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A Multi-Center Study of Private Residential Treatment Outcomes


Abstract and Figures

This paper presents the results from a multi-center study on outcomes for youth treated in private residential treatment programs. The sample of 1,027 adolescents and their parents was drawn from nine private residential programs. Hierarchical linear modeling indicated that both adolescents and parents reported a significant reduction in problems on each global measure of psycho-social functioning from the time of admission up until a year after leaving the program (e.g., Total Problems Scores, Internalizing Scales, and Externalizing Scales of the Child Behavior CheckList, CBCL, and Youth Self-Report, YSR). Furthermore, youth and parents reported that the youth improved on all syndromes between the point of admission and discharge (YSR and CBCL syndrome scales: Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems, Attention Problems, Aggressive Behavior, Rule-Breaking) and that most of the syndromes remained stable and within the normal range for up to one year after discharge from treatment.
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JTSP  •  29
A Multi-Center Study of Private
Residential Treatment Outcomes
Ellen Behrens, Ph.D.
Canyon Research & Consulting
Kristin Sattereld, M.D., Ph.D.
University of Utah
Correspondence should be addressed to Dr. Ellen Behrens, E-mail:
This paper presents the results from a multi-center study on
outcomes for youth treated in private residential treatment programs.
The sample of 1,027 adolescents and their parents was drawn from nine 
private residential programs. Hierarchical linear modeling indicated
that both adolescents and parents reported a signicant reduction in 
problems on each global measure of psycho-social functioning from the
time of admission up until a year after leaving the program (e.g., Total
Problems Scores, Internalizing Scales, and Externalizing Scales of the Child
Behavior CheckList, CBCL, and Youth Self-Report, YSR). Furthermore,
youth and parents reported that the youth improved on all syndromes
between the point of admission and discharge (YSR and CBCL syndrome 
scales: Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, 
Thought Problems, Attention Problems, Aggressive Behavior, Rule-
Breaking) and that most of the syndromes remained stable and within the 
normal range for up to one year after discharge from treatment.
30  •  JTSP
A Multi-Center Study of Private Residential
Treatment Outcomes
Since the early 1990’s hundreds of private residential programs have 
been established in the United States. Outcomes of youth treated in
these programs are largely unknown (Friedman, Pinto, Behar, Bush, 
Chirolla, Epstein … & Young, 2006).  Previous research has focused 
almost entirely on public residential treatment programs (RTPs) (Curry,
2004; Curtis, Alexander, & Longhofer, 2001; Hair, 2005; Leichtman, 
Leichtman, Barbet, & Nese, 2001; Lieberman, 2004; Whittaker, 2004).   In 
fact, there is virtually no published outcome research on private RTPs.
This paper attempts to build a research corpus expressly for private RTPs
using a large-scale, systematic exploration of treatment outcomes.
It can be argued that private RTPs and public RTPs are fundamentally
different. They developed independently and therefore have different
histories, professional associations, client services, and client populations.
Public RTPs originated in the 1940s, with the work of Bruno Bettleheim, 
Fritz Redl, and David Wineman (Cohler & Friedman, 2004). The primary 
professional association representing public RTPs is the American
Association of Children’s Residential Centers (, which 
was founded in the 1950’s.  Clients in public RTPs are typically referred 
through public avenues (i.e., juvenile justice system, child protection
agencies, or public mental health systems) (Curtis, et. al., 2001; Epstein, 
2004; Hair, 2005) and funded with public money.  Public RTP clients are 
predominantly males and disproportionately selected from ethic minority
backgrounds (Asarnow, Aoki, & Elson, 1996).  A literature search of 
the PsycInfo database produced dozens of research studies conducted
at public RTPs, enough to warrant a few literature reviews published 
in referee journals (e.g., Curry, 1991, Epstein, 2004; Hair, 2005, Little, 
Kohm, & Thompson, 2005).  
In contrast, private RTPs were established in the late 1980’s and early 
1990’s (Young & Gass, 2007) with the most rapid growth occurring after 
2000 (Santa & Moss, 2006). Private RTPs were founded by a different 
and loosely organized network of individuals including John Santa, John 
Reddman, Kimball Delamare, and John Mercer (Santa & Moss, 2006). The 
National Association of Therapeutic Schools and Programs (NATSAP),
founded in 1999, is the major association representing professionals 
in private RTPs.  Private RTPs are typically for-prot entities.  Private 
RTP services typically feature adventure activities, challenge courses,
art therapy, and equine programs  (Young & Gass, 2007). Services are 
most often funded by parents or, in some cases, by insurance companies
(Friedman et al., 2006; Young & Gass, 2007). The large number of co-
educational and female-only programs suggests that female youth are
well represented within private RTPs.  Unlike public RTPS, private RTPS 
are costly for families, ranging from $5,000 to $12,000 a month (Young 
& Gass, 2007), which largely circumscribes the client base to families of 
a high socio-economic status. In contrast to the large body of research
JTSP  •  31
on public RTPs, only one published outcome study has been conducted
at a private RTP , specically at The Menninger Residential Treatment 
Program, an intensive, short-term program. The primary measures
for the study of 123 youth were the Child Behavior Checklist (CBCL) 
(Achenbach, 2001) and the Youth Self-Report (YSR) (Achenbach, 2001). 
The study found that parents and youth reported a signicant decline in 
problems from admission to 3 months post-discharge with maintenance 
of gains up to 12 months post-discharge (Leichtman et al., 2001). 
The ndings of Leichtman and colleagues stand in contrast to the 
large body of literature on public residential treatment. Though a critical
mass of studies have found that 60%-80% of adolescents improve during 
stays in public RTPs (Curry, 1991; Curtis et al., 2001; Epstein, 2004; 
Hair, 2005; Wells, 1991), many others have found that treatment gains 
come slowly, are spotty, and leave quickly.  For instance, The National 
Adolescent and Child Treatment Study found that youth treated for
“serious emotional disturbance” in public RTPs took three years to
move from clinical to normal range of functioning (Greenbaum, Dedrick, 
Friedman, Kutash, Brown, Lardieri, & Pugh, 1996).  In addition, based on 
published outcomes, reviewers have concluded that residential treatment 
is most appropriate for higher functioning, less vulnerable youth (Connor,
Miller, Cunningham, & Melloni, 2002; Epstein, 2004; Gorske, Srebalus, 
Walls, 2003; Wells, 1991).  Numerous other reviews of public RTPs 
conclude there is “no evidence” of lasting benets for youth who received 
treatment:  a signicant portion of adolescents who function well at 
discharge subsequently experience a decline when transferred to a lower 
level-of-care (Curry, 1991; Epstein, 2004; Hair, 2005; Little, Kohm, & 
Thompson, 2005). The U.S. Department of Health and Human Services 
(1999) concluded after a review of the research conducted in public RTPs, 
“Given the limitations of current research, it is premature to endorse the 
effectiveness of residential treatment for adolescents.” In part because
of this pronouncement, public policy shifted from RTP placements to
community-based services. Bennett Leventhal and D. Patrick Zimmerman
(2004), guest editors for a special issue of the Child and Adolescent
Psychiatric Clinics of North America on (public) residential treatment, open
the issue by stating,
…the role of residential treatment seems to have little or no
place in the continuum of care for children with mental disorders.
Facilities for the intensive, long-term treatment of children and
adolescents with serious and persistent psychiatric illness seem to
have disappeared or quietly slipped in the shadows of available
services. The public sector has seen dramatic downsizing or closures
of most long- and short-term inpatient psychiatric treatment centers
for children and adolescents. (p.7)
The poor outcomes reported for public RTPs are based on a
research corpus that has been sharply criticized for methodological
32  •  JTSP
aws.  Reviewers have criticized this body of work for its poor samples, 
retrospective designs, unstandardized measures, and unsophisticated
statistical analyses (Curry, 1991; Curtis et al., 2001; Epstein, 2004, Hair, 
2005). The majority of studies used only one informant, even though 
multiple informants have been shown to be necessary (Rend, 2005), 
and many studies use self-styled measures that lacked normative data
and psychometric rigor (Hair, 2005). Sample sizes for studies of public 
RTPs also tend to be very small.  Additionally, relatively few studies 
used advanced statistics to control for error or explore the impact of
moderator and predictor variables.
