Community-based Residential Programs Research Articles

A - 43 Examining the Utility of the Adaptive Behavior Scale-3rd Edition (ABAS-3) in Capturing Age-Related Changes in Daily Functioning for Neurodiverse Populations.

Current guidance for the assessment of cognitive decline for mild cognitive impairment or dementia lacks sufficient information for assessing neurodiverse populations (Janicki et. al, 2022), and standardized scores often have floor effects. This study investigated the utility of the Adaptive Behavior Scale-3rd Edition (ABAS-3) in characterizing age-related changes in daily functioning for individuals with autism and other intellectual and developmental disability (I/DD). Participants (20-76years old) resided in community-based residential programs (CBRPs) for individuals with I/DD. Aim 1 examined mean ABAS-3 raw scores for participants with at least 1 ABAS-3 (N = 171, autism n = 115, other I/DD n = 56). Aim 2 examined changes in ABAS-3 raw scores over 2years (N = 61, autism n = 37, other I/DD n = 24). ABAS-3 scales included "home-living" (HL), "self-care" (SC) and "health and safety" (HS). Aim 1 indicated variability within and across diagnostic groups, with lower performance for autistic versus other I/DD participants (p < 0.001, large effect size across all subscales). Aim 2 found varying patterns of loss, gain, and stable scores across timepoints. HL (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%), SC (autism loss 29.7%, gain 16.2%, stable 54%; I/DD loss 12.5%, gain 33.3%, stable 54.2%), HS (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%). This proof-of-concept study demonstrates feasibility in characterizing ADLs of individuals with autism and I/DD living in CBRPs. Future research will assess distal ABAS-3 raw score changes to track cognitive decline in individuals with autism and other I/DD.

Developing a realist theory of community-based residential substance use treatment

Community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, which has been hypothesized to be due to the variability of program offerings across treatments. Therefore, the purpose of the present study was to develop a realist program theory of a community-based residential treatment centre to understand which components of treatment are most effective, who benefits from treatment, and why. The study was completed in collaboration with a community-based residential treatment program located in Canada. A realist evaluation was conducted using qualitative interviews (N = 27) with program stakeholders. Transcripts were analyzed using thematic analysis to identify Context-Mechanism-Outcome (CMO) configurations that create the program theory. The analysis identified an overarching organizational context and 11 CMO configurations that comprise the program theory. The CMOs were grouped into three themes (i.e. relational, psychological, and diversity), underscoring the multiple pathways in which recovery is achieved for individuals with SUDs. Across the themes, the importance of building peer recovery relationships, creating structure, and inter-agency collaborations were highlighted. The results of the present study offer a contribution to the literature in understanding how, why, and for whom community-based residential treatment for SUDs is effective while offering specific recommendations to best tailor treatments to individuals.

Clinical and Administrative Leadership in Community-Based Residential Programs

Oregon’s Public Mental Health System includes a continuum of small community- based residential programs offering mental health treatment and 24/7 personal care support for adults experiencing severe mental illness. A team of several mental health paraprofessionals working under the direction of the facility administrator and the Master level therapist strive to gently challenge residents to set personally meaningful goals, practice functional skills and slowly take charge of their lives in the community. The author asserts that the manner in which daily operational and behavioral challenges are resolved by the treatment team, affects residents’ lives not less than strictly therapeutic interventions. This paper has a twofold aim: 1) To characterize leadership, organization and staff communication as building blocks of the collaborative, person-centered and strength-based residential treatment; 2) To show how clinical and administrative processes must interplay to create a spirt of recovery and optimism in home-like community residential facilities.

“A scarlet letter”: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting

Background: Trust in health care has been shown to influence health care utilization, perceptions of fair treatment, and health outcomes in the general population. The literature on trust in health care in individuals with a history of substance use disorder (SUD) is more limited, primarily examining the patient-provider relationship. Women seeking substance abuse treatment in community-based programs have higher rates of prior trauma and health disparities compared with male counterparts and the general population. With higher rates of prior trauma, this population is theoretically at high risk of decreased interpersonal trust and altered interpersonal relationships. Objective: This study sought to identify factors influencing trust in the health care system for women seeking substance abuse treatment in a community-based residential treatment program. Methods: Six client focus groups (n = 30), 1 provider focus group (n = 7), and 2 individual clinical administrator interviews (n = 2) were conducted between November 2016 and August 2017. Focus groups and interviews were audio recorded and transcribed. Coding and coding reconciliation were conducted by 2 independent coders. Themes were extracted and analyzed from sorted and coded quotes. Results: Six themes emerged. Factors that influence trust in the health care system in this population include (1) prior experiences with diagnosis, treatment, and outcomes; (2) stigma of addiction; (3) payment and reimbursement structure; (4) patient rights and protections; (5) efficiency-driven care; and (6) the health care system's role in causing and/or enabling addiction. Conclusions: These themes demonstrate a general distrust of the health care system by women in this population. Distrust is influenced by a perception of a health care system providing care that is variable in quality, often stigmatizing, unaffordable, efficiency driven, and often influencing individuals’ SUD. This aligns with and extends prior literature around trust of health care in individuals with SUD. Future directions in research include formally assessing the impact of trust on health outcomes such as treatment entry and retention.

