The Language Functioning of Youth at Entry to Residential Treatment

Although much is known about the behavioral and educational characteristics of youth at entry to residential care, little is known about youth language performance. Given the impact of language deficits on outcomes, this study assessed the specific language skills of 70 adolescents at entry to a residential treatment setting. Results revealed elevated levels of risk across Core Language and comprehensive language indexes. Areas of greatest concern were with receptive language skills with just over 75% of the sample indicating some level of impairment. Implications for treatment and practice, study limitations, and recommendations for future research are discussed.     

Mentoring and Other Adult Involvement with Juveniles in Treatment: Do They Decrease the Probability of Elopement?

ABSTRACT

This paper focuses on whether running away from adolescent residential care facilities is related to having off grounds passes with an adult resource. It was hypothesized that as off grounds passes increased in frequency and duration, runaway behavior would decrease in frequency and duration. Data were collected from two hundred closed client files. Spearman's rho correlation and linear regression were used to analyze the data. Results show a weak negative relationship exists between number of passes and both number of runaway occurrences and hours spent on the run. The data were collected from a single agency, suggesting that caution be used when attempting to generalize to the entire population. The results, however, are very useful to inform future research and guide the development of future hypotheses.     

Exploring Suicide Risk History Among Youth in Residential Care

Adolescents in residential care settings have double the national average of suicide risk histories (attempts, threats, and ideation). However, little is known about youth with specific suicide-risk histories. This study explored differences in demographic characteristics and mental health variables for 509 youth in residential care with high and low suicide-risk histories. Overall, nearly 40% of participants had a high suicide-risk history, and significant differences between low and high suicide-risk history groups were found for multiple variables (e.g., gender, ethnicity, number of diagnoses). This study highlights a need for research into areas associated with suicide-risk history in residential care.     

Training Youth Workers in Residential Treatment

ABSTRACT

The role of a youth worker in residential treatment is multifarious and requires the ability to establish collaborative relationships, comprehend and describe the nature of interactions, influence transactions, facilitate constructive problem solving and to be able to interpret the effects of behaviour from one individual upon another. Unlike out-patient therapeutic approaches, (e.g., family therapy), in order to provide for the physical and emotional needs of a divergent population, residential treatment requires continuity from staff to staff. Youth workers must demonstrate similar abilities, skill levels and work as a team to create constancy within the environment, and ensure the efficacy of each treatment plan. This article outlines a skills training/evaluation process of youth workers developed in a residential treatment program for emotionally disturbed adolescents.     

A Survey of Mental Health Service Provision in New York State Residential Treatment Centers

Thirty-seven of 43 (86%) agencies operating child welfare residential treatment centers in New York State responded to a survey about the provision of mental health services. Questions were asked about provision of services, satisfaction with services, and suggestions for improvement in five domains: therapeutic milieu, individual therapy, group therapy, family therapy, and psychiatric services. Results revealed that due to funding constraints most agencies reported hiring direct care staff with limited formal education to work with children who present with increasing intensity and severity of emotional and behavioral problems, which in part led to high turnover rates and moderate levels of satisfaction with services. Taken together, the data highlight the demands on the system as more severely troubled youth are being served with fewer dollars provided for their care. The findings suggest many avenues for advocacy, clinical intervention, staff development, and further research.     

Outcomes Monitoring After Discharge From Residential Treatment Facilities for Children and Youth

Residential treatment facilities operate under increased pressure to demonstrate outcomes, yet little is known about the outcomes monitoring practices of such facilities. This study analyzed data from a survey of residential treatment facilities to examine the extent to which residential treatment facilities monitor outcomes after discharge. Sixty-nine percent of facilities measured satisfaction with residential treatment after discharge; roughly half measured the use of mental health services, housing status, school performance, and/or clinical functioning after discharge. Facilities that were licensed by the state had 2.17 higher odds (95% CI: 1.22–3.84) of measuring at least one of these outcomes after discharge. Most facilities that measured outcomes did so for no more than sixmonths after discharge. Continued efforts are needed to encourage the monitoring of outcomes after discharge from residential treatment.     

Resilient Youth in Residential Care

Youth typically enter residential treatment once other less-intensive interventions have been ineffective. Youth in residential care often have trauma histories, resulting in significant behavioral and emotional impairments. Given the adversity residential youth have faced, how can resiliency and protective factors be fostered? The purpose of the present study is to examine the relationship between adverse childhood experiences (ACEs), resiliency, and positive youth development in a sample of adolescent youth placed in residential care. The sample included 42 youth between the ages of 13–18 in five different residential treatment centers. Results showed that higher levels of resiliency indicated higher levels of positive youth development. A strong, positive correlation was found between resiliency and positive youth development. Results suggest that higher levels of trauma are related to lower levels of resiliency. A moderate, negative correlation was found between trauma and resiliency. Understanding and accessing youth's sources of strength is an important tool to build upon in therapy. These findings may lead to more effective treatment interventions that are tailored to residential youth's specific needs, ultimately fostering resilient outcomes.     

