Delphine Collin-Vézina,
Kim Coleman & Lise Milne

• Goal: To present the findings of a mixed methods research study on the levels of trauma and subsequent needs of youth who reside in residential care.
– Why focus on trauma?
– Why focus on youth in residential care?

• Official maltreatment reports correspond to only a small manifestation of a larger problem (tip of the iceberg), i.e. most traumas get unreported.
Analogy of the iceberg:
Only one-ninth of the volume of an iceberg is above water.
The shape of the underwater portion can be difficult to judge by looking at the portion above the surface.
• Thus, gathering information from additional sources regarding past traumatic experiences is warranted.

• Residential care is considered to be the most restrictive setting (e.g. secured units for youth who are deemed to be at risk to themselves or to others).
• Most studies conducted among these youth describe the host of behavioural and emotional problems that they have…
…but fail to connect these problems to actual trauma by documenting them through traumaspecific research or measures.

• Current controversy: ethics of asking and not asking research participants about abuse
• By failing to ask about a history of child maltreatment, an important predictor of later-life problems may be overlooked:
– strong evidence of the association between early traumatic experiences and some of the major public health and mental health problems issues of our day.
Becker-Blease & Freyd, 2006

– To provide a more comprehensive representation of the youth’s past and current issues.
– To review existing programming so as to better address the whole array of needs these youth present with.
– To give youth a voice in child welfare research.

• A convenience sample of 53 youth aged 14 to 17 recruited from six child protection residential care units agreed to voluntarily participate in the study.
• After parental consent was obtained, youth were invited to participate in the completion of a questionnaire.
• Child care workers were asked to fill out a questionnaire on behalf of each of these youth.

Youth Protocol
ATTACHMENT
Worker Protocol
Face Sheet (demographic information)
Inventory of Parent and Peer Attachment
(IPPA)
REGULATION
Behavior Assessment System for Children
– Second Edition (BASC-2)
COMPETENCY
Draw a Person in the Rain
Children and Youth Resiliency Measure
(CYRM)
TRAUMA
Childhood Trauma Questionnaire (CTQ)
Child Welfare Trauma Referral Tool
(CWTRT)
Trauma Symptom Checklist for Children
(TSC-C)

N =53
Racial Group
20.8
17
18.9
39.6
Aboriginal or
1st Nations
Black
White or
European
Other

1. What is the prevalence and severity of trauma symptoms of adolescent youth who reside in residential care?
2. How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?
3. Why have youth in residential placement entered the child welfare system and how does the reason for involvement (i.e. alinéa) correlate to the trauma reported by both youths and workers?
4. How do projective drawing measurements compare to standardized self-report instruments on identifying and measuring trauma indicators?

What is the prevalence and severity of trauma symptoms of adolescent youth who reside in residential care?
Type of Abuse None or
Minimal
Low to
Moderate
Moderate to
Severe
Severe to
Extreme
Physical abuse 40 %
Emotional abuse 32 %
17 %
26 %
Sexual Abuse 62 % (none) 6 %
Physical Neglect 2 % 41%
Emotional Neglect 42 % 25 %
9%
9 %
9%
21 %
17 %
34%
32 %
23%
36 %
17 %
60%
68%
38%
98%
58%

What is the prevalence and severity of trauma symptoms of adolescent youth who reside in residential care?
• No youth from the sample reported no history of maltreatment;
• 18.9% of the sample reported only one form of maltreatment,
• 11.3% reported two,
• 18.9% three,
• 30.2% four (N=16),
• 20.8% all five forms of maltreatment (N=11).
More than half of the sample (51%) reported four or all five different forms of abusive or neglectful experiences that the CTQ captures.

What is the prevalence and severity of trauma symptoms of adolescent youth who reside in residential care?
• Many of these youth experience trauma-related symptoms including depression, posttraumatic stress, dissociation, anger, and sexual concerns.
• The findings point to two groups in particular who stand out as especially vulnerable :
– Females with a history of sexual abuse trauma who are at higher risk for clinical levels of sexual concerns, posttraumatic stress and dissociation symptoms;
– Youth who report 4 or all 5 forms of trauma who are at higher risk for clinical levels of depression, anger, posttraumatic stress, and dissociation symptoms and who have lower levels of resiliency features.

• http://www.springerlink.com/content/j517044141005444/ful ltext.pdf

How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?
Youth Self
Report
Workers’ perceptions
Sexual Abuse
Physical Abuse
Physical Neglect
Emotional Abuse & Neglect

How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?
• Child Welfare Trauma Referral Tool
– This measure is designed to help child welfare workers make more trauma-informed decisions about the need for referral to trauma-specific and general mental health services.
– It is to be completed by the child welfare worker through record review and key informants.
– Section A allows the child welfare worker to document history of exposure to a variety of types of trauma and indicate the age range over which the child experienced each trauma.

How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?

