Group Care Workers Research Articles

Adverse childhood experiences and residential care environment: The mediating role of trauma-related symptoms and psychological maladjustment in adolescents

BackgroundResearch has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects. ObjectiveTo analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment. Participants and settingThe sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12–18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain. MethodsThis study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions. ResultsDifferential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems. ConclusionsMental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs.

Family-Centeredness in Secure Residential Treatment and Its Relationship With Parental Involvement and Adolescent Behavioural Outcomes

Various Dutch secure residential youth care (SRYC) institutions are implementing a family-centered approach aiming to increase parental involvement and improve treatment outcomes. However, it remains unclear if and how family-centeredness (FC) is related to increased parental involvement and to improved treatment outcomes of adolescents. In this study, we unravelled the relation between FC, parental involvement, and behaviour problems of adolescents in SRYC. Families of 404 adolescents admitted to one of seven participating Dutch SRYC institutions completed a survey (at the start, at the end, and at 6-months follow-up) on problem behaviour of adolescents. In addition, 411 group care workers filled out a questionnaire about their residential group’s level of FC every 6 months. Moreover, the mentor of each adolescent filled out a questionnaire about the level of parental involvement. We analysed the data using multiple mediator models. Associations were found between FC and parental involvement. However, no relation was found between FC and adolescent problem behaviour, and no mediation and no moderation effects of parental involvement were found. Overall, results showed that most parents were involved during the residential stay, and, independent of FC, adolescent problem behaviour decreased over time. Implementing FC in SRYC institutions seems to be helpful in involving parents during the residential stay, but was not found to be associated with adolescent behavioural outcomes. Our results indicate that institutions could improve their level of FC by offering more informal contact moments for parents and by addressing barriers to FC among residential staff.

Individualized behavioral change of externalizing and internalizing problems and predicting factors in residential youth care.

The present study examined individualized behavioral change of externalizing and internalizing problems of adolescents in residential youth care, divided into different change groups (improvement, no change, or deterioration), by using the reliable change index. We also identified demographic and clinical factors that may predict individual behavioral change. A naturalistic dataset was used which consisted of adolescents referred to open or compulsory residential care who had outcome measures at the beginning and end of treatment. In total 742 reports of behavior problems were included: the sample consists of 265 adolescents with self-reports, 341 adolescents with group care worker reports, and 136 adolescents with parent reports. Only 42 adolescents had three sources of report, 202 adolescents had two sources of report, and 212 adolescents had one source of report. The majority of adolescents (50-73%) showed nonsignificant change in either externalizing or internalizing problems during their stay in residential care, regardless of informant. Higher problem severity at the beginning of treatment was a significant predictor of improvement in externalizing and internalizing problems throughout treatment, but the other factors (i.e., age, gender, ethnicity, and treatment duration) showed no effect. In conclusion, this study shows that with the current system of monitoring, more than half of the adolescents in residential care do not show significant change over time. This may indicate either that residential stay does not necessarily cause a significant change in problems for all adolescents, or that the system currently used for treatment monitoring is suboptimal in detecting such a change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Feeling Better: Experiences and Needs of Adolescents and Professionals Regarding Their Mentoring Relationship in Residential Youth Care

BackgroundIn residential youth care, group care workers and teachers often serve as a mentor for individual adolescents. Although favorable mentoring relationships are associated with positive adolescent outcomes, few studies examined the role of mentoring in residential youth care.ObjectiveThe present study aims to assess adolescents’, care workers’ and teachers’ mentoring relationship needs in terms of their one-on-one conversations during residential care.MethodsWe conducted structured interviews with eleven adolescents, ten group care workers and two teachers and content analysis to assess the dataResultsAll respondents are rather satisfied with their conversations, which are often concerned with how the adolescent is doing. Adolescents mostly consider their family and home-situation as difficult topics, while care workers mostly consider sexuality as a difficult topic to talk about. Although ‘improvement’ with the youth is often the aim, most adolescents report that they do not (know if they) show changes because of these conversations. Moreover, only one of the twelve professionals thinks that it is his core task to achieve behavior change with the adolescents. According to the professionals, conversations often aim at building a good relationship, coaching, determining treatment goals, and gaining insight into the adolescent. Adolescents prefer a mentor who is calm, has respect, listens, and is reluctant in giving advice. Most professionals do not use a specific method and doubt whether they want to have conversations according to a manual or support tool.ConclusionsDespite being rather satisfied, adolescents and professionals indicate several points for improvement of one-on-one conversations.

