Could you please describe a Discussion section of this study which I have included below. I would like to be able to relate this study to previous studies, and also how this study could be expanded for future studies? Please provide relevant references from previous studies.

The study that I am studying includes youth who completed extended residential programming at a facility located in the midwestern region of the United States between 2016 and 2020. The determination of participant eligibility for inclusion in the DTAP was determined through clinical interviews and formal assessment procedures with youth and their family members/guardians. Within the omnibus dataset of 62 participants, one was excluded based on the absence of demographic information that would support the generalization of findings. Participant characteristics Participants were 61 youth (37 girls, 60.56%; 24 boys, 39.34%) with a mean age of 13.23 years (SD = 2.91, range = 11). Participants who were born in the United States were predominately White/Caucasian (n = 23; 37.70%) with others identifying as either Black/African American (n = 6; 9.84%), multi-racial (n = 6; 9.84%), Hispanic/Latino (n = 5; 8.19%), and native American (n = 1; 1.63%). Several participants also identified as having nationalities outside of the United States (n = 20; 32.78%). The average number of previous psychiatric hospitalizations prior to the DTAP was 3.63 (SD = 4.74) with 1.41 (SD = 1.54) of those within 12 months prior to admission. The majority of participants (n = 56; 93.33%) were receiving medical management for psychiatric symptoms prior to admission with the average number of related medications prescribed being 2.90 (SD = 1.77). The average time in the DTAP among participants was 424 days (SD = 199). Measurement of constructs Trauma symptoms The PTSD Reaction Index (PTSD-RI) for the Diagnostic and Statistical Manual of Mental Disorders (Pynoos & Steinberg, 2015) was developed to assess the frequency of PTSD symptom severity. The PTSD-RI is intended for use with youth aged 6 to 18 and asks respondents to rate how often they have experienced a symptom during the previous month using a 5-point scale (0 = never; 4 = almost every day) with higher scores corresponding to higher levels of trauma symptom severity. Elements of the PTSD-RI include a section for identifying types of trauma(s) experienced and nature of contact as a victim, witness, or learning/hearing about the event. Section 2 of the PTSD-RI identifies the severity of the symptoms across 27 items related to symptoms of intrusion (five items), avoidance (two items), negative alterations in cognitions and mood (13 items), and arousal and reactivity (seven items). Kaplow et al. (2020) reported reliability estimates ranging from acceptable to excellent for scores on the Intrusion ( = 0.85, 0.85), Avoidance ( = 0.67, 0.69), Negative Cognitions ( = 0.76, 0.81), Arousal and Reactivity ( = 0.76, 0.81), and Total ( = 0.94, 0.96) scales. Similar internal consistency estimates were reported by Doric et al. (2019) based on the data of 4201 adolescents across 11 international community samples. Both Kaplow et al. and Doric et al. reported reasonable evidence for internal structure, relations with conceptually related variables, and predictive associations with clinically relevant criteria. Sampling procedures Non-parametric sampling of individuals meeting criteria for admission to the DTAP was implemented to collect survey protocols suitable for estimates of treatment gain. Participants and their guardians completed all relevant informed consent procedures for assessment, treatment, and evaluation activities, including those associated with quality improvement and impact evaluations of treatment. All participants received treatment regardless of whether they completed any/all of the assessments. Retrospective, anonymous sampling of data to support impact evaluation activities was approved by the second author's Institutional Review Board. Study setting This evaluation was undertaken at an extended residential facility for children and adolescents who have experienced severe trauma and attachment-based difficulties that are associated with emotional and behavioral impairments to development and functioning. Although the program is located in a midwestern community, referrals for treatment have a national base with nearly two in every three admitted youth identifying as adoptees from the foster care or international adoption system. The facility is an affiliate member of the National Child Traumatic Stress Network and is dually accredited as a healthcare and education-providing entity. The facility is staffed by several professionals with specializations in psychiatry, clinical psychology, clinical social work, professional counseling, case management, behavioral management, and educational development. The average stay of a child within the residential program can range from 12 to 18 months. DTAP intervention The DTAP is founded on theories of children's brain development and associated impacts of traumatic experiences on the child's working model of safety, security, and self in relation to others and within their environment. Participants completing the DTAP undertook a scaffolded set of therapeutic protocols across a number of intervention modalities within the residential milieu. Individual therapy is completed with frequency and duration adapted in response to progress with treatment plan objectives. An identified staff member is integrated within weekly counseling activities to support bridging the therapeutic work back into the milieu. Group meals and relationship-building activities support cultivating skills, developing routines, incorporating rituals, and promoting capacities for engagement that can generalize to the home environment. Weekly family therapy is conducted in person or via telehealth to support shifting the family system to a healthier relational style and provide caregiver education regarding attachment and trauma processes, as well as parent skill coaching. Additionally, there is 24-h access to crisis interventionists, behavior managers, and mental health counselors as needed. Educational programming that integrates the principles and practices of DTAP modalities is provided Monday through Friday for 6.5 h. Additional features include morning and afternoon check-ins, afternoon and evening snacks, scheduled sensory room/calm room breaks, phone calls with families, and bedtime/tuck-in routines. Data collection Participants completed standard clinical interviews during admission and discharge activities. Admission interviews included a biopsychosocial assessment, assessment of the risk of harm to self and others, and self-report measures including the PTSD-RI. Discharge interviews also included the PTSD-RI. The DTAP staff entered all data and participant demographics into a secure, encrypted, password protected database using procedures that were consistent with the Health Insurance Portability and Accountability Act of 1996.

Results

Variable 1 = Intrusion

Variable2= Avoidance

Variable 3 = Negative Cognitions

Variable 4 = Arousal Activity

Variable 5 = Total PTSD Symptoms

Paired-sample t-test and P-values Intrusion admission/discharge t = 5.23; p < .01

Avoidance admission/discharge t = 4.75; p < .01

Negative Cognitions admission/discharge t = 5.17; p < .01

Arousal Activity admission/discharge t = 4.36; p < .01

Total PTSD Symptoms admission/discharge t = 5.82; p < .01

Table 1.

Means and SD for the variables before admission.

Intrusion - M = 8.31, SD = 5.74

Avoidance - M = 4.32, SD = 2.54

Negative Cognitions - M = 13.31, SD = 6.49

Arousal Activity - M = 10.67, SD = 4.81

Total PTSD Symptoms M = 36.62, SD = 17.44

Table 1.

Means and SD for the variables after discharge.

Intrusion - M = 5.08, SD = 4.84

Avoidance - M = 2.72, SD = 2.55

Negative Cognitions - M = 9.26, SD = 7.09

Arousal Activity - M = 8.01, SD = 5.12

Total PTSD Symptoms - M = 25.08, SD = 17.94