The present study was designed to systematically explore youth 
outcomes in private RTPs and to simultaneously address some of the
aws noted in the public RTP research corpus.  The study used a multi-
center design, with repeated standardized measures, prospective data, 
a large sample, and two informant groups. The Western Institutional 
Review Board ( approved consent/assent forms and issued
Certicates of Approval for the study. The research questions were:
1) What are the characteristics of adolescents treated in the private
2)  How do adolescents function during and after treatment in private 
2a) How does adolescent functioning vary across the selected 
treatment outcomes (e.g., total problems, internalizing problems,
externalizing problems, aggressive behavior, anxious/depressed
symptoms, withdrawn/depressed symptoms, somatic complaints, 
social problems, thought problems, attention problems, aggressive
behavior, and rule-breaking behavior)?
2b) Do youth outcomes vary according to age, gender, or number of 
presenting problems?
The sample consisted of 1,027 adolescents who, along with their 
parents or guardians (hereafter referred to as “parents”), agreed to
participate in the study and who completed measures at admission, 
discharge, and 6- and 12-months after discharge from the program 
(regardless of discharge status). Students were admitted to one of nine 
programs located in the Eastern and Western United States, between 
August 2003 and August 2005. Demographic information (i.e., ethnicity, 
parental income, gender, age) provided by the residential programs
indicated the sample was representative of students enrolled in the 
programs during the same time period.
Description of the residential programs
The nine participating programs were private, out-of-home, licensed 
(when applicable), therapeutic placements for adolescents and were 
JTSP  •  33
member programs of the National Association of Therapeutic Schools
and Programs (NATSAP). The RTPs were Academy at Swift River, Aspen 
Ranch, Copper Canyon Academy, Mount Bachelor Academy, Stone
Mountain School, Pine Ridge Academy, SunHawk Academy, Turnabout 
Ranch, and Youth Care ( The contribution
of each of the residential programs to the sample was relatively equal, 
ranging from 9% to 16%.  This sample consisted of a mean of 55% of 
adolescents admitted to the residential programs during the identied 
time period.  Though the participating programs were owned by one 
parent company, Aspen Education Group, curriculum and programming 
were developed “on-site.” This individual development resulted in 
signicant diversity of curriculum and programming. The participating 
programs varied in terms of size (ranging from 15-bed programs to 
120-bed programs), location (Massachusetts, Utah, Arizona, Oregon, 
North Carolina), treatment philosophy (therapeutic boarding school
or residential treatment, the latter of which is more clinically focused 
and designed for more severely impaired adolescents), and services
(e.g., equine assisted therapy, neurofeedback, adventure therapy, partial
community placements). The diversity of the participating programs is
reective of the broader private residential treatment industry.
Design and measures
Since no control or comparison group was available, a single-group, 
pretest-posttest design was used.  The primary measures were the 
Child Behavior Check List (CBCL) and the Youth Self Report (YSR)
(Achenbach, 2001). The CBCL and YSR are two related and widely used 
measures of adaptive and maladaptive psychological and social functioning.
The CBCL and YSR syndrome scores, Internalizing and Externalizing
Scores, and Total Problem Score have excellent reliability (alpha values
range from .78 to .97 for the CBCL scales and from .71 to .95 for the 
YSR scales) and validity (e.g., Achenbach, 2001; Bérubé & Achenbach, 
2006). The CBCL is a parent-report measure of adolescent functioning 
that consists of 113 items. The YSR is a youth self-report measure that
consists of 112 items. The measures have the same item format and 
scales, which makes them highly compatible.  Items are rated on a three-
point scale and are primarily objective or behaviorally anchored (e.g.,
“cries a lot”, “gets teased”, “dgets”, “truant”). The CBCL and YSR yield 
11 scales:
Eight (8) Syndrome scales:  Anxious/Depressed, Withdrawn/
Depressed, Somatic Complaints, Thought Problems, Attention
Problems, Rule-Breaking Behavior, Aggressive Behavior,
Three (3) Aggregate or broad-band, scales: Internalizing
(problems that are mainly within the self), Externalizing (problems 
that mainly involve conict with other people and their expectations 
for the child), and Total Problems (the sum and severity of all the
problems reported on the measure).
34  •  JTSP
High scores on a scale indicate clinical deviations from the norm and
the presence of numerous and severe problems. Each raw-scale score 
can be converted into a T-score, percentile rank, and range (Normal,
Borderline Clinical, and Clinical).  This study used raw scores for statistical 
analysis, as recommended in the CBCL and YSR manual, because T scores
are truncated (Achenbach, 2001).  The corresponding range for each 
syndrome’s mean raw score was reported for informational purposes, to 
provide a benchmark relative to the normative data.
Background questionnaires were completed by both parents and 
adolescents at admission and discharge, and then again at the six and
12 month marks after discharge. The questionnaires evaluated psycho-
social history (e.g., psychotropic medication use, legal problems, grade
point average, matriculation in school, presenting problems and program
evaluation) and satisfaction with the RTP.   Residential program staff 
completed a brief form for each participating adolescent that indicated
discharge status and problems that had been the focus of treatment.
Characteristics of the sample
The mean age for all participants was 16 (SD = 1.2) with 55% 
being male. Most participants were Caucasian (87%), with small 
percentages of other ethnic groups. The median annual family income
was >$100,000. Almost all (97%) of the adolescents were placed in 
treatment by their parents.  The overwhelming majority of youth had 
previous treatment at other levels of care (94%). Specically, 80% had 
received outpatient treatment in the prior year, 70% had recently been 
prescribed psychotropic medications, and 31% had at least one psychiatric 
hospitalization. Only 22% of the youth had a legal record. The mean grade 
point average for participants was 2.0 on a 4.0 scale (D).  
At the admission mark, “Total Problems” raw scores were 74 on the 
CBCL and 63 on the YSR, placing youth problems at the 97th percentile 
according to parents and the 91st percentile according to youth. This 
nding is salient:  when treatment began, the adults and adolescents 
indicated that the adolescents were functioning worse than more than 
90% of the adolescent population.  
While in the residential program, the majority of adolescents were 
treated for multiple problems (82%). The most common treatment foci 
within the sample were disruptive behavior disorders (50%), substance 
use disorders (40%), and mood disorders (34%). The average length 
of stay was 10.5 months for those discharged with maximum benet 
and seven months for those who were discharged with partial benet 
or against program advice. The majority of the sample discharged with 
staff approval:  54% of students were discharged with maximum benet, 
JTSP  •  35
19.8% discharged early but with approval, 17.3% discharged against 
program advice, and 8.2% were transferred to a different program.  At 
the discharge mark, mean parental and youth satisfaction with treatment 
was 4.4 and 4.3, respectively, on a scale ranging from one (poor) to ve 
Change in functioning during and after treatment
Table 1 contains the mean raw scores and ranges of functioning on the 
CBCL and YSR scales. Both adolescents and parents reported a dramatic
decline in youth problems from admission to discharge, on all scales of the
YSR and CBCL. Furthermore, scores changed from either the clinical or
borderline clinical range at the admission mark to the normal range at the
discharge mark and for up to one year after that, on all of the aggregate
scales of the CBCL and YSR.  For example, as shown in Figure 1, parent 
report of total problems decreased from the 97th percentile (Raw Score 
73.82, Clinical Range) at admission to the 72nd percentile (Raw Score 
31.14, Normal Range) one year after treatment. The complementary data 
from adolescents was similar: youth-reported total problems decreased 
from the 91st percentile (Raw Score 63.5, Clinical Range) at admission 
to the 60th percentile (Raw Score 38.5, Normal Range) one year after 
Table 1
Raw Score Scale Means and Range of Functioning
Admission Discharge 6-Months
Post 12-
Aggregate Scales
Internalizing  CBCL  19.09, CL   7.96, N  7.88, N  7.99, N
    YSR  18.15, B  10.41, N  10.37, N  10.49, N
Externalizing  CBCL  28 .19, CL  8.34, N  11.13, N  11.12, N
    YSR  24.52, CL  12.52, N  14.23, N  15.06, N
Total Problems  CBCL  73.82, CL  27.81, N  30.94, N  31.14, N
YSR  63.50, CL  36.37, N  38.49, N  38.35, N
Syndrome Scales
Anxious/Depressed  CBCL  8.49, N  4.00, N  3.52, N  3.42, N
    YSR  7.97, N  4.84, N  4.61, N  4.87, N
Withdr awn/Depressed  CBCL  6.95, N  2.63, N  2.91, N  2.91, N
    YSR  5.36, N  2.87, N  3.15, N  2.87, N
Somatic Complaints  CBCL  3.64, N  1.34, N  1.45, N  1.66, N
    YSR  4.81, N  2.70, N  2.62 , N  2.75, N
Notes.  CL = Clinical Range of Func tioning, spans the 98th to 100 th percent ile, B = Borderline Clinic al 
Range of Functioning, spans the 95th to 97th percentile, N = Normal Range of Functioni ng, below the 
95th percent ile.  CBCL ns = 252- 650, YS R ns = 139-773. ( Table 1 Cont inued on page 34)
36  •  JTSP
Private Residential Outcomes, p. 23
Figure 1.
