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Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003
Abstract
The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic
changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies
from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations.
The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and
(b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children
and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment
that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions
must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research
results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of
care are addressed.
... The long term effectiveness of residential care placement seems to be related to the service's capacity to engage more widely with the child's support network. From a service perspective, there is clear support for the inclusion of family-focused interventions for young people with severe behavioural problems (Knorth et al., 2008;Leichtman et al., 2001) and for the inclusion of other networks in the assessment, residential care and post-care support phases (Curtis et al., 2001;Frensch & Cameron, 2002;Hair, 2005). Having residential care workers engage with family and community supports, rather than having the family work being divorced from the program and left to case managers, is likely to be more effective (Hillan, 2006). ...
... Family support appears to be important, even if it is unlikely that the child will ever return to their biological family (Hart et al., 2015). Conceptually, this is often framed as an ecological model, embracing family and community involvement when possible (Bay Consulting, 2006;Hair, 2005). Additionally, the program should have active strategies for engaging with or developing the young person's educational, training and/or work experience network, because academic success and support are also related to positive outcomes (Curtis et al., 2001;Hair, 2005). ...
... Conceptually, this is often framed as an ecological model, embracing family and community involvement when possible (Bay Consulting, 2006;Hair, 2005). Additionally, the program should have active strategies for engaging with or developing the young person's educational, training and/or work experience network, because academic success and support are also related to positive outcomes (Curtis et al., 2001;Hair, 2005). ...
Commissioned report on the use of Therapeutic Residential Care for children at risk of harm. Appendix to the Nyland Royal Commission Report on Child Protection Systems.
... Vi fant svaert få systematiske oversiktsartikler om institusjonsbehandling for rusproblemer, og forskningskvaliteten var gjennomgående svak. De fleste evalueringene hadde forskningsdesign som innebar seleksjonseffekter og frafallproblemer, små utvalg, ingen kontrollgrupper eller manglende randomisering og høyt behandlingsfrafall ( "drop-out") sammenlignet med forskning på modeller i behandling (Hair, 2005) Continuing Care "(ACC) (Godley et al., 2002). Den sistnevnte modellen er en tilnaerming som kan se lovende ut for behandlingsfeltet. ...
... De fleste ungdommer starter sin ruskarriere med alkohol og deretter cannabis. Rusmidlene alkohol og marihuana var de hyppigst brukte rusmidlene blant amerikanske ungdom i behandling mellom -2005(Dembo & Muck, 2009Leukefeld et al., 2009). En meta-analyse om behandling cannabisbruk framhevet flere av de samme familie-og naermiljøbaserte modellene som denne kunnskapsoversikten har presentert som positive og lovende (Bender et al., 2010) Se www.chestnut.org ...
... Behandlingsinnhold og strukturHair (2005) påpeker viktige elementer som kan medføre bedre resultater for institusjonsbehandling av ungdommer. Det er familietilnaerming og familieterapi, ettervern som inkluderer skole eller arbeid og gjennomføring av behandlingsopplegget.Plant & Panzarelle (2009) fremhever noen av de samme trekkene ved virksomme institusjonsbehandlingsmodeller, nemlig fullført behandling -eller behandling over 90 dager, involvering av familien(Frensch & Cameron, 2002), mindre strikte regler, motiverende tilnaerming og fokus på skadereduksjon(Mayes & Handley, 2005).Andreassen (2003) påpeker at flere metoder innenfor en kognitiv atferdstilnaerming viser gode resultater: tegnøkonomi, aggresjonskontrolltrening, modellaering m.m. og videre der hvor institusjoner bruker multimodale modeller, for eksempel ART-"aggresion replacement training", blir resultatene gode. ...
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som
en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet mot ungdom kan derfor også ha en forebyggende effekt. Denne kunnskapsoversikten vil primært fokusere på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg er det et formål med kunnskapsoversikten å gi noen anbefalinger om
videre arbeid med å utvikle rusbehandling. Rapporten er basert på kunnskapsoppsummeringer og systematiske oversikter som vurderer
virkningen av tiltak mot alkohol- og narkotikamisbruk hos ungdom i alderen 12-26 år, med vektlegging av tiltak for ungdom under 20 år.
... An early review of the research was undertaken by Hair (2005), who reviewed 11 studies conducted between 1993 and 2003. The review aimed to determine what factors increased the likelihood of positive outcomes for children upon leaving a residential setting. ...
... The review aimed to determine what factors increased the likelihood of positive outcomes for children upon leaving a residential setting. The findings showed that children with severe emotional and behavioural disorders, which matches the diagnosis of those at the MBS, can benefit from and sustain positive outcomes when the residential setting has been multi-modal, holistic and ecological in its approach (Hair, 2005). ...
... Building on Hair's (2005) review, the most thorough review of the literature is Hart, La Valle and Holmes's (2015) comprehensive overview of residential care for the UK Department for Education, which focussed on evidential outcomes. This again highlighted the difficulties associated with outcome measurement, recognising the limited amount of measurement, particularly for longer-term outcomes (Dooner and James, 2019). ...
The impact of early-life trauma on young children should not be underestimated, nor the impact of living and working alongside these children. This study is concerned with how a therapeutic residential special school affects primary-aged children who have experienced early-life trauma. The therapeutic environment focusses on building relationships as a way to support the children to understand and manage their impulsive behaviours. This study makes an original contribution to the field of therapeutic residential childcare, looking at how a psychodynamically informed model, underpinned by group work, affects children and their families. The study employed a case study approach, focussing on the Mulberry Bush School and its therapeutic approach to care, with the cases of four children forming embedded units. Seven interviews per child were undertaken over an 18-month period, supported by observations and documentation. Psychodynamic and reflective practice approaches were adopted for the analysis and discussion of the evidence. The analysis found that the therapeutic environment positively affects the children’s ability to understand their feelings, leading to more positive relationships and improvements in behaviour. However, the analysis also identified significant variation in expectations about child placements and their benefits, with many of the staff having expectations of emotional development that exceeded what the children had the potential to display. Despite many positive outcomes, how these were achieved was often poorly articulated and misunderstood. In part, this may be understood as a defence against their experiences of emotional trauma, which paradoxically leads to increased levels of anxiety among children, families and staff. This highlights training and organisational implications for the school, and more widely for the therapeutic childcare sector. This research makes an original contribution to the existing knowledge about the therapeutic approaches used for looking after children who have experienced early-life trauma. The conclusions from this thesis have implications not only for the Mulberry Bush School – the organisation and its training provision – but also for the therapeutic childcare sector as a whole.
... This hypothesis is tested in the present study. In doing so, we will take into account the received professional support that is usually still needed for these families (Hair, 2005;Tausendfreund, Knot-Dickscheit, Schulze, Knorth, & Grietens, 2016). ...
... Despite beneficial changes that are made during treatment, it is likely that families with multiple problems must still address persistent problems afterwards and that professional support remains necessary (Hair, 2005;Tausendfreund et al., 2016). Research showed, for example, that on average, children still demonstrate behavioral problems at the end of treatment (Asscher, Deković, Manders, Van der Laan, & Prins, 2013;Van Assen et al., 2020;. ...
... The buffering hypothesis was confirmed, taking into account the fact that further professional support for families with multiple problems after treatment is usually still is needed (Hair, 2005;Tausendfreund et al., 2016). In our study, the professional support appeared to fall into two main groups: professional support that was concentrated on the child behavioral problems (61%) and support that was focused on both child behavioral and parenting problems (33%). ...
The present study examined the long-term treatment outcomes of the family-centered program Intensive Family Treatment (IFT) for families with multiple problems. We also tested the hypothesis that parental empowerment at the end of IFT constitutes a buffer between the negative influences of parental stress on their children’s behavioral problems afterwards. We included 275 families with multiple problems. Information about parental empowerment and child behavioral problems was gathered at the start and end of IFT and at follow-up, on average 2.8 years (SD = 1.6) later. At follow-up, information was also collected about parental stress and professional support. Data were analyzed through latent regression analyses. Significant improvements in child behavioral problems (effect size .60) and parental empowerment (effect size .53) were observed during treatment. Improvements were sustainable for child behavioral problems after IFT. Nevertheless, child behavioral problems remained severe on average and might be a stressor for parents. Together with other environmental stressors after IFT, these problems can increase parental stress and subsequently increase child behavioral problems. However, taking into account that professional support after IFT often still is needed, the findings of our study showed that parental empowerment at the end of IFT constitutes a buffer; parental stress had a less negative influence on child behavioral problems at follow-up when parents had a higher level of parental empowerment at the end of IFT. This study stresses the importance of empowering parents during family treatment to successfully cope with environmental stressors after treatment, including the problematic behavior of the child.
... Although the research is on outcomes is mixed (Lee et al. 2011;Lyons and McCulloch 2006;Pecora and English 2016), several studies have found that youth can make significant gains during treatment (e.g., Hair 2005;Knorth et al. 2008). That is, from admission to discharge, many youth exhibit a reduction in externalizing behavior symptoms (Larzelere et al. 2004;Larzelere et al. 2001;Frensch et al. 2009;Sunseri 2005) and internalizing problems (Frensch et al. 2009;Larzelere et al. 2001;Portwood et al. 2016). ...
... Aftercare services should also be comprehensive, flexible, individualized, and be delivered by well-trained staff . When considering functioning during care and its relation to outcomes, research indicates that lower parental involvement during care (Hair 2005;Lakin et al. 2004) and poor family functioning (Sunseri 2005) are associated with worse post-discharge functioning. Other pre-discharge factors related to poor post-discharge outcomes include a shorter length of stay (Lakin et al. 2008;Yampolskaya et al. 2013), residential/placement instability (den Dunnen et al. 2013), and severity of mental health and conduct problems (den Dunnen et al. 2013;Lee et al. 2010;Yampolskaya et al. 2013). ...
... Although there are some mixed findings (Hair 2005;Harder et al. 2011), evidence indicates that quality, individualized aftercare services help youth to sustain treatment gains and remain at home and in school (e.g., Trout et al. 2013). However, relatively few studies have examined the specific post-discharge factors that result in readmission to therapeutic residential care. ...
Multiple placements in therapeutic residential care is expensive, and is associated with poor outcomes; thus, identifying barriers to successful reintegration into the home and community school settings is essential for developing appropriate post-discharge supports, and reducing societal costs. Participants were seven youth (four female; three White/Caucasian, one Black/African American, one Hispanic/Latino, two multi-racial) recently readmitted to a therapeutic residential care program and five of their primary caregivers (four female; four White/Caucasian, one Black/African American). Through semi-structured interviews with caregivers and youth, this exploratory study investigated (1) the perceptions of preparedness for the youth’s successful transition from therapeutic residential care to the home setting, (2) the post-discharge factors that contributed to the youth’s return to care, and (3) the lessons learned about the youth’s transition from therapeutic residential care to home. The results of this exploratory, qualitative study revealed rich information about youth and their caregivers’ perspectives about their experiences prior to returning to care, such as the importance of healthy relationships (family and peers), transition planning, and post-discharge supports at the individual, family, and school levels.
