The Impact of a Trauma Informed Program Model on Psychotropic Medication Usage in a U.S. Children’s Therapeutic Residential Setting

The purpose of psychotropic medication is to manage children’s behavior to improve their emotional health and well-being. Nursing staff who monitor these medicated children observe side effects such as amenorrhea, gynecomastia, thyroid problems, and involuntary movements that interfere with children’s development and perceptions of self.

The study documents the trend in psychotropic medication usage rates from 2006 to 2017 in a therapeutic residential facility. In 2010 the facility implemented the Children and Residential Experiences: Creating Conditions for Change (CARE), a principle-based program model that supports and expects congruent, reciprocal, and consistent developmentally appropriate relationships between staff and children in a trauma-sensitive environment. After CARE training and implementation, nursing staff continued to monitor psychotropic use since they identified the side effects as a measure that matteredfor trauma sensitive children. In partnership with the nursing staff, university-based researchers used 5-years of pre-CARE implementation medication rates and compared those to 7-years of post-implementation medication rates.

The findings document a declining trend in medication rates from CARE pre- to post-implementation sustained over seven-years. After CARE training and implementation with its focus on understanding children’s trauma history and their need for developmentally appropriate relationships with adults 1) staff shifted their focus from coercion and control to maintaining these developmentally appropriate relationships, 2) the agency dropped the point and level system which often triggered conflict and outbursts, 3) there was a decrease in the frequency of physical restraints during this same post-CARE implementation period, 4) and staff were more reflective and introspective about children`s behavior. These factors contributed to the decrease in using psychotropic medication for behavior control.

The study illustrates ways in which agencies can collaborate with researchers to enhance data analyses and to assess the efficacy of their program model and practices to support relationships.