Effectiveness of a multidisciplinary treatment with youth-initiated mentoring for youths with mental health needs from multi-problem families: a quasi-experimental study.

BACKGROUND: Children from multi-problem families have an increased risk for experiencing mental health problems. These families face problems in several domains that are often found to be chronic and intergenerational. Yet, the effects of mental health care for youths from multi-problem families are small at best, urging research on new treatment programs. The InConnection approach is an integrated care program to improve resilience of youths with mental health needs from multi-problem families by connecting professional expertise from multiple disciplines with the informal social network of the youth. Youths are asked to nominate a youth-initiated mentor (YIM) from the supportive adults in their network. METHODS: This quasi-experimental study compared the effectiveness of the InConnection approach to treatment as usual in a sample of 107 families (n = 66 intervention group, n = 41 control group) with n = 115 youths receiving treatment (cases). Youths (n = 102 reports, Mage = 15.59 years), parents (n = 85 reports) and case managers (n = 107 reports) responded to questionnaires four times over 15 months. Using these data, we measured youth resilience as the primary outcome, seven secondary outcomes, and three intermediate outcomes. RESULTS: Latent growth models showed only one significant change in outcomes over time across conditions, namely a decrease in case manager-reported child unsafety, and only two condition effects, which were both parent-reported. Parents in the InConnection group reported improvements over time in youth's emotional and behavioral problems and their own positive parenting, whereas control parents reported no changes (ps ≤ 0.013). DISCUSSION: The treatment conditions were not effective in improving most of the youth and parental outcomes over time, except for child safety reported by the case manager. The InConnection approach only outperformed care as usual on two parent-reported outcomes. Future research should examine for whom and under what circumstances the InConnection approach works more convincingly. TRIAL REGISTRATION: Netherlands Trial Register NL7565. Retrospectively registered on 05/03/2019.

A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy.

OBJECTIVE: The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. METHODS: A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. RESULTS: Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). CONCLUSIONS: It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.

Cross-age peer mentoring for youth: A meta-analysis.

Although most mentoring programs for youth are structured around intergenerational relationships, a growing number of programs rely on cross-age peer mentoring. Such programs capitalize on the availability of youth mentors to promote positive outcomes in younger peers. This study used a multilevel meta-analytic approach to estimate the effect size of cross-age peer mentoring programs and evaluate potential moderators of peer mentoring program effectiveness. Analyses included six studies and revealed a medium-sized overall effect of cross-age peer mentoring programs (g = 0.45). Several characteristics moderated effect sizes, with larger effects for programs that were conducted outside of the school setting (i.e., weekend, summer, or in community settings), conducted in urban settings, and had moderate/high levels of adult oversight and supervision. Results highlight the potential benefits of cross-age peer mentoring for youth.

What makes Dutch youth comply with preventive COVID-19 measures? An explorative study.

The measures to contain the spread of COVID-19 are challenging for youth, especially the social isolation measures. These measures are antagonistic to healthy youth development, which requires sufficient social contact with peers and adults. This explorative study examined what factors are associated with adherence to COVID-19 measures in a sample of Dutch youth (N = 263; 79.8% female) with ages ranging between 16 and 24 years (M = 21.1 years; SD = 2.44 years), who completed an online questionnaire about their compliance to measures, resilience, coping strategies, mental health, and availability of a natural mentor. Results showed that youth with fewer depressive symptoms adhered better to measures of social distance. Youth who were less suspicious, more resilient, and those with an active coping strategy or a natural mentor more often complied with COVID-19 measures. These results can be used to help youth comply with the COVID-19 measures.

Effectiveness and working mechanisms of the InConnection approach in multi-problem families: study protocol of a mixed-methods study.