CBCL and YSR Mean Raw Total Scores Over Time
Table 1
Raw Score Scale Means and Range of Functioning
Admission Discharge 6-Months
Post 12-
Syndrome Scales
Social Problems
    CBCL  5.25, B  2.14, N  2.00, N  2.06, N
    YSR  5.30, N  3.43, N  3.39, N  3.31, N
Thought Problems
    CBCL  5.53, B  2.21, N  2.05, N  2.10, N
    YSR  6.81, N  4.25, N  4.37, N  4.41, N
Attention Problems
    CBCL  10.10, B  4.73, N  5.24, N  5.27, N
    YSR  8.72, N  5.76, N  6.12, N  5.09, N
Rule Breaking Behavior
    CBCL  13.80, CL  3.93, N  5.24, N  5.27, N
    YSR  13.07, CL  5.77, N  7.26, N  7.63, N
Aggressive Behaviors
    CBCL  14.39, B  4.41, N  5.33, N  5.31, N
    YSR  11.45, N  6.75, N  6.98, N  7.43, N
Notes.  CL = Clinical Range of Func tioning, spans the 98th to 100 th percent ile, B = Borderline Clinic al 
Range of Functioning, spans the 95th to 97th percentile, N = Normal Range of Functioni ng, below the 
95th percent ile.  CBCL ns = 252- 650, YS R ns = 139-773.
(Continued from p age 34)
JTSP  •  37
Paired samples t-tests were used to examine change in YSR and 
CBCL aggregate and syndrome scale scores from the admission mark to
the discharge mark.. All scales of the YSR and CBCL showed signicant 
in-treatment changes  (Table 2).  As shown in Table 1, all syndrome raw 
score scales reduced to the normal range by discharge or, in the case of
those scales that were already in the normal range at admission, reduced 
to levels further within the normal range at discharge. 
One year after the discharge mark parents reported on some other
important indicators of outcomes. Eighty-nine (89%) percent of the youth 
remained at home and had not been placed in any type of out-of-home
care (i.e., residential treatment, boarding school, short-term psychiatric
hospitalization). Eighty-six percent of parents reported their child was 
“somewhat better” or “much better” in response to the question, 
“Currently, how would you describe your child’s problems in comparison 
to when s/he entered the program?”
Note. ** = p<.001. CBCL ns = 215, YSR ns = 420
Table 2
T-tests for Syndrome Scale Scores at Admission and Discharge
Measure t test value
Aggregate Scales
Internalizing   CBCL  21.19**
YSR  12.75**
Externalizing  CBCL  17.65**
YS R  13.12* *
Total Problems  CBCL  25.22**
Y S R  17.9 8 * *
Syndrome Scales
Anxious/Depressed  CBCL  14.37**
YSR  11.15**
Withdrawn/Depressed  CBCL  11.47**
YS R  14 .71**
Somatic Complaints  CBCL  9.60 **
Y S R   11. 3 9 * *
Social Problems  CBCL  13.94**
SR  10.41**
Thought Problems  CBCL  11.81**
YSR  10.45**
Attention Problems  CBCL  18.09**
YS R  14. 31* *
Rule Breaking Behavior  CBCL  22.82**
Y S R  12.17 * *
Aggressive Behaviors  CBCL  21.10**
YS R  13. 56**
38  •  JTSP
Hierarchical linear modeling was used to evaluate changes in global 
functioning over time (admission through 12 months after discharge) 
and to explore if functioning was related to gender, age, or number of 
presenting problems.  Hierarchical linear modeling is ideal when, as with 
this study, the goal is to model change over time but there are unequal
time intervals and missing data (Hedeker & Gibbons, 1997), and when 
the goal is to determine if outcomes vary for different groups within the 
sample.  Two-level, growth curve models were conducted using HLM6 
(Raudenbush, Bryk, & Cheong, & Congdon, 2004) (Table 3). Growth 
models were estimated separately for Internalizing, Externalizing, and 
Total Problems scales using raw scores for the CBCL and YSR.  Predictor 
variables were age, gender and number of presenting problems. Models 
were run separately for each predictor to maximize the available data. 
Because the major focus for the study was the trajectory of outcomes 
over time, attention was primarily on the linear and quadratic trend 
components rather than the intercepts. The linear trend isolated
outcomes at admission and discharge. The quadratic trends isolated
outcomes during the year after discharge. Table 3 displays chi-square
tests that showed signicant variability among subjects in their intercepts, 
linear slopes, and quadratic trends, (p < .05). Attempts to account for 
the reliable variance in linear and quadratic components with the youths’ 
age, gender, or number of presenting problems were unsuccessful.  Taken 
together, the HLM models indicated that youths’ problems improved 
signicantly from admission to 12 months after discharge and that these 
trends did not differ based on gender, age, or number of problems.
Table 3
Growth Model Mean Scores for Internalizing, Externalizing, and Total Problems of
the CBCL and YSR
Intercept Linear Slope Quadratic Component
Internalizing  CBCL  7.21*  -1.96*  1.66*
YSR  8.29*  -1.55*  1.51*
Externalizing    CBCL  7.74*  -2.87*  3.23*
YSR  10.44*  -1.51*  2.52*
Total Problems    CBCL  25.29*  -7.45*  7.30*
YSR  30.46*  -4.72*  5.33*
Note. * = p<.05
JTSP  •  39
Repeated-Measures ANOVAs were computed for all syndrome scales 
of the YSR and CBCL, using Greenhouse-Geisser corrections, to test 
whether changes made during treatment were maintained after leaving 
the program, on each syndrome (Table 4).   The within-subjects variable 
was time, which was measured by comparing scale scores obtained at 
the discharge mark to those obtained at six months and 12 months after 
discharge from the program.  The hypothesis was that there would not 
be signicant change over time, rather that gains made during treatment 
would be maintained.  As seen in Table 4, time was not signicant for 
most of the syndrome scales.