... Research on out-of-home treatment showed that child behavioral problems decreased in residential care (Knorth et al., 2008) but that these problems did not change significantly for children in foster care (Goemans et al., 2015). Moreover, when children and their families after a period of treatment were reunited, child behavioral problems increased both for children treated in residential and those in foster care (Hair, 2005;Lau et al., 2003;Quay, 1979). In a synthesis study largely based on research in the UK and USA, Thoburn (2009) reported that 20% to 50% of the reunited children re-entered care within two years, and other reunifications often remained problematic. ...
... This statistic may indicate that, during treatment, no significant attention is paid to strengthen children's parents in their complex home environment. Therefore, elements of FCS directed at families during children's out-of-home treatment are increasingly being proposed and used to support an optimal development of children, to promote a successful family reunification, or to stimulate acceptance and parent-child bonding when returning home is impossible (Berrick et al., 2011;Carrà, 2014;Haans et al., 2010;Hair, 2005;Knorth, et al., 2008). Parental empowerment is an important factor in this approach. ...
... This hypothesis is tested in the present study. In doing so, we will take into account the received professional support that is usually still needed for these families (Hair, 2005;Tausendfreund et al., 2016). ...
Families with multiple problems represent a vulnerable group in society. Parents and children in these families face difficulty in improving their complex situation, despite great desire and effort. Some of these families enter youth care, such as family-centered treatment. In family-centered treatment, empowering parents is seen as an important way to achieve positive treatment outcomes in the short and long term, such as in the behavior of children.
In this dissertation, we examined the relationship between parental empowerment and the behavioral problems of children in vulnerable families during and after family- centered treatment. The family-centered support included Intensive Family Treatment (IFT). The findings underline the importance of empowering parents of these families during family-centered treatment in handling their children’s behavioral problems in the short and long term.
... With regard to constructing validities, all factor loadings were significant and greater than 0.65 (p < 0.001; loadings ranging from 0.65 to 0.95). The estimates of average variance extracted (AVE) for this study constructs ranged from 0.50 to 0.96 were the suggested guideline of 0.50 [56,57]. Furthermore, the construct reliability (C.R.) coefficients, ranging from 0.79 to 0.88, were greater than the suggested criterion value of 0.60 [58]. ...
... Furthermore, the construct reliability (C.R.) coefficients, ranging from 0.79 to 0.88, were greater than the suggested criterion value of 0.60 [58]. The measurement model was conducted to analyze the scales' overall factor structure and construct validity with all Cronhach's alphas above 0.70 [57]. These results indicated commonly acceptable evidence of the construct validity in the measurement model. ...
This study investigated how sustainability-related messages of cotton textile and apparel products influence consumers’ attitudes toward the message and interaction with other consumers in social media. Three hundred and eighty-eight online survey data of US consumers investigated the effects of perceived information and emotion toward sustainability practice messages on attitude toward and social interaction with other consumers and the effects of attitude on social interaction in social media. The results confirm that emotion is an influential variable, and, specific, positive emotion is an influential variable for attitude, and attitude influences social interaction with other consumers of sustainability practice messages. Negative emotions influence both attitude and social interaction. The information does not influence attitude but directly impacts social interaction, which may bring the purchase intention of sustainable fashion products. Thus, apparel marketers should consider emotionally sustainable promotion messages when tailoring their brand communications on social media. This study helps clarify the relationships between emotion and social interaction for sustainable fashion products. It also contributes to the theoretical foundation and has implications for sustainable fashion marketing and management in social media.
... When less restrictive outpatient treatment plans fail, youth can be admitted voluntarily or involuntarily to a pediatric psychiatry ward in a hospital, or to a residential treatment centre. The cost and the restriction on personal freedoms associated with such an intensive psychiatric treatment, demands limiting its use to circumstances of ' last resort' while applying the 'least restrictive treatment' (Frensch & Cameron, 2002;Hair, 2005;Stroul & Friedman, 1986). ...
... The body of literature regarding reviews of residential treatment outcomes generally encompasses the time period of 1990-2005 of published studies. Hair (2005), looking at studies from 1993 to 2003, noticed the effect of methodological weakness on the validity of study results, particularly emphasising that future research measures need to better reflect the complexities of the specific intervention. Clearly, many factors interact in a complex way to influence the behaviour of children and youth in treatment. ...
This review focuses on studies that examine factors influencing the long-term outcome of youth after discharge from residential treatment centres. We have identified 33 new publications since the last review was published necessitating the current review. These outcome studies published between 2008 and 2018 described outcomes at a minimum of thirty days after discharge. Pre-admission factors and intervention characteristics that influence behavioural outcomes, placement outcomes, family outcomes, treatment adherence as well as criminality were identified. Lack of randomised controlled studies makes it difficult to draw strong conclusions about efficacy of the residential treatment. We identified other gaps in the extant research design and outcome measures. Much of the research to-date has been informed by psychosocial models, without considering the fast growing stream of neurobiological data from genetic and imaging studies. A broader model encompassing psychosocial and neurobiological measures may improve our understanding of factors that influence outcomes after discharge. Over time this promises deeper insights and more tailored interventions resulting in improved quality of care and better outcomes.
... Most research shows that youth placed in RGC experience gains while in care (Bettman and Jasperson 2009;Hair 2005;Knorth et al. 2008). Across studies, findings show that youth characteristics and treatment experiences or service elements affect outcomes (Bettman and Jasperson 2009;Hair 2005). ...
... Most research shows that youth placed in RGC experience gains while in care (Bettman and Jasperson 2009;Hair 2005;Knorth et al. 2008). Across studies, findings show that youth characteristics and treatment experiences or service elements affect outcomes (Bettman and Jasperson 2009;Hair 2005). Collectively, this research contributes to an understanding of the general effectiveness of RGC, encompassing a wide range of programs and populations. ...
The purpose of this study was to examine differences in discharge outcomes between latent classes of youth in psychiatric residential treatment. The mediating effect of family therapy, behavioral management incidents, and length of stay on class membership and treatment outcomes were examined. The sample included 447 youth assigned to one of four classes. Guided by Thornberry and Krohn’s (2005) interactional theory of continuity and change, change in functional impairment was predicted based on the composition of risk versus protective factors that comprised the latent classes. A manual 3-step approach was used to fit a latent class mixture model and estimate conditional effects on impairment at discharge. A mediation model was used to examine indirect effects of treatment factors on outcomes between latent classes. The results showed that classes with lower-level risk factors and more protective factors experienced significantly greater reductions in impairment on average. Treatment outcomes were mediated by behavioral management incidents but not length of stay or the number family therapy sessions. The results demonstrate the usefulness of person-centered approaches for conducting subgroup analyses in residential care outcomes studies; highlighting differences in outcomes between groups and treatment factors that may mediate these differences.
... The current study aimed to provide a valid contribute for developing specific instruments able to assess the psychological functioning and behavioral changes in adolescent patients of therapeutic communities. Few studies have been conducted to establish how therapeutic communities work to produce positive outcomes, not reporting the description of those tools included in the psychological assessment (12). Behavioral changes are crucial to improve those voluntary behaviors over which the person has at least a degree of control (10,12). ...
... Few studies have been conducted to establish how therapeutic communities work to produce positive outcomes, not reporting the description of those tools included in the psychological assessment (12). Behavioral changes are crucial to improve those voluntary behaviors over which the person has at least a degree of control (10,12). Recovery or improvement thus requires the individual takes active steps to change unhelpful habits or entrenched patterns of behavior. ...
Clinicians involving in the treatment of adolescent patients should use a valid and efficient psychological assessment. The evaluation of the efficiency in clinical interventions may provide helpful information in terms of cost-effectiveness and may contribute to increase the quality and efficacy of the public services. Despite the importance of clinical and therapeutic interventions, we may observe several aspects limiting the chance in using them. For example, the neuropsychiatry context due to heterogeneous users (such as children and adolescents) makes the replicability of clinical trials difficult in terms of results. Thus, efficient clinical programs and interventions—potentially able to identify specific and long-term effects—need to be defined. In clinical contexts (i.e., therapeutic communities). It should be a priority both to manage aspects of emergency/urgency we may observe in adolescents, and to focus on those aspects placed on a timing dimension. The current study reports a description of innovative measures developed specifically for assessing adolescent patients and for tracking psychological features and behavioral changes. Furthermore, a clinical case is examined by using a multimethod assessment including such innovative measures. Clinical implications are discussed. The development and sharing of “assessment cultures” among professionals should represent a priority in improving the effectiveness of therapeutic communities.
... Subsequently, as suggested by Jolliffe [44], the reliability of each measurement scale resulting from the ACP was verified. The verification of the validity and reliability of the scales, as indicated in Table 2, resulted in an iterative process which, at the end, provided all the values able to satisfy the minimum thresholds of acceptability, with regard to the KMO Test (>0.5, Hair et al. [45]), at the spherical test of Bartlett (Sign. < 0.005, Tabachnick e Fidell [46]), to the explained variance of the phenomenon analyzed (>0.50, Pett et al. [47]; Hair et al. [45]) and Cronbach's Alpha (>0.70, ...
... The verification of the validity and reliability of the scales, as indicated in Table 2, resulted in an iterative process which, at the end, provided all the values able to satisfy the minimum thresholds of acceptability, with regard to the KMO Test (>0.5, Hair et al. [45]), at the spherical test of Bartlett (Sign. < 0.005, Tabachnick e Fidell [46]), to the explained variance of the phenomenon analyzed (>0.50, Pett et al. [47]; Hair et al. [45]) and Cronbach's Alpha (>0.70, Capelli et al. [48]): ...
... Research on out-of-home treatment showed that child behavioural problems decreased in residential care (Knorth, Harder, Zandberg, & Kendrick, 2008) but that these problems did not change significantly for children in foster care (Goemans, van Geel, & Vedder, 2015). Moreover, when children and their families after a period of treatment were reunited, child behavioural problems increased both for children treated in residential and those in foster care (Hair, 2005;Lau, Litrownik, Newton, & Landsverk, 2003;Quay, 1979). In a synthesis study largely based on research in the UK and USA, Thoburn (2009) reported that 20% to 50% of the reunited children re-entered care within 2 years, and other reunifications often remained problematic. ...