Characteristics Associated With the Continuity of Atypical Antipsychotic Treatment Among Youth Discharged From Residential Treatment

This article examined the continuity of atypical antipsychotic medications among children and adolescents following discharge from a residential mental health treatment facility in the state of Florida from 2005 through 2011. Discharge data are reported by the residential providers, while post-discharge data are from Medicaid enrollment and claims files. Fifty-five percent of youth were receiving antipsychotic medications when discharged from residential treatment. Of those receiving such medications, 55% continued with their medication after discharge. Antipsychotics were more likely at discharge among youth who were older, had longer treatment episodes, showed greater improvements during treatment, and had prior involuntary examinations and out-of-home treatment episodes. Continuation of antipsychotic medication was more common among youth who had greater family involvement in treatment, longer treatment episodes, improved more during treatment, and had prior involuntary examinations. Continuation was less likely for youth with prior out-of-home treatment episodes. These results contribute to the existing literature by examining the continuity of atypical antipsychotic medication among children and adolescents following residential treatment.     

Effect of Organizational Climate on Youth Outcomes in Residential Treatment

This study examined the association between organizational climate and changes in internalizing and externalizing behavior for youth in residential treatment centers (RTCs). The sample included 407 youth and 349 front-line residential treatment staff from 17 RTCs in Illinois. Youth behavior was measured using the Child Functional Assessment Rating Scale. Organizational climate was measured via the Areas of Worklife Survey. Using hierarchical linear modeling, results demonstrated that a higher perception of person-job match on community among front-line staff was associated with more improvement on youth externalizing behaviors. Counter-intuitively, higher person-job match on fairness and workload were each associated with less improvement on internalizing and externalizing behavior. These results offer several potential implications for residential treatment leadership, front line workers, policymakers, youth, and researchers.     

Outcomes of Children Participating in Mental Health Residential and Intensive Family Services: Preliminary Findings

It has been estimated that approximately 20% of children experience some form of mental health problem, with 14% in the clinical range. Residential mental health treatment is often reserved for those with the most severe presentation of disorder, and intensive home-based alternatives have been developed to cope with increasing demand. The purpose of this study was to examine the long-term developmental trajectories, personal functioning, and life circumstances of the children and youth who accessed residential mental health treatment or the home-based alternative along a number of domains (e.g., clinical outcomes, school personal well-being), and determine if differences between the groups exist.     

Development of a Model for Predicting Running Away from Residential Treatment Among Children and Adolescents

The effectiveness of mental health care services is severely limited when young people run away from residential treatment. This study describes the development of a decision support model for predicting discharge due to running away on the basis of individual characteristics. Subjects include 667 wards of a large Midwestern state between the ages of 7 and 20 who were placed in residential treatment and discharged during 2007. A model combining eight predictors—namely School Attendance, History of Running/Runaway Ideation, and linear as well as quadratic terms for Age, Substance Abuse and Delinquency—demonstrated good internal validity and moderate predictive power for discharge due to elopement. Results of this study can support mental health care workers in identifying potential recipients of interventions that reduce the likelihood of premature exits from residential care among young people.     

Hope and Siege: The Experiences of Parents Whose Children Were Placed in Residential Care

This qualitative study focused on research into the impact on parents of children's out-of-home placement. Twelve couples (24 parents) were interviewed. Three major themes emerged: (a) parents' perception of out-of-home placement as necessary because of children's destructive behavior and parents' victimhood; (b) parents' acknowledgment of positive changes in the child and the family, their pain surrounding the child's pressurizing to return home and fear of regression if this should come about; (c) guilt as a major emotion that impacts their couple relationship. The study results are evaluated in the context of research on parents' reactions to children's removal from home.     

Feasibility of Inpatient and Outpatient Multidimensional Family Therapy for Improving Behavioral Outcomes in Adolescents Referred to Residential Youth Care

In this study, half of a cohort of adolescents referred to a secure residential youth care institution in The Netherlands was actually placed in the center where they received well-tested Multidimensional Family Therapy (MDFT). The others were offered outpatient MDFT in a last-minute effort to avert juvenile judge accorded out-of-home placement. All adolescents had problems with their family, and virtually all of them with school. Externalizing behavior problems were prevalent. As expected, both groups of adolescents benefited from MDFT on externalizing behavior, family, and school outcome measures. MDFT was well-liked by adolescents and parents.     

