The unique relation of childhood emotional maltreatment with mental health problems among detained male and female adolescents

Mounting evidence indicates that emotional maltreatment is at least as harmful as physical and sexual abuse. Notwithstanding their high occurrence among detained adolescents, the link between emotional maltreatment and mental health problems in these youths is not well researched. This study, therefore, was designed to examine the unique link between emotional maltreatment and mental health problems, with particular attention to gender differences. Well validated self-report measures of maltreatment experiences (Childhood Trauma Questionnaire) and mental health problems (Youth Self Report) were completed by 341 detained adolescents (156 boys, 185 girls) aged 12 to 18 years. As expected, girls reported higher levels of maltreatment experiences and internalizing and externalizing mental health problems than boys. Blockwise multiple linear regression analyses indicated that in both genders emotional abuse was uniquely and positively associated with internalizing and externalizing mental health problems, over and above the influence of other types of maltreatment. Furthermore, sexual abuse was uniquely related with internalizing problems in girls only, whereas only in boys this type of abuse was uniquely related with externalizing problems. Detained adolescents who have been the victim of emotional abuse in combination with another type of maltreatment may be the worst subgroup in terms of mental health problems. Therefore, emotional maltreatment experiences in adolescents who offend should receive more research and clinical attention.     

Severity of maltreatment and personality pathology in adolescents of Jammu,India: A latent class approach

The aims of the present study were to identify discrete classes of adolescents based on their reporting of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect of several levels of severity using a person-centered analytic approach (i.e., latent class analysis), and to compare the latent classes on 17 dimensions of personality pathology. It was hypothesized that based on types of maltreatment and severity levels within each type there would be discrete latent classes, and that classes of adolescents exposed to a larger number of maltreatment types with higher severity (i.e., moderate–severe) would report higher levels of personality pathology than adolescents in classes exposed to less types with less severity, after controlling for age and gender. Participants were 702 adolescents from Jammu, India (13–17 years, 41.5% females). The latent classes were based on three levels of severity for each type of maltreatment assessed via the Childhood Trauma Questionnaire (Bernstein et al., 2003). Four distinct classes of adolescents, namely, Moderate–severe abuse and physical neglect (Class 1), Low to moderate–severe abuse (Class 2), Moderate–severe neglect (Class 3), and Minimal abuse or neglect (Class 4) were found. Classes with higher percentages of adolescents reporting abuse and neglect with higher severity (Classes 1 and 2) reported higher levels of personality pathology than the other classes. There are distinct classes of adolescents’ identifiable based on levels of severity and types of abuse and neglect, which are differentially associated with specific dimensions of personality pathology. Implications for research and practice are discussed.     

Gender differences in the effects of childhood maltreatment on adult depression and anxiety: A systematic review and meta-analysis

Child maltreatment has well-documented long-term, adverse effects on mental health, but it is not clear whether there are gender differences in these effects. We conducted a systematic review to investigate whether there are gender differences in the effects of maltreatment on adult depression and anxiety. Medline, PsycINFO, Web of Science, and Lilacs were searched for relevant studies published up to May 2016. Eligible studies included population-based studies (with a cohort, case-control or cross-sectional design) which assessed maltreatment during childhood or adolescence (≤18 years) and its association with major depression or generalized anxiety disorder (DSM/ICD diagnostic criteria) in adulthood (>18 years) separately for females and males. Meta-analysis was performed to estimate the association between each exposure and outcome using fixed and random effects models. Pooled odds ratios (OR) were estimated separately for women and men and compared. Five studies of physical and sexual abuse were included in the meta-analyses. These provided twenty-two effects sizes estimates (11 for men, 11 for women) for associations between physical/sexual abuse and depression/anxiety. Exposure to each kind of abuse increased the odds of depression/anxiety. Associations were larger for women than for men, however, these gender differences were not statistically significant. Physical and sexual abuse in childhood/adolescence are risk factors for depression/anxiety in adulthood and the effect could be larger for women; however, currently there is insufficient evidence to definitively identify gender differences in the effects of maltreatment.     