BACKGROUND: Multi-problem families face problems in several domains that are often found to be chronic and intergenerational. Effective mental health care for youth from these families is currently lacking, urging research on new methods. The InConnection approach is an integrated care program to improve resilience in multi-problem families by connecting the professional expertise from multiple disciplines with the informal social network of the youth. Specifically, youth are asked to nominate a youth initiated mentor (YIM) from among the supportive adults in their network. The aim of this protocol is to describe the design of a mixed-methods study to examine the effectiveness and working mechanisms of the InConnection approach. METHOD/DESIGN: The effectiveness of the InConnection approach is studied in a quasi-experimental questionnaire study using propensity score matching, with N = 300 families with youth aged 10-23 years receiving treatment in either the intervention group (InConnection approach) or the control group (care as usual). The main outcome variables include youth resilience (primary), youth mental health, parental functioning, and the number, duration and types of out-of-home placements. Mediators, moderators, and predictors of effectiveness are examined. Assessments take place at the start of the care program and after three, nine and 15 months. Additionally, semi-structured interviews are conducted with families who have and have not nominated a YIM to understand why some families successfully nominate a YIM, whereas others do not. DISCUSSION: Effective care for youth in multi-problem families is urgently needed. Given its flexibility and accessibility to suit all youth aged 10-23 years from multi-problem families, and its low costs compared to out-of-home placements, the InConnection approach seems an appealing approach to support these families. The current study will provide information on the effectiveness of the InConnection approach. Strengths of this study include its robust design, the ecological validity, and the inclusion of possible mediators, predictors, and moderators of treatment effects. TRIAL REGISTRATION: Netherlands Trial Register NL7565 . Retrospectively registered on March 5, 2019.

The Effects of Youth Mentoring Programs: A Meta-analysis of Outcome Studies.

Mentoring programs, which pair youth with caring, non-parental adults with the goal of promoting positive youth development, are an increasingly popular strategy for early intervention with at-risk youth. However, important questions remain about the extent to which these interventions improve youth outcomes. The present study involved a comprehensive meta-analysis of all outcome studies of intergenerational, one-on-one youth mentoring programs written in the English language between 1975 and 2017, using rigorous inclusion criteria designed to align with developmental theories of youth mentoring. Analysis of 70 mentoring outcome studies, with a sample size of 25,286 youth (average age of 12 years old), yielded a statistically significant effect of mentoring programs across all youth outcomes. The observed effect size fell within the medium/moderate range according to empirical guidelines derived from universal prevention programs for youth, and was consistent with past meta-analyses of youth mentoring. Moderation analyses indicated that programs serving a larger proportion of male youth, deploying a greater percentage of male mentors or mentors with a helping profession background, and requiring shorter meetings yielded larger effect sizes, as did evaluations that relied on questionnaires and youth self-report. Taken together, these findings provide some support for the efficacy of mentoring interventions, while also emphasizing the need to remain realistic about the modest impact of these programs as currently implemented, and highlighting opportunities for improving the quality and rigor of mentoring practices.

Internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) for children age 6 to 12.

BACKGROUND: The aim of the present study was to examine the internal structure and reliability of the Attachment Insecurity Screening Inventory (AISI) 6-12. The AISI 6-12 years is a parent-report questionnaire for assessing the parents' perspective on the quality of the attachment relationship with their child aged between 6 and 12 years. METHODS: The sample consisted of 681 mothers and fathers reporting on 372 children (72.3% adoption parents, 14.9% non-biological primary care takers including foster parents, and 12.8% biological parents). The internal structure was assessed with multilevel confirmatory factor analyses (CFA) and the reliability of the scores with Cronbach's and ordinal alphas. RESULTS: Multilevel CFA confirmed a three-factor model of avoidant, ambivalent/resistant and disorganized attachment. Multi-group CFA indicated full configural and metric measurement invariance, and partial scalar and strict measurement invariance across mothers and fathers. Reliability coefficients were found to be sufficient. CONCLUSIONS: This study showed the potential of using parental reports in the initial screening of attachment related problems, especially considering the practical approach of parental reports. However, further development of the AISI 6-12 years seems important to increase the validity of the AISI 6-12 years. In addition, future studies are necessary to replicate the current findings, and to strengthen the evidence that the AISI 6-12 years is appropriate for the use in middle childhood and validly assesses the parents' perspective on attachment insecurities in their child.

The effectiveness of Dutch Cell Dogs in correctional facilities in the Netherlands: a study protocol of a quasi-experimental trial.