A Schema Therapy Based Milieu in Secure Residential Youth Care:Effects on Aggression, Group Climate, Repressive Staff Interventions, and Team Functioning

ABSTRACT Group care workers of residential youth care settings face the challenge of creating a warm and involved treatment climate against the demands and restrictions of the treatment setting. We tested the effects of SafePath, a milieu-based intervention based on Schema Therapy principles, during the first year of implementation on two secure residential treatment units compared to two control units. Staff’s daily reports on 139 individual patients were coded on use of schema mode language (implementation check), occurrences of aggression (primary outcome) and repressive staff interventions. In addition, repeated questionnaires were filled out by patients (n = 87) on group climate and by staff (n = 50) on team functioning. Compared to the control units, SafePath units showed higher improvements in group climate and repressive interventions. Both SafePath and control units showed decreased aggression over time. Team functioning was consistently better in the SafePath units compared to the care-as-usual units from baseline through 12 months. In conclusion, a Schema Therapy based milieu as implemented with SafePath may contribute to a warm and supportive group climate with less repressive interventions in secure residential youth care.

The Inside Out? Views of Young People, Parents, and Professionals Regarding Successful Secure Residential Care

Although adolescents often seem to improve in their functioning during residential care, there still is little knowledge on what factors are important in achieving these changes. The present study aims to identify the care factors that are important for adolescents’ behavior change during secure residential care. We conducted in-depth interviews with eight adolescents, their parents, eight group care workers and seven teachers concerning their in-care experiences. Both adolescents and parents commonly attributed changes during secure residential care to the treatment environment. Group care workers and teachers did not have a clear, consistent view on the treatment aspects causing positive change with the adolescents. According to the adolescents, good professionals apply a fine balance between rules and freedom, show empathy and are available for support. The view of parents corresponds to this image. Although group care workers are perceived as available for support, adolescents tend to make little use of this help if they experience personal problems during care. The results highlight the importance of responsiveness of secure residential care professionals to the needs and perspectives of adolescents and parents.

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns. MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained. ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation. ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.

Study protocol: a randomised controlled trial testing the effectiveness of 'Op Volle Kracht' in Dutch residential care.

BackgroundAlthough adolescents are often referred to residential treatment centres because of severe externalizing behaviours, a vast majority demonstrated comorbid symptoms of depression and anxiety. Covert internalizing symptoms in these adolescents might be easily unrecognized and therefore untreated. Adolescents with mild intellectual disability (MID) are overrepresented among youth with both externalizing and internalizing problems. There are yet few treatment programs available for adolescents with both externalizing and internalizing problems.Methods/designThe CBT-based resiliency program, Op Volle Kracht (OVK), which is based on the US Penn Resiliency Program (PRP), was adapted to suit the needs of adolescents with both externalizing and internalizing problems, either with or without MID, in Dutch residential treatment centres. The effectiveness of this group intervention program of eight sessions will be tested in a randomised controlled trial (RCT) with N = 182 adolescents aged 12–16, allocated to either the target intervention plus treatment as usual (OVK + TAU) or treatment as usual only (TAU). The main outcome variables include depressive symptoms (primary), anxiety, behavioural problems, and group therapeutic climate. Cognitive styles and coping styles will be included as possible mediators. Assessments take place at baseline (T1), one week before the start of the program (T2), immediately after the program (T3), and at three months follow-up (T4).DiscussionThe program assets include its wide implementation possibilities due to low costs, the short duration of the program and the delivery by group care workers, and its suitability for adolescents with MID. Further strengths of the present study design include its robust method (RCT), the ecological validity, and the inclusion of possible mediators of treatment effect. The program emphasizes individual risk factors for depression rather than social and family factors. Implications for practice and future research are discussed.Trial registrationDutch Trial Register NTR4836

Group care worker interventions and child problem behavior in residential youth care: Course and bidirectional associations

Group care workers in residential youth care are considered important in influencing behavioral development of children. In spite of this, their role has largely been neglected in research on residential care. The aim of the current study was twofold. First, longitudinal changes in group care worker interventions and child behaviors were investigated separately. Second, bidirectional influences between group care worker interventions and child behaviors were investigated. Group care workers completed the Group care worker Intervention Checklist and Child Behavior Checklist for128 children (66% boys, mean age 8.63years) at the beginning of the treatment and at two measurement intervals that followed (6 and 12months, respectively). Most results contradicted the predictions. There was no change in controlling and warm and supportive interventions by group care workers. Autonomy granting interventions increased during treatment. Second, there were no changes in externalizing and internalizing behaviors of children over time. Third, cross-lagged analyses revealed that higher levels of controlling interventions increased externalizing problems of children. In the opposite direction, higher levels of children's externalizing problems were associated with an increase in controlling interventions of group care workers. In addition, higher levels of children's internalizing problems were associated with lower subsequent levels of autonomy granting interventions. These significant longitudinal paths were found only for the first phase of treatment. This study emphasizes the potential of the role of group care workers in residential youth care. Residential institutions should be aware of the dynamics between group care workers and children. Training and ongoing supervision in effective responses to behavior problems can increase the effect of group care worker interventions on child behavioral changes.

Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

Background The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children.

Managing behaviour in child residential group care: unique tensions

AbstractResidential group care workers are frequently required to support children with extremely challenging and aggressive behaviour. Our knowledge about the tensions that may exist for workers that manage difficult behaviour is theoretically and empirically underdeveloped. The aim of this exploratory study was to contribute to our understanding of the dynamics of behaviour management in the residential environment by identifying the worker‐reported tensions involved in the management of challenging and disruptive behaviour. Seventeen South Australian residential group care workers participated in semi‐structured interviews in which they were asked to describe their management of behaviour. These interviews were subjected to thematic analysis. The analysis revealed several dynamics that influence workers' management of challenging behaviour: the sense of parenting at a distance, the pressure for consistency, the desire for balance between control and connection, the desire for normality and the inconsistent nature of relationships. These findings contribute to our knowledge about the interpersonal context in which behaviour is addressed in the residential group home and enhance our understanding of the unique tensions that workers' experience in managing behaviour in the residential environment. The findings have implications for the development of staff training and the support of residential care workers managing challenging behaviour.

A secure base? The adolescent–staff relationship in secure residential youth care

ABSTRACTThe client–therapist relationship is recognized as an important factor contributing to outcomes of child and youth care. Particularly in secure residential youth care, in which adolescents with mainly externalizing behaviour problems are often placed coercively, the client–staff relationship seems to be important for the achievement of positive outcomes. The present study aims to assess the client–staff relationship for a group of 135 adolescents in secure residential care and factors associated with a positive relationship. The results show that adolescents, group care workers and teachers experience a limited affective bond in their relationship 2 months after the adolescents were admitted to the secure care centre. Adolescents do tend to use care workers and teachers as a secure attachment figure, which suggests that an affective bond is no precondition for the adolescents to experience staff as a secure base. Main predictors of a good relationship are the positive treatment skills of both group care workers and teachers. These findings point to the need for training of care workers and teachers so that they are better prepared for working with these adolescents.

Measuring Group Care Worker Interventions in Residential Youth Care

By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. In this study, a questionnaire called the Group care worker Intervention Checklist was developed. Group care workers completed the questionnaires for 212 children placed in youth residential care in the Netherlands. Factor analyses revealed three constructs: controlling, warmth/support, and autonomy granting. Reliability of these scales proved to be good. Controlling was associated with Externalizing Behavior Problems while both Warmth/Support and Autonomy Granting were associated with Internalizing Behavior Problems. These findings imply that group care worker interventions can be reliably measured and are related to child problem behavior.

Securing the Downside Up: Client and Care Factors Associated with Outcomes of Secure Residential Youth Care.

BackgroundAlthough secure residential care has the potential of reducing young people’s behavioral problems, it is often difficult to achieve positive outcomes. Research suggests that there are several common success factors of treatment, of which the client’s motivation for treatment and the quality of the therapeutic relationship between clients and therapists might be especially relevant and important in the context of secure residential care.ObjectiveThe objective of the present study was to explore the association of these potential success factors with secure residential care outcomes.MethodsA repeated measures research design was applied in the study, including a group of adolescents in a secure residential care center that was followed up on three measurements in time. Interviews and questionnaires concerning care outcomes in terms of adolescents’ behavior change during care were administered to 22 adolescents and 27 group care workers. Outcomes in terms of adolescents’ treatment satisfaction were assessed by the use of questionnaires, which were completed by 51 adolescents.ResultsAdolescents reported some positive changes in their treatment motivation, but those who were more likely to be motivated at admission were also more likely to deteriorate in treatment motivation from admission to departure. Treatment satisfaction was associated with better treatment motivation at admission and with a positive adolescent-group care worker relationship.ConclusionsThe results suggest that outcomes can be improved by a more explicit treatment focus on improving the adolescent’s treatment motivation and the quality of the adolescent-care worker relationship during secure residential care.