... This statistic may indicate that, during treatment, no significant attention is paid to strengthen children's parents in their complex home environment. Therefore, elements of FCS directed at families during children's out-of-home treatment are increasingly being proposed and used to support an optimal development of children, to promote a successful family reunification, or to stimulate acceptance and parent-child bonding when returning home is impossible (Berrick, Cohen, & Anthony, 2011;Carrà, 2014;Haans, Robbroeckx, Hoogeduin, & Van Beem-Kloppers, 2010;Hair, 2005;Knorth et al., 2008). Parental empowerment is an important factor in this approach. ...
The aim of this study was to examine changes in parental empowerment and child behavioural problems during a period of youth care and how changes are related to the kind of services provided. We compared a preservation service that was family‐centred (FCS) with out‐of‐home services that were primarily child‐centred (CCS). The sample consisted of 621 families who were supported by FCS (n = 434) or CCS (n = 137). Information about parental empowerment and child behavioural problems was gathered at the start and end of youth care. Significant changes during treatment were identified with t tests and effect sizes. Significant improvements emerged on all empowerment scales for FCS but only on the behavioural control subscale for CCS. Moreover, significant improvements emerged on all child behavioural scales for both FCS as CCS. Cross‐lagged analysis showed that the kind of service, in favour of FCS, predicted parental empowerment but not child behavioural problems. Parental empowerment and child behavioural problems were negatively related. This paper discusses the potential for parental empowerment and FCS elements in CCS out‐of‐home care and the need for follow‐up research on this subject.
... Vi fant svaert få systematiske oversiktsartikler om institusjonsbehandling for rusproblemer, og forskningskvaliteten var gjennomgående svak. De fleste evalueringene hadde forskningsdesign som innebar seleksjonseffekter og frafallproblemer, små utvalg, ingen kontrollgrupper eller manglende randomisering og høyt behandlingsfrafall ("drop-out") sammenlignet med forskning på modeller i familie-og naermiljøbasert behandling (Hair, 2005) Continuing Care "(ACC) (Godley et al., 2002). Den sistnevnte modellen er en tilnaerming som kan se lovende ut for behandlingsfeltet. ...
... De fleste ungdommer starter sin ruskarriere med alkohol og deretter cannabis. Rusmidlene alkohol og marihuana var de hyppigst brukte rusmidlene blant amerikanske ungdom i behandling mellom -2005(Dembo & Muck, 2009Leukefeld et al., 2009). En meta-analyse om behandling cannabisbruk framhevet flere av de samme familie-og naermiljøbaserte modellene som denne kunnskapsoversikten har presentert som positive og lovende (Bender et al., 2010) Se www.chestnut.org ...
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet motungdom kan derfor også ha en forebyggende effekt. Kunnskapsoversikten fokuserer primært på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg gir kunnskapsoversikten anbefalinger med hensyn til videreutvikling av rusbehandling.
... The meta-analyses on the efficacy of public residential care include studies that were mostly conducted in the USA and Europe (and did not include France). They noted a decrease in symptoms among the young people in care, although the improvement appeared to wane after discharge (82)(83)(84). Favourable results in the long term seemed in particular linked to the stability of accompaniment in the ambulatory facilities after discharge, and to whether or not the families were implicated in the care (82,83). However, as this treatment is perceived as a "last resort" solution, the studies included in these reviews were only pre-experimental (two measurements over time performed within a sample, before and after an intervention) or quasi-experimental studies (two groups are offered a different intervention and studied at two time points) (84). ...
... They noted a decrease in symptoms among the young people in care, although the improvement appeared to wane after discharge (82)(83)(84). Favourable results in the long term seemed in particular linked to the stability of accompaniment in the ambulatory facilities after discharge, and to whether or not the families were implicated in the care (82,83). However, as this treatment is perceived as a "last resort" solution, the studies included in these reviews were only pre-experimental (two measurements over time performed within a sample, before and after an intervention) or quasi-experimental studies (two groups are offered a different intervention and studied at two time points) (84). ...
Early psychosocial rehabilitation of young people presenting mental disorders is a major challenge. In France, the therapeutic residential care called “ soins-études ,” combining care and educational provision, in the Fondation Santé des Etudiants de France (FSEF) can have a role in this rehabilitation. After recalling the history and the concept underpinning soins-études in psychiatry, we performed a systematic review of the literature based on the PRISMA statement via a search for quantitative studies on soins-études facilities. Eleven quantitative studies on 10 different samples of young people hospitalised in psychiatry in FSEF were identified between the opening of the first unit in 1956 and 2016. The young people involved were mostly aged 16–20 years, which reflects the curricula covered in the FSEF establishments. These young people generally presented severe chronic psychiatric disorders. Their previous care trajectory had lasted for more than 3 years and 24–55% of them had attempted suicide at least once. Their stays lasted more than 6 months. Depending on the severity of the disorders, 44–63% of the young people were considered to have improved at discharge. The contribution of soins-études appears valuable for these young people, since there was a clinical improvement for 54–74% of them 1–15 years after their hospitalisation, with resumption of schooling, professional training or entry into employment in 60–75% of the cases. These results are compared with data in the international literature concerning therapeutic residential care, and lines for future research are identified.
... Autorul a ajuns la fabuloasa cifră de peste 1500 de studii clinice controlate privind rezultatele psihoterapiei cu copii şi adolescenţi şi a 12 revizuiri importante ale studiilor dintre 1998 şi 2002. Aceste studii contolate au avut ca scop demonstrarea eficienţei intervenţiei terapeutice, adică probabilitatea ca o terapie dată să producă efecte benefice în condiţii ideale (vezi Hair, 2005 Toate aceste revizii si metaanalize arată interesul extrem de ridicat al comunităţii ştiinţifice internaţionale pentru studiul eficienţei demersului psihoterapeutic la copii. Cercetarea de faţă se înscrie pe această linie, dorind să se constituie într-un studiu privind eficenţa unui demers psihoterapeutic cu copii printr-o strategie combinată de cercetare: studiul clinic controlat este completat de analiza calitativă a procesului terapeutic. ...
... Problema este însă că aceste studii clinice controlate se centrează pe respectarea cu stricteţe a condiţiilor de cercetare: repartizarea aleatorie a pacienţilor în grupurile experimentale, utilizarea loturilor de control şi tratament fix după manual. În realitatea clinică însă lucrurile nu stau aşa şi acelaşi autor (Hoagwood, 2003) spune că 90% dintre serviciile reale de psihoterapie din clinici nu au nici o dovadă de eficienţă, deoarece condiţiile reale nu sunt nici pe departe cele din studiile controlate evidence-based: nu se pot lăsa pacienţi netrataţi pentru a constitui lot de control, terapeuţii experimentaţi nu lucrează după manual, etc. Din aceste motive, se înregistrează discrepanţe foarte mari între studiile clinice controlate şi practica clinică reală (vezi Hair, 2005, Journal of Child and Family Studies) ...
... Lakin, Brambila, and Sigda (2004) found that families with greater involvement functioned significantly better at discharge than families that were less involved, and that higher family functioning was a protective factor against readmission. Hair (2005) examined outcome studies between 1993 and 2003 and found that the maintenance of therapeutic gains after discharge was associated with the extent that the family was involved in the treatment process. ...
This is a follow-up to a 2004 study I conducted and again it shows that children with serious mental health problems do best when the entire family is treated as a whole and family functioning improves.
... However, cohort studies of children who were in care in the early 1990s, indicate that young adults who were placed as children run an increased risk of attaining a low level of education, being dependent on social assistance, prone to criminal behaviour, teenage pregnancy, psychiatric care and early death, etc. (Vinnerljung & Sallnäs 2008). Similar poor outcomes of residential care are found in many countries (e.g., Hair 2005;Knorth et al. 2008;Lee et al. 2010;Kääriälä & Hiilamo 2017). Plausible explanations are, for example, that the preventive family services fail, that the quality of out-ofhome care is inferior, that there are problems with care disruptions and that leaving care services fall short (Kääriälä & Hiilamo 2017). ...
The aim of this dissertation is to describe and analyse the prerequisites and practices of auditing Swedish residential care for children. Residential care is a complex intervention provided to children in vulnerable life situations. The care is extensively delivered by private providers and shows difficulties in demonstrating clearly positive treatment effects. Licensing and inspections are policy instruments to address alleged quality problems in decentralised and marketised welfare services. However, in research there are mixed opinions on the ability of audits to generate improved service quality.
The dissertation consists of four papers exploring central facets of the audit system. The empirical material is based on interviews (n=50) with inspectors and residential staff, documentation (n=286) in terms of guidelines and license/inspection decisions and observations (n=12) at inspection-related events. Each paper includes a unique set of data.
Paper I analyses the controls that private residential homes undergo prior to their entry into the market. The results show that a majority of applicants are granted a license and that the controls do not reduce the need for ex post control. There is limited guidance on care content and research evidence is weakly incorporated in the controls. Overall, the state exerts limited influence over the composition and professional development of the care market.
Paper II explores the operationalisation process of care quality in inspections. The results show that the standards display a marked variation and there is no differentiation between different residential homes. In general, the standards focus on reducing malpractice and not maximising care quality. In practice, the inspections are often discussion-based and standards relating to work with children are often indistinct.
Paper III analyses how inspections are perceived by representatives from residential homes. The results show that inspections induce reflection and to some extent shape the administrative parts of care, but also that it is difficult to discern the actual impact of the inspections on the work. The inspections appear to bring a degree of stability and legitimacy to the work, but there are sometimes tensions between standards and professional judgment.
Paper IV studies the influence the inspection process grants children in care. The results suggest that different inspectorial rationales (regulative, supportive and protective) may influence the agency children exert and that it is difficult to allow children’s views to have a substantial impact on the process. Overall, there tends to be a gap between what the children find important and what the audits can address in concrete terms.
The theoretical ideas used to analyse the results are derived from institutional organisational theory and the thesis on the audit society. The overall analysis shows that 1) making certain core care aspects auditable and ensuring their impact is difficult (e.g., children-staff relationships, children’s views and use of research knowledge), 2) the system has a restrained character and is in many senses associated with inconclusive formative effects, 3) the use of uniform goals does not necessarily equal a more suitable care provision and 4) the audits signify strong symbolic values. Despite the limitations, the audits may help to discipline care providers, secure a minimum level relative to the audited care aspects and induce reflection among auditees.