Conservatism and personality factors in a sample of adolescents

Relationships between Cattell High School Personality Questionaire factors and the adolescent version of the Wilson-Patterson Conservatism Scale were examined in a sample of 492 teenagers. Conservatism was significantly related to a number of personality traits in both boys and girls. Results suggest the existence of a “conservative personality.”     

Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya

Objectives

This study aims to determine the prevalence of maltreatment experienced by institutionalized children prior to their admission to Charitable Children's Institutions (orphanages) in western Kenya, and to describe their socio-demographic characteristics, reasons for admission, and the factors associated with prior experiences of maltreatment.

Methods

A systematic file review was undertaken in five CCIs. Demographic, prior caregiving settings and maltreatment data were extracted. Forms of maltreatment were recorded according to WHO and ISPCAN guidelines. Logistic regression was used in bivariate and multivariable analyses of factors associated with reasons for placement and forms of maltreatment.

Results

A total of 462 files were reviewed. The median (interquartile range) age of children was 6.8 (5.08) years at admission, 56% were male, and 71% had lost one or both parents. The reasons for admission were destitution (36%), abandonment (22%), neglect (21%), physical/sexual abuse (8%), and lack of caregiver (8%). The majority of child and youth residents had experienced at least one form of maltreatment (66%): physical abuse (8%), sexual abuse (2%), psychological abuse (28%), neglect (26%), medical neglect (18%), school deprivation (38%), abandonment (30%), and child labor (23%). The most common reason for non-orphans to be admitted was maltreatment (90%), whereas the most common reason for orphans to be admitted was destitution (49%). Girls (adjusted odds ratio, AOR: .61, 95% CI: .39–.95) and orphans (AOR: .04, 95% CI: .01–.17) were both independently less likely to have a history of maltreatment irrespective of whether it was the reason for admission. Children whose primary caregiver had not been a parent (AOR: .36, 95% CI: .15–.86) and orphans (AOR: .17, 95% CI: .06–.44) were less likely to have been admitted for maltreatment, while children who were separated from siblings were more likely to have been admitted for maltreatment (AOR: 1.62, 95% CI: 1.01–2.60).

Conclusions

The high prevalence of maltreatment prior to admission, particularly among nonorphans, suggests the need for better child abuse and neglect prevention programs in communities, and psychosocial support services in institutions. The significant proportion of children admitted for poverty, predominantly among orphans, indicates that community-based poverty-reduction programs might reduce the need for institutionalization.     

Parenting in the context of historical childhood trauma: An interpretive meta-synthesis

BackgroundParents with childhood trauma histories are more likely to experience difficulties with child-rearing. The literature often pathologizes the parenting behaviours of parents with abuse histories, meaning strengths sometimes are neglectedObjectiveThis article presents a meta-synthesis of qualitative studies into the parenting experiences of survivors of childhood abuse. This analysis was undertaken to develop awareness of the experiences of this population, with the hope findings would be of use to policy-makers and professionals supporting parents and their children.MethodFollowing a systematic search and process of quality appraisal, 11 papers were subjected to an interpretive meta-synthesis, utilising a meta-ethnographic method.ResultsThree themes were generated. Forming a Parental Identity Through the Lens of Trauma related to how parents and authors of the primary studies tended to interpret all parenting experiences, especially challenges, in terms of the effects of childhood abuse. Protecting Against Cycles of Abuse related to many parents fearing they would be unable to protect children from harm. The Need for Safe Support was concerned with how parents often felt they needed support but experienced this as unsafe.ConclusionsResults pointed to how ambivalence towards professional input should typically be regarded as understandable in the context of lived-experience of abused parents. Professionals should seek to avoid pathologizing parental difficulties and support parents by normalising and making sense of difficult emotional reactions in order to support engagement and promote containing parent-child interactions. Trauma-informed approaches to therapy could usefully be employed by services and agencies working with parents to support children.     

