Children In Residential Treatment Research Articles

National Seclusion and Restraint Trends within Child Residential Treatment Facilities: 2010-2020 in Review.

This study aimed to estimate the percentage of child RTCs utilizing seclusion and restraint (S/R) practices and examine predictors associated with increased likelihood of S/R use between 2010 and 2020. A secondary analysis of the National Mental Health Services Survey was conducted (n-range = 580-781). Facility-level client demographics and facility characteristics were examined using multi-level logistic regression. One-way ANOVA indicated that the percentage of child RTCs using S/R significantly decreased between 2010 and 2020 [F(4, 58074) = 75.62, p <.001]. A post-hoc Bonferroni test found that the percentage of facilities reporting the use of SR in 2010 was significantly higher than in 2014, 2016, 2018, and 2020 (all p <.001). Multi-level logistic regression analysis found that facility-level client demographics (percent male, white, and involuntarily committed) did not significantly predict facility use of SR in 2010, 2014, or 2016. However, facility-level characteristics of SED program (all p <.01), use of psychotropic medication (all p <.001), and facility size as measured by number of mental health beds (all p <.01) consistently predicted usage of SR in 2010 [F(11) = 68.38, p <.001], 2014 [F(12) = 74.25, p <.001], and 2016 [F(12) = 74.48, p <.001]. Facility ownership and accepting Medicare payments did not significantly predict facility usage of SR. Use of SR within child RTCs significantly declined between 2010 and 2020. Larger facilities, facilities with an SED program, and facilities that used psychotropic medications with clients were more likely to use SR practices between 2010 and 2016. More high-quality, publicly available data for monitoring S/R use in mental health services within the United States is needed.

“I Thought That We Could Nurture the Nature Out of Our Son”: Making Meaning of Parenting in the Narratives of Parents of Children in Residential Treatment

ABSTRACT Enrolling a child in residential treatment for behavioral or emotional disorders is often considered a last resort for parents and can be accompanied by feelings of desperation and failure. Coupled with social discourse inexorably linking parenting with mental health outcomes, parents might experience stigma as they seek support for themselves and their children. Thus, this study implements relational dialectics theory to explore the meaning of parenting from the perspective of parents who have enrolled a child in a residential treatment program. Contrapuntal analysis of six interviews revealed two discourses competing to make meaning of parenting, the Discourse of Demanding Parenting Ideals (DDPI), consisting of two themes: relentless sacrifice and complete responsibility, whereas themes of boundary-setting and acceptance compose the Discourse of Realistic Best Effort (DRBE). Discursive interplay between these discourses occurred in the forms of diachronic separation, synchronic interplay, and discursive transformation to make meaning of parenting.

A qualitative study on the implementation of a transdiagnostic cognitive behavioral therapy for children in a child welfare residential treatment program

BackgroundYouth with severe emotional or behavioral issues who are involved with child welfare authorities are sometimes placed in intensive care services in a residential treatment program. Evidence-based psychotherapies are often used in residential treatments, but there is very little research on how to adapt psychotherapy for residential treatment. ObjectiveTo describe the implementation of a transdiagnostic cognitive behavioral therapy (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children) in a residential treatment program for children. Participants and settingStaff (n = 20) at a residential facility in Calgary, Canada. MethodsA combination of qualitative interviews and focus groups were conducted before and after therapy to identify barriers and facilitators to implementation. Data were analyzed and reported using the Consolidated Framework for Implementation Research and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. ResultsModifications were made to the program including creating inclusive language, integrating relevant content targeting pediatric irritability, delivering sessions online for caregivers, and using additional staff to support youth to learn and practice the application of the content and behavioral interventions. Key barriers to implementation of the Unified Protocol included staff turnover and the difficulty of sustaining a critical mass of knowledge surrounding the Unified Protocol. The major facilitators to implementation were the perceived quality of the program and advantages of the program to children and their caregivers. ConclusionsThis study supports the feasibility and acceptability of providing transdiagnostic cognitive behavioral therapies for children in residential treatment and provides a template for how to implement evidence-based practice in residential treatment.