BACKGROUND: Many former inmates recidivate, resulting in high costs for societies worldwide. Evidence based treatment practices may not work in prisons, due to detainees' lacking motivation, impaired well-being, and an unsafe group environment. One attempt to improve social group climate and well-being is the use of Prison-based Animal Programs (PAP). Using a quasi-experimental design, the aim of the current study is to examine the effectiveness of one such PAP in the Netherlands: Dutch Cell Dogs (DCD). METHODS/DESIGN: Participants (N = 256) from 12 justice centers, including psychiatric, juvenile and adult facilities, will be recruited. Half of the sample (n = 128) will receive DCD training after voluntarily signing up (intervention group); The other half (n = 128) will be recruited to participate in the research and receive treatment-as-usual (TAU/Ccomparison group). Factors related to psychosocial functioning (e.g., self-esteem, empathy, self-control, life satisfaction, attention) and general therapeutic factors (i.e., therapeutic alliance, treatment motivation), expected to contribute to treatment success, will be assessed to measure the effectiveness of DCD. In addition, behavioral problems will be measured as well as recidivism rates. Questionnaires and neuropsychological tests will be employed to measure aforementioned outcome variables. Moreover, physiological data, based on heart rate and cortisol measures, will be collected to provide insight into the functioning of participants' physiological stress response and to determine whether stress reduction occurs over time. Multimethod data collection will occur at pre-training (T1), at 1-month (halfway training/T2), at 2-months (end training/T3), and 6-months after the end of the training (follow up/T4). DISCUSSION: This is the first study to examine the effectiveness of a widely implemented PAP in the Netherlands. Challenges associated with conducting the proposed study are typical for practice based research in correctional settings (e.g., a demanding workload of staff, lack of motivation to participate in research). Study results on the effects of a PAP will have an impact on inmates, justice centers, and municipalities across the Netherlands. TRIAL REGISTRATION: Retrospectively registered. The Netherlands National Trial Register TC = 6894 .

Cost-effectiveness of Family Group Conferencing in child welfare: a controlled study.

BACKGROUND: This study aimed to examine the short- and long term (cost-) effectiveness of Family Group Conferencing (FGC) compared to care as usual (CAU) in terms of improved child safety, empowerment and social support. METHODS: A subgroup of a larger randomized controlled trial, comprising 69 families in child welfare (experimental group: n = 46; control group: n = 23), was included. RESULTS: No additional effects of FGC on child safety, social support and only short-term positive effects on empowerment were found. There were no differences in costs between FGC and CAU. The chance for FGC to be cost-effective was small. For families who refused FGC, the FGC approach was more cost-effective than CAU, whereas it was less cost-effective for families that prepared or completed FGC. CONCLUSIONS: Overall, FGC is not (cost-)effective in improving child safety, empowerment and social support, but cost-effectiveness varies at different levels of FGC-completion. TRIAL REGISTRATION: Dutch Trial Register number NTR4320 . Registered 17 December 2013.

Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis.

BACKGROUND: Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior. METHOD: The effectiveness of MDFT in reducing adolescents' substance abuse, delinquency, externalizing and internalizing psychopathology, and family malfunctioning was examined by means of a (three-level) meta-analysis, summarizing 61 effect sizes from 19 manuscripts (N = 1,488 participants). RESULTS: Compared with other therapies, the overall effect size of MDFT was significant, albeit small in magnitude (d = 0.24, p < .001), and similar across intervention outcome categories. Moderator analysis revealed that adolescents with high severity problems, including severe substance abuse and disruptive behavior disorder, benefited more from MDFT than adolescents with less severe conditions. CONCLUSIONS: It can be concluded that MDFT is effective for adolescents with substance abuse, delinquency, and comorbid behavior problems. Subsequently, it is important to match specific characteristics of the adolescents, such as extent of impairment, with MDFT.

Practitioner review: Effective ingredients of prevention programs for youth at risk of persistent juvenile delinquency--recommendations for clinical practice.

BACKGROUND: There is a lack of knowledge about specific effective ingredients of prevention programs for youth at risk for persistent delinquent behavior. The present study combines findings of previous studies by examining the effectiveness of programs in preventing persistent juvenile delinquency and by studying which particular program, sample, and study characteristics contribute to the effects. Information on effective ingredients offers specific indications of how programs may be improved in clinical practice. METHOD: A literature search in PsychINFO, ERIC, PubMed, Sociological Abstracts, Criminal Justice Abstracts, and Google Scholar was performed. Only (quasi)experimental studies and studies that focused on adolescents at risk for (persistent) delinquent behavior were included. Multilevel meta-analysis was conducted on 39 studies (N = 9,084). Participants' ages ranged from 6 to 20 years (M = 14 years, SD = 2.45). RESULTS: The overall effect size was significant and small in magnitude (d = 0.24, p < .001). Behavioral-oriented programs, focusing on parenting skills training, behavioral modeling, or behavioral contracting yielded the largest effects. Multimodal programs and programs carried out in the family context proved to be more beneficial than individual and group-based programs. Less intensive programs yielded larger effects. CONCLUSIONS: Prevention programs have positive effects on preventing persistent juvenile delinquency. In order to improve program effectiveness, interventions should be behavioral-oriented, delivered in a family or multimodal format, and the intensity of the program should be matched to the level of risk of the juvenile.