Computerized cognitive training is associated with improved psychosocial treatment engagement in schizophrenia

Poor treatment engagement is an enduring problem in the care of patients with schizophrenia. Evidence suggests that targeted cognitive training (TCT) improves cognition and functional outcomes, but this time-consuming intervention might reduce patients' engagement in other treatment activities when implemented in real-world settings. This is especially true of residential care programs which encourage patients to engage in group therapies, self-care, and a wide variety of structured social, work, and other rehabilitation activities. This study aimed to determine whether TCT negatively impacts engagement in other psychosocial treatments. Patients with schizophrenia were recruited from a community-based residential care program and randomized to one of two intervention arms: treatment as usual (TAU; n = 22) or TAU augmented with TCT (n = 24). Psychosocial treatment engagement was tracked over 20 weeks. Treatment groups did not significantly differ on baseline variables or psychosocial treatment engagement in the 5 weeks prior to randomization. TCT had a positive effect on engagement (β = 0.112, p = 0.003), but there was no treatment-by-time interaction (β = −0.029, p = 0.672). Participants in TCT engaged in an average of 1.34 additional group therapies, 0.58 additional activities of daily living, and 0.84 additional rehabilitation activities per week in comparison to TAU participants. Baseline cognition was also a significant predictor of psychosocial treatment engagement. Overall, results suggest that TCT can be implemented in real-world settings without negatively impacting engagement in other psychosocial treatments. Additional studies are needed to determine what role nonspecific factors play in the positive impact of TCT.

S202. EFFICACY OF LONG-TERM RESIDENTIAL TREATMENT FOR PERSISTENT MENTAL ILLNESS

BackgroundIn the United States, the number of public and private psychiatric hospital beds has steadily declined in recent years, despite the lack of intensive intermediate care alternatives in the community. The design and implementation of intensive residential treatment programs are not currently guided by controlled studies, but these studies are necessary to determine the clinical and economic utility of such programs. We present clinical and outcome data on an initial sample of patients treated over the last 5 years.MethodsNaturalistic, non-controlled assessment of symptomatic and functional outcome in an initial sample of young adults with persistent mental illnesses treated in a community-based residential program. Patients were treated with an individualized combination of modalities such as Illness Education and Management, Supported Employment, Individual, Group and Family Psychotherapies and Psychopharmacology. Standard clinical rating scales were used during the period of treatment and all discharged patients were contacted on an annual basis in order to complete a survey of clinical outcome.Results101 patients had been admitted and treated since the facility opened in October 2011. Median age of the patients was 25 years, mean illness duration was 12.6 years, and the mean number of prior hospitalizations was 6.5. Diagnostic distribution was: 36.7% psychotic disorders, 27.7% unipolar mood disorders, 19.8% bipolar mood disorders, 7.9% autism spectrum disorders, and 7.9% post-traumatic stress disorder or other anxiety conditions. 37% of residents met criteria for personality disorders, the majority of which was borderline personality disorder. 42% of residents also met criteria for a substance use disorder in the year prior to admission. Ratings on the Multnomah Community Ability Scale improved by 16%, ratings on the Brief Psychiatric Rating Scale declined by 20% and ratings on the Montgomery-Asberg Depression Rating Scale declined by 37%. The average survey response rate after discharge was 59%. With regard to community engagement: 40.3% of current residents and 35.1% of discharged residents were competitively employed. 16.7% of current residents and 17.8% of discharged residents worked as volunteers, and 23.3% of current residents and 26.3% of discharged residents were attending school. A survey of dispositions revealed that: 49.7% of discharged residents were living independently, 14.9% were living with family, 2.2% were homeless, and 5.4% had died from suicide. The hospitalization rate declined from 0.84/year to 0.57/year before and after discharge.DiscussionLong-term residential treatment for young adults with persistent mental illness results in improved symptomatic recovery, independent living, increased employment rates, and reduced hospitalizations.

