Relationship Between Time in Residential Treatment and Youth Outcomes: Results from a Cross-Site 5-Year Analysis

There is a need to evaluate the effectiveness of residential treatment centers (RTCs) due to scrutiny around use of this service that is viewed as costly, restrictive, and has resulted in mixed outcome results for youth. Discrepancies exist in residential literature regarding the amount of time in treatment that is optimal for having a positive effect on youth outcomes. This study used archival data to examine the relationship between time in treatment and youth’s improvement in functioning and restrictiveness of living environment in a cross-site evaluation of a large sample of youth (N = 716) who discharged from RTCs over a 5 year time period. Researchers aimed to identify an ideal time in treatment that is beneficial for youth and to add to the practice-based evidence for the effectiveness of RTCs. Results of segmented regression analyses indicate a non-linear relationship that showed a longer time in treatment predicts improvement in overall functioning and restrictiveness of living environment during the first 6 months of treatment. However there is no relationship between time in treatment and outcome variables between 6 and 10 months, and a negative relationship exists between longer time in treatment and outcome variables after 10 months in treatment. Practical implications of results can be used to inform advocacy efforts, discharge planning, and return on investment calculations.     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

Mental Health and Dangerousness: Characteristics and Outcomes of Children and Adolescents in Residential Placements

Violence has been identified as a significant risk behavior among children and adolescents. Dangerousness is a factor in psychiatric hospitalizations and out-of-community placements. However, there is only a small amount of research that has investigated the mental health co-morbidities and treatment outcomes of violent children and adolescents. A random sample of children and adolescents in residential placements through the State of Florida's child welfare system were studied. Cases were classified into three levels of dangerousness. Results indicated that dangerousness was associated with much elevated mental health co-morbidity. Also, cases who were dangerous at the time of admission had less developed peer and moral/spiritual strengths than did other cases. Although dangerous cases had worse dispositional outcomes, there was strong evidence that these cases derived the most clinical benefit from residential treatment.     

Intensive Treatment of Specific Phobias in Children and Adolescents

One-session treatment (OST), a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one 3-hour session. In this paper, we review the application of OST for specific phobia in youth and highlight practical matters related to OST and its use in a clinical setting. We also briefly review results of treatment outcome studies and suggest future directions for clinical research and practice. We conclude that OST is an efficient and efficacious treatment.     

Exploration of Coping Strategies of Youth Accessing Residential and Day Treatment Programs

Youth with emotional and behavioral disorders are often dealing with many challenges such as strained relationships, academic difficulties and family conflict in addition to their clinical symptoms. Youth can access intervention for these challenges in day and residential treatment centers. However, little is known about how these adolescents cope with stress or the strategies they use. The purpose for this study was to explore the ways youth report coping with stress, and in particular the active, passive/depressive and risky strategies they report using in response to stress. A second purpose was to explore the relationships between active, passive/depressive and risky strategies and their self-reported psychological difficulties. Using a crosssectional design, 30 adolescents (12–18 years of age, 79 % female) completed standardized measures of psychological difficulties and coping with stress. Youth reported using a variety of strategies to cope, and endorsed learning to live with it, and doing an activity alone as the two most commonly used. There were robust relationships between active (negative association) and risky behaviors (positive association) with psychological difficulties. Implications for family therapy are discussed.     

Characteristics of Children and Adolescents Admitted to a Residential Treatment Center

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.     

The Subjective Experience of Being Medicated in Troubled Youth: A Sample from Residential Treatment

The use of psychotropic medications in youth has significantly increased in recent years. Moreover, the use of multiple medications, or polypharmacy, has seen a corresponding increase. The use of medications is largely based on diagnostic impressions and the targeted symptom. However, due to the dearth of applied research with severely troubled youth, there is very little “evidence base” to guide this practice. The Survey of Adolescent Treatment Experience study surveyed youth, currently placed in residential care, on their impressions of medication effectiveness on a wide-range of symptom categories. Youth report only mediocre effectiveness in their medication across a range of symptom questions. Approximately one third of youth indicated that they felt positive about taking medications. On average, slightly less than 50 % of youth reported benefits from medications across symptom categories. It is argued that these findings should inform the efforts toward individualized treatment models.     

Partnering for Success Symptom Monitoring Outcomes: Cognitive Behavioral Therapy Plus for Children and Youth in Child Welfare

Journal of Child and Family Studies - A substantial proportion of children and youth in the child welfare system have mental health concerns that warrant attention. While these youth are more...     

Psychological Outcomes in Fathers of Critically Ill Children in the Pediatric Intensive Care Unit: A Systematic Review

Journal of Clinical Psychology in Medical Settings - Systematically review evidence of psychological distress in fathers of children admitted to the pediatric intensive care unit (PICU). Two...     

Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.     

Assessment of Needs in Residential Care: Perspectives of Youth and Professionals

The evaluation and identification of needs profiles for youth in residential care, through qualitative and quantitative methodologies involving different stakeholders, are still relatively uncommon, even though they are essential in developing specific and effective services. This article will present two studies, one with youth and another with professionals. To assess needs from the standpoint of youth, four focus groups were held with youth in residential care (n = 21). To identify needs profiles of youth from the standpoint of professionals, 47 professionals evaluated a sample of youth in residential care (n = 110) using the RCYNA questionnaire. The results of the study with youth point to needs in three main areas: living situation, social and family relationships, and education. The results of the study with professionals reveal three needs profiles with distinct risk levels: low risk, without emerging needs; intermediate risk, with needs in terms of the economic and living situation; and high risk, with needs in terms of relationships, behavioural, psychological and emotional skills, and education and employment.     

Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Connecting the Dots: Stages of Implementation,Wraparound Fidelity and Youth Outcomes

Several necessary system and organizational support conditions for wraparound have been identified (Walker et al. 2003). Yet, the relationship between these necessary system level conditions and wraparound fidelity has only recently begun to be examined. Similarly, few studies have included a measure of wraparound fidelity when examining the relationship between wraparound implementation and youth outcomes. The statewide implementation of a wraparound demonstration grant offers the opportunity to explore these relationships and to identify factors that predict improvement in functioning for youth receiving wraparound. Findings suggest that significant relationships exist between (1) the stage of development of necessary support conditions for wraparound and wraparound fidelity and (2) wraparound fidelity and improvement in youth outcomes. Specific elements of wraparound (i.e., outcomes based and community based) and baseline needs and strengths (e.g., high levels of anxiety and conduct issues, poor functioning at home and in school, judgment, and risks) were found to predict a reduction in youth needs. Other unexpected relationships between youth outcomes and the cultural competence element of wraparound and being multi-racial were also discovered. These findings reinforce the importance of supporting high fidelity wraparound for youth and their families in a recovery focused behavioral health system.     

A Clinical Model in Action in Intensive Residential Treatment: Meeting the Needs of Adolescent Boys who have Experienced Domestic Violence

The Habitat Program at Wood’s Homes, Calgary, Alberta, is an eight bed residential treatment program for conduct-disordered youth who have been exposed or subjected to high levels of violence in their family home. The program was based on the assumption that working effectively with such youth requires consideration of the background experiences of family violence, yet traditional treatment models often ignore or minimize the importance of these experiences. We present a clinical model which incorporates aspects of milieu treatment, relationship-based daily interventions and elements of Jenkins’ invitational approach to working with men and boys who use violence as well as Wade’s response-based approach to counseling with victims and perpetrators of violence. The model also incorporates ideas based on Maruna’s research into recidivism and excuse-making. The purpose of the model is twofold: to be broad enough to structure an overall treatment strategy based on the assumption that successful treatment results from the cumulative effect of many interactions over time, and to be specific enough to guide staff in developing strategies for specific situations that typically arise in daily interaction with the youth. We use a case example format to illustrate how staff has utilized the model to engage youth in exploring both their experiences of violence in the family home and in developing new ways of thinking and talking about behavioural choices.     

Favourable Employment Status Change and Psychological Depression: A Two‐year Follow‐up Analysis of the National Longitudinal Survey of Youth

This study examines the relationship between favourable employment change and well‐being. Using the National Longitudinal Survey of Youth, respondents who were inadequately employed (i.e. unemployed or underemployed, N = 1,160) in 1992 were followed up in 1994. Results suggest that among the unemployed in 1992 (time‐1), higher depression at time‐1 was significantly associated with decreased odds of both adequate employment and underemployment relative to unemployment at time‐2 (1994). Among the underemployed at time‐1, gender moderated the relationship between time‐1 depression and employment at time‐2. The odds of employment (both adequate and underemployment) were higher for males than females at lower levels of depression, but this gender advantage fell as depression increased. Additional analyses revealed that any employment at time‐2 relative to unemployment was significantly associated with lower depression in 1994 when controlling for time‐1 depression and other important background variables. Neither time‐1 status (unemployment versus underemployment) nor type of time‐2 employment (adequate versus underemployment) were significantly associated with later depression.     

Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT psychotherapy initially. Although effective, symptom remission with medication alone is rare (e.g., only 21.4% of youth achieved remission with sertraline in the Pediatric OCD Treatment Study, 2004) and residual symptoms often remain (e.g., 58% of subjects in the March et al. [1998] sertraline trial were not considered treatment responders). This paper reviews the literature on the efficacy of CBT for pediatric OCD, particularly as it relates to the treatment of youth with prior inadequate response to medication. It also describes an intensive, family-based CBT program for children and adolescents with OCD and support for its efficacy among those with prior partial- or nonresponse to medication. Finally, we present a case study of an adolescent girl with OCD who participated in the intensive treatment program after having limited benefit from medication and non-CBT psychotherapy and experienced a favorable response.     

Children and Careers: A Longitudinal Study of the Impact of Young Children on Critical Career Outcomes of MBAs

The purpose of this study was to investigate theimpact of young children on the careers of men and womenwith MBAs who graduated between the years of 1973 and1982. The outcome variables studied were salary, months of non-full-time employment, andpromotions. We began our analyses by looking at the fullsample of 829 respondents. We found that men had highersalaries than women regardless of parental status. Women with young children experiencedsignificantly more months of non-full-time employmentand were more likely to drop out of the workforce thanmen and other groups of women. The spouses of men with young children and only older children workedin paid employment significantly fewer hours than allother groups of respondents. Those women with youngchildren who did remain continuously in the paidworkforce did not appear to experience any salary benefitbased on this decision. Interruptions to full-time workwere detrimental for women without children or thosewomen whose children were older. In general, having children was correlated with lowersalaries for women and higher salaries formen.