Psychiatric Residential Care Research Articles

Validation of the Client Satisfaction Scale for Youth in Residential Psychiatric Care

ABSTRACT Youth with severe mental and behavioral health symptoms often require high levels of care, such as residential placement. Given the acuity of the residential population, the high cost of services, and the separation of children from their families, remarkably little research exists on engagement, mechanisms, and outcomes. Treatment satisfaction is a critical process and outcome indicator but is not always assessed in residential care. When satisfaction is assessed, the quality of the assessment tools varies and is rarely assessed as part of treatment progress, so little is known about how and if it might change during treatment. This study aimed to examine the psychometric properties of the newly developed Client Satisfaction Scale (CSS) for youth in residential psychiatric care. The CSS was administered to all patients in the current study (N = 2,933, M age = 15.36, SD = 1.35). Results of exploratory and confirmatory factor and item response theory analysis support evidence of structural validity, and bivariate correlation and regression supported evidence of concurrent and predictive validity, respectively. Findings suggested the CSS scale may be a viable tool for assessing youth satisfaction with treatment outcome and services at residential treatment centers.

Treatment Readiness in Psychiatric Residential Care for Adolescents.

There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients' readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed.

Changes in institution for mental diseases (IMD) ownership status and insurance acceptance over time.

State Medicaid programs are prohibited from using federal dollars to pay institutions for mental diseases (IMDs)-freestanding psychiatric facilities with more than 16 beds. Increasingly, regulatory mechanisms have made payment of treatment in these settings substantially more feasible. This study evaluates if changing financial incentives are associated with increases in for-profit ownership among IMD facilities relative to non-IMD facilities, as well as greater increases in Medicaid acceptance among for-profit IMD facilities relative to for-profit non-IMD facilities. We used data from the 2014-2020 National Mental Health Services Surveys and examined 11 945 facility-years. Relative to non-IMDs, the increase in for-profit ownership among IMDs was 6.6 percentage points greater. The largest proportional change in Medicaid acceptance occurred among for-profit IMD facilities relative to for-profit non-IMDs (18.5 percentage points). Existing research is mixed on the quality of inpatient and residential psychiatric care provided in for-profit vs nonprofit and public facilities, as well as in IMD relative to non-IMD facilities. As payment policy increasingly incentivizes for-profit facilities to enter the psychiatric care space, we should be mindful of the impact of these decisions on patient safety.

Predicting successful placements for youth in child welfare with machine learning

Out-of-home placement decisions have extremely high stakes for the present and future well-being of children in care because some placement types, and multiple placements, are associated with poor outcomes. We propose that a clinical decision support system (CDSS) using existing data about children and their previous placement success could inform future placement decision-making for their peers. The objective of this study was to test the feasibility of developing machine learning models to predict the best level of care placement (i.e., the placement with the highest likelihood of doing well in treatment) based on each youth's behavioral health needs and characteristics. We developed machine learning models to predict the probability of each youth's treatment success in psychiatric residential care (i.e., Psychiatric Residential Treatment Facility [PRTF]) versus any other placement (AUROCs > 0.70) using data collected in standard care at a behavioral health organization. Placement recommendations based on these machine learning models distinguished between youth who did well in residential care versus non-residential care (e.g., 80% of those who received care in the recommended setting with the highest predicted likelihood of success had above average risk-adjusted outcomes). Then we developed and validated machine learning models to predict the probability of each youth's treatment success across specific placement types in a state-wide system, achieving an average AUROC score of greater than 0.75. Machine learning models based on risk-adjusted behavioral health and functional data show promise in predicting positive placement outcomes and informing future placement decisions for youth in care. Related ethical considerations are discussed.

Tevredenheidsvragenlijsten bij residentiële geestelijke gezondheidszorg voor minderjarigen: systematische review

Satisfaction questionnaires for residential care in child psychiatry: a systematic review Background. The measurement of patient satisfaction in child psychiatry is used for evaluation, quality projects and scientific research. It is recommended to use instruments with sufficient validity and reliability. Methodology. The goal of this systematic review is to make an overview of the questionnaires that are currently used in residential child psychiatric care, and to evaluate the quality of those instruments. A search was performed in the databases Medline and Cochrane Library. Studies with patients aged below 18 years or their parents, who have used residential psychiatric care, were included. The studies were published in peer-reviewed magazines in Dutch, French or English. The quality of the instruments was evaluated based upon their psychometric properties (using the COSMIN (‘Consensus-based Standards for the Selection of Health Measurement Instruments’) criteria) and descriptive features were compared. Results. In 50 relevant articles, 44 questionnaires were found. For 31 questionnaires, psychometric properties were mentioned. Validity was determined more frequently than reliability (30 versus 2 questionnaires). Conclusion. Questionnaires YSS (Youth Services Survey) and YSSF (Youth Services Survey for Families) are recommended to use because of their good content validity and internal consistency.

Validation of the Behavioral Health Screen-Depression With Adolescents in Residential Care

Abstract: The purpose of this study was to (1) examine the psychometric properties of the Behavioral Health Screen Depression Subscale (BHS-DS), including internal consistency, factor structure, convergent and discriminant validity, and (2) identify cut-off scores on the BHS-DS to distinguish patients with depression risk and their level of severity among an acute clinical sample of adolescents in residential psychiatric care. Participants included 861 youths ages 10–24 at residential treatment centers who completed a battery of measures, including the BHS-DS and Patient Health Questionnaire (PHQ-9). Factor analysis, bivariate correlation, and Cronbach’s α suggested the BHS-DS is a unidimensional scale with evidence of internal consistency reliability and convergent and discriminant validity. Receiver operating characteristic curve analysis identified four clinical cut-off scores (no, mild, moderate, and severe depression risk). Analysis of variance, Cohen’s kappa (κ), and Wilcoxon signed-rank test results suggested the four groups differ from each other and that the BHS-DS exhibits moderate agreement with the PHQ-9. The BHS-DS demonstrates good psychometric properties among a sample of residential youth, offering clinicians a good alternative to the PHQ-9 in screening for depression.

