Monitoring and Managing Outcomes in Residential Treatment: Practice-Based Evidence in Search of Evidence-Based Practice

Mental Health Services and Policy Program, Northwestern University, Feinberg School of Medicine, Abbott Hall, Suite 1205, 710 North Lake Shore Drive, Chicago, IL 60611, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 03/2006; 45(2):247-51. DOI: 10.1097/01.chi.0000190468.78200.4e
Source: PubMed
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Available from: John S Lyons, Sep 28, 2014
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    • "Curry (1991), for example, suggested that cross-sectional data would address the challenges inherent in attempting to compare treatment approaches. Additionally, the quality improvement process can be used to create “practice-based evidence” (Lyons & McCulloch, 2006) in which treatment outcomes provide feedback about effective—or ineffective—practice. The need for objective data to support conclusions about the success of treatment outcomes has been emphasized (Behrens & Satterfield, 2006). "
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    ABSTRACT: The Relational Re-enactment Systems Approach to Treatment model is a coherent and comprehensive approach to residential treatment that increases family involvement through system-wide clinical consultation. The therapeutic alliance with youth and their families is emphasized as the key to creating client-centered goals for discharge to a less restrictive environment. The current study examined outcomes from four years of the model's implementation. Results indicated a significant increase in the proportion of youth discharged to a family home. Additionally, the proportion of discharges that were the result of youth running away from treatment was reduced by half.
    Residential Treatment for Children & Youth 04/2012; 29(2):103-117. DOI:10.1080/0886571X.2012.669252
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    • "Furthermore, our study also demonstrated that comprehensive outcome data with regard to social functioning and level of care can be collected successfully for the first year after discharge, and both the data and the research process can be beneficial to the agency and its clientele. But to make full use of these findings, more attention is needed to integrate data collected through post-discharge outcome research with treatment protocols and clinical care (Lyons & McCulloch, 2006). This includes analyzing and reflecting upon the experiences of youth and their families/guardians and when appropriate, making changes in treatment practices and policies. "
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    ABSTRACT: Residential treatment for troubled adolescents continues to generate controversy. Youth may improve during treatment, but are these gains sustained upon return to the community? We explore this question by analyzing outcome data collected at three months and one year post-discharge for 49 adolescent girls discharged from long-term programs at a residential treatment center in Massachusetts. Qualitative data reveals the range of post-discharge challenges experienced by adolescents and their families. Quantitative data shows a 77% reduction in restrictive level of care placements comparing the year before admission to the year after discharge (p < .001). This success rate suggests that improvements accomplished during long-term residential treatment are sustained by a majority of adolescent girls up to at least one year post-discharge. We will also discuss the process we used to collect outcome data and its impact on our agency staff and clientele.
    Residential Treatment for Children & Youth 07/2011; 28(3-3):251-267. DOI:10.1080/0886571X.2011.605051
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    • "A general trend in the UK towards more cost-effective services with shorter in-patient stays has raised the concern that such short stays may influence the therapeutic milieu and reduce the success of outcomes [9,18]. A study in the United States monitored and compared the outcomes of several in-patient services and revealed important differences in service outcomes and quality [19]. The current evidence base provides very little guidance for the development of in-patient CAMHS or alternative services, and it has been suggested that several units be audited to increase the current level of evidence available because randomized controlled trials may be difficult to implement [15]. "
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    ABSTRACT: Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model. The sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission. Acute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.
    International Journal of Mental Health Systems 01/2011; 5(1):1. DOI:10.1186/1752-4458-5-1 · 1.06 Impact Factor
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