Group Care Worker Behavior and Adolescents' Internalizing and Externalizing Problems in Compulsory Residential Care

In the present study, group care workers' behavior toward adolescents' problem behavior was measured. The sample consisted of 126 adolescents (M age = 15.80, SD = 1.23, 56% boys), residing in a new Dutch compulsory residential treatment program. Latent growth curve analyses revealed that group care workers exerted more structuring and controlling behavior toward adolescents with externalizing problems and more warmth and support toward adolescents with internalizing problems. No associations were found between group care workers' behavior and the adolescents' treatment progress. Clinical implications of these findings and suggestions for future research are discussed.

Compulsory residential care: An examination of treatment improvement of individual and family functioning

The aim of the present study was to examine the treatment progress of both adolescent's and their families' functioning in a new compulsory residential treatment program. The sample consisted of 339 admitted adolescents (56.3% boys). The mean age at time of entry was 15.69 ( SD = 1.30). Adolescents stayed on average 9.42 months ( SD = 4.66) in a new residential treatment program. Data on adolescents' internalizing and externalizing problems were assessed using self-reports, parent reports, and group care worker reports. In addition, adolescents reported their substance use and delinquency and parents also reported family functioning and level of perceived parental stress. The findings revealed a significant decrease in adolescents' self-reported internalizing and externalizing problems, delinquency, and substance use. According to parent ratings, a significant improvement was found concerning adolescents' problem behaviors during treatment. However, according care worker ratings, adolescents showed no improvement on internalizing problems and showed an increase in externalizing problems. Concerning families, although there was no improvement in family functioning, parental stress significantly improved over time. Further research should examine whether improvements experienced during treatment are maintained after treatment.

The role of acquaintanceship in the perception of child behaviour problems

The role of acquaintanceship with the child on reports of child behaviour by different informants was examined within the framework of a general theory of personality judgment. Mothers of referred children and group-care workers rated videotaped behaviour samples of a well known and an unknown child in the clinic. Independent observers also rated the videotapes. In line with the acquaintanceship hypothesis, mothers were found to perceive more behaviour problems than independent observers when rating well known children but not unknown children. Contrary to the acquaintanceship hypothesis, however, the group-care workers in our study reported more behaviour problems than the other informants regardless of their acquaintance with the children. The clinical and methodological implications of these findings are discussed.

Tasks and skills in youth with problem behaviour. Development of a questionnaire

Although in treating adolescents with problem behaviour emphasis is placed on teaching skills of immediate relevance to everyday prosocial functioning, instruments for assessing these skills have been lacking. This article describes the development and preliminary validation of an instrument that enables group care workers to assess skilful behaviour in adolescents in residential treatment facilities: the Adolescents' Tasks and Skills Questionnaire (TASQ). TASQ was constructed using data on 567 adolescents in Dutch residential treatment facilities. TASQ's 29 scales provide insight into specific skills and comprise six wide-ranging competency dimensions. Internal consistency is satisfactory and the preliminary validation study yielded promising results.

Attachment and problem behavior of adolescents during residential treatment

Attachment theory suggests that representations of previous attachment experiences may explain differences in psychosocial functioning. However, the nature of the association in clinical populations is unclear. Attachment representations were classified on the basis of Adult Attachment Interviews with 61 adolescents (13–20 years old; 70% female) admitted to a residential treatment institution. Group care workers rated their problem behavior. Compared to dismissing and autonomous adolescents and adolescents unresolved/disorganized with respect to trauma, adolescents with preoccupied attachment representations showed the highest levels of truancy and rule breaking, according to the institution's records, and externalizing behaviour, according to the group care workers. Unresolved/disorganized adolescents displayed lower levels of violence to staff than dismissing and autonomous adolescents. The effectiveness of residential treatment might be enhanced by taking account of the attachment strategies with which adolescents enter institutions.

The Impact of the Big Five Personality Traits on Reports of Child Behavior Problems by Different Informants

The present study compared ratings of a standardized sample of child behavior problems across informants and examined the effects of informant personality traits on child behavior ratings by mothers, teachers, and group-care workers. Participants were 55 clinic-referred children, aged 6-12 years. All informants watched and rated the same 17-min videotaped behavior sample of a familiar target child. Independent trained observers rated the same videotapes to provide criterion ratings. Informants' personality traits were assessed using the NEO Five Factor Personality Inventory. Results showed that mothers reported fewer behavior problems than did the professionals, that the informants who were familiar with the child reported more behavior problems than did the independent observers, and that higher levels of informant neuroticism were related to higher ratings of child behavior problems in the case of the professionals, but not in the case of the mothers. In addition, group-care workers who were less extraverted and open were likely to report more child behavior problems than group-care workers with normal levels of extraversion and openness. Finally, no relations were found between agreeableness or conscientiousness and ratings of child behavior. Findings suggest that professionals who work with children are not immune to distortions based on their own personality.