When Care Harms: Revising the Institutional Betrayal Questionnaire for Experiences In Youth Residential Programs

Background and Purpose
Institutional betrayal refers to harm that occurs when institutions fail to prevent or respond appropriately to wrongdoing in contexts where individuals depend on them for care and protection. While examined in healthcare and higher education, it has not been systematically applied to youth-serving congregate care settings, including residential treatment programs, therapeutic boarding schools, and group homes, which are characterized by restricted autonomy, developmental vulnerability, and high behavioral control.

This study advances measurement of institutional betrayal in these contexts through a data-informed revision of the Institutional Betrayal Questionnaire (IBQ), resulting in the Institutional Betrayal Questionnaire–Childhood Residential (IBQ-CR). Qualitative data from adult survivors of institutional child abuse (n = 305), grey literature, and empirical research on institutional outcomes were used to refine the construct and adapt items to youth residential care.

Methods
Revision of the IBQ followed an iterative, data-informed process. Data were drawn from in-depth qualitative interviews with adult survivors of youth residential placements, recruited through survivor networks, advocacy organizations, legal and youth-serving organizations, social media, and word of mouth. A systematic review of the literature identified adverse outcomes associated with specific experiences and environmental conditions in congregate care.

Survivor narratives were analyzed to identify institutional conditions and responses experienced as violations of trust and care. These patterns informed modification of existing IBQ items and development of additional items reflecting the structural and relational dynamics of youth residential settings.

Item development focused on mechanisms not consistently captured in prior IBQ versions, including suppression of disclosure, retaliation for reporting, coercive compliance systems, and normalization of harmful practices. Items were refined through iterative comparison with qualitative data. The resulting 12-item IBQ-CR assesses four domains: (1) failure to prevent harm, (2) harmful institutional responses, (3) suppression and retaliation, and (4) environmental conditioning and normalization of harm.

Results
Findings indicate that institutional betrayal in youth residential settings extends beyond failure to act. Participants described institutional responses that discouraged reporting, enforced compliance through threat or punishment, and reframed harmful practices as treatment or necessity.

These patterns informed revisions to IBQ items and the addition of domains capturing active suppression and conditioning processes. The IBQ-CR operationalizes these dynamics across a large qualitative sample.

Conclusions and Implications
This study refines measurement of institutional betrayal by adapting the IBQ to youth residential contexts using survivor-derived data. The IBQ-CR provides a structured tool for assessing institutional conditions associated with harm in congregate care.

For research, the revised measure supports empirical investigation of institutional betrayal in youth-serving settings. For practice and policy, it offers a way to identify institutional conditions that may contribute to harm, including suppression, coercion, and normalization processes embedded in program design. Future work will focus on psychometric validation of the IBQ-CR and examination of its relationship to long-term developmental and relational outcomes.