A longitudinal study on the relationship among childhood emotional abuse,gratitude, and suicidal ideation of Chinese adolescents

Background and objectiveSuicidal ideation is a significant predictor of suicidal attempt. Based on the developmental psychopathology perspective and the resilience theory, this study examines whether trait gratitude mediates the relationship between childhood emotional abuse and adolescent suicidal ideation.Participants and settingA sample of 909 Grade 8 to Grade 9 adolescents aged 12–18 years in Hong Kong, a Special Administrative Region in China, was recruited from six secondary schools.MethodA two-wave longitudinal study was conducted. Participants completed the same measures on Gratitude Quesitonnaire-6, Suicidal Ideation Scale, emotional subscale of Child Abuse and Trauma Scale at two time points 12 months apart.ResultsResults of cross-lagged analyses showed that adolescents’ suicidal ideation was positively associated with childhood emotional abuse and negatively associated with gratitude; further, the association between childhood emotional abuse and suicidal ideation was mediated by gratitude.ConclusionsFindings of this study implied that while exposure to parental emotional abuse might have an adverse impact on the development of gratitude, adolescents’ current level of gratitude still exerts its protective effect by directly reducing their suicidal ideation. Gratitude or other resilience factors that might comprise additional mediating mechanisms from childhood emotional abuse to mental health problems in later life is worthy of further investigation.     

The mediating role of self-compassion in the relationship between victimization and psychological maladjustment in a sample of adolescents

The objectives of the present study were to analyze the relationship between victimization and psychological maladjustment in adolescents and the role of self-compassion as a mediator in this relationship. The sample was composed of 109 adolescents aged from 15 to 18 years old with poor school performance. The participants filled out a battery of questionnaires made up of: a socio-demographic data questionnaire; the Juvenile Victimization Questionnaire (JVQ); the Youth Self-Report (YSR); and the Self-Compassion Scale (SCS). Results indicated that victimization was positively associated with psychological maladjustment. Moreover, adolescents reporting poly-victimization showed significantly higher level of psychological maladjustment and different types of victimization show different effects on adolescents’ psychological maladjustment. Self-compassion partially mediated the relationship between victimization and psychological maladjustment and reduced negative consequences in adolescents who reported having been victimized. Adolescence is a time of development and search for identity in which strengthening personal protective factors could help overcome any traumas experienced. Therefore, developing self-compassion in adolescence could be a good way to help young people recover from bad experiences and protect themselves against future negative experiences. As self-compassion can be improved with practice it could be included in adolescent intervention and prevention programs.     

A longitudinal study of the effects of chronic maltreatment on children's behavioral and emotional problems

OBJECTIVE: The aim of the present longitudinal study was to examine the links between chronicity of maltreatment and child behavioral and emotional problems. METHOD: Forty-nine maltreated children (32 victims of continuous, or chronic, maltreatment; 17 victims of transitory maltreatment) and their mothers were evaluated in their homes three times over a period of 6 years: at the time of recruitment (T1), 3 years following the initial evaluation (T2) and 6 years following the initial evaluation (T3). The home visits were designed to obtain longitudinal assessments of different types of behavioral and emotional problems in the children, and of the mothers' self-reported potential for abuse to help determine the chronic/transitory aspect of the maltreatment situation. Child Protection Services (CPS) files were also consulted at each assessment time in order to obtain more accurate information regarding the chronic/transitory aspect of the maltreatment situation. RESULTS: The results show that over time the victims of chronic maltreatment (Chronic group; CH) had significantly more emotional problems (i.e., Anxiety/Depression) than those victims of transitory maltreatment (Transitory group; TR). There was also a tendency for CH children to exhibit more aggressive behavior and social withdrawal problems than the children in the TR group. Furthermore, at T3, the proportion of children in the CH group showing a clinical level of behavior problems in general was significantly higher than in the TR group. CONCLUSIONS: The study confirms that there are differences among maltreated children in levels of behavior and emotional problems and shows that chronicity must be taken into consideration in order to identify more clearly the impact of maltreatment on the child. Chronically maltreated children appear to be at high-risk for developing clinical levels of problems. The results also suggest that intervention efforts resulting in an improvement of the family situation (i.e., reduction or elimination of maltreatment), also lead to an improvement in the behavior of children.     

