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Trauma-Informed Care is Critical for Youth Needing Residential Services


Monday, August 26, 2019

​​​​​​​​​Repeated exposure to trauma is extremely common for youth that end up in residential programs. Exposure to trauma changes these kids, even altering their brain development [1], in ways that affect their responses to many aspects of their environment, including how they will respond to those people who are attempting to help them. In some cases, this means that attempts to treat kids unintentionally ends up traumatizing them further.

Boys Town, however, uses a trauma-informed car​e model that takes past trauma exposure into account in order to prevent the treatment from causing additional trauma. Additionally, Boys Town developed a screening instrument to identify possible symptoms youth may have related to past trauma [2]. Boys Town clinicians use this information to determine the supports and services youth need to help them heal. While this approach is widely accepted as the recommended approach for improving care in residential programs, research is also needed to support existing practices and to help us further improve how we take care of at-risk kids.

To help understand the benefits of our trauma-informed model, researchers at Boys Town, led by Patrick Tyler, Ph.D., recently conducted a study examining records for 1,096 youth from 9 to 18 years old who received Boys Town services. Their goals were to assess how trauma was associated with behavioral incidents, as well as the effects of trauma on psychological health at intake and when youth discharged from our program. [3]

Among the discoveries from their study, the researchers found that trauma symptoms were the best predictor of emotional problems and self-injury. Additionally, girls had higher rates of self-injurious behaviors than boys, whereas boys had higher rates of conduct problems at intake than girls in this study. Younger children also had higher rates of disruptive behavior compared to older children.

This study also showed that boys and girls who were grouped into either high or low trauma categories responded favorably to the trauma-informed program. Overall decreases were observed in disruptive and self-injurious incidents while in care, as well as conduct and emotional problems from intake to discharge for all of the groups. However, youth whom clinicians identified as having lower levels of trauma did have greater decreases in emotional problems.

A primary goal of Dr. Tyler’s team for this study was to determine how well the trauma-informed model has been working for youth that receive Boys Town services. Future studies will build on this by looking at best practices for incorporating trauma screening and assessment into the admission process in order to plan and provide the most effective care for our youth. Research is currently ongoing to identify strategies that can help youth with higher levels of trauma make even greater improvement.


  1. Blair K.S., Aloi J., Crum K., et. al. (2019) Association of Different Types of Childhood Maltreatment With Emotional Responding and Response Control Among Youths 2019 2(5). JAMA Netw Open.
  2. Tyler, P.M., Mason, W.A., Chmelka, M.B., et. al. (2019) Psychometrics of a Brief Trauma Symptom Screen for Youth in residential care Journal of Traumatic Stress. doi: 10.1002/jts.22442.
  3. Tyler P.M., Patwardan I., Ringle J.L., et. al., (2019) Youth Needs at Intake into Trauma-Informed Group Homes ​and Response to Services: An Examination of Trauma Exposure, Symptoms, and Clinical Impression​. doi: 10.1002/ajcp.12364. Am J Community Psychol