Table 4
Repeated Measures Analysis of Variance with Time as a Within Subject Variable
Syndrome Scales MS df F p Partial eta sq
CBCL  3.50  1.94, 317.30  .69  .50  .004
YSR  4.70  1.85, 168.52  .50  .59  .005
CBCL  9.13  1.93, 314.75  2.58  .08  .016
YSR  6. 58  1.88, 173.33  1.79  .17  .019
Somatic Complaints
CBCL  1.30  1.97, 321.76  .75  .47  .0 05
YSR  .78  1.95, 179.19  .23  .79  .002
Social Problems
CBCL  3.43  1.87, 305.12  1.22  .29  .007
YSR  2.72  1.77, 163.03  .57  .55  .006
Thought Problems
CBCL  1.59  1.93, 315.36  .60  .54  .004
YSR  .78  1.82, 170.36  .08  .91  .001
Attention Problems
CBCL  55.23  1.92, 313.61  7.76  .001  .045
YSR  29.79  1.88, 72.92  5.19  .008  .053
Rule Breaking Behavior
CBCL  349.04  1.96, 319. 41  27.02  .000  .140
YSR  184.10  1.79, 164.88  15.42  .000  .144
Aggressive Behaviors
CBCL  135.24  1.90, 309.73  10.58  .00  .060
YSR  60.17  1.94, 178.41  4.49  .01  .046
These ndings indicate that neither the youth nor their parents thought 
that the youth had changed signicantly during the year after discharge from 
the treatment program in terms of anxiety, withdrawal, somatic complaints, 
social problems, and thought problems.  However, both parents and youth 
reported that the youth had changed (worsened) signicantly in the year 
after discharge in terms of rule breaking, aggression, and attention. Note
that the effect sizes, measured with partial eta square values, were very
small for each of these scales, which indicates that there was only a small 
proportion of total variability.  Thus, though statistically signicant, the 
40  •  JTSP
increase in rule-breaking, aggressive behaviors, and attention problems
during the year after discharge was very small.  Raw mean scores (Table 
1) for the syndrome scales indicate that after discharge, parents and youth
reported only a one-to-two point increase in those problems (on scales 
that have a ceiling of 30-34 points) and that the scores remained well 
within the normal range.  
This study represents the rst large-scale attempt at a systematic 
exploration of long-term treatment outcomes in private residential
treatment.  The 1,027 adolescents who participated in the study were 
sampled from nine private RTPs that varied widely in their approach and 
services. The variety among these private RTPs was intended to reect 
private residential treatment in general. The typical client in these private
RTPs was a white, upper middle- to upper class, 16-year-old male or 
female with prior treatment failures who was functioning below average 
academically and had multiple psycho-social problems. The most common
youth problems were disruptive behavior, substance use, and mood 
This present sample was fundamentally different from the samples 
reported in public residential treatment studies (Curtis et al., 2001; 
Epstein, 2004; Hair, 2005). Public residential treatment clients are 
primarily males, disproportionately selected from ethic minority
backgrounds, and referred by public authorities. In this private RTP
sample clients were equally likely to be male or female, unlikely to be 
from ethnic minority backgrounds, and were placed in treatment by their 
parents. These demographic data lend credence to the claim that private
and public residential treatment programs have distinct services and
Adolescents in this study had serious psychological and social
problems. At admission, both adolescents and parents reported that
the adolescents’ problems were worse than adolescents in the normal 
population (97.5% and 91%, respectively).  Additional study variables point 
to high levels of distress among the adolescents in the sample such as
an extensive treatment history (94% had prior treatment at least one 
level-of-care), a high rate of  multiple problems (82%), and a 10.5 month 
average length-of-stay for those discharged with maximum benet.   
Both adolescents and parents reported a signicant decline in 
problems during treatment, on every measured outcome of global
psycho-social functioning (CBCL and YSR Total Problems, Internalizing,
and Externalizing Scales), as well as at the syndrome level (YSR and 
CBCL syndrome scales). Perhaps the most meaningful nding was 
that functioning changed from the clinical or borderline clinical range
at the admission mark to the normal range at the discharge mark and
remained in the normal range during the year after discharge, on all of
the aggregate scales of the CBCL and YSR (Internalizing, Externalizing,
JTSP  •  41
and Total Problems Score). In the year after discharge, adolescents also
maintained gains on syndrome scales, with relatively minor recurrence 
of problems with rule breaking, aggression, and attention. These long-
term positive outcomes stand in contrast to the outcomes reported for
public residential treatment program about which numerous reviewers 
have concluded that there is no evidence of lasting benet (Curry, 1991; 
Epstein, 2004; Hair, 2005).   
This study’s data suggest that treatment outcomes generally do not 
vary according age, gender, or number of problems.  These null ndings 
stand in contrast to the ndings in the public RTP research corpus.  A 
critical mass of research suggests that youth with relatively numerous 
and severe problems are less likely to benet from treatment in public 
RTPs (Connor et al., 2002; Curry, 1991; Epstein, 2004; Gorske et al., 
2003; Hussey & Guo, 2002). This nding, however, did not bear out in the 
present study. In the present study, favorable outcomes were obtained 
for youth even though co-morbidity rates and problem severity were 
very high. Furthermore, the public RTP research corpus suggests that
outcomes vary by gender and age of the youth (Connor et al., 2002; 
Epstein, 2004; Lyons & McCulloch 2006).  In the present study, males 
and females as well as younger and older adolescents had comparable 
outcomes.  Perhaps one explanation for these null ndings in the present 
study lies within the differences between private and public residential 
treatment clientele and services.  This is a hypothesis that warrants 
further empirical study.
Given that this sample had co-morbid conditions, had failed at prior 
levels of care, and was largely in the severe range at admission, the 
shift in scores toward the normal range during and after treatment is 
noteworthy and speaks to the clinical signicance of the change. Perhaps 
a point of comparison will help to interpret these data. Two of the most 
acclaimed evidenced-based treatments for youth with behavioral and 
substance abuse problems, Multi-systemic Therapy (MST) and Functional
Family Therapy (FFT), show high rates of problematic functioning 
after treatment. The primary outcome indicator used to establish
the effectiveness of MST and FFT was recidivism.  Research suggests 
that recidivism rates were reduced with MST by 25% - 70% and FFT 
by 25-80% (Fonagy, Target, Cottrell, Phillips & Kurtz, 2002; NREPP). 
Though primary outcome indicators were different for those studies 
than the present study, a lesson can be derived. Even treatments already
deemed as “evidence-based” do not “cure” all youth.  In fact, a signicant 
portion of youth who complete the “best of the best” evidence-based 
programs, have serious problems that persist. In this context, the clinical
signicance of the present study’s ndings is remarkable: youth who came 
to private residential treatment had the most severe of problems, but a
year after discharge function within the normal range.
A number of issues warrant further research attention. First, this 
study did not use a control group. The lack of experimental designs (i.e.,
42  •  JTSP
control groups, random assignment to different conditions) in residential
treatment outcome research is a common occurrence due to the
practical and ethical constraints involved in leaving seriously disturbed
adolescents untreated or treated at a lower level-of-care. In this age of 
outcome-based contracting and evidence-based practice standards, it is
clearly desirable to use more robust, experimental designs when possible. 
Curry (1991) has suggested some creative and practical alternatives to 
classic experimental design that use within-program and across program 
comparison groups. Private residential treatment research would also 
benet from process-focused studies that attempt to attribute change to 
specic components of treatment. Private residential care is so multi-
facetted and complex that it is less an intervention and more a tapestry
of interventions (Fahlberg, 1990).  As such, attempts to tie program 
components to outcomes would have profound clinical implications.  
JTSP  •  43
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Disclosure Statement:  Aspen Education Group provided funding for this study.
... Ainsi, Savic et al.. ont montré une association entre la gravité des lésions traumatiques de la moelle épinière et la mortalité globale (199). Au niveau international, les évaluations concernant les therapeutic residential care, dispositifs de soins se rapprochant des soins-études développés en France, retrouvent également une amélioration significative de la psychopathologie, des fonctionnements psychosocial, familial et scolaire des jeunes entre le début et la fin de la prise en charge, puis un an après leur sortie (103,104,107). Mais ces études souffrent des mêmes limites que celles sur les soins-études, avec une absence de groupe de comparaison et, souvent, un faible taux de répondants (103,104,107). ...
... Au niveau international, les évaluations concernant les therapeutic residential care, dispositifs de soins se rapprochant des soins-études développés en France, retrouvent également une amélioration significative de la psychopathologie, des fonctionnements psychosocial, familial et scolaire des jeunes entre le début et la fin de la prise en charge, puis un an après leur sortie (103,104,107). Mais ces études souffrent des mêmes limites que celles sur les soins-études, avec une absence de groupe de comparaison et, souvent, un faible taux de répondants (103,104,107). ...