... Pratt (2013) [12] argued for a placement system that takes into consideration the juvenile's risk assessment of their detrimental impact on the community. Several studies have discovered that juveniles who have entered into residential treatment facilities show a reduction in negative symptoms (e.g., aggression, depression, anxiety, suicidality), a rise in daily functioning, and high rates of school completion within the course of treatment as well as post-treatment [14,15]. Conversely, the newfound structure of a treatment program, in relation to the juvenile's previous experience with chaos, abuse and neglect in their families of origin or ecological context of school, neighborhood, and community [16], may create confusion and discomfort for them. ...
... Nevertheless, important indications of evidence for the effectiveness of residential treatment can be gleaned from evaluations and quasi-experimental designs. For example, studies suggest that residential treatment reduces adolescent symptoms and improves their psychosocial functioning (Bean, White, Neagle, & Lake, 2005;Black & Chung, 2014;Caldwell & Van Rybroek, 2005;Fishman, Clemmey, & Adger, 2003;Grella, Hser, Joshi, & Rounds-Bryant, 2001;Hair, 2005;Morral, McCaffrey, & Ridgeway, 2004;Winters, Stinchfield, Opland, Weller, & Latimer, 2000). This appears especially true for youth who complete treatment (Jainchill, Hawke, DeLeon, & Yagelka, 2000) and participate in aftercare (Godley, Godley, Dennis, Funk, & Passetti, 2006). ...
... Lakin, Brambila, and Sigda (2004) found that families with greater involvement functioned significantly better at discharge than families that were less involved, and that higher family functioning was a protective factor against readmission. Hair (2005) examined outcome studies between 1993 and 2003 and found that the maintenance of therapeutic gains after discharge was associated with the extent that the family was involved in the treatment process. ...
Residential treatment is typically reserved for children with the most serious mental health issues. Previous research has identified an association between better family functioning and positive treatment outcomes among children placed into residential care. This study attempted to replicate and expand upon these findings by examining outcomes among 18,046 children and adolescents placed into residential treatment programs in the United States located in the state of Indiana. As predicted, numerous treatment outcomes again were found to be highly associated with the level of the child’s family functioning including successful discharge, successful discharge by level of care, restrictiveness of discharge environment, behavioral improvements over the course of treatment, and client functioning at discharge. The results of this study once again provide evidence that children from low functioning families should be identified at the time of referral (the “Hidden Figures”) and that they do better when placed in higher level, more intensive programs. Additionally, the probability of a successful discharge increases if family functioning can be improved over the course of treatment. Overall, these data provide further evidence that suggests improving family functioning is a key ingredient for improving children’s mental health.
... In our work with teens and young adults after treatment, the research highlighting the central role parents play in long-term success was verified. When taking into account the key factors identified by a meta-analysis of the then existing research on long-term success after treatment (Hair, 2005), it became clear that outside the student themselves, parents have the potential to have the greatest influence on the eventual outcome. ...
... Evidence has shown that proper separation experiences not only increase adolescents' autonomy but also strengthen their emotional ties to parents, particular for adolescent boys (Geuzaine, Debry, & Liesens, 2000;Sullivan & Sullivan, 1980). In addition, findings suggest that family involvement is associated with better wellbeing of youth in residential care (Huefner, Pick, Smith, Stevens, & Mason, 2015;Palareti & Berti, 2010), lower readmission rates (Lakin, Brambila, & Sigda, 2004), and has the most significant effect on successful discharge and continued adaptation after residential treatment (Hair, 2005;Walter & Petr, 2007). Engaging parents in their children's boarding school life seems to be a promising protective factor of positive transition. ...
... These young people have been unable to live at home due to problems on the part of parents, child abuse and neglect, or severe behavioral problems (Handwerk et al. 1998;Knorth et al. 2008;Whittaker et al. 2016). Treatment usually takes place within a therapeutic holding and learning environment (Hair 2005), and institutions are increasingly adhering to evidence-based treatment interventions (De Swart et al. 2012). We distinguish TRC from other types of residential care with other primary purposes, including detention, isolation, and basic care (e.g., prisons and orphanages). ...
Background: Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC.
Objective:
To improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC.
Methods:
Four-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC.
Results:
The original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported.
Conclusions:
Compared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity.
... For instance, in a review of research on residential care outcomes, Hair (2005) argues that reduction of problem behaviors during the first six months suggests that shorter length of stay (LOS) is associated with treatment gains and allows for more bed availability for youth who need this level of care. This argument is based on two of the 18 articles reviewed: Shapiro, Welker, and Pierce (1999) and Hoagwood and Cunningham (1992). ...
The high cost of residential services for troubled youth is an ongoing concern, and has formed the basis for arguments made for reducing or eliminating residential services for these youth with some recommending that lengths of residential stay be less than 6 months. This is countered by the view that the challenges faced by troubled youth are associated with high public funds expenditures in the future due to limited education, underemployment, and increased risk of criminality. Analysis used 24 month follow-up education, employment, and criminality data from 1476 former residential care youth who were now in their 20s. Individuals who were in the program for more than 6 months had better educational, employment, and criminality outcomes than youth that were in the program for less than 6 months. These improved outcomes were associated with significantly better estimated financial societal benefit over the long-term, specifically a 361% return on investment from a societal perspective.
... Research might consider, for instance, quality of students' friendships and peer relationships, work-related burnout experienced by teachers, and perceptions of other school staff members in residential treatment center schools. In a review of research on outcomes of youth in residential treatment center, Hair (2005) concluded that positive behavior and educational outcomes can be sustained in residential treatment centers that utilize a treatment that is multi-modal, holistic, and ecological in its approach. Thus, an ecological approach to understanding factors that are associated with educational outcomes of youth in out-of -home care is warranted. ...
The purpose of the present study was to explore student and teachers’ perceptions of the academic environment in an urban residential treatment center school setting, which serves female students with myriad behavioral, social, emotional, and/or academic challenges, half of which have IEPs and the remainder of which are significantly at-risk and also receive individual learning plans. Using focus group interview methods provided important information from both students (n = 58) and teachers (n = 27) regarding specific areas in need of improvement. The research team identified four primary themes throughout the student data and four in the teacher data. Themes that emerged throughout the student data included need for least-intrusive behavioral management, preventative strategies for behavior, differentiated instruction, and recognition. Teacher data resulted in themes of lesson plan difficulties, academic versus social-emotional well-being, balancing academic and behavioral needs, and additional assistance within the classroom. Both students and teachers voiced a number of significant concerns and provided useful ideas that can enhance the preparation and supports for teachers in training and practice, most immediately the information informed teachers in this specific context. Implications for research and broader practice are also discussed.
... SC is considered to be a critical aspect for change or development of young people in TRC (e.g., Attar-Schwartz, 2017;Bastiaanssen et al., 2012;Hair, 2005;Huefner & Ainsworth, 2021;Lanctôt et al., 2016;Leipoldt et al., 2019;Mathys, 2017;Mathys et al., 2013;Moore et al., 2018;Souverein et al., 2013;Van der Helm, 2011, 2019Ward, 2004). It can be defined as : : : the quality of the social and physical environment in terms of the provision of sufficient and necessary conditions for the physical and mental health, well-being, and personal growth of the residents, with respect for their human dignity and human rights as well as (if not restricted by judicial measures) their personal autonomy, aimed at participation in society (Stams & Van der Helm, 2017, p. 4). ...
Previous research has shown that social climate (SC) is important for the daily life of youths living in therapeutic residential youth care (TRC). However, little is known on how SC can promote a positive quality of life (QoL) for the heterogeneous TRC population. This study, therefore, investigates how TRC and youth characteristics are associated with SC and QoL. We employed a combination of person-centered and variable-centered approaches in a cross-sectional design using a sample of 400 Norwegian youths. We used previously established TRC and youth classes in a structural equation model, where these classes were regressed on latent SC and QoL. Both direct and indirect effects were analyzed. All youth classes were associated with SC and QoL, such that youth with family problems, incidental problems, and the migrant background class scored higher on SC and QoL compared to the severe problems class. In addition, SC mediated the association of the incidental problems and migrant background classes on QoL. TRC staff should acknowledge that a positive SC can strengthen the QoL of youths with severe problems. Future research should longitudinally investigate these associations to establish long-term effects on QoL during stay in TRC. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Some studies found a positive link between length of stay in the care setting and positive adjustment, such as positive educational outcomes ( Thompson et al., 1996) andadolescents' behavioral, emotional, andsocial functioning (Attar-Schwartz, 2008;Knorth, Harder, Zandberg, & Kendrick, 2008;Lee & Thompson, 2009;Pinchover & Attar-Schwartz, 2012;Zemach-Marom, Fleishman, & Hauslich, 2002). Other studies found no association between length of stay in care and children's functioning (Heflinger, Simpkins, & Combs-Orme, 2000;Hukkanen, Sourander, Bergroth et al., 1999), or even a negative association (Hair, 2005;Hoagwood & Cunningham, 1992;Hussy & Guo, 2002). The current study examined the contribution of length of stay in the current RCS to youths' emotional and behavioral adjustment difficulties and the moderating role of length of stay in the link between staff support and adjustment difficulties. ...
Residential child care workers, acting in loco parentis, are in continuous, daily contact with the children in their care, and as such they are one of the key support providers in their lives. However, there is little research on the extent of the support and contribution they make to the children’s well-being. This study examines the link between perceived staff social support and emotional and behavioral adjustment difficulties of adolescents in educational residential care settings (RCSs) designed for youth from underprivileged backgrounds in Israel. It also examines the moderating role of adolescents’ length of stay in the RCS in the link between staff support and adolescent adjustment. The study includes the reports of a random cluster sample of 1,409 adolescents in grades 8 to 12, residing in 16 Israeli educational RCSs. The adolescents reported an average of medium to high level of staff support. Being female, Israeli-born, and perceiving greater parental support were found to be positively correlated with perceived staff support. Staff support was associated negatively with adolescent adjustment difficulties, above and beyond the contribution of parents’ support. A significant interaction was found between length of stay and staff support in predicting adjustment difficulties. Specifically, among adolescents residing for longer periods in the RCS, there was a stronger link between staff support and fewer adjustment difficulties. The findings have implications for residential care policy and practice, especially regarding the need to strengthen the role of child care staff as a social support system for children and adolescents in residential care.
... Evaluations of the effectiveness of residential treatment are relatively limited in number and necessarily (due to intensity of need) fail to utilize random assignment to a wait list control group. There are a handful of large-scale reviews indicating residential treatment can be effective in improving functioning for children and youth with serious behavioral and emotional disorders (e.g., Frensch & Cameron, 2002;Hair, 2005;Knorth et al., 2008). Numerous authors have noted the lack of high-quality studies evaluating the effects of residential treatment (e.g., Butler & Richard, 2013;Cuthbert et al., 2011;Frensch & Cameron, 2002;Harder & Knorth, 2015;Walter & Petr, 2007). ...