Factors associated with caregiver stability in permanent placements: a classification tree approach

Objective

Identify individual and environmental variables associated with caregiver stability and instability for children in diverse permanent placement types (i.e., reunification, adoption, and long-term foster care/guardianship with relatives or non-relatives), following 5 or more months in out-of-home care prior to age 4 due to substantiated maltreatment.

Methods

Participants were 285 children from the Southwestern site of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Caregiver instability was defined as a change in primary caregiver between ages 6 and 8 years. Classification and regression tree (CART) analysis was used to identify the strongest predictors of instability from multiple variables assessed at age 6 with caregiver and child reports within the domains of neighborhood/community characteristics, caregiving environment, caregiver characteristics, and child characteristics.

Results

One out of 7, or 14% of the 285 children experienced caregiver instability in their permanent placement between ages 6 and 8. The strongest predictor of stability was whether the child had been placed in adoptive care. However, for children who were not adopted, a number of contextual factors (e.g., father involvement, expressiveness within the family) and child characteristics (e.g., intellectual functioning, externalizing problem behaviors) predicted stability and instability of permanent placements.

Conclusions

Current findings suggest that a number of factors should be considered, in addition to placement type, if we are to understand what predicts caregiver stability and find stable permanent placements for children who have entered foster care. These factors include involvement of a father figure, family functioning, and child functioning.

Practice implications

Adoption was supported as a desired permanent placement in terms of stability, but results suggest that other placement types can also lead to stability. In fact, with attention to providing biological parents, relative, and non-relative caregivers with support and resources (e.g., emotional, financial, and optimizing father involvement or providing a stable adult figure) the likelihood that a child will have a stable caregiver may be increased.     

The impact of childhood maltreatment on adolescent gang involvement

BackgroundA number of risk factors for gang involvement have been identified in the literature, such as victimization, poor parental monitoring, aggressive behavior, and affiliation with delinquent peers. However, few studies have examined the influence of maltreatment experiences during childhood on gang involvement later in adolescence.ObjectiveThis study examines how differential experiences of maltreatment might impact future gang involvement.Participants and settingWe analyze self-report data and official maltreatment records on 611 youth (52% female; 76% non-white) in the US, from a larger dataset (Longitudinal Studies on Childhood Abuse and Neglect; N = 1354).MethodsMultinomial logistic regression models were used to examine the influence of experiencing different types of maltreatment on gang involvement.ResultsResults show that childhood experiences of maltreatment (p = .005) generally and neglect (p = .013) specifically were significantly associated with an increased risk of involvement in stable gang affiliations later in adolescence.ConclusionsThese findings demonstrate the value of considering gang involvement as an outcome of maltreatment and tailoring best practice interventions to support maltreated youth at risk of gang involvement.     

Family poly-victimization and cyberbullying among adolescents in a Chinese school sample