The development and validation of the Youth Actuarial Care Needs Assessment Tool for Non-Offenders (Y-ACNAT-NO).

BACKGROUND: In The Netherlands, police officers not only come into contact with juvenile offenders, but also with a large number of juveniles who were involved in a criminal offense, but not in the role of a suspect (i.e., juvenile non-offenders). Until now, no valid and reliable instrument was available that can be used by Dutch police officers for estimating the risk for future care needs of juvenile non-offenders. In the present study, the Youth Actuarial Care Needs Assessment Tool for Non-Offenders (Y-ACNAT-NO) was developed for predicting the risk for future care needs that consisted of (1) a future supervision order as imposed by a juvenile court judge and (2) future worrisome incidents involving child abuse, domestic violence/strife, and/or sexual offensive behavior at the juvenile's living address (i.e., problems in the child-rearing environment). METHODS: Police records of 3,200 juveniles were retrieved from the Dutch police registration system after which the sample was randomly split in a construction (n = 1,549) and validation sample (n = 1,651). The Y-ACNAT-NO was developed by performing an Exhaustive CHAID analysis using the construction sample. The predictive validity of the instrument was examined in the validation sample by calculating several performance indicators that assess discrimination and calibration. RESULTS: The CHAID output yielded an instrument that consisted of six variables and eleven different risk groups. The risk for future care needs ranged from 0.06 in the lowest risk group to 0.83 in the highest risk group. The AUC value in the validation sample was .764 (95% CI [.743, .784]) and Sander's calibration score indicated an average assessment error of 3.74% in risk estimates per risk category. CONCLUSIONS: The Y-ACNAT-NO is the first instrument that can be used by Dutch police officers for estimating the risk for future care needs of juvenile non-offenders. The predictive validity of the Y-ACNAT-NO in terms of discrimination and calibration was sufficient to justify its use as an initial screening instrument when a decision is needed about referring a juvenile for further assessment of care needs.

The association between childhood maltreatment, mental health problems, and aggression in justice-involved boys.

The link between childhood maltreatment and adolescent aggression is well documented; yet, studies examining potential mechanisms that explain this association are limited. In the present study, we tested the association between childhood maltreatment and adolescent aggression in boys in juvenile justice facilities (N = 767) and examined the contribution of mental health problems to this relationship. Data on childhood maltreatment, mental health problems, and aggression were collected by means of self-report measures and structural equation models were used to test mediation models. We found that mental health problems mediated the link between maltreatment and aggression. Results demonstrated different pathways depending on the type of aggression examined. The association between childhood maltreatment and reactive aggression was fully mediated by a variety of mental health problems and for proactive aggression the association was partially mediated by mental health problems. We also found that reactive and proactive aggression partially mediated the association between maltreatment and mental health problems. These findings suggest that a transactional model may best explain the negative effects of childhood trauma on mental health problems and (in particular reactive) aggression. In addition, our findings add to the existing evidence that reactive and proactive aggression have different etiological pathways.

Family group conferencing in youth care: characteristics of the decision making model, implementation and effectiveness of the Family Group (FG) plans.