72.2 EVIDENCE-BASED TREATMENTS IN RESIDENTIAL CARE

There is a dearth of studies looking specifically at what works in the treatment of aggression in residential care settings. To address this shortcoming, a literature review was performed to identify evidence-based and best practices in the treatment of aggression specific to residential settings. Because aggression is not a diagnosis and most studies are designed to evaluate the treatment of specific conditions, the search included PubMed and PsycINFO databases using the following medical subject heading (MeSH) terms in order to identify potential studies for inclusion: aggression, residential, child and adolescent, management, prevent, externalizing, disruptive, bipolar, attention deficit, and impuls*. In addition to database searches and to maximize a focus on residential settings, a specific search was conducted of the Taylor & Francis publishing database to access articles in the Association of Children’s Residential Centers (ACRC) journal, Residential Treatment for Children & Youth. Finally, references of all papers that were found via the search were reviewed for additional citations. Reasons for exclusion included the following: not specific to children or adolescents, not using a specific intervention to treat aggression, and/or not in a residential setting. Only English language papers were included, although a number of studies were conducted in international residential care settings. Although many papers addressed the Six Core Strategies developed by the National Association of State Mental Health Program Directors (NASMHPD), there is a developing evidence base for specific interventions designed to treat aggression in residential care settings. Aggression is often a main reason for referral to residential care settings. Given the limited evidence-based interventions for the treatment of aggression in residential care settings, aggression is a diagnostic entity that deserves further study in the human services literature.

Parenting a Child in Residential Treatment: Mother’s Perceptions of Programming Needs

The purpose of this study was to describe the experiences and perspectives of mothers with children in residential treatment (RT) regarding parenting, discharge planning, and home-based safety. One-hour interviews were conducted over the phone with 15 mothers. Transcripts were analyzed using a content analysis approach. Three themes were generated including parenting a child in RT, unprepared for discharge, and crisis intervention in the home. This study contributes insight into the lives of an underserved population with implications to inform future research interventions and clinical guidelines to address the needs of families with children in RT.

A Consensus Statement About Therapeutic Residential Care for Children and Youth - Residential Treatment for Children and Youth (2016), 33, 2, 89–106. Publisher: Taylor and Francis.

In April 2016, an international work group on therapeutic residential care (TRC) met at Loughborough University in England (see Appendix A for the list of 32 participants from 11 countries). The purpose was to plan and endorse a definition of TRC, to develop key principles stemming from that definition and to promote a consensus statement about TRC that had international standing. Given the current world-wide discussion about TRC and its place in the continuum of child welfare services this was an important goal.

When Love is Not Enough: Parenting an Adopted Child with Mental Illness

This article presents the results of a qualitative study designed to explore the experiences of adoptive parents who placed an adopted child with mental illness in a residential treatment center (RTC). Twenty-four adoptive families from across the United States who placed an adopted child in residential treatment were interviewed. The adopted children represented various types of adoption including public child welfare, domestic infant, and intercountry adoption. Parents reported feeling victimized by their child and by the very systems designed to help them, including child welfare, mental health, health care, and education. The findings reveal signs of trauma in the adoptive parents as a result of their experiences. The article concludes with recommendations from adoptive parents for adoption, mental health, and residential treatment professionals who work with adopted children and their families.

Facilitators and barriers to interagency collaboration in mother–child residential substance abuse treatment programs

Interagency collaboration is imperative to address the multiple and co-occurring needs of youth and families impacted by substance abuse. Mother–child residential treatment programs represent a unique program model where success often hinges on collaboration between substance abuse agencies and a range of other service providers. Little is known, however, about the facilitators and barriers to implementing these service programs. The purpose of this qualitative study was to uncover these program influences within six mother–child residential treatment programs in one southeastern state and identify whether there were differences in these influences based on the developmental stage of the collaborative. Interviews were conducted with 26 stakeholders from substance abuse agencies and their community partners. Field notes also were captured at each site. All qualitative data were analyzed using open, axial, and selective coding methods. Three overarching themes represented by both facilitators and barriers emerged, including 1) Clarity, Credibility, & Support for the Model (e.g., success stories, stakeholder support), 2) Continuity of Care across Agencies (e.g., interagency communication, disciplinary service silos), and 3) Knowledge and Processes for Collaborative Work (e.g., commitment to client population, need for training, sustainable practices). These influences on interagency collaboration were found to vary based on developmental stage of the collaborative. Implications and recommendations for child and family service practitioners, policymakers, and researchers are discussed relative to maximizing the positive impact of mother–child residential treatment programs for children and families.