Ethnicity, Ethnic Identity, and Adolescent Narcissism

The present study explored the influence of ethnicity and ethnic identity on adolescent narcissism, as well as the role of these variables in the link between narcissism and adolescent aggression. Participants were 348 at-risk adolescents (278 males, 70 females), ranging in age from 16 to 18 (M = 16.7 years; SD = 0.69 years) who were enrolled in a community-based residential program. Results revealed significant ethnic differences on narcissism, such that Black participants scored higher than White participants. Ethnic identity partially explained why ethnicity was associated with narcissism. Overall, the findings of this study speak to the importance of considering cultural context in narcissism, as well as other forms of self-perception. However, the limitations, particularly regarding the generalizability of these findings, are also discussed.

Predictors of Retention of Women Offenders in a Community-Based Residential Substance Abuse Treatment Program

Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in the high recidivism rates of women offenders (50–70% within one year). Understanding factors that enhance and deter women from retention in substance abuse treatment will facilitate tailored interventions to improve treatment outcomes. This prospective study examined the relationship of substance use characteristics, childhood trauma, current trauma-related symptoms, motivation to treatment, and socio-demographic characteristics, in predicting the retention of women offenders in an urban, residential substance abuse program as they re-enter the community from incarceration. All women were interviewed within the first week of admission to the residential program using the following measures: the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), and the Trauma Symptom Inventory (TSI), and socio-demographic characteristics. Length of stay was tra...

Evaluation of the House of Healing: An Alternative to Female Incarceration

The House of Healing (HOH) is a court-mandated, community-based residential program for female offenders. Women reside with their children at the HOH, which serves as a base from which to receive health/mental health care and substance abuse treatment while working toward successful community reintegration. An evaluation based on the records of 94 female offenders residing at the HOH for various time periods between 1998 and 2006 revealed a significant relationship between residents' reunification with their children and successful completion of the HOH program. Furthermore, there was a significant relationship between successful program completion and female offenders' recidivism.

Research Challenges: Implementing Standardized Outcome Measures in a Decentralized, Community-based Residential Treatment Program

With residential treatment services under pressure to produce outcome data, the process of executing research in such settings presents considerable challenges. This paper describes how a large, decentralized, community-based residential treatment program in southern and central Maine designed and implemented a research outcome process study using standardized measures on a variety of dimensions. The study’s rationale, process, challenges and findings are presented. Results indicated that the challenges to this work were minimized due to careful planning and collaboration by and with administration and treatment staff. Unique to this work was the process where a formal research approach was used in the context of a private, geographically diverse organization.

APA Tells Congress: End Medicare's Higher Copay for MH Treatment

APA Tells Congress: End Medicare's Higher Copay for MH Treatment

Outcomes in Community-Based Residential Treatment and Rehabilitation for Individuals with Psychiatric Disabilities: A Retrospective Study.

This study evaluated outcomes for participants of a community-based residential treatment and rehabilitation program. The study used repeated measures to retrospectively evaluate 25 individuals with severe psychiatric disabilities who completed a 1-year follow-up period after discharge from the program. Results indicated that following the program these individuals lived for significantly longer periods in the community in more independent settings and functioned at higher levels than in the 6 years prior to participation in the program. These positive outcomes suggest that residential treatment and rehabilitation may be an important consideration in the care of some individuals with severe psychiatric disabilities.

The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders

This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1-3) and longer-term (months 4-9) abstinence. Two-group randomized design. Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States. A total of 183 adolescents, ages 12-17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits. Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study

INCREASING THE EFFECTIVENESS OF CORRECTIONAL PROGRAMMING THROUGH THE RISK PRINCIPLE: IDENTIFYING OFFENDERS FOR RESIDENTIAL PLACEMENT*

Research Summary: This study analyzed data on 7,306 offenders placed in 1 of 53 community-based residential programs as part of their parole, post-release control, or probation. Offenders who successfully completed residential programming were compared with a group of offenders (n = 5801) under parole/post-release control who were not placed in residential programming. Analyses of program effectiveness were conducted, controlling for risk and a risk-by-group (treatment versus comparison) interaction term. Policy Implications: Significant and substantial differences in the effectiveness of programming were found on the basis of various risk levels. This research challenges the referral and acceptance policies and procedures of many states’ departments of corrections, local probation departments and courts, and social service agencies that provide offender services.

