These results suggest that the use of a TFM may promote positive changes in problematic behavior displayed by maltreated children in Japanese residential treatment settings.

The Client Satisfaction Questionnaire-8: Psychometric properties in a cross-sectional survey of people attending residential substance abuse treatment.

The Client Satisfaction Questionnaire (CSQ-8) is one of a limited number of standardised satisfaction measures that have been used widely across mental health services. This study examined the CSQ-8 as a measure of general satisfaction within residential substance abuse treatment. It compared the CSQ-8 with another established measure of client satisfaction that was developed for substance abuse treatment settings (Treatment Perceptions Questionnaire, TPQ). It also sought to examine the relationship between the CSQ-8 and commonly used process measures. Cross-sectional data was collected from across 14 Australian residential medium-to-long term alcohol and other drug treatment facilities (N = 1378). Demographic, substance abuse and mental health characteristics were collected, as well as process measures of craving, general functioning, self-perceptions, recovery and symptom distress. A confirmatory factory analysis established that the CSQ-8 retains a single factor. The scale was strongly correlated with the TPQ, suggesting high concurrent validity. However, while the TPQ was normally distributed, the CSQ-8 was highly negatively skewed. Significant associations were found between the CSQ-8 and cross-sectional process measures. Results suggest that that CSQ-8 is an appropriate measure to be used in residential substance abuse treatment settings. However, because of the high levels of negative skew, it is likely that the TPQ is more accurate in capturing clients' dissatisfaction than the CSQ-8. Future research should include longitudinal studies of satisfaction in order to examine how changes in satisfaction may be related to client characteristics, outcome measures, dropout or re-engagement in treatment. [Kelly PJ, Kyngdon F, Ingram I, Deane FP, Baker AL, Osborne BA. The Client Satisfaction Questionnaire-8: Psychometric properties in a cross-sectional survey of people attending residential substance abuse treatment. Drug Alcohol Rev 2018;37:79-86].

Erratum to: Self-Reported Chronic Pain as a Predictor of Relapse Post Residential Addiction Treatment: a 6-Month Follow-Up Pilot Study

With the rise of prescription opioids and the subsequent increase in opioid use disorders, the relationship between chronic pain, opioid use disorders, and drug replacement therapy has received great attention. However, few studies have examined the relationship between chronic pain and relapse from a variety of substance use disorders following residential addiction treatment. This pilot study seeks to examine the role of self-reported chronic pain as a predictor of relapse from a variety of substance use disorders for individuals who attended residential addiction treatment. In 198 adult patients, a Spearman’s rank correlation coefficient determined that there was not a significant relationship between self-reported chronic pain and relapse at 6 months following treatment: r (198) = −.056, p = .433. However, among those self-reporting chronic pain, women reported slightly more slips and complete relapses than men. The findings of this study can inform professionals working within a residential addiction treatment setting.

Tobacco-Free Policy Outcomes for an Inpatient Substance Abuse Treatment Center

We assessed changes in patient census, smoking prevalence, and intention to remain abstinent associated with the voluntary enactment of a campus-wide tobacco-free policy in a for-profit residential addictions treatment center. Employing nationally recognized tobacco-free policy strategies, steps toward implementation were tailored to addictions treatment settings. Census data and survey of client tobacco use data were collected for 1 year before the policy began and for 1 year following the policy. Average daily census increased for both the inpatient and extended residential treatment programs after enactment of the tobacco-free policy. Number of tobacco users admitted to treatment increased significantly, while the number of tobacco users who left treatment early did not significantly change. In addition to reducing smoking, the policy was associated with a significant increase of patients reporting the intention to remain abstinent after discharge. Contrary to common concern, a tobacco-free policy implemented in an inpatient residential addictions treatment setting did not negatively affect census rates. This study suggests potential clinical and organizational benefits for campus-wide tobacco-free policies.

An Overview of Youth Substance Abuse Recovery Strategies in Norway

ABSTRACTThere are a number of available adolescent substance abuse treatment centers and services in Norway. The overall responsibility to help youth that need alcohol and/or drug treatment lies in the municipalities. Treatments take place either in institutions (e.g., child welfare institutions or inpatient settings) or at outpatient clinics (e.g., opioid maintained treatment, psychiatric youth team). If the adolescent needs detoxification services, they typically receive this in a hospital or residential treatment setting. This article will describe available opportunities and barriers for youth treatment and aftercare in Norway.