Health Risk Factors in an Adolescent Psychiatric Residential Treatment Facility

To date, there is limited information regarding prevalence of health-related risks profiles of youths in psychiatric residential treatment, including weight and physical activity. To address this gap in the literature, weight and associated health risk behaviors in a sample of adolescents in a psychiatric residential treatment center were assessed. Adolescents in this sample have nearly twice the rate of being overweight or obese (46.6%) when compared to national (28.8%) norms and only 47.8% met national physical activity recommendations. Adolescent psychiatric residential treatment facilities are poised to intervene with adolescents who are at high risk for unhealthy weight.     

Considering Residential Treatment for Youth in the Continuum of Care: A Systems Perspective

This article examines the residential treatment alternative in social and historical contexts. It provides recommendations for clearly defining residential treatment services and measuring the effectiveness of residential treatment programs. The study suggests models for family involvement, after care, and follow-up that may enhance the long term success of residential treatment. The research has been designed to assist Orion House, Inc., a residential treatment center for male youth in Newport, New Hampshire, and therefore the study includes information about the macro-environment in which Orion House operates. However, suggested methods may be generalized and applied to other residential treatment facilities.     

Predictors of Burnout in Children's Residential Treatment Center Staff

This study explored burnout among frontline staff within a children's residential treatment center (RTC) population. Data were collected from 375 full-time, frontline, children's RTC staff employed at 21 RTCs in Illinois. Using hierarchical linear modeling (HLM), results indicated that frontline staff age, training, empathic concern, communicative responsiveness, neuroticism, extraversion, job satisfaction, and managerial support were associated with subscales of the Maslach Burnout Inventory (MBI). Further, burnout scores varied significantly at the provider level of analysis for the Emotional Exhaustion and Personal Accomplishment subscales of the MBI, lending support to the hypothesis that organizational variables may be associated with workers' burnout experiences. These findings have implications for personnel hiring, burnout prevention, and future research on the organizational correlates of burnout.     

Collaborative Implementation of a Sequenced Trauma-Focused Intervention for Youth in Residential Care

Few evidence-based interventions have been developed or tested with youth in residential care. Moreover, models for transferring implementation knowledge from clinical trials to service settings are sparse. This article addresses the lessons learned about addressing this technology transfer gap by presenting a case study of a collaborative effort to implement a trauma-informed pilot program with youth in residential care. Key considerations are the collaborative nature of implementation efforts, the requirement of organizational support, the need for interventions to be sensitive to the child and the milieu, and the lack of fit between Medicaid reimbursement and evidence-based intervention.     

The Role of National Youth Policy in the Development of Residential Education in the United States

The role of the federal government in youth policy in general, and residential education policy in particular, has been limited to targeted programs that have been subject to change and instability, with the exception of the large scale, publicly funded Job Corps program. State and local governments have been considered to be the most appropriate governmental units to develop and implement residential policies. Services have tended to be fragmentary and vary widely in quality. Residential treatment programs have received the broadest financial support, whereas developmentally oriented residential education programs are still very isolated, and it is not likely that the federal government will have a strong presence in supporting them. But the government can play an important role in facilitating information exchange about the best practices, providing for technical assistance, helping with networlnng, and supporting basic research about residential education, most of which is operated through the private sector.     

Beyond Control: Staff Perceptions of Accountability for Children and Youth in Residential Group Care

This article explores the perceptions of residential staff teams regarding the concept of accountability for children and youth living in group care situations. Using a qualitative research approach, the authors held focus groups with residential staff teams in children's mental health and private group care facilities and then interviewed the supervisors separately in an effort to explore how these teams conceive of their responsibility to teach children and youth about accountability, as well as in order to determine the specific tools used and approaches taken for this purpose. The authors found that a strong reliance on control-based approaches persists and that, furthermore, very little conceptual or theoretical thinking informs team discussions or approaches to holding children and youth accountable for their actions. It is argued here that there is an urgent need to seriously engage with residential care providers about the lived experiences of children and youth under conditions. The use of control and vigilance around the enforcement of program expectations are rarely focused on the individual needs of the clients and typically reflect the intuition or “common sense” of residential staff teams instead.     

Community Adaptation of Youth Accessing Residential Programs or a Home-Based Alternative: Contact With the Law and Delinquent Activities

This article presents the findings from a longitudinal investigation of the prevalence of negative contact with the law for a sample of youth 12–18 months after graduating from residential and intensive children's mental health programming. Results of this study suggest serious community adaptation difficulties face many youth graduating from these children's mental health programs. This study suggests that delinquency outcomes may be particularly problematic for older males who are transitioning out of treatment programs, as well as for youth with prior contact with the law, and greater challenges adapting to school at program admission.