Attachment, Regulation, and Competency (ARC)

A substantial percentage of youth exposed to trauma experience multiple or prolonged adversity (Copeland et al., Arch Gen Psychiatry 64:577–584, 2007; Finkelhor et al., Pediatrics 124:1411–1423, 2009; Spinazzola et al., J Trauma Stress 18:425–436, 2005), often resulting in a complex array of symptoms and functional impairments that include but go beyond PTSD. These behavioral, emotional, and functional challenges may result in placement in and services from a wide range of systems. As compared with nonexposed youth, youth impacted by multiple traumas are overrepresented in juvenile justice, residential, and other acute treatment systems (see Chaps. 24 and 25), are at risk for involvement with the child welfare system and disruption from multiple out-of-home placements, have a higher likelihood of eligibility for special education services, and seek medical care at higher rates (Abram et al., Arch Gen Psychiatry 61:403–410, 2004; Annerback et al., Child Abuse Negl 36:585–595, 2012; Dube et al., Prev Med 37:268–277, 2003; Kisiel et al., J Child Adol Trauma 2:143–160, 2009; Zelechoski et al., J Fam Violence 28(7):639–652, 2013). This high service utilization across settings suggests the need for trauma-focused treatment for this complex population that incorporates, but goes beyond, traditional therapy approaches.