... En effet, les programmes concernant les jeunes adultes (après 18 ans) sont orientés vers l'autonomisation des jeunes et permettent aux jeunes de sortir plus librement dans la journée pour suivre des formations à l'extérieur de la structure(104). Les auteurs évaluant ces établissements privés retrouvent une amélioration significative de la psychopathologie, évaluée par les parents et les jeunes eux-mêmes, entre le début et la fin de la prise en charge(103). Un an après leur sortie, les symptômes augmentent mais restent significativement plus faibles qu'à l'admission, avec des scores dans les limites de la normale(103). ...
Contexte : En santé, une intervention complexe est définie par l'interaction entre un certain nombre d'éléments distincts qui produit un résultat ne se limitant pas à la somme des effets de chacun des composants. Certains services de la FSEF proposent une prise en charge spécifique grâce au travail coordonné d'équipes du champ de la psychiatrie et d'autres disciplines, en particulier l'enseignement de l'Education Nationale. L'étude de ces systèmes complexes nécessite une méthode d'évaluation particulière. L'objectif de ce travail est de débuter leur évaluation en décrivant les dispositifs eux-mêmes, les populations qu'ils prennent en charge et certains éléments de leur évolution clinique durant ou après les soins.Méthode : Nous avons mené une revue systématique de la littérature pour synthétiser les données existantes sur l'évaluation des soins-études. Nous avons ensuite réalisé deux études d'épidémiologie clinique dans deux types de services proposant des interventions complexes : un soins-études en psychiatrie et un service transdisciplinaire. Ce dernier dispense des soins coordonnés de psychiatrie et de rééducation aux personnes ayant fait une tentative de suicide grave, avec des séquelles physiques importantes. Nous avons étudié des indicateurs liés au fonctionnement de ces dispositifs ou à l'évolution clinique des sujets (tels que la poursuite ou non des hospitalisations, la durée d'hospitalisation et la mortalité à long terme). Nous avons analysé les éléments cliniques associés à ces évolutions.Résultats : La revue de la littérature sur les soins-études retrouvait onze publications. Elles décrivaient le dispositif soins-études, les particularités des populations prises en charge et l'évolution clinique au cours et après ces soins. La première étude présentait ensuite un outil d'évaluation de la pertinence de la poursuite des hospitalisations en soins-études et son application. Les facteurs prédictifs de sortie pour non-pertinence étaient une alliance thérapeutique fragile, une faible autonomie, des difficultés à s'inscrire dans un cadre de vie collective et à adhérer au projet de soins. La deuxième étude décrivait les personnes hospitalisées dans le service transdisciplinaire après une tentative de suicide. A l'admission, elles présentaient des troubles psychiatriques et somatiques sévères. La durée d'hospitalisation dans l'unité et la surmortalité à cinq ans étaient liées à des caractéristiques sociodémographiques des sujets et à la sévérité des séquelles physiques.Discussion : Nos résultats soutiennent l'intérêt des systèmes complexes de soins étudiés ici. Néanmoins ces premières évaluations sont limitées par leur méthode et leurs faibles échantillons. Nous proposons donc les modalités selon lesquelles des études prospectives pourraient être construites, abordant de manière plus complète ces interventions. Des perspectives sont proposées afin qu'à la complexité des dispositifs de soins psychiatriques réponde des évaluations adaptées.
... In the USA there are also private residential care facilities, where the population intake and the functioning differ markedly from public residential care. The young people are admitted at their own request and that of their families (85,86). They are most often oriented by an educational consultant (87,88) for serious mental disorders, behavioural disorders (aggressive behaviours towards others), or relational difficulties with their families and/or at school (87). ...
... They are most often oriented by an educational consultant (87,88) for serious mental disorders, behavioural disorders (aggressive behaviours towards others), or relational difficulties with their families and/or at school (87). These facilities are closer to the FSEF facilities, since they offer environmentbased therapy with individual psychiatric care and in groups, in particular via therapeutic activities, and family therapies (87), occurring within full-time care lasting 10-12 months on average (85,87). The young people catered for are more often adolescents and young adults (16 years on average for adolescent facilities, 21 for the young adult facilities) (85-88), having already been in psychiatric care (85,88), and from privileged backgrounds (given the cost for the families or their private insurance policies in the USA) (85,87,88). ...
... These facilities are closer to the FSEF facilities, since they offer environmentbased therapy with individual psychiatric care and in groups, in particular via therapeutic activities, and family therapies (87), occurring within full-time care lasting 10-12 months on average (85,87). The young people catered for are more often adolescents and young adults (16 years on average for adolescent facilities, 21 for the young adult facilities) (85-88), having already been in psychiatric care (85,88), and from privileged backgrounds (given the cost for the families or their private insurance policies in the USA) (85,87,88). Their educational level is described as acceptable or good (88,89), but on average they have a delay of one semester in their schooling (89). ...
Full-text available
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.
... Many also administer programs which teach work, relational interpersonal skills and ability to earn money, thereby incentivizing behavioural changes (den Dunnen et al., 2013;van Wattum et al., 2013). One study solely examined private RTCs, which offer a wider range of therapies (Behrens & Satterfield, 2011). Moreover, the clients are generally brought in by their parents, and are from a higher socio-economic class than those from public RTCs (Behrens & Satterfield, 2011). ...
... One study solely examined private RTCs, which offer a wider range of therapies (Behrens & Satterfield, 2011). Moreover, the clients are generally brought in by their parents, and are from a higher socio-economic class than those from public RTCs (Behrens & Satterfield, 2011). ...
... It appears that there are no well-established overall gender differences regarding outcome in RT. Several studies showed no gender difference in: intensity or quality of relationships, quality of parental contact, social network development, alcohol consumption, and living situation at follow-up or mental health changes (Behrens & Satterfield, 2011;Farmer et al., 2009;Nijhof et al., 2012;Van, Nelson, Epstein, & Thompson, 2014). Such gender differences that were found appeared unrelated to treatment and reflect differences observed in general population e.g. ...
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.
... The adolescent OBH and RTC research suggests that adolescents and/or their parents report significant improvement from the point of admission to the point of discharge for emotional, behavioral, academic, family, and substance abuse problems in RTC and OBH programs (Behrens, 2006;Behrens, 2011;Behrens, Santa, & Gass, 2010;Behrens & Satterfield, 2007;Bettmann, Tucker, Behrens, & Vanderloo, 2016;Russell, Gillis, & Lewis, 2008;Tucker, Norton, DeMille, & Hobson, 2016a;Tucker, Paul, Hobson, Karoff, & Gass, 2016b). Furthermore, the research suggests that adolescents maintain gains up to one year post-discharge (Behrens, 2011;Tucker et al., 2016a;Tucker, Smith, & Gass, 2014;Tucker, Zelov, & Young, 2011;Zelov, Tucker, & Javorski, 2013). ...
... The adolescent OBH and RTC research suggests that adolescents and/or their parents report significant improvement from the point of admission to the point of discharge for emotional, behavioral, academic, family, and substance abuse problems in RTC and OBH programs (Behrens, 2006;Behrens, 2011;Behrens, Santa, & Gass, 2010;Behrens & Satterfield, 2007;Bettmann, Tucker, Behrens, & Vanderloo, 2016;Russell, Gillis, & Lewis, 2008;Tucker, Norton, DeMille, & Hobson, 2016a;Tucker, Paul, Hobson, Karoff, & Gass, 2016b). Furthermore, the research suggests that adolescents maintain gains up to one year post-discharge (Behrens, 2011;Tucker et al., 2016a;Tucker, Smith, & Gass, 2014;Tucker, Zelov, & Young, 2011;Zelov, Tucker, & Javorski, 2013). ...
... Demographic data for young adult samples on the NATSAP PRN were similar with that of adolescent samples from the NATSAP PRN. In fact, most adolescent studies reported similar ratios of males to females, profiles of ethnicity, as well as numbers and rates of presenting problems (Behrens, 2011;Tucker et al., 2011;Tucker et al., 2014;Tucker et al., 2016a;Tucker et al., 2016b; 0.282 ***p< .001, a significant pairwise mean difference between admit and discharge (p< .05), b significant pairwise mean difference between discharge and six months post-discharge (p< .05), ...