How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?
Sexual abuse
Physical abuse
Emotional abuse/neglect
Youth - Worker
YES 15.1%
(n=8)
13.2%
(n=7)
28.3%
(n=15)
Youth - Worker
NO
54.7%
(n=29)
22.6%
(n=12)
9.4%
(n=12)
Neglect
41.5%
(n=22)
1.9%
(n=1)
Agreement
Youth –YES
Worker -
SUSPECTED
69.8%
15.1%
(n=8)
35.8%
20.8%
(n=11)
37.7%
28.3%
(n=15)
43.4%
17.0%
(n=9)
Total Agreement
*includes emotional neglect
84.9% 56.6% 66.0% 60.4%

How do the workers’ perceptions compare to youth selfreports on identifying and measuring trauma indicators?
• By including suspected maltreatment category there is the risk of false positives (ie worker suspects, child does not indicate maltreatment)
False positives % of sample
Sexual Abuse
Physical Abuse
Neglect
Emotional abuse/neglect
3
4 none
5
5.6%
7.5% none
9.4%

Why have youth in residential placement entered the child welfare system and how does the reason for involvement (i.e. alinéa) correlate to the trauma reported by both youths and workers?
Youth Self
Report
Legal reason for service
(Pij)
Workers’ perceptions
Sexual Abuse
Physical Abuse
Physical Neglect
Emotional Abuse & Neglect

Why have youth in residential placement entered the child welfare system and how does the reason for involvement (i.e. alinéa) correlate to the trauma reported by both youths and workers?
Reason for involvement
(alinéa)
Sexual abuse n=3
Physical abuse n=2
Emotional abuse* n=1
Neglect n=14
Youth/Worker response Complete agreement
Youth –Yes / Worker –Yes n=3
Youth – No / Worker –Yes n=2
Youth –Yes / Worker –Yes n=1
Youth –Yes / Worker –Yes n=5
Youth –Yes / Worker – Suspected n=5
Youth –Yes / Worker – No n=4
(all 3 informants)
3/3
0/2
1/1
5/14
*psychological maltreatment

How do projective drawing measures compare to standardized self-report instruments on identifying & measuring trauma indicators?

Psychoanalytic Tradition
Cognitive – Developmental Tradition
Drawings are PROJECTIVE
• Most drawing assessments are projective
• Reveals unconscious material
• Interpreted
Kinetic Family Drawing (KFD)
* Projects the child’s feelings about their place in the family.
House Tree Person (HTP)
* Child’s perception of their home life
& social environment
Drawings are OBJECTIVE
• The 1 st drawing assessment was designed as a measure of intelligence.
Goodenough Draw-a-Man Test
(Goodenough, 1926)
• Reveals cognitive structure, abilities & developmental level
• Scored
• The Goodenough-Harris Test (1968) asks youth to directly to draw themselves as a test of intellectual maturity
•Of all drawing techniques, this has shown the strongest validity and reliability.
Decades of research have shown, at best, mixed results in terms of the reliability and validity of using drawings for assessment purposes

The DAPR is a variation of
Machover’s
Draw-A-Person assessment (1948).
Seeks to asses:
* A person’s vulnerability
* Environmental stressors
* Supports
* Coping strategies . . . Can it be used to assess the impact of TRAUMA ?

3 Methods of Analysis:
Distress Index, Level of Pathology & Content Indicators
Protective Factors:
•Hat
•Coat
•Shoes
•Umbrella
•Tree
•Roof/Awning
•Smile
Distress Index Distress Factors:
•Small Rain
•Large Rain
•Diagonal Rain
•Rain Focused over
Figure
•Clouds
•Puddles
Non-Clinical Range Borderline Clinical Range Clinical Range

How do projective drawing measures compare to standardized self-report instruments on identifying & measuring trauma indicators?
Our study shows that drawings do not compare to standardized self-report measures on identifying & measuring trauma indicators
Therefore it supports the wealth of research that questions the interpretation of drawings as an assessment technique

How do projective drawing measures compare to standardized self-report instruments on identifying & measuring trauma indicators?
However, there is a renewed interest & growing research evidence to support other benefits of children drawings:
• As catalysts to discussion
(Driessnack, 2005)
*
Especially when it comes to topics or events that are difficult to discuss
(Gross & Hayne, 1998; LaGreca, 1990; Pipe, Salmon, & Priestley, 2002;
Stafstrom, Rostasy, & Minster, 2002; Weinle, 2002; Wesson & Salmon, 2001).
• Their expressive capabilities
(Burkitt, et al. 2003a, b, 2004; Jolley et al. 2004).
• In aiding traumatic memory recall when drawing is incorporated into trauma assessment interviews
(Burgess &
Hartman, 1993), often eliciting a more accurate recall of events than interviews alone
(Butler, Gross, & Hayne, 1995).

• Results revealed high rates of abusive and neglectful experiences in the lives of these youth; most have experienced multiple forms of trauma.
• Youth are the best sources of information for their own trauma experiences.
• Worker perceptions are usually accurate but may result in false negatives/some false positives.
• We fall short of having the proper information if we rely solely on the legal reason for child welfare service.
• Projective measures do not seem to be appropriate tools for identifying and measuring trauma indicators.

• Future research including a larger sample of youth would enable cluster analyses that could more precisely identify profiles of youth.
– This knowledge has the potential to inform social services, referrals, and therapeutic programs implemented in residential care settings.
• Mandatory requirement for parental consent is an obstacle to conducting studies in this area
– Our sample may not include youth who have experienced serious trauma (many filters)
– Every youth cannot be given a voice
• Next steps? Implementing systematic screening tools…

For more information, please contact
Delphine, Kim or Lise Milne
Delphine.collin-vezina@mcgill.ca
Kim.coleman@mail.mcgill.ca
Lise.milne@mail.mcgill.ca