Measuring Therapeutic Alliance With Children in Residential Treatment and Therapeutic Day Care

Purpose: This study examined the construct validity and reliability of a therapeutic alliance measure (Children’s Alliance Questionnaire [CAQ]) for children with psychosocial and/or behavioral problems, receiving therapeutic residential care or day care in the Netherlands. Methods: Confirmatory factor analysis of a one-factor model “therapeutic alliance” was conducted on two samples of 115 and 116 children, aged 4–14 years. Reliability analysis and concurrent validity were examined. Results: Results showed a good fit to the data, indicating construct validity of the measures. Cronbach’s α reliability coefficients were good for both alliance measures. Concurrent validity was supported by significant relations between the alliance scale and positive group climate (Group Climate Instrument for Children [GCIC]) and treatment motivation (Adolescent Treatment Motivation Questionnaire). No correlations with negative group climate (GCIC) were found. Discussion: The CAQ can be used as an assessment tool for therapeutic alliance within both residential treatment and therapeutic day care settings for children.

Deliberate Self-harm Among Children in Tertiary Care Residential Treatment: Prevalence and Correlates

BACKGROUND: Few studies have examined deliberate self-harm (DSH) among children in residential treatment in Canada. Most of the existing studies examined adolescent students or children from pediatric emergency departments. OBJECTIVES: The objectives of this study were to examine the prevalence of DSH among children in tertiary care residential treatment and the factors associated with DSH. METHODS: Data on 284 children aged 5-17 years (M = 11.54 years, SD = 2.56) with mental health problems in tertiary care residential treatment were analyzed. Binary logistic regression was performed to examine the likelihood of engaging in DSH. RESULTS: About 35 % of children engaged in DSH. Suicidal talk emerged as the strongest factor to be associated with DSH. Children who used alcohol or drugs were also more likely to engage in DSH than those who did not use alcohol or drugs. Furthermore, symptoms of conduct problems were associated with the likelihood of engaging in DSH. CONCLUSIONS: Identifying children at risk for engaging in DSH and suicidal behavior is of critical importance to mental health care providers. These factors could assist in identifying children who might require more specialized treatment related to self-harm during their stay in residential treatment. Language: en

Visit Consistency and Functioning Among Foster Children in Residential Treatment

Residential treatment centers often serve the most troubled foster children. During treatment, visits by caring adults may enhance foster children's emotional and behavioral functioning through social support and role modeling. However, there has not been enough research on the impact of consistency of visits and possible gender differences. This study analyzed data from a residential treatment center to examine the interaction effect of visit consistency and gender on foster children's improvement in functioning from intake to discharge. The sample included 77 foster children aged 6 to 13 years old. Results showed that visit consistency is associated with improvement in functioning for girls but not for boys. Girls who had consistent visitors only showed the greatest amount of improvement in functioning, followed by girls who had inconsistent visitors only and then by girls who had a mixture of consistent and inconsistent visitors. Difference in consistency between family and non-family visitors was observed, leading to practice and research implications.

Outcomes in Children's Residential Treatment Centers: A National Survey 2010

In 2010 the Research Committee for the American Association of Children's Residential Centers (AACRC) embarked upon a project to repeat the survey that was originally sent out in 1999, hoping to learn how agencies have adapted as well as what was new in the residential treatment environment. The committee was interested in population changes, length of stay, diagnosis, gender, and race, and whether there had been changes in sources of funding and services funded. The committee was particularly interested in the role of data collection and analysis, and how agencies use data to improve process and evaluate outcomes. The growth and sustainability of residential treatment as a viable service option may depend upon the field's willingness to track results, partner with families and the youth they serve, and to make themselves accountable to all stakeholders in the children's services system.

Predicting outcomes of children in residential treatment: A comparison of a decision support algorithm and a multidisciplinary team decision model

Residential treatment is the most intensive and costly component of all child welfare systems per episode of care. At the same time, decisions to place in residential treatment centers are prioritized by the practice of least restrictive setting and best interest for children. There are, however, no standard evidence-based criteria for placing children in residential treatment. Clinical judgment, staffing dynamics, and other system factors are part of the decision-making process. Thus, some residential placements may be unnecessary and may be even harmful. The present study compares two models of decision-making, a multidisciplinary team approach and an objective decision support algorithm, and assesses outcomes when the two models either concur or not. Concordant decisions predicted greater clinical improvement than discordant decisions, but no differences were found in length of stay in placement. Policy implications for the decision-making process in child welfare are discussed.