The sustained increase in their use of social networking facilitates the development of adolescents but comes with the risk of cyberbullying, which creates new challenges in regard to adolescent protection. Past evidence shows that family victimization may play an essential role in the way adolescents learn cyberbullying behaviors. Yet, research on the co-occurrence of family victimization and cyberbullying is limited. This study aims to investigate the associations between cyberbullying and family victimization among adolescents, and to examine the health correlates of cyberbullying and family poly-victimization. A large sample of 18,341 students, aged 15–17, from six cities in China, collected between 2009 and 2010 is employed in the present study, which investigated the association between various kinds of family victimization and adolescent cyberbullying. Data analysis was conducted in 2017. In-law conflict, intimate partner violence, elder abuse and neglect, and child maltreatment were associated with a higher possibility of children becoming internet victims. Parents’ divorce and separation, low family income, mother’s low level of education, and father’s unemployment were all associated with cyberbullying victimization. Cyber victimization was positively correlated to symptoms of PTSD and depression, self-harm, and other physical and mental health variables. Possible explanations for the relationships found in this study are discussed and implications for future research and services are provided. Proactive screening for family poly-victimization and cyberbullying is suggested. Schools are highly recommended to cooperate with parents to promote cyber safety.     

Predictors of psychological recommendations in child protection evaluation

Child protection matters from an important social and legal challenge, in which psychologists may be called upon to address a series of questions relevant for judicial decision-making. In an explorative manner, the current study investigates variables that influence psychological evaluators’ recommendations in child protection cases. The data is based on a quantitative content review of 103 psychological evaluation reports, conducted at an institute of forensic psychology in Germany. Using bivariate and logistic regression analyses, the following predictors were analyzed in this study: Child-related factors, familial risk factors, and general custody criteria. The outcome measure was the evaluator’s recommendation regarding long-term placement of the child and long-term custody arrangements. Evaluators were more likely to recommend permanent foster placement if the child showed insecure or disorganized attachment patterns, especially when combined with developmental delays, or if the child was temporarily in institutional or foster placement at the time of evaluation. The results support the conclusion that the most important factors for psychological expert recommendations refer to the “harm of the child” criterion in terms of developmental and psychological maladaptation.     

Motivational capacities after prolonged interpersonal childhood trauma in institutional settings in a sample of Austrian adult survivors

A considerable amount of research has been conducted on the aversive impact of prolonged interpersonal childhood trauma, but data on possible associations with motivational concepts (self-efficacy, self-esteem and locus of control) in adult survivors is scarce. The purpose of this study is to investigate specific coherences between childhood abuse and adult life events with (a) motivational concepts (MC), (b) the emotion regulation strategy “goal-directed behavior” and (c) the possible mediation of emotion regulation (ER) on motivational concepts. We use data from a cross-sectional survey in Vienna (VIA-S) obtained from 220 adult survivors of prolonged interpersonal childhood trauma. In addition, we assess the Childhood Trauma Questionnaire, the Life Events Checklist for DSM-5, the subscale “Goals” (Difficulties in Emotion Regulation Questionnaire), the Short Scale for Measuring General Self-Efficacy Beliefs, the Multidimensional Self-Esteem Scale, and an extended version of the Internal-External Control Beliefs-4 Scale. An estimated multi-group path-model, divided by gender, was also conducted with the measures indicated above. Our results show that prolonged interpersonal childhood trauma directly relates to reduced self-efficacy, self-esteem, and difficulties in ER. Concurrently, ER serves as a mediator for all MC. No gender differences were observed. Associations with adult life events were only found regarding self-efficacy. This study supports the notion that prolonged interpersonal childhood trauma in institutional settings impacts ER, which further mediates MC. Despite several study limitations (e.g. lack of a control group) the presented findings underline the importance of broadening the perception of trauma sequelae as well as integrating inhibited ER strategies and MC.     

Interpersonal violence: identification of associated features in a clinical sample

Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.     

Prevalence and correlates of multiple victimization in a nation-wide adolescent sample

Objectives

Adolescents often experience different types of victimization across a specified period of time in different situations. These multiple victimization experiences can have a number of deleterious effects on psychosocial well-being. To expand on research gathered primarily from US samples, the current study estimated the prevalence of multiple victimization in a nationally representative sample of Canadian adolescents. We also expanded on past research by adopting an ecological approach to identify correlates of multiple victimization.