This study investigated whether children/youth in Ontario triaged to residential services showed a higher intensity of need than those referred to outpatient services, and whether residential treatment gains were sufficient for transition to community services. Participants included 2053 children/youth assessed at 23 diverse mental health agencies across Ontario using the interRAI™ Child and Youth Mental Health (ChYMH) instrument. Various presenting problems were examined utilizing scales including: Disruptive/Aggressive Behavior, Hyperactive/Distraction, Social Disengagement, Anxiety, and Sleep Difficulties. Analyses were conducted separately for boys and girls.
Notable differences were found in the initial assessment, with residential boys scoring higher on all scales than outpatient boys, and residential girls scoring higher on the externalizing scales (Disruptive/Aggressive Behavior, Hyperactive/Distraction) than outpatient girls. Treatment gains at residential discharge included improvements in Anxiety, Social Disengagement, Hyperactive/Distraction and Sleep Difficulties for boys and girls to levels at or below the initial scores of outpatient peers. Disruptive/Aggressive Behavior is still a high need following residential services.
The results highlight differences in severity of mental health presentation between children/youth receiving residential and outpatient services, and how multiple agencies in Ontario are providing services that successfully reduce the severity of mental health needs.
... As half of the youth in Cluster 1 were Crown wards, and many had lengthy CPS involvement, it is also possible they had stabilized during their stays. Research supports that some youth in GC improve over time (Farmer et al., 2017;Hair, 2005); however, these stable presentations indicate the potential to step down into less restrictive placements or return home. Also, while the clusters identified distinct subgroups, among some variables, wide variation existed. ...
Background
Many adolescents in group care have experienced higher rates of traumatic event exposure, behavior problems, and severe trauma sequelae compared to those outside of group care. Yet, little research has examined from a person-centered perspective their diverse trauma profiles and corresponding service needs.
Objective
This exploratory study aimed to examine the heterogeneity of trauma-related profiles among youth in group care to highlight potential distinct service needs among subgroups.
Method
Data from the Maltreatment and Adolescent Pathways Study identified 96 randomly selected youth (14–17 years) in Canadian group care settings who completed a battery of self-report measures. Cluster analysis was employed to reveal common patterns of maltreatment and trauma symptoms among subgroups, further described and validated by externalizing behaviors (substance use, risky sexual behavior), internalizing symptoms (global mental health, anger), and personal/parental demographic factors.
Results
Four distinct clusters emerged: (1) no/low maltreatment, low trauma; (2) moderate physical and emotional abuse, moderate trauma; (3) moderate-severe maltreatment, low trauma; and (4) severe maltreatment, high trauma. Clusters 1, 2, and 4 reflected ‘dose-response’ relationships between maltreatment and trauma symptoms; Cluster 3 was characterized as ‘resilient’. Females were highly over-represented in Cluster 4, echoing previous research.
Conclusions
Findings align with previous research confirming high incidence of maltreatment, internalizing, and externalizing problems among youth in group care, but extends to emphasize the importance of providing trauma-informed services tailored to their variable, complex presentations. Limitations and suggestions for group care settings to provide this wide range of services at program and individual levels are discussed.
... Since relationships with family constitute a major challenge for care leavers, it is an important focus for intervention, whether or not the family can actually provide a consistent and long lasting relationship. Studies indicate that maintaining family relationships during care contributes to better adjustment both in care and after leaving care (Courtney et al., 2009;Hair, 2005;Hart, La Valle, & Holmes, 2015;Knorth, Harder, Zandberg, & Kendrick, 2008). ...
The transition to adulthood for young people leaving care has become a significant subject of research over recent decades, especially given consistent findings that suggest that alumni of care are at high risk of adverse outcomes. However, there is no definitive consensus on how findings from research can best inform practice with youth in transition out of care. The aim of the present article is to provide principles that can support practice based on a project mounted by a group of international care leaving researchers. These principles include, among others, the importance of listening to the young people, to supporting their autonomy during and after care as well as their cultural identity and diversity, to ensuring their access to education after care, to ensure preparation for leaving care and ensure that care leavers rights are upheld so that they get the support they need. The discussion considers these principles in light of the micro-, meso- and macrosystem levels in Bronfenbrenner’s social ecological model (1994) and the United Nations Convention on the Rights of the Child (1989) and reviews the challenges of generating these principles. In addition, implications for policy are highlighted in relation to rights, entitlements and access to services.
... Outcome research investigating the effectiveness of residential care for young people often has methodological problems, such as lack of control groups, outcome measures with insufficient reliability or validity, and retrospective design (Bettmann & Jasperson, 2009;Blanz & Schmidt, 2000). Results from existing outcome studies reveal positive effects, negative effects or no effects at all (Armelius & Andreassen, 2007;Baglivio, Wolff, Jackowski, & Greenwald, 2017;Hair, 2005;Lipsey, 2009;Ryan, Marshall, Herz, & Hernandez, 2008;Weisz et al., 2017). There is a risk that delinquency is further increased by https://doi.org/10.1016/j.jcbs.2020.03.008 ...
Treatment of youth in residential care may be a challenging task for most providers because comorbid problems are common and general psychosocial functioning is low. Cognitive behavioral therapy (CBT) is found to be the most effective treatment but results in only rather small improvements. Hence, there is potential to improve treatment approaches. Acceptance and Commitment Therapy (ACT) could be one such approach. The purpose of this study was to test the effectiveness and feasibility of a brief trans diagnostic ACT group intervention for youth with comorbid problems in residential care. We also wanted to see whether increased psychological flexibility (PF) mediated potential positive outcomes, and to test the intervention under real-world conditions in residential care when delivered by less-specialized staff. With a quasi-experimental design, 69 youth (mean age 17.3 years) received Treatment-As-Usual (TAU), and 91 youth received TAU with an additional 12 h of ACT in a group setting (TAU + ACT). Follow-ups were conducted two weeks, 1 month, 6 months and 18 months after baseline. Intention-to-Treat (ITT) analyses showed statistically significant improvements 18 months after baseline, measured by the interaction of treatment and time for the primary outcomes of, anxiety [ACT * Months = −0.885 (0.445), p < 0.05, d = 0.34], depression [ACT * Months = −1.058 (0.526), p < 0.05, d = 0.39] and psychological flexibility [ACT * Months = −0.970 (0.413), p < 0.05; ACT * Months² = 0.053 (0.023), p < 0.05; d = 0.44] in TAU + ACT youth compared to TAU alone. Regarding secondary outcomes 6 months after baseline, the TAU + ACT group showed a significant decrease in anger, disruptive behavior, and increased self-concept, with small to medium effect sizes. We also observed that psychological flexibility mediated the decrease in the primary outcome of decreased anxiety. ACT in group format may be of help in promoting various positive outcomes for youth in residential care when added to treatment as usual. Increasing PF is a promising process variable that can be targeted to increase the effectiveness of interventions for this population.
... Research on the effectiveness of residential care shows that most youth experience improvements following placement (Bettmann & Jasperson, 2009;Hair, 2005;Knorth, Harder, Zandberg, & Kendrick, 2008). Yet, not all programs are created or managed equally (Barth, 2005b) and the quality of care children receive affects service outcomes (Grietens & Hellinckx, 2004;Lyons, Terry, Martinovich, Peterson, & Bouska, 2001). ...
With the increased emphasis on accountability at the federal and
state levels, efforts to identify and address issues impacting the
quality and effectiveness of residential care programs are needed.
Establishing quality practice standards with measurable performance
indicators is a useful means for promoting and evaluating
the quality of care in residential programs and informing a process
of continuous quality improvement. In this article, we
describe a state-wide initiative to enhance the quality of residential
group care in Florida. Specifically, we describe efforts to
establish a set of quality standards for residential programs and
to operationalize the standards by developing and piloting an
assessment designed to measure the extent to which group
home practices align with the standards. In addition to describing
steps taken, we highlight important conceptual and practical
considerations for translating standards generated from extant
research, best practices, and field experts into clearly defined
domains and measurable standards that can be meaningfully
transported into a complex practice setting. Finally, we discuss
lessons learned and recommendations that may guide similar
efforts beyond the state of Florida.
... We found a trend indicating that longer during placements were associated with smaller effect sizes, which shows that it might not be effective to place adolescents in an alternative educational facility for a long period of time. This corresponds with research on residential care (Hair, 2005), and might be explained by adolescents' loss of motivation to work on their future perspective if this is too far ahead (Van der Helm, 2011). This finding requires further research. ...
In this multilevel meta-analysis the outcomes of adolescents with complex problems at risk for school drop-out attending nonresidential alternative educational facilities were examined. Ten studies (87 effect sizes), examining outcomes on social-emotional functioning, academic achievement, academic attitude, externalizing and internalizing problems, were included. The findings indicated a small but significant overall effect (d = 0.15, p = .03), providing preliminary evidence that these facilities may be associated with positive outcomes for adolescents. Study quality, measurement type and reliability of the assessment instruments were significant moderators of the overall effect size. Results of this study urge for more high quality research on nonresidential alternative educational facilities, because they can contribute to positive youth outcomes, which in turn may prevent school drop-out and other negative life outcomes.
... treatments (Hair, 2005), underscoring the need to continue to develop and identify effective, accessible, targeted, and creative treatments for these youth. ...
Relational Savoring (RS) is a recently-developed, brief, transdiagnostic intervention that can be administered by paraprofessionals. Although RS has demonstrated efficacy, it has not been examined among at-risk youth. This pilot study adapted RS for the at-risk adolescent population and examined its efficacy. Twenty male youth in residential treatment participated in a four-week long experimental study in which they were randomly assigned to participate in weekly sessions of RS or a savoring control. The study measured participants’ state affect, relationship schema, and attachment styles before and after the intervention. Compared to control participants, participants assigned to RS showed significantly greater reductions in negative affect and attachment anxiety, as well as significantly greater improvements in relational schema. Findings are discussed both in terms of their contribution to theory and as support for a test of the intervention with greater statistical power within this population of youth residing in residential treatment.
... It is estimated that about twenty percent of children in the child welfare system are being treated in a residential facility (Baker, Wulczyn, & Dale, 2005). Since residential treatment is generally regarded as effective (e.g., increased academic performance and psychological adjustment) (Coll, Stewart, Juhnke, Thobro, & Haas, 2009;Leichtman, Leichtman, Barber, & Neese, 2001;Hair, 2005), there is a significant need to comprehensively describe and illustrate via a logic model what processes work for adolescents in residential treatment facilities and how to make improvements (Bean, White, Neagle, & Lake, 2005). used constructs for understanding psychosocial development (Coll, 2017). ...