Engaging Families in the Residential Treatment Process Utilizing Family-Directed Structural Therapy

This article summarizes qualitative and quantitative literature specific to family involvement in children's residential treatment, highlighting the lack of specific types or methods of family therapy/interventions that might provide efficacious outcomes with this population. An overview of Family-Directed Structural Therapy (FDST) and corresponding assessment tools is presented, offering a means by which to begin to address this gap in the literature and practice knowledge. Finally, an interview with the Executive Director of a residential treatment facility successfully implementing FDST is summarized.

Adult visitation and permanency for children following residential treatment

The absence of parents for foster children in residential treatment undermines the known positive effects of parental visits during treatment on children's permanency. To date, little attention has been given to the scope and role of visitation by non-parental adults. This study utilized clinical data from a residential treatment center for children to examine the patterns of adult visitation during treatment and their effects on children's permanency at and 6 months following discharge. Different types of relationships including parents, extended family and non-family adults, and various measures of visitation, such as frequency and regularity of visits, were included in descriptive and logistic regression analyses. Results showed that while children had the most number of visits from parents compared to other visitors, non-family visitors were just as likely to visit regularly. Logistic regression analysis indicated that having parent visitors only as opposed to having parents and other visitors was positively associated with permanency at and 6 months after discharge. In addition, controlling for composition of visitors and age at discharge, more visits by non-family increased the likelihood of permanency. Implications for practice and theory are discussed.

A Descriptive Study on Sexually Exploited Children in Residential Treatment

Sexual exploitation and prostitution of children and adolescents is a multibillion dollar industry in the United States (Estes and Weiner in Medical, legal & social science aspects of child sexual exploitation: A comprehensive review of pornography, prostitution, and internet crimes, vol I, G.W. Medical Publishing, Inc, St Louis, 2005; Milloy in Essence 33(5):429–436, 2002). It is estimated that 293,000 youth are at-risk of being commercially sexual exploited (Estes and Weiner in The commercial sexual exploitation of children in the U. S., Canada and Mexico, The University of Pennsylvania, Philadelphia, 2001). Courtrooms in major cities around the country are reporting an increase of juveniles who are prostituted and of the individuals who prostitute them. Issues such as negative family dynamics, poor parenting skills, lower intellectual functioning, poor school success, inadequate social skills, and abuse and neglect are risk factors associated with juvenile prostitutes. This descriptive study focused on a unique group home treatment program in a large southern city for adolescent females with a history of juvenile prostitution. The authors found that the participants had low IQ scores and multiple mental health disorders. Implications for intervention and treatment are discussed.

Redefining Residential: Becoming Family-Driven

This paper represents current thinking of the American Association of Children's Residential Centers (AACRC) regarding the importance of family-driven care for youth placed in congregate facilities. AACRC is the longest standing national association focused on the needs of children in residential treatment and their families.

Redefining Residential: Family-Driven Care in Residential Treatment—Family Members Speak

This is the sixth in a series of papers issued by the American Association of Children's Residential Centers (AACRC) regarding emerging and best practices in the field of residential treatment for children, youth, and families. AACRC is a long standing national association focused exclusively on practice and policy issues related to the provision of residential treatment. The “Redefining Residential” series is an effort by the Association to stimulate dialogue that can lead to more effective use of this critical and specialized resource in communities around the country.

Predictors of Burnout in Children's Residential Treatment Center Staff

SUMMARY 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.

Assessment of Violence Exposure Among Residential Children and Adolescents

SUMMARY Childhood victimization is an important factor in assessing children in residential treatment. These children often have extensive histories of abuse and neglect, and are of high risk for violence exposure in their schools and neighborhoods. This article describes the concept of exposure to community violence, and its importance in assessing and treating children/adolescents in residential treatment settings. The Recent Exposure to Violence Scale (REVS) is presented and its psychometric properties and usefulness in residential treatment settings are elaborated.