Pregnant, Substance-Abusing, and Incarcerated: Exploratory Study of a Comprehensive Approach to Treatment

Interventions addressing the multiple needs of incarcerated women are rare. In this study, several measures were used to assess functional changes among pregnant, substance-dependent, incarcerated women transferred to a community-based residential treatment program that allowed their infants to reside with them. Women engaged in comprehensive therapeutic and skill-building activities for 6 to 9 months. The program's goal was to assist women in childbirth and in the continuing relationship with their child while improving psychological and social functioning. Examination of changes were limited to those who completed treatment and all measures (n = 27). Although significant improvements were noted, nearly half were discharged with symptoms indicative of a depressive disorder. Assessment of long-term outcomes comparing this group with pregnant women who remained in prison is under way.

Health Officials Bringing Alzheimer’s Care Back Home

Health Officials Bringing Alzheimer’s Care Back Home

The Social Construction of Resilience Among "Problem" Youth in Out-of-Home Placement: A Study of Health-Enhancing Deviance

Case studies of 43 youth with experience in child welfare, mental health, and correctional settings examined how resilience is socially constructed by participants and their caregivers. The deviant behaviors of these youth are explained as ways they successfully cope with the risk factors they face. Placement in institutions and community-based residential programs offers to high-risk youth “forums” in which to create continuities or discontinuities in their identity stories. Getting placed, surviving inside, and going home are experienced by high-risk youth as opportunities to enhance their discursive empowerment in the social discourse which defines them as either vulnerable or resilient. Collaboration between service partners can have a negative or positive impact on the development of healthy identities in high-risk youth depending on whether care providers participate in the construction of problem-saturated or health-enhancing identities. Support for this understanding of healthy deviance can be found in a number of studies of high-risk adolescent populations.

Role of the Working Alliance in the Treatment of Delinquent Boys in Community-Based Programs

Examined the role of the working alliance in the treatment of delinquent boys in community-based residential programs, clarifying the relation between therapeutic process and behavioral change. Horvath and Greenberg's (1989) Working Alliance Inventory was used to assess the therapeutic alliance between youth and staff after 3 weeks in treatment and again after 3 months. Achenbach's (1991) Child Behavior Checklist (CBCL; Youth Self-Report [YSR] and Teacher Report Form [TRF]) and recidivism scores were used to assess treatment progress and outcome. Results indicated that a positive working alliance assessed after 3 months in treatment related to positive psychological changes and predicted lower rates of recidivism. Unexpectedly, a positive working alliance assessed early in treatment was associated with negative outcomes (increased internalizing and externalizing symptoms and higher rates of recidivism). This finding suggests that for some delinquent youth initially optimistic assessments may be prognostic of slow progress or treatment failure.

Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: A case control study

Objectives: To compare the outcomes of severely brain-injured individuals treated in a postacute residential rehabilitation program with a matched sample of individuals receiving limited services in their homes or on an outpatient basis. Design: Controlled study using a matched design in a before-and-after trial and a 1-year follow-up trial. Setting: A postacute community-based residential rehabilitation program or in the homes of patients. Patients and Other Participants: The treatment group included all persons admitted consecutively for rehabilitation to the postacute residential program over a 3-year period ( n = 23). All subjects had severe traumatic brain injury. The comparison group was selected from the roster of a support group on the basis of a systematic matching procedure. Matching variables included gender, age, length of coma, time since injury, and level of disability. Subjects of the two groups were matched on an individual basis. Main Outcome Measures: A functional assessment instrument (modified Health and Activity Limitations Survey [HAls]) and the Community Integration Questionnaire (CIQ). Results: Individuals with traumatic brain injury who received residential-based postacute rehabilitation displayed a statistically significant increase in functional abilities when compared with a traditional (home-based) service group. More specifically, treatment subjects showed significantly greater improvement in motor skills and cognitive abilities. Treatment subjects also showed greater improvement in community integration, although this may have been accounted for by initial group differences. Conclusions: Postacute rehabilitation appears to be effective in improving function for individuals with severe brain injury. Residential-based services appear to produce greater functional improvement, whereas home-based services are more effective at maintaining community integration.

Using a Social Guide to Improve Social Relationships of People with Severe Disabilities

Staff members of community-based residential programs serving individuals with intellectual disabilities often have difficulty helping participants develop social relationships with community members. A “social guide model” taught staff of an apartment-based residential program to use a set of “community network strategies” to improve the social relationships of three women with disabilities. Results demonstrated a functional relationship between staff members' use of the strategies under the supervision of the social guide model and increases in the size of participants' social networks and the frequency with which they experienced social integration. The intervention also was associated with a higher weekly rate of introduction of new network members and a higher rate of socially integrated activities per network member per week. Gains generally were maintained during a follow-up period, with a regular staff member assuming the role of social guide.