Methods

Cross-sectional data from the 2000-2001 cycle of the National Longitudinal Survey of Children and Youth (NLSCY) were used to estimate the prevalence of multiple victimization (verbal harassment, threat of and actual physical assault, school social exclusion, discrimination) in 1,036 13-16 year olds. We also examined household (e.g., parental education), family (e.g., parenting practices), and adolescent (e.g., friendship quality) correlates of multiple victimization for the whole sample and separately by sex.

Results

Among the 6 in 10 adolescents who reported at least 1 victimization experience, 30.5% reported 2 types of victimization whereas 23.7% reported 3 or more types. There was an increased probability of multiple victimization (2 or more types) in adolescents who reported greater parental rejection, who engaged in more frequent out-of-school activities, and who experienced non-victimization adversity. The probability decreased if adolescents reported greater friendship quality.

Conclusions

The clustering of different types of victimization is common among adolescents. For both males and females, a difficult parent-child relationship characterized as rejecting is important when considering risk for multiple victimization, as is the adolescent's functioning outside of the home in the context of friendship quality and involvement in out-of-school activities. Non-victimization adversity (e.g., death of a loved one) also emerged as a significant multiple victimization correlate.

Practice implications

Non-physically invasive types of victimization (although adolescents also endorsed physical assault) are a reality for a number of adolescents. As such, we need to inquire about such experiences as school social exclusion, discrimination, and verbal threats in applied contexts. Moreover, in order to better identify adolescents who may be vulnerable to multiple forms of victimization, we need to adopt an ecological approach that considers individual, family, and household functioning.     

The intertwined effect of lack of emotional warmth and child abuse and neglect on common mental disorders in adolescence

Adolescence is a vulnerable period for mental health problems. Although child abuse and neglect (CAN) are known risk factors for some of them, it is not clear if the negative consequences on mental health also occur in families where CAN and a warm parent-child relationship coexist. The aim of this study is to explore this gap and investigate the effects of different types of CAN according to levels of warmth in the parent-child relationship on common mental disorders (CMD) in adolescence. This is a cross-sectional study encompassing 487 adolescents attending the ninth grade at 2 public and 4 private schools in Rio de Janeiro, Brazil. CAN was measured by the Child Trauma Questionnaire (CTQ), CMD by the General Health Questionnaire (GHQ-12) and the level of warmth in the parent-child relationship were recalled using short Egna Minnen Betraffände Uppfostran (s-EMBU-23). The adjusted separate effects of different types of CAN and a low level of warmth in the parent-child relationship, and both in tandem, were estimated using multivariate linear regression models. Results indicated that emotional abuse and neglect, physical abuse and neglect, and a low level of warmth in the parent-child relationship are important risk factors for CMD in adolescence. Nevertheless, in families where CAN coexist with a warm and affectionate parent-child relationship, the negative effects of CAN on mental health are attenuated. Evidence indicates that actions to prevent or interrupt CAN and improving parental practices could be effective strategies to reduce CMD in adolescence.     

略论历史教学中的人格教育

人格教育在素质教育中占有重要地位,历史教育教学更要体现这一功能。要充分利用各种人格教育素材,采取恰当的教学方法,不断创设人格教育环境,帮助学生构建优良人格。     

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms,suicidality, and self-injury

BackgroundAdolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts.ObjectiveThis longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited.ParticipantsRunaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups.SettingAn urban Midwestern city's hospital-based Children's Advocacy Center.MethodsTrauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change.ResultsFrom program entry to 3 and 6 months, mean values decreased significantly for emotional distress (−0.67, −.91) self-harm (−.30, −.55), suicidal ideation (−.45, −.57), suicide attempts (−.58, −.61), and trauma symptoms (−11.8, −16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (−.038), self-injury (−.020), suicidal ideation (−.025) and attempts (−.032), while empowerment groups predicted trauma symptoms (−.525) and all others except suicide attempts.ConclusionsThe program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.