... Taking early and effective action can facilitate better outcomes for young people with social, behavioural and psychological problems. Promotion, prevention, and early intervention strategies are Behrens & Satterfield, 2006;Bocarro, 1998;Brand, 1998;Castellano & Soderstrom, 1992;Gillespie & Allen-Craig, 2009;Grayson, 2001;Kingston et al., 1997;McGarvey, 2004;Nettina, 2005;Rai, 2003;Russell, 2007;Stewart, 1978;Talbot, 2001;Trainor, 1998;Weeks, 1985;Winterdyk, 1980) Cultural Cultural bridging, cultural well-being (Norton & Hsieh, 2011;Palmer et al., 2006) Economic Preparation for vocational, educational and employment placements (Crisp & O'Donnell, 1998;O'Brien, 2009;Pfahlert, 2006;Sproles, 1997;Sveen & Denholm, 1993) ...
... Alienation, asocialisation, gender identification, group cohesion, independence, leadership, social maladjustment, social skills, peer relationships (Allsop, 2012;Behrens & Satterfield, 2006;Bettmann et al., 2012;Brand, 1998;Garst, Scheider, & Baker, 2001;Grayson, 2001;Mathieu, 1999;Mulvaney, 2011;Neill, 2001;O'Mahar, 2009;Pommier & Witt, 1995;Raymond, 2003) Spiritual Morality, spirituality (Alexander, 1969;Anderson, 1995;Hutter, 2000;Kingston et al., 1997;Maizell, 1988;Rancie, 2005;Thompson-Grim, 1999) vital for improving the mental health and well-being of young people, as well as reducing the prevalence and burden of mental health problems and mental disorders. ...
... Thus, findings from this thesis suggest that the use of adventure therapy for adolescent youth may develop greater physical competence and confidence (Pryor, 2003); increase physical fitness, strength and physical activity (Pryor, 2009); increase levels of energy and vitality (Pryor, 2009); enhance self-care (e.g., healthy eating, hygiene, medication adherence; Pryor, 2009); develop mastery of certain outdoor skills (Haynes & Gallagher, 1998); enhance connection between physical and emotional experiences (Blake & Katsikas, 2004); reduce somatic complaints (Behrens & Satterfield, 2006;Bettmann et al., 2012) and enhance weight loss (Jelalian et al., 2006;Lloyd-Richardson et al., 2012). ...
Full-text available
Adventure therapy involves use of small groups, nature-contact, adventure activities, and therapeutic processes to create opportunities for psychological change in participants, usually with the purpose of supporting an individual (or family) to move towards greater health and well-being. Adventure therapy programs involve diverse target groups, settings, program models and aims; yet too little is understood about their characteristics and efficacy. This thesis including published works assists in improving the health and well-being of Australian youth by providing up-to-date information, consolidating and advancing understanding of the therapeutic uses and treatment effectiveness of adventure therapy. Further, by evaluating two specific therapeutic adventure-based interventions for youth, this thesis provides valuable insight about the current utility and therapeutic outcomes of adventure therapy programs in Australia. This thesis includes four studies reported in four papers, each of which contributes to its overall aims. Study 1 examines the efficacy of adventure therapy programs internationally through a meta-analysis of outcomes and moderators. Study 2 provides an up-to-date description of outdoor adventure interventions for youth in Australia based on a national survey of program managers and leaders. Study 3 examines the efficacy of the Wilderness Adventure Therapy® (WAT) model of clinical treatment for Australian youth, while Study 4 examines the efficacy of the Queensland Police-Citizens Youth Welfare Association Bornhoffen Catalyst program for Australian youth-at-risk (Study 4). Meta-analytic results from Study 1 confirmed that adventure therapy programs are moderately effective (.47) in facilitating positive short-term change in psychological, behavioural, emotional, and interpersonal domains and that these changes appear to be maintained in the longer-term. Such magnitude of benefit is comparable to the majority of efficacious treatments for patients across the age span reported in the literature. As the most comprehensive and robust meta-analysis of adventure therapy studies to date, the findings from Study 1 can be recommended for use in benchmarking and monitoring program effectiveness. Results from Study 2 indicated considerable breadth, depth, diversity and differences in the organisation, program, staff, and participant characteristics of outdoor adventure interventions in Australia. The main outcomes of outdoor adventure interventions, as perceived by staff, were recreation, and personal and social development. Surveyed staff believed that the majority of participants obtained significant long-lasting benefits. Findings from Studies 3 and 4 suggest some cautious promise that two Australian adventure therapy programs (WAT and the Catalyst program) each offer a viable alternative to traditional psychotherapeutic approaches through prevention and intervention programs for youth at-risk. Overall, the findings of this thesis confirm that adventure therapy has the potential to play important roles in improving the health and well-being of Australian youth. While adventure therapy is not a panacea, these findings indicate that it is useful in a wide range of settings and for a broad spectrum of clients. Thus, findings from this thesis strongly support the assertion that adventure therapy should be in the suite of therapeutic interventions that operate in diverse service settings across Australia. Future research could build on Study 2 by conducting a dedicated survey of adventure therapy programs in Australia. In addition, research utilising a comparison or wait-list control group, multiple sources of data, and a larger sample, could help to qualify and extend findings of Studies 3 and 4. Overall, despite the promising findings, more rigorous research evaluations of adventure therapy programs (e.g., quasi/experimental, case study, observational, mixed method, and longitudinal design) are needed to strengthen the reliability, validity, and usability of adventure therapy research.
... A small subset of these out-of-home placements are adventure therapy (AT) programs such as outdoor behavioral healthcare (OBH) programs. To date, relatively little research has been able to link specific program components to the successful client outcomes being reported in OBH programs (Behrens & Satterfield, 2011;Roberts, Stroud, Hoag, & Massey, 2017;Russell, 2003Russell, , 2005Tucker & Rheingold, 2010;Tucker, Smith, & Gass, 2014). Since many OBH programs identify as wilderness therapy programs, a closer evaluation of wilderness therapists using the conceptual mapping task (CMT) (Impellizzeri, Savinsky, King, Leitch-Alford, 2017) could provide a mechanism for therapists to voice their unique understanding of what they do in practice. ...
... While authors have discussed the need to explore the unique role of mental health providers working in these out-of-home placement options (Bunce, 1998;Itin,1998), research to date has focused on field staff or instructors rather than therapists (Marchand, 2008;Marchand, Russell, & Cross, 2009;Marchand & Russell, 2013). In contrast, there is a multitude of outcome studies asking whether publicly funded (Curry, 1991(Curry, , 2004Lipsey & Wilson, 1993), or privately funded residential treatment centers (Behrens & Satterfield, 2011;Tucker & Rheingold, 2010) are effectively addressing the needs of adolescents in these settings. McKenzie (2000) suggested that future AT research efforts use a qualitative methodology to understand the role that being an AT therapist plays into outcomes, as well as using that qualitative data in identifying what program characteristics are tied to positive outcomes. ...
