Abstract
Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite best efforts, effect sizes remain moderate, which may be due to the disregarding of internalizing symptoms – in particular anxiety - and to limitations regarding the delivery model of interventions. This initial randomized controlled trial (n = 37) aimed to examine the effectiveness of a biofeedback videogame intervention (Dojo) as an addition to treatment as usual for youths with and without intellectual disability (ID) in residential care with clinical levels of anxiety and externalizing problems. Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations. Youths were randomly assigned to play Dojo (eight 30-min gameplay sessions) or to treatment as usual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline, posttreatment, and 4-months follow-up through youths’ self-report and mentor-report. Completers-only analyses revealed decreases in self-reported anxiety and externalizing problems, and mentor-reported anxiety at posttreatment for participants in the Dojo condition compared to the control condition. Only mentor-reported anxiety was maintained at follow-up. No effect was found for mentor-reported externalizing problems. These findings provided preliminary evidence that Dojo is a promising, innovative intervention that engages high-risk youths. Practical implications are discussed.
Highlights
The most intensive form of interventions for youth is residential care, which is often seen as a last resort solution for youths who have not responded well to previous treatment programs
Significant interactions were reported for self-reported anxiety and externalizing problems at posttreatment, and mentorreported anxiety at both posttreatment and follow-up
The findings of this study suggest that Dojo is worth further evaluation as an intervention for short-term reductions in anxiety and externalizing problems among highrisk youths in residential care
Summary
The most intensive form of interventions for youth is residential care, which is often seen as a last resort solution for youths who have not responded well to previous treatment programs. Residential care is an out-of-home placement that typically provides 24-h care and offers mental health services with the Residential care has a twofold purpose: first, to provide a safe and structured living environment for the youths in their group homes within the institution, and second, to offer intensive treatment to target problem behavior. A meta-analysis on the effectiveness of residential treatment showed an average effect size of d = .36 in the reduction of behavior problems for residential care with evidence-based treatment compared to standard residential care (group home care without specific treatment; de Swart et al 2012). That meta-analysis highlights the importance of providing youths with treatment during their stay in the institution, but despite these promising outcomes, the average effect size of evidence-based treatment in residential care remains modest (Cohen 1988)
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