Trauma-Informed Care in Inpatient and Residential Settings

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 posttraumatic stress disorder (PTSD) from 13% to 45%. 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%. Despite these realities, inpatient psychiatric and residential treatment settings often struggle to adeqautely identify and address trauma exposure and its mental health consequences in youth, leading to inadequate treatment 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) multidisciplinary staff 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 detention settings.