Conference Paper
Review of the Literature While the mentor/mentee relationship has been associated with traditional teacher education apprentice models (Ambrosetti & Dekkers, 2010; Feiman-Nemser,1996; Little, 1990), it is increasingly reported as integral for experiential education (EE) and leisure instructor training programs (Propst & Koesler, 1998). Moreover, prominent experiential education and leisure programs have asserted the primacy of mentoring as part of their field instructor programs (Divine, 2016; Outward Bound, 2006). The literature, practitioners, and students seem to agree that the mentor/mentee relationship is a critical component of effective experiential education and leisure programming (Cain, 1989; Galloway, 2002; Shooter, Sibthorp, & Paisley, 2009), yet there remains no detailed investigation into the operational definition of mentoring in these contexts and the desirable characteristics of mentoring programs as identified by practitioners to foster the interpersonal relationships essential to the learning of implicit knowledge in these contexts. Closer examination of the mentor/mentee relationship in experiential education and leisure contexts reveals troubling issues. An inherent problem in the fields of experiential education and leisure is that while the mentor/mentee relationship is both a necessity and an proffered methodology, there is little conceptualization of the terms and definitions comprising the mentor/mentee relationship. For example, if authors insert the words mentor, apprentice, or protégé into an article’s conclusion or recommendation section and do nothing to conceptualize that term, they assume the requisite experience of the reader to do that for themselves. However, if the reader does not have the requisite experiences to conceptualize what is meant by these terms, there is no structure by which to guide them to an appropriate use of this concept within the context of the authors’ recommendations. As an example, Morrison-Shetler and Heinrich (1999) state “Given the interdisciplinary nature of experiential teaching and the notion of ‘group as mentor,’ the idea of an interdisciplinary faculty group that mentors members around experiential teaching approaches makes sense” (p. 5). While the authors reference formal mentor/mentee programs, they do not define or conceptualize the components of a mentor/mentee relationship. The purpose of this study is to determine the amount as well as thematic relation and focus of literature on the topic of the mentor/mentee relationship within the fields of EE and leisure. Second, this study sought to provide a potential structure for conceptualization of the terms encapsulating the mentor/mentee relationship. We consider the present review to be timely, as recent advances in EE and leisure, coupled with anecdotal evidence, provide contemporary practitioners and researchers with increasingly clearer insight into the mechanisms by which field instructors and experiential educators exhibit fundamental skills and implicit knowledge, such as that required for decision-making and risk management, leading to effective functioning in a variety of situations. The gains derived via specific types of the mentor/mentee relationship may be of importance for field instructors and experiential educators as effective behavior is guided by both intrapersonal and interpersonal factors related to the mentor/mentee relationship. Methods A systematic review of papers published prior to March 2017 was undertaken using experiential education and leisure peer-reviewed journals currently in publication (n=12; see Table 1). Each journal was searched using three search terms in four search fields (see Table 1). Database searches, screening, and eligibility of records were performed independently by two authors at two different institutions. Figure 1 shows the identification, screening, and selection of the final full text articles included the qualitative analysis, resulting in a full review of 19 papers and final inclusion of 19 papers. After the initial database search and the removal of duplicates, records that were screened (n = 30) contained at least one of the three search terms (mentor*, apprentice*, or protégé*) in at least one of the search fields (All, Keywords, Abstract, Title). At this point, records were excluded (n = 11) because they were book reviews and thus did not meet inclusion criteria. Next, full text articles (n = 19) were assessed for eligibility included in the qualitative synthesis. Qualitative synthesis will be performed using NVivo software to analyze keywords-in-context to identify thematic convergences among articles. Results Although qualitative analysis has not been performed at this time, preliminary results reveal that the majority of papers published where mentor*, apprentice*, or protégé* appear in the Keywords, Abstract, or Title are qualitative in nature (Bachert, 2007; Bell, 1990; Chand & Shukla, 2003; Coakley, 2006; Colvin & Tobler, 2013; Gladwell, Dowd & Benzaquin, 1995; Gray, 2008; Maxson, 1983), with three quantitative studies (Morgan, Sibthorp, & Tsethlikai, 2016; Norton & Watt, 2014; Propst & Koesler, 1998), and three theoretical papers (Coakley, 2006; Karagatzides et al., 2011; Wheal, 2000). Four papers propose mentor program curricula (Gladwell, Dowd & Benzaquin, 1995; Powell & Sable, 2001; Schaumleffel, 2009; Wittmer, 2001). These papers implement diverse methods, such as case studies (Bachert, 2007; Bell, 1990; Chand & Shukla, 2003; Colvin & Tobler, 2013; Gray, 2008; Pelchat & Karp, 2012; Skalko, Lee, & Godlenberg, 1998) and informal interviews (Morrison-Shetlar & Heinrich, 1999), to assess the effectiveness of the mentor/mentee relationship in the context of faculty and peer mentoring programs. Both informal and formal mentoring contexts are examined in the papers, with few papers describing the effectiveness of a formal mentoring program. No standardized assessment measures are implemented in the research, with informal semi-structured interviews being the dominant assessment measure. Overall, there is little homogeneity in the investigation of the effectiveness of mentoring programs in experiential education and leisure contexts. Limitations of this study were found mainly within the selection criteria themselves. While the selection criteria provided a operationalized definition of the focus of an article, it was found that articles may have included much information on the terms without having included them in any search criteria category. This meant that potentially impactful information on elements of the mentor/mentee relationship that were missing from the results due to the limitations of the search criteria. A second limitation may well have come from the articles themselves. Very few references were made to literature in periods other than the 19th and 20th century, potentially eliminating some beneficial “primary” source material. Discussion Although some articles support the notion that the mentor/mentee relationship is valuable to developing implicit knowledge in EE and leisure contexts (Bachert, 2007; Bell, 1990; Chand & Shukla, 2003, Gladwell, Dowd & Benzaquin, 1995, Maxson, 1983; Morrison-Shetlar & Heinrich, 1999; Morgan, Sibthorp, & Tsethlikai, 2016; Propst & Koesler, 1998; Wittmer, 2001), few papers explicitly conceptualized the defining attributes of the mentor/mentee relationship (Gladwell, Dowd & Benzaquin, 1995; Powell & Sable, 2001; Schaumleffel, 2009; Wittmer, 2001). To further elucidate the conceptualization of the mentor/mentee relationship in EE and leisure contexts, future research directions should include a framework, such as that outlined by Jacobi (1991). Jacobi’s research is particularly relevant to this study because she sought to alleviate the subjectivity of a [mentoring] models’ measurement by a personalized definition of that subject. Jacobi’s lowest common denominators for a mentor/mentee relationship exemplifies a more holistic concept of the term, and therefore, robust model by which to apply that term. For example, a literature review of medical, higher education, and teacher training programs may determine thematic convergences leading to a conceptual model that optimizes learning in EE and leisure contexts. Without such systematic investigation into the conceptualization of the mentor/mentee relationship, the effective characteristics comprising mentoring programs to optimize learning for additional gains in implicit knowledge will remain a challenge. Another future research direction might include a timeline of literature to include greater connections to more primary source literature on which future articles may wish to base their literature reviews of the mentor/mentee relationship. Doing so may add a depth of knowledge previously unknown to many intrigued by these terms. References Ambrosetti, A., & Dekkers, J. (2010). The interconnectedness of the roles of mentors and mentees in pre-service teacher education mentoring relationships. Australian Journal of Teacher Education, 35(6), 42. *Bachert, R. E. (2007). NAAEE virtual mentors: Influencing future environmental educators at Bloomsburg University of Pennsylvania. Applied Environmental Education & Communication, 6(2), 197-197. doi:10.1080/15330150701598288 *Bell, M. (1990). Pathways of emerging practitioners the value of tracing an apprenticeship. Journal of Experiential Education, 13(1), 14-19. doi:10.1177/105382599001300102 Cain, K. D. (1989). A Delphi study of the development, evaluation, and documentation of judgement and decision-making ability in outdoor leadership of adventure education programs. Dissertation Abstracts International, 49(9). *Chand , V. S., & Shukla , S. R. (2003). Biodiversity contests': Indigenously informed and transformed environmental education. Applied Environmental Education & Communication, 2(4), 229-236. doi:10.1080/15330150390256782 *Coakley, J. (2006). The good father: Parental expectations and youth sports. Leisure Studies, 25(2), 153-163. doi:10.1080/02614360500467735 *Colvin, J., & Tobler, N. (2013). Cultural speak: Culturally relevant pedagogy and experiential learning in a public speaking classroom. Journal of Experiential Education, 36(3), 233-246. doi:10.1177/1053825913489104 Divine, A. (2016). Mentoring at NOLS. NOLS Instructor Association. Retrieved from Feiman-Nemser, S. (1996). Teacher mentoring: A critical review. ERIC Digest. Retrieved from ERIC database (ED397060). Galloway, S. (2002). Theoretical cognitive differences in expert and novice outdoor leader decision making: Implications for training and development. Journal of Adventure Education & Outdoor Learning, 2(1), 19-28. *Gladwell, N., Dowd, D., & Benzaquin, K. (1995). The use of mentoring to enhance the academic experience. SCHOLE: A Journal of Leisure Studies & Recreation Education, 10, 56-65. *Gray, H. J. (2008). " I'm present,'A'please": A case study examining grading issues in a recreation curriculum. Schole: A Journal of Leisure Studies & Recreation Education, 23, 43-61. Jacobi, M. (1991). Mentoring and undergraduate success: A literature review. American Educational Research Association. 