Youth with Oppositional Defiant Disorder at Entry into Home-Based Treatment,Foster Care,and Residential Treatment

We explored and compared rates of youth diagnosed with oppositional defiant disorder (ODD) at entry into three broad program types, home-based care, foster care, and residential care. We also explored factors other than an ODD diagnosis that could be associated with program placement, and compared the presence of these factors in youth with and without an ODD diagnosis. Analyses were conducted using data from an ongoing, private-agency led, outcome measurement project. Programs were grouped into low (home-based), moderate (foster), or high (residential) categories, based upon levels of supervision and structure provided. A sample of 9,564 youth admitted into care between years 2005 and 2007 was used. Results suggested the following rates of ODD: 14.2 % overall; 7.9 % for low level programs; 5.3 % for moderate level programs; 21.1 % for high level programs. Rates were significantly different by program level (p ≤ 0.001). Sixty of 65 additional risk factors were also significantly associated with placement by level of program. No risk factors were unique to youth with ODD. Of the significant factors for youth with ODD, 4 were particularly strong: Classification as a child in need of services (CHINS), history of neglect, verbal aggression, and truancy. Youth classified as CHINS and with substantiated or suspected neglect were more likely placed into a moderate level program. Youth with verbal aggression or truancy were more likely placed into a high level program. Results suggested many factors are considered at program entry. Given the potential for poor prognosis and social costs of ODD, results support an individualized approach to placement determinations, with increased attention to symptoms of ODD and associated features at program entry.