There is a significant need to comprehensively describe and illustrate via a logic model what processes work for adolescents in residential treatment facilities and how to make improvements (Bean, White, Neagle & Lake, 2005).The purpose of this article is to highlight one Adolescent TRC’s journey to develop and implement a working Logic Model.
... Therefore, if a treatment center does engage the family system in the change process, it follows that the limitations on second order systemic change are likely to be diminished. There is also an argument to be made that one of the limiting factors of community-based treatment is that individuals cannot receive adequate treatment unless they are removed from their problematic context and dysfunctional system (Hair, 2005). Out of home placement can provide the space to begin the change process in the absence of constant triggers to re-engage in unhealthy behaviors and dynamics. ...
Die Kinder- und Jugendhilfe, in diesem Beitrag fokussiert auf den Bereich der stationären Perspektivklärung, soll Kindern in Notsituationen Unterstützung und ein vorläufiges Zuhause bieten. Für Fachkräfte kann diese Tätigkeit aufgrund von Grenzüberschreitungen durch die zu betreuenden Kinder, fehlenden personellen wie zeitlichen Ressourcen oder einer nicht ausreichenden fachlichen Vorbereitung höchst belastend sein.
Introduction
We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups.
Method
The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community.
Results
Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships.
Conclusion
Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
Managing sex offenders within communities is a daunting task, given the nature of this type of criminal offending. This chapter highlights the important aspects of the sex offending literature, with a focus on reentry efforts for sex offenders. Obstacles and consequences of sex offending are provided, along with significant management strategies that communities have attempted to address sex offending and sex offenders. This chapter reviews the major models of sex offender management and prospects and barriers to their implementation. It is concluded that there is no one type of sex offender and no one best method to manage sex offenders in the community. Instead, sex offending, like other criminal offending, must be understood as diverse and dynamic, and as such, there must be a comprehensive and eclectic approach to successfully managing sex offenders in the community.
Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status.
This paper attempts to develop a model which shows the relationship between TQM practices and customer satisfaction level particularly in Indian manufacturing context through an empirical approach. Though there is considerable literature available in this area to examine the impact of TQM practices on organisation performance across the globe, still little is known about the effect of TQM practices on firm’s performance in Indian organisations. To examine the linkage more closely, the relationship between individual TQM practices and customer satisfaction level as a performance indicator was investigated explicitly. The empirical data were collected from a survey of 260 Indian manufacturing organisations using a self-administrated questionnaire. The study has contributed a model of 10 TQM constructs. The data were analysed and hypotheses regarding individual TQM practices were tested using multiple regression. In addition to that, structural equation modelling was used to determine the relationship between TQM and customer satisfaction level. Overall, the findings indicated that there exists a positive and significant relationship between TQM practices and customer satisfaction level. The study also revealed that knowledge management and customer focus were perceived as the most dominant TQM practices associated with customer satisfaction.
Customer engagement (CE) is emerging in the marketing literature with preliminary research indicating that it has an important construct that not only reflects consumers' interactive experience and the relationship within brand communities but also is conducive to a firm’s financial value. Contemporaneously, regarding within interactive, progressive business environments, CE represents a strategic imperative with the aim of boosting business performance including sales revenue, outstanding competitive advantage, and profitability. Likelihood, empirical studies suggested that considering customer loyalty, CE is a decisive strategic imperative. However, there were studies toward exploring antecedents and consequences of CE, it has no consensus among researches for this problem. Specifically, while CE is suggested is antecedent to lead to perceived value, corporate reputation, brand image and loyalty. It is also demonstrated to be consequences of these constructs. The statement that a company's activities to acquire engaged customers are beneficial for brand image and corporate reputation and improve perceived value creates a heat debated among authors these days. Concurring with this observation, we suggest that specific CE relational outcomes may expand to activate as CE antecedents in ensuing CE procedure and/or cycles over time. Therefore recognizing the repetitious nature of the engagement process is the goal’s paper
With the increased emphasis on accountability at the federal and state levels, efforts to identify and address issues impacting the quality and effectiveness of residential care programs are needed. Establishing quality practice standards with measurable performance indicators is a useful means for promoting and evaluating the quality of care in residential programs and informing a process of continuous quality improvement. In this article, we describe a state-wide initiative to enhance the quality of residential group care in Florida. Specifically, we describe efforts to establish a set of quality standards for residential programs and to operationalize the standards by developing and piloting an assessment designed to measure the extent to which group home practices align with the standards. In addition to describing steps taken, we highlight important conceptual and practical considerations for translating standards generated from extant research, best practices, and field experts into clearly defined domains and measurable standards that can be meaningfully transported into a complex practice setting. Finally, we discuss lessons learned and recommendations that may guide similar efforts beyond the state of Florida.
Despite teacher self-efficacy and burnout’s influence on student outcomes, little research has been conducted on teacher self-efficacy and burnout in residential treatment schools. This study attempts to fill this need by examining the self-efficacy and burnout of teachers and paraeducators in a residential treatment school in the United States. We explore the relationships between educators’ perceptions of school supports and educators’ sense of self-efficacy and burnout Our results revealed that while educators’ perceptions of school supports were not related to educators’ sense of efficacy, there was a significant relationship between educators’ perceptions of school supports and reported levels of burnout. Educators who reported lower levels of school supports had high levels of burnout. We discuss implications for larger studies on this topic and for supporting educator well-being in residential treatment schools.
A common and critical issue faced by youth discharged from residential treatment is the gradual loss of gains made while in residential treatment. This can put these youth at greater risk for negative long-term outcomes such as poor behavioral and emotional functioning. The objective of this study was to identify factors that can improve long-term outcomes following discharge from residential treatment. Of special interest was the interplay of protective factors, including a variety of youth strengths (e.g., coping skills, family support, educational support) with youth behavioral and emotional outcomes. This study also considered the role of race/ethnicity, age, gender, and post-residential placement type. A sample of 799 youth who were discharged from residential treatment was examined. This study found a positive relationship between the total number of strengths at residential discharge and behavioral and emotional outcomes at 6 months following residential discharge. This study also found that the overall change in the number of youth's strengths (improvement or deterioration) after discharge from residential treatment was associated with decreased or increased youth behavioral and emotional needs over time. Additionally, change in two specific types of strengths—interpersonal and coping skills—following residential discharge was associated with decreased or increased youth behavioral and emotional needs over time. Overall, this study suggests that interventions that help to maintain or build youth strengths following discharge from residential settings may lead to decreased emotional and behavioral needs over time.
The role of therapeutic residential care (TRC) is changing. In fact, this article reframes the terminology of TRC and uses “residential interventions” to more accurately reflect that residential programs provide time-limited “intervention” and treatment efforts must connect and extend to families and communities. Such changes are being compelled by necessity and innovation. Necessity is demanding evidence, data, and durable positive outcomes for this expensive intervention. Innovation is transforming basic service delivery through meaningful inclusion of youth and families and effective collaboration with community-based organizations. Service elements that confound this changing role are being reconsidered, including reductions in length of stay, a focus on long-term permanency, and the location of the actual intervention from program-centric practice to interventions in the home and community.
Purpose
Total quality management practices have been embraced by many quality-oriented firms around the world in order to improve performance in terms of quality, productivity, customer satisfaction and profitability. The purpose of this paper is to investigate the direct and indirect effects of TQM practices on various performance indicators specifically in the Indian manufacturing context. This paper focuses on developing an integrated model encompassing significant structural relations showing the linkage between TQM practices and multiple performance indicators – quality performance, customer satisfaction level, operating performance, employee performance, innovation performance, society results and financial performance. Apart from analyzing the direct relationship between constructs, the main purpose of this work is also to identify all the possible mediation effects of performance indicators on others using structural equation modeling (SEM).
Design/methodology/approach
An in-depth literature review was conducted to identify the key practices for the successful implementation of TQM in an organization as well as to explore TQM-performance effects. As a result, four TQM practices and seven performance indicators were identified. The data were collected from 260 Indian manufacturing organizations. After confirming the reliability and validity using exploratory and confirmatory factor analysis, the proposed hypotheses were tested using SEM.
Findings
Through testing the proposed hypothesized structural model, the direct and indirect effects of TQM practices have been examined. Moreover, this work developed an integrated model showing the interrelationships between TQM practices and performance indicators identified. The findings gave an insight that the effective implementation of TQM practices assists in reaping benefits in the every facet of an organization. By implementing these practices effectively, managers can expect to realize improvement in all these performance areas.
Research limitations/implications
This study is subject to certain limitations. Even if all variables were found to be reliable, valid and satisfactory non-response bias test results, the remote possibility of bias in the data might not be fully ruled out. There is a probability of occurrence of common method variance and common method bias, since the data for both dependent and independent variables were collected from the same respondents in the organization. Additionally data on performance indicators were based on the respondent’s assessment and awareness only. The mediating relationship between individual TQM practice and performance indicators can be investigated in future studies. Since society results are a necessity in future, the direct and indirect practices focusing toward this can be explored. In addition, there is a research scope to identify the moderating effect of contextual factors such as degree of TQM implementation, scope of operation and type of organization.
Practical implications
The findings of the research offer some potentially valuable insights into the relevance of TQM practices and its strong linkage on various performance indicators, through which the overall organization performance can be enhanced. By implementing these practices effectively, managers can expect to realize improvement in all these performance areas. Hence, the managers can adopt this approach to assess their organization’s level in the quality path and as a guideline in implementing TQM practices. They can also measure the impacts of TQM practices on multiple performance measures in order to evaluate their TQM initiatives. Especially the deployment of quality culture is a requisite to excel in the every facet of performance. The positive relationship between TQM practices and various performance indicators can motivate the managers to allocate resources in time, effort and capital for TQM implementation in pursuing quality, leading to customer retention and competitiveness. The findings of the study strongly suggest the need for the holistic implementation of TQM practices for the survival of the organization.
Originality/value
While there is a considerable volume of researches carried out to investigate the linkage between TQM and organization’s performance across the globe, still little is evidenced regarding the mediating effect of performance indicators on others, especially in the Indian manufacturing context. The present paper attempts to extend and add knowledge to this line of research and to bridge the gap and provide sufficient empirical evidence specifically in the Indian scenario. Thereby helps the organization to follow a guideline to improve the overall performance.
The rate of alcohol and drug abuse among adolescents and the number of youth at risk for the development of substance use disorders later in life remain a serious, national health concern. Deeper end services, such as residential treatment, may be indicated for youth with severe substance use disorder. Residential substance abuse treatment for adolescents has continued to lack adequate research regarding its practices and outcomes. However, separately, there are best practices, principles and strategies in both residential treatment and in adolescent substance abuse treatment. In this chapter both are summarized to outline the best possible care for adolescents with substance use disorder. Also explored are the prevalence rates of commonly used substances among adolescents (e.g., alcohol, marijuana), population parameters, theoretical background of principle interventions, interventions that work, interventions that might work, interventions that do not work, policy changes pertaining to health care, and treatment recommendations.