61, (4), 505-532. *Karagatzides, J. D., Kozlovic, D. R., De Iuliis, G., Liberda, E. N., General, Z., Liedtke, J., . . . Tsuji, L. J. S. (2011). Youth environmental science outreach in the Mushkegowuk Territory of Subarctic Ontario, Canada. Applied Environmental Education & Communication, 10(4), 201-210. doi:10.1080/1533015X.2011.669684 Little, J. W. (1990). The mentor phenomenon and the social organization of teaching. In C. Cazden (Ed.), Review of Research in Education. Vol. 16 (pp. 297-351). Washington, DC: American Educational Research Association. *Maxson, L. (1983). Mentors. Journal of Experiential Education, 6(1), 7-9. doi:10.1177/105382598300600103 *Morrison-Shetler, A. & Heinrich, K. T. (1999). Mentoring at the edge: A faculty group fosters experiential teaching. Journal of Experiential Education. 22, (1), 5-11. Moher D., Liberati A., Tetzlaff J., Altman D.G., The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097 *Morgan, C., Sibthorp, J., & Tsethlikai, M. (2016). Fostering self-regulation skills in youth: Examining the effects of a mentoring curriculum in a summer recreation program. Leisure Sciences, 38(2), 161-178. doi:10.1080/01490400.2015.1083496 *Norton, C. L., & Watt, T. T. (2014). Exploring the impact of a wilderness-based positive youth development program for urban youth. Journal of Experiential Education, 37(4), 335-350. doi:10.1177/1053825913503113 Outward Bound. (2006). Mentor. In Outward Bound Training Manual. Retrieved from al-leadership/mentoring/view *Pelchat, C., & Karp, G. G. (2012). Using critical action research to enhance outdoor adventure education instructional practice. Journal of Outdoor Recreation, Education and Leadership, 4, 199-219. *Powell, L., & Sable, J. (2001). Professional preparation of allied health practitioners and special educators using a collaborative, transdisciplinary approach. SCHOLE: A Journal of Leisure Studies & Recreation Education, 16, 33-48. *Propst, D. B., & Koesler, R. A. (1998). Bandura goes outdoors: Role of self‐efficacy in the outdoor leadership development process. Leisure Sciences, 20(4), 319-344. *Schaumleffel, N. A. (2009). Enhanced academic advisement with online learning management systems. SCHOLE: A Journal of Leisure Studies & Recreation Education, 24, 142-148. *Skalko, T., Lee, Y., & Godlenberg, R. (1998). Seeking active collaboration through a comprehensive fieldwork system in therapeutic recreation: A case example. SHCOLE: A Journal of Leisure Studies & Recreation Education, 13, 63-72. Shooter, W., Sibthorp, J., & Paisley, K. (2009). Outdoor leadership skills: A program perspective. Journal of Experiential Education, 32(1), 1-13. *Wheal, J. R. (2000). The agony or the ecstasy? The academy at the crossroads. Journal of Experiential Education, 23(3), 135-142. doi:10.1177/105382590002300304 *Wittmer, C. R. (2001). Leadership and gender-role congruency: A guide for wilderness and outdoor practitioners. Journal of Experiential Education, 24(3), 173-178. doi:10.1177/105382590102400308 *Denotes articles included in systematic review
... Finding consistent with previous research (Behrens & Satterfield, 2006;Magle-Haberek et al., 2012). ...
Full-text available
Correlation between (1) MMPI-A-RF as a measure of adolescent personality and psychopathology, and (2) treatment outcomes in wilderness therapy measured by symptom improvement.
... The study sample comes from a private-pay organization and as such may not be transferable to government-funded organizations. Behrens and Satterfield (2006) suggest that private-pay programs are different enough from government-funded programs that separate research is needed to explore effectiveness. Last, the sample group of the program alumni was voluntary, which potentially introduces bias. ...
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A therapeutic model referred to as young adult transition programs has emerged to better address the unique developmental challenges found in this age group. This study examined 317 critical incidents that supported or hindered young adults in a therapeutic transition program. The research design used a combination of an instrumental case study and critical incident technique (CIT). Using interviews and the Outcome Questionnaire 45.2, the study explored in-depth the experiences of 17 young adults who were alumni of a young adult transition program. The objective was to better understand the transition experience from a participant perspective and, through the findings, inform program development and evaluation for young adult transition programs. Several significant findings emerged from the data, among them the importance of interpersonal relationships, experiential education and adventure, individualized programming, and community and culture. An understanding of these findings leads to a discussion on transformational mentoring and leadership as well as relational cultural practice and how this can support leaders of transition programs in further research and program development. The limitations of the study are discussed and suggestions for future studies are offered
Despite the call for more community-based treatment options, each year a significant number of adolescents find themselves participating in some form of residential treatment. Therapists working with these adolescents need support to ensure they are delivering the best treatment possible and effectively integrating family therapy into the treatment process. Therefore, the purpose of this book is to provide therapists and researchers foundational information that will help increase the use of family therapy in residential work with adolescents. This particular chapter presents background information on residential treatment and the challenges associated with working in these settings, as well as a discussion of the costs of residential treatment and who pays for these services . General definitions and terminology are also presented to help orient the reader. This chapter serves as the introduction to the book and concludes with a rational for the organization of the chapters, as well as components of the chapters that are the same throughout the book.
Research concerning outcomes for adolescents in residential setting has consistently shown that family involvement is an important part of effective treatment. Nevertheless, most of the research that has been done on this topic is focused on outcomes and does not sufficiently focus on the process of family therapy in these settings, nor does the available research consider the cost of the treatment. The lack of cost-effectiveness research in this area of study leaves the field open to criticism that the outcomes do not justify the costs . In order to strengthen the role of family therapy in residential settings for adolescents more research is needed to address these gaps. This chapter discusses how qualitative, quantitative, and mixed methods can be used to advance family therapy research in such settings. Furthermore, examples are provided of research questions that could be answered using these methods, as well as examples of different studies that could be conducted to deepen the understanding of the role of family therapy in positive outcomes with this population.
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Random-effects regression models have become increasingly popular for analysis of longitudinal data. A key advantage of the random-effects approach is that it can be applied when subjects are not measured at the same number of timepoints. In this article we describe use of random-effects pattern-mixture models to further handle and describe the influence of missing data in longitudinal studies. For this approach, subjects are first divided into groups depending on their missing-data pattern and then variables based on these groups are used as model covariates. In this way, researchers are able to examine the effect of missing-data patterns on the outcome (or outcomes) of interest. Furthermore, overall estimates can be obtained by averaging over the missing-data patterns. A psychiatric clinical trials data set is used to illustrate the random-effects pattern-mixture approach to longitudinal data analysis with missing data. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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 Substance Abuse and Mental Health Services Administration's (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) is an online database of mental health and substance-abuse interventions that have undergone an independent review process to rate their quality of research and readiness for dissemination. Originally conceived as a U.S.-based national registry, NREPP has effectively become an international resource on evidence-based programs and practices, containing information on interventions from around the world and drawing an international audience. The objectives of this descriptive study were to determine how many interventions in the registry (1) have been implemented outside the United States, (2) have materials translated into one or more languages, (3) have received funding from a non-U.S. source, and (4) have been evaluated in studies conducted outside the United States. The growing interest in other countries for tools to assist in the identification and implementation of evidence-based programs suggests that NREPP will become increasingly relevant and useful to international mental health constituencies.
Both advocates of residential group care and therapeutic foster care claim that their programs serve the most troubled children and youth. Prior research, often limited to single sites and small numbers of subjects, have not confirmed such claims. The authors describe the evidence regarding these claims, the research literature pertaining to program effectiveness, and a means for empirically evaluating the impact of residential group care and therapeutic foster 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 &equals; 13.89 years, SD &equals; 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.