I See Your Face Before Me: Some Thoughts on Carol Ganzer’s Becoming Visible

This commentary on Dr Ganzer’s thoughtful account of her work with a challenging patient in a residential treatment setting is organized around three areas of interest. The first concerns the residential setting itself that, in my experience, is often characterized by tensions reflecting the complex interactions between the therapist, the patient and the staff. I note that the setting also provides a window into the patient’s experience beyond the psychotherapeutic hour. Secondly, I explore the patient’s history with an eye to its place in the treatment and the emergence of significant metaphors that seem to organize the relationship between Dr. Ganzer and Collette. Finally, I offer ideas on the therapeutic interaction and how Dr. Ganzer’s presence played such an important role in Collette being seen and the powerful and poignant experience of recognition. I note, again, the role metaphor plays in the treatment and comment on Dr. Ganzer’s thoughts on how a Relational approach with an emphasis on enactments might have deepened the treatment.

Typical Reading Instructional Practices Provided to Students With Emotional and Behavioral Disorders in a Residential and Day Treatment Setting: A Mixed Methods Study

ABSTRACTThe current study investigated the typical reading practices provided to students with emotional and behavioral disorders (EBD) at a residential and day treatment setting in the Northeast. Observations of reading instruction and teacher interviews were completed over the course of the 2013 to 2014 school year. The majority of students in observed reading groups were in the early elementary grades. Study findings include a considerable amount of lost instructional time due to problem behaviors and task transitions. Reading comprehension instruction and time spent reading text were observed infrequently. Fluency practice and phonological awareness activities were not observed. This study highlights the need for additional reading intervention studies for students with EBD and continued efforts to disseminate information on effective practices to educators who work with students that have pervasive behavioral difficulties. Teacher interviews revealed the need for strong models of professional development, coaching, and the provision of resources for implementation.

Adolescent Girls in Out-of-Home Care: Associations Between Substance Use and Sexual Risk Behavior

ABSTRACTSubstance use and sexual risk behaviors continue to be major concerns for today's youths, and are particularly problematic for those who have been placed in out-of-home care settings. The purpose of this study was to explore these associations in a sample of 120 girls placed in a residential treatment setting and attending an on-site school in a major metropolitan area in the Midwest. A modified Youth Risk Behavior Survey (YRBS) was administered including questions relating to the youths' foster care or adjudicated status. The substance use variables targeted were alcohol and drug use. The sexual risk behavior variables were age of onset of first sexual intercourse, virginity status, contraceptive use, age of first sexual partner, and experience with ever having been forced to have sex. Results indicate that earlier onset and greater frequency of substance use were both correlated with number of sexual partners. Frequency of substance use was a significant and consistent contributor. Age of sexual partner was an inconsistent contributor, and history of forced sexual activity was not a contributor. Implications for policy and practice are offered to enhance the health and well-being of this unique population.

A Narrative Review of Outcome Studies for Residential and Partial Hospital-based Treatment of Eating Disorders.

The objective of this study was to review the current eating disorders outcome literature after residential or partial hospitalization programme (PHP) treatment. Articles were identified through a systematic search of PubMed and PsycINFO. Twenty-two PHP and six residential treatment studies reported response at discharge and tended to find improvement. Fewer studies (nine PHP and three residential) reported outcome at some interval after discharge from treatment. These tended to find sustained improvement. A substantial proportion of patients were lost to follow-up, particularly for residential treatment. Only two follow-up studies used controlled trials; both showed efficacy for PHP compared with inpatient treatment with regard to maintaining symptom remission. Improvement at discharge may not predict long-term outcome. Long-term follow-up studies were confounded by high dropout rates. While higher levels of care may be essential for reversing malnutrition, there remains a lack of controlled trials showing long-term efficacy, particularly for residential treatment settings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice

BackgroundThis study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States. MethodsThis is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression. ResultsResidential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively. ConclusionWe speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

Comparative analysis of treatment conditions upon psychiatric severity levels at two years among justice involved persons

The aim of this investigation was to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n = 39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally-run residential integrated treatments for justice involved persons who have dual diagnoses. Results support the utilization of low-cost, community-based treatments for a highly marginalized population. Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

For All You Do, This Article is For You: Thoughts on Optimizing and Evolving Treatment Evaluation

This preliminary research focuses on the perceptions of academic staff working in residential settings with youth who have experienced psychological trauma. The article provides the psychometric properties of three instruments that assess academic staff perceptions of student behavior (TPSB), awareness of trauma (TTS), and responses to student behavior (TRSB). These measures can be used to assess academic staff readiness in working with traumatized students. Measurement validity/reliability were established using a sample of 26 academic staff whose school was affiliated with a publically funded residential treatment center. Factor analyses indicated that scales were comprised of questions that were adequately correlated; each scale reliably measured its own individual construct (i.e., staff perceptions, awareness, responses). Cronbach’s alpha internal consistency coefficient demonstrated that scales were reliable for measuring each construct, where the TPSB resulted in α= 0.83 for its “acting out” and “shutting down” subscales, the TTS had α = 0.91, the TRSB resulted in α = 0.79 for the “acting out” subscale, and α = 0.81 for the “shutting down” subscale. These instruments may be useful for teachers and academic staff working with traumatized students, particularly in residential treatment settings.