This study aims to analyze the causes and progression of Disruptive Behavior Disorders (DBD), in childhood / adolescence, and its impact on the development of a possible Substance Abuse Disorder (SAD) in order to establish action strategies from nursing, using the taxonomy NANDA-NOC-NIC. The methodology is the systematic search of major databases (Cochrane Library, Tripdatabase, Medline, Lilacs, and CUIDEN), setting narrative and systematic reviews, meta-analysis, Randomized Clinical Trials (RCTs) and non-randomized and observational or descriptive studies indexed in the last ten years, as the selection criteria. Under these criteria finally we selected a total of 20 articles for their special relevance and relationship to the subject of this study. Based on this review, and taking particular account of the nursing study of Miotto Wright, which proposes the Critical-Holistic Model, the protocol outlines a plan of nursing care. The analysis reveals the existence of a cause-effect relationship between the DBD, increasingly common among children and adolescents, and the development of SAD and the great influence the family and community have on this progression. That is why, we believe that the nursing role can be crucial, in the levels of early diagnosis, secondary prevention, treatment, and rehabilitation.
Demonstrations of high-quality services have surpassed cost control as the primary task of health care. In this study we evaluated the relationship between several traditionally accepted standards of quality of children's mental health care and client mental health outcomes. Three customary performance guidelines (therapeutic relationship, satisfaction, and parent involvement) that are believed to be indicators of quality care were tested for their ability to account for improvement of mental health outcomes among adolescent clients. In addition, we examined service utilization to determine whether it represents an intermediate outcome of the treatment process.The results showed statistically significant, yet weak and inconsistent, relationships between these commonly accepted measures of quality and client outcomes among adolescents receiving outpatient treatment. We did not find service utilization to be a mediator. Limitations of the study and implications of the results are discussed.
Residential treatment programs serve troubled youth who tend to first fail in other treatment programs. Residential treatment is often regarded as a treatment of last resorts. A review of available studies of the effectiveness of residential treatment delivered in group home settings and residential treatment centres concludes that, despite methodological shortcomings and variability in programming, residential services do improve functioning for some, but not all, youth. However, gains made during treatment are not easily maintained and tend to dissipate over time. The level of family involvement in treatment is generally regarded as predictive of posttreatment patterns of adjustment. Successful posttreatment patterns of adjustment also depend on posttreatment environmental factors such as available support and residential stability. Continued long-term followup of youth in residential treatment is critical to our understanding of the types of individuals for whom residential settings are a particularly good match.
Outcome research on residential care indicates that a significant number of children fail to complete treatment. Although estimates vary, as many as half of children admitted may be discharged prematurely due to problematic behavior. The purpose of this study was to determine if children at risk for noncompletion could reliably be identified at the time of referral. Data were collected on 313 children admitted to residential treatment. Follow-up data were obtained one year from the date of placement to determine the outcome (program completion or noncompletion). The results indicate that a substantial number of risk factors exist that are related to unplanned discharge. Of equal importance to identification of risk factors, a model was built to predict noncompletion with an accuracy rate of 96%. Additional relevant findings are discussed such as the importance of consistent family visitation. This study successfully demonstrated that it may be possible to use an empirically validated method to assess children referred for care in order to reliably identify those that require more intensive services.
Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.
Discusses issues related to the identification of psychosocial interventions for children that have demonstrated efficacy. Recent debate concerning differences between clinical trials research and clinical practice is summarized, including the tradeoff between interpretability (internal validity) and generalizability (external validity) of outcome studies. This article serves as an introduction to the special issue containing articles that have as their focus the identification of empirically supported psychosocial interventions for children as part of a task force. The article provides an overview of the history, agenda, and methodology used by the task force to define and identify specific empirically supported interventions for children with specific disorders. Whereas a number of well-established or probably efficacious interventions are identified within the series, more work directed at closing the gap between research and practice is needed.
This article describes a family-centered residential treatment model and presents results from a quasiexperimental study examining its effectiveness in achieving permanency outcomes for children. Greater postdischarge stability was achieved for participants in the family-centered program than in the agency's standard residential treatment service. Implications for child welfare policy and practice are highlighted.
This paper addresses the need for a coherent conceptual therapeutic approach to guide work with disturbed children and adolescents in residential treatment centers. The paper identifies changes in the population currently in care; examines the two dominant approaches that historically have shaped the standard treatment models used by most residential centers; and discusses four longstanding debates that have complicated the development of a consistent therapeutic approach for residential programs. It concludes with a description of The Sanctuary Model. Integrating a variety of treatment approaches, this trauma-based systems approach to care was first used with adult inpatients traumatized as children. It is now being introduced by a major social agency into three of its residential centers to provide a systematic treatment model for use in their schools, living units, and treatment sessions.
A single-sample, within-subject descriptive study was completed to ascertain individual subject characteristics associated with outcome for 87 youths discharged from a residential treatment facility. Two different methods of assessing outcome were also compared. Variables assessing a history of abuse and internalizing psychopathology at admission to residential care were associated with outcome. Low levels of staff agreement were found on the 2 outcome measures. Implications for acute residential care are discussed.
The practice of placing children and adolescents with severe conduct problems (e.g., Oppositional Defiant Disorder {ODD} and Conduct Disorder {CD}) in residential settings is expanding. In 1983, estimates were that more than 19,000 such youngsters were in residential care. By 1986, the number had increased 32% to more than 25,000 (Select Committee on Children, Youth, and Families, 1990). These data are surely an underestimate in that they exclude those placed in for-profit residential treatment centers. The American Public Welfare Association estimated that approximately 70% of the total funding for children’s mental health services was used for residential services. Yet little research exists on either the short-term effectiveness or long-term benefits of these placements (Burns & Freidman, 1990). In commenting on the effectiveness of various components of the system of care for children and adolescents, Burns, Hoagwood, and Maultsby (1998) noted that “A dominant observation is that the least evidence of effectiveness exists for residential services, where the vast majority of dollars are spent” (p. 690). Moreover, there is some indication in the literature that children and adolescents who have disruptive behavior problems with antisocial and aggressive symptoms are among the most difficult population to treat in residential settings and that they tend to benefit the least when compared to their nonantisocial counterparts in care (Zoccolillo & Rogers, 1991).
We examined Treatment Foster Care (TFC) in residential trajectories for youth with psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care.
The specific purpose of the study was to compile descriptive data on children with serious emotional disturbance (SED), including (a) demographic and family characteristics, (b) level of psychological and adaptive functioning, (c) services received, and (d) outcomes or how the children fared over time. The sample consisted of 812 children, ages 8 to 18 years (M = 13.89 years, SD = 2.35), who had been identified as having SED and were being served by either mental health (46%) or public school (54%) systems in accordance with P.L. 94–142. Data were collected annually during a 7-year period. Results indicated that, at entry into the study, the children already had serious problems in many domains and the problems remained serious for these children at the end of the study.
Examined outcomes and service utilization among a total population of children discharged to their families from a residential treatment center (RTC) during a 3-year period Consistent with the view that RTC treatment is frequently associated with continuing placement and dependency, the risk of replacement was 32%, 53%, and 59% by the end of the first, second, and third post discharge years, respectively. Results underscore the continuing service needs following RTC discharge and provide an example of a successful partnership between a social service agency and a university, with the goal of documenting out comes for a high-cost high-need population.
Outcome research on residential treatment indicates that, although adolescents often improve in residential treatment, those gains are frequently lost when they return to the community. This paper examines reasons for these findings and highlights two shortcomings of many residential programs that contribute to the problem: limitations on family participation in treatment and lack of opportunities for involvement in the community. Consideration is given to ways in which the need to develop short-term residential treatment programs can provide an impetus to addressing the problem.
Children removed from their biological parents because of abuse or neglect enter a child welfare system that is broken and needs to be fixed. The number of children in foster care has nearly doubled in the past 15 years while the number of potential foster families has declined. Foster care was designed to provide a temporary home for children who would eventually be reunited with their parents or adopted. But not all parents can be rehabilitated and many children—older, handicapped, and minority children—are difficult to place in adoptive homes. This brief argues the need to confront this crisis in the child welfare system by broadening the options available to include congregate care or group homes that would provide a more stable environment for these children.
This commentary briefly surveys some of the practical and methodological difficulties related to residential treatment outcome research, both in terms of earlier criticisms of outcome research and of more recent commentaries noting the increased importance of finding issues and fiscal accountability. The paper concludes with a dcscriptive and comparative survey listing of selected possible outcome assessment instruments, including: (1) clinical interview schedules, (2) objective rating scales (including global fhnctioning, behavioral, and specialized focus scales), (3) objective personality inventories, and (4) projective tests.
The authors retrospectively studied the case histories of forty-two former residents of an adolescent residential program, with either a diagnosis of Conduct Disorder or a court finding of juvenile delinquency, to uncover the variables which might predict which youth go on to become antisocial adults and which do not. This study uncovered two findings: that significantly fewer youth persisted in their antisocial behavior into adulthood than the national average of 40–50% (Robins, 1966); and that of those who persisted, none completed treatment, as compared to the 55.2% who completed treatment (chi-square = 14.36, p
Residential treatment agencies face increasing external pressure to conduct outcome evaluation research, due to mandates by accrediting agencies, managed care, and the changing nature of the client population. This study explored the current status of outcome research conducted by a nationwide sample of 93 residential treatment centers for youth with behavioral disorders. Sixty-five percent of agencies interviewed were currently involved in outcome research; however, methodological sophistication varied widely. Common areas assessed included family relationships, legal involvement, school attendance, and emotional well-being. Barriers to quality research included inadequate resources and methodological barriers.
Communities have a wide range of resources that can contribute substantially to the quality of residential treatment. This paper describes: (1) ways in which such resources can be incorporated into the treatment process; (2) the use of specific programs such as public schools, churches and synagogues, vocational training workshops, jobs, and recreational activities; and (3) the types of contributions such programs can make to helping adolescents negotiate the transition from residential treatment into the community.
This longitudinal study investigated the effectiveness of residential treatment for 27 adolescents aged 11–15 with histories of mental health and delinquency-related problems. The clients were assessed with a variety of self-report and staff-report measures at the beginning and end of treatment and at several timepoints in between. The measures assessed behavioral and emotional problems, delinquency-related maladjustment, response to psychotherapy, and client satisfaction. There was significant evidence of improvement on 5 measures, suggestive evidence on 3, and no evidence of positive change on 3 measures. Most of the improvement that occurred took place during the first six months of treatment.
Adolescents in residential treatment are at risk for having difficulty making the transition to productive, independent adulthood. This study evaluated the psychological, behavioral, and educational functioning of thirty young men who were previously in residential treatment. Correlations and frequencies were performed on data about these young men while in treatment and after discharge. Results suggested that most have made modestly successful transitions to various levels of independence; however, they continue to struggle emotionally, interpersonally and economically. Recommendations for treatment and future research are suggested.
The treatment of adolescents with behavior disorders represents significant challenges. This article reviews some of the most effective behavioral and pharmacological treatments identified in the research. The study used outcome data from a residential treatment program to identify variables that predicted level of functioning post-discharge. Significant variables included diagnosis (mood vs. behavior disorder spectrum), co-morbidity and discharge placement.
Examined the postdischarge environment, levels of adaptation achieved, and professional supports provided for 186 children aged 13 yr. or more. The factors most significantly associated with adaptation were the child's perception of family support after discharge and continuity of family support throughout. Results indicate that greater emphasis should be placed on work with families as a unit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A record review was conducted on 130 adolescents who had completed residential treatment to determine their discharge status. Five sets of variables were used to predict discharge status. One set of variables consisted of demographic variables. A 2nd set of variables consisted of the victimization variables. A 3rd set of variables consisted of family dysfunctional behaviors. A 4th set of variables consisted of the residents' antisocial behaviors prior to placement. A 5th set of variables consisted of 7 different types of therapy. The results show that the odds were 8:1 that residents who received family therapy were discharged to less restrictive settings. Residents who experienced both parental abandonment and sexual abuse or came from families with a criminal history and family substance abuse problem were more likely to be discharged to juvenile detention or a psychiatric hospital. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Associations between sleep and behaviour in 635 children, aged six to eight years, were investigated using parental responses to a sleep habits questionnaire, and to a behavioural screening form, the Strengths and Difficulties Questionnaire (SDQ). Global reports of sleep problems in 4.9% of the children were associated with a total SDQ score indicative of behaviour problems in 36% of the cases. Conversely, 15% of children with behaviour problems had global reports of sleep problems. Associations between specific sleeping features and different dimensions of behaviour and emotions were also explored. Hyperactivity was associated with tossing and turning during sleep, and with sleep walking; conduct problems were related to bedtime resistance; and emotional symptoms were associated with night terrors, difficulty falling asleep and daytime somnolence. Peer problems were associated with somewhat shorter total sleep time. Finally, a total SDQ score indicative of behaviour problems was associated with bedwetting, nightmares, tossing and turning during sleep and sleep walking, as well as with a slightly shorter total sleep time.
We conclude that sleep and behaviour problems are associated in children, and that characteristic associations exist between particular sleep disturbances and specific dimensions of behaviour.
We aimed to identify profile characteristics for a recent sample of young residential children, examine the differential impact that profile characteristics have on behavior change, and describe the relationship between behavioral symptomatology and length of stay in residential treatment. A sample of 142 consecutively admitted residential treatment children were studied over a five-year period. Hierarchical Linear Modeling was the primary statistical method used to analyze behavioral rating data for a subset of 57 children assessed by teachers and treatment staff using the Devereux Scales of Mental Disorders. Younger age, female gender, and lower IQ were associated with increased levels of psychopathology. Residential length of stay was strongly linked to levels of behavioral symptomatology. HLM is a valuable analytic strategy that employs client profile characteristics to model behavioral change trajectories and help predict treatment responsiveness. System reform philosophies that promote expectations for rapid symptom improvement and removal of residential treatment from the continuum of care may exceed current treatment capacities.
Pre-treatment and post-treatment data was collected from adolescent clients of a new residential treatment center at Girls and Boys Town. Youth who received treatment improved significantly on the Child Behavior Checklist and the Children's Global Assessment Scale and were maintaining their treatment gains at follow-up. Ten months following discharge, the majority were stabilized and functioning adequately in school and with their primary caregiver. For these youth, residential treatment succeeded where other interventions failed.
A study was conducted of the outcomes of all children and adolescents (N=114) with serious emotional disturbance who had been placed by school districts in residential treatment facilities for educational purposes over a three-year period. Both cost and outcome analyses were conducted. Cost analyses indicated a total annual expenditure in excess of 5 million, or5 million, or 80,000 per youth per length of stay. Outcome analyses, consisting of ratings of outcomes and outcome interviews with special education directors, revealed that 63% of the youth had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the students' return to school or placement into a vocational training program. Another 11% of the youth were making substantial progress. Analyses of the relationships between outcomes and cost revealed no relationship. However, positive outcomes were associated with shorter lengths of stay. Further, students in the positive outcome categories had more severe functioning deficits at intake than students in the negative outcome categories. The availability of community-based services for the student and family was the single most likely reason reported by special education directors for positive discharge status.
This review summarizes the literature for residential treatment, family preservation services, treatment foster care, and
individualized services and evaluates characteristics of each model, methodological limitations of outcome studies, and treatment
effectiveness with children. Although residential care is often viewed negatively, empirical evidence does not suggest differential
levels of effectiveness compared to nonresidential alternatives. The results of some nonresidential outcome studies are promising,
but efficacy claims should be viewed critically due to the absence of methodologically rigorous evaluations for both residential
and nonresidential approaches. Future research should focus on establishing empirically grounded placement criteria, identifying
what presenting problems are most amenable to each form of treatment, and maximizing the maintenance of treatment gains in
the postdischarge environment.
This descriptive study examined the relationships among differing sources of social support, stress, stability, and adaptation of youths who had been in residential treatment. Study subjects were 50 former residents one to three years postdischarge. Data were drawn from interviews with youths and from youths' treatment records. The structured interview included four standardized measures. The study interviewer knew neither the subjects nor their clinical status at discharge. Correlational and multivariate analyses of data revealed that (a) differing dimensions of adaptation are related; (b) differing sources of social support are not related; (c) among the sources of social support, family support is related most strongly to adaptation; (d) family support, stress, and stability, considered together, are related to adaptation. Each also has an independent effect on differing dimensions of adaptation; (e) when knowledge of youths' scores on family support, stress, and stability is applied, it is easier to predict youths who have adapted poorly postdischarge than those who have adapted well. Implications of findings for future research and program design are delineated.
Adults and adolescents, who as children, received day or residential treatment were followed up ten years after treatment completion. No differences were found between the two treatment modalities on follow-up ratings of personal and social adjustment. This pattern was not influenced by gender, IQ, or presenting problem. Overall, about two-thirds of the children demonstrated improvement at follow-up. As expected, individuals demonstrating higher levels of personal and social adjustment at initial assessment were functioning better at outcome. However, the magnitude of therapeutic gain was not significantly different for mild versus moderate-to-severe presenting problems. Suggestions for future research are included.
The clinical question--"Which treatment(s) for which patients with what set of subgrouping characteristics working by what mechanism(s)?"--rests at the heart of differential therapeutics. Experimentally, this question reduces to a test of how well we can predict the outcome of treatment using the treatment conditions plus other moderating and mediating variables. Reflecting the discussions held at a recent National Institute of Mental Health (NIMH) conference on psychosocial treatments, and using pediatric anxiety disorders as a case in point, we discuss the problem of prediction in treatment outcome studies from the standpoint of definition of terms, using the general linear model of prediction. We also outline types of studies that may be useful in testing potential predictors, and put forward a possible matrix of predictor variables as currently implemented in an NIMH-funded treatment outcome study of pediatric obsessive-compulsive disorder (OCD). We conclude by making specific suggestions for implementing a broader approach to the study of predictors.
Cross-sectional follow-up data on 111 adolescents in a re-education residential facility were obtained in three domains--school, legal, and level of care--at 6, 12, 18, and 24 months postdischarge. Reports by community-based professionals on individual functioning were assessed on several criteria, the most stringent of which indicated successful outcomes for nearly 60% of the adolescents. Characteristics of the more successful students are noted, applications of the psychoeducational residential approach for program structure are considered, and implications for positive ecological outcomes are discussed.
As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.
Psychotherapy research improved its methodological rigor in the last half of the past century and as we begin a new millennium and a new generation of research it is important to evaluate its effectiveness. In this article the historical perspective of psychotherapy evaluation is reviewed, followed by the presentation of the Child Task Force criteria for evaluating psychotherapy outcomes. The results of the American Psychological Association Task Force review of well-established and probably efficacious treatments for depression, anxiety, disruptive behavior disorders and attention deficit hyperactivity for child and adolescent disorder are presented. Finally, the advantages and disadvantages of these very structured criteria for evaluating psychotherapy research with children and adolescents are discussed, and future directions are proposed.
The body of evidence on child and adolescent psychotherapy outcomes has now grown to more than 500 studies. Here we summarize key findings, focusing on effectiveness and efficacy research. Research is sparse on the effectiveness of treatment in everyday practice, but available evidence suggests little benefit. By contrast, extensive research on efficacy of structured treatments administered under controlled conditions shows very substantial evidence of benefit. We note several specific treatments for which evidence is encouraging, and we offer suggestions for future research. Particularly important will be research on treatment models most often used in practice settings, tests of outcome mediators and moderators, tests employing a broadened range of treatment delivery models, and research bridging the gap between lab-tested treatments and the conditions of real-world practice.
Youth with severe emotional and behavioral disorders (EBD) were randomly assigned for 3 months of intensive treatment to a 5-day residential program (5DR Program) or a community-based alternative, family preservation program (FP Program). Programs differed not only in method of service delivery (residential unit vs. home-based), but also in treatment philosophy (solution focused brief therapy vs. cognitive behavioral). Results confirmed high rates of comorbidity in this population for externalizing and internalizing disorders. A significant Treatment x Program interaction was evident for internalizing disorders. At 1-year follow-up, significantly higher percentages of youth from the FP Program revealed a reduction of clinical symptoms for ADHD, as well as, general anxiety and depression, whereas significant proportion of youth from the 5DR Program demonstrated clinical deterioration and increased symptoms of anxiety and depression. Results have implications for future treatment of youth with EBD and suggest that greater emphasis be placed on research linking treatment to specific symptom clusters, especially highly comorbid clusters in this hard to serve population.
A single-sample, within-subject descriptive study was completed to ascertain individual subject characteristics associated with outcome for 87 youths discharged from a residential treatment facility. Two different methods of assessing outcome were also compared. Variables assessing a history of abuse and internalizing psychopathology at admission to residential care were associated with outcome. Low levels of staff agreement were found on the 2 outcome measures. Implications for acute residential care are discussed.