Exploring Technology-Based Enhancements to Inpatient and Residential Treatment for Young Adult Women with Co-Occurring Substance Use

Objectives Young adults have the highest rates of substance use of any age group. Although men historically have higher rates of substance use disorders (SUDs) than women, research shows this gender gap is narrowing. Young adults with comorbid psychiatric disorders are at increased risk for developing a SUD. Co-occurring psychiatric disorders such as depression, anxiety, eating and post-traumatic stress disorders are more prevalent in women than men with SUDs, yet mental health treatment often does not adequately address substance use in patients receiving care for a comorbid psychiatric disorder. Tailored gender-responsive interventions for women with psychiatric disorders and co-occurring SUD have gained empirical support. Digital interventions tailored to young adult women with co-occurring disorders have the potential to overcome barriers to addressing substance use for young adult women in a psychiatric treatment setting. This study utilized a user-centered design process to better understand how technology could be used to address substance use in young adult women receiving inpatient and residential psychiatric care. Methods: Women (N = 15; age 18–25 years), recruited from five psychiatric treatment programs, engaged in a qualitative interview and completed self-report surveys on technology use and acceptability. Qualitative interviews were coded for salient themes. Results: Results showed that few participants were currently using mental health web-based applications (i.e., “apps”), but most participants expressed an interest in using apps as part of their mental health treatment. Participants identified several important topics salient to women their age including substance use and sexual assault, stigma and shame, difficulties abstaining from substance use while maintaining social relationships with peers, and negative emotions as a trigger for use. Conclusions: These data provide preliminary evidence that a digital intervention may be a feasible way to address co-occurring substance use problems in young adult women receiving care in a psychiatric setting.

Predictors of Mental Health Diagnoses Among Youth in Psychiatric Residential Care: A Retrospective Case Record Analysis

In this study the relation between familial risk factors and maltreatment types and mental health diagnoses among youth in residential care were examined. Using data from a larger study, six separate hierarchical logistic regression models were specified using family risk factors and maltreatment type to predict risk for attention deficit hyperactivity disorder (ADHD), conduct disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), reactive attachment disorder, and major depressive disorder. The results show that, for this population, demographic characteristics are more predictive of diagnoses compared to family risk factors and maltreatment. Specifically, age and gender significantly predicted four out of the six diagnoses. Maltreatment types were associated with two diagnoses, ADHD and PTSD. Findings from this study suggest residential treatment programs should include person-centered treatment plans considering demographics and maltreatment experiences.

Animal-assisted therapy on happiness and life quality of chronic psychiatric patients living in psychiatric residential care homes: a randomized controlled study

BackgroundPsychiatric patients who live in psychiatric residential care homes may often feel a loss of autonomy, decision making, and participation in social activities. They usually have few or no visitors and also do not have any purpose for living. Animals may increase the happiness and quality of life of psychiatric patients. This study aimed to evaluate the effects of Animal-Assisted Therapy (AAT) on happiness and quality of life of chronic psychiatric patients living in psychiatric residential care homes in Tehran, Iran.MethodsThis randomized controlled trial was conducted with 70 males with a chronic psychiatric disorder who were living in psychiatric residential care homes in Tehran, Iran, in 2016. The patients were randomly selected and divided into animal therapy intervention group and control group. Patients in the intervention group received animal-therapy with a bird for eight weeks. Patients in the control group received no intervention. The Oxford Happiness Inventory evaluated all patients pre and post-intervention. To evaluate life quality, the Wisconsin Quality of Life Index was used. Data were statically analyzed using SPSS Ver.19.0. ANCOVA with pretest statistical control. The significance level was set as p < 0.05.ResultsThe mean age in both control and intervention groups were 47.12 and 45.82 years, and the mean age of illness onset for both control and intervention groups was 18.94 and 16.83 years, respectively. The result of this study showed that happiness in the intervention group had significantly increased (p < 0.001). The results also showed that the quality of life in four sub-domains increased significantly.ConclusionTo bring happiness to chronic psychiatric patients living in psychiatric residential care homes is essential and may result in returning them to society and healthy life. The results of this study showed that AAT was helpful for chronic psychiatric patients living in psychiatric residential care homes and not only made them happy but also increased their quality of life.Trial registrationThis was registered in Iranian Registry of Clinical Trials (IRCT) (clinical trial code: IRCT20101013004922N4. Registered 2018-08-19. Retrospectively registered, https://www.irct.ir/trial/32390

Anxiolytic benefits of compounded Atenolol–Scopolamine in eight patients in psychiatry

Abstract There is an unmet medical need for fast-acting, effective, non-dependent and non-addicting anxiolytic treatments, in lieu of benzodiazepines. Compounded tablets of PanX® Atenolol–Scopolamine HBr were administered orally in eight patients with complex diagnoses receiving residential psychiatric care for acute anxiety and/or other conditions. Three of the eight patients were being treated for substance abuse. The primary endpoint was a reduction in the severity of State anxiety symptoms using the Beck Anxiety Instrument (BAI-S), prior to drug administration and one hour and/or approximately four hours after oral administration. Six of the eight patients were responders with