BACKGROUND: The model of Family group-conferencing (FG-c) for decision making in child welfare has rapidly spread over the world during the past decades. Its popularity is likely to be caused by its philosophy, emphasizing participation and autonomy of families, rather than based on positive research outcomes. Conclusive evidence regarding the (cost) effectiveness of FG-c is not yet available. The aim of this protocol is to describe the design of a study to evaluate the (cost) effectiveness of FG-c as compared to Treatment as Usual. METHOD/DESIGN: The effectiveness of FG-c will be examined by means of a Randomized Controlled Trial. A multi-informant approach will be used to assess child safety as the primary outcome, and commitment of the social network, perceived control/ empowerment; family functioning and use of professional care as secondary outcomes. Implementation of FG-c, characteristics of family manager and family will be examined as moderators of effectiveness. DISCUSSION: Studying the effectiveness of Fg-c is crucial now the method is being implemented all over the world as a decision making model in child and youth care. Policy makers should be informed whether the ideals of participation in society and the right for self-determination indeed result in more effective care plans, and the money spent on FG-c is warranted. TRIAL REGISTRATION: Dutch Trial Register number NTR4320. The design of this study is approved by the independent Ethical Committee of the Faculty of Social and Behavioral Sciences of The University of Amsterdam (approval number: 2013-POWL-3308). This study is financially supported by a grant from ZonMw, The Netherlands Organization for Health Research and Development, grant number: 70-72900-98-13158.

Psychosocial and developmental characteristics of female adolescents who have committed sexual offenses.

The present study aimed to examine differences in psychosocial and developmental characteristics between Adolescent Females who have committed Sexual Offenses (AFSOs; n = 40), Adolescent Females who have committed nonsexual Violent Offenses (AFVOs; n = 533), and Adolescent Males who have committed Sexual Offenses (AMSO, n = 743). Results showed that AFSOs and AMSOs were remarkably similar, whereas AFSOs and AFVOs were remarkably different on the measured variables. Compared to AFVOs, AFSOs less often had antisocial friends and problems in the domains of school (truancy, behavior problems, dropping out of school) and family (e.g., parental problems, poor authority and control, and run away from home). Victimization of sexual abuse outside the family and social isolation were found to be more common in AFSOs than in AFVOs. Victimization of sexual abuse outside the family was the only specific characteristic of female adolescent sexual offending, as this was more common in AFSOs than in both AMSOs and AFVOs.

Group Climate in Residential Youth Care: Development and Validation of the Group Climate Instrument-Revised.

Group climate in residential youth care is considered to be essential for treatment of youth and young adults. Various instruments exist to measure quality of living group climate, but some are lengthy, use complicated wording, which make them difficult to fill out by youth and individuals with a mild intellectual disability. The present study describes the development and rationale for the Group Climate Instrument-Revised (GCI-R). Construct validity and reliability of the GCI-R were examined by means of Confirmatory Factor Analysis (CFA) in a two-step validation process using a construction sample (n = 190 youth, representing 41 groups) and a validation sample (n = 207 youth, representing 42 groups). Results indicated a good fit of a five-factor model (Support, Growth, Physical Environment, Peer interactions, and Repression). Reliability of the scales was good. These findings indicate that the GCI-R can be used as a parsimonious, valid, and reliable instrument to assess perceptions of group climate in youth. Recommendations for future research and practice are suggested.

Differences in the prevalence and impact of risk factors for general recidivism between different types of juveniles who have committed sexual offenses (JSOs) and juveniles who have committed nonsexual offenses (NSOs).

To date, there is surprisingly little research on differences in the prevalence and impact of risk factors for general recidivism between juveniles who have committed sexual offenses (JSO) and juveniles who have committed nonsexual offenses (NSO). Therefore, we examined differences in the prevalence and impact of dynamic risk factors for general delinquency between youth with nonsexual offenses (NSO, n = 504), youth with misdemeanor sexual offenders (MSO, n = 136), youth with felony sexual offenders (FSO, n = 116) and youth with offenses against much younger children (CSO, n = 373). The sample consisted of boys with a mean age of 15.3 years (SD = 1.5). The prevalence of dynamic risk factors for general delinquency was significantly lower in JSOs than in NSOs. More serious sexual offenses were associated with a lower prevalence of dynamic risk factors. In contrast, the impact of most dynamic risk factors on general recidivism proved to be significantly larger among JSOs compared to NSOs. The relative importance of the dynamic risk factors varied for each type of JSO, resulting in differences in the dynamic risk profiles of the various types of JSOs.

A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy.

Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.

Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors.

A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children's trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the "Demographic and Family" risk domain (r = .121), with factors including being male, child protective services involvement or placement, and minority status, and for the "Youth Alliance" risk domain (r = .207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the "Demographic and Family" domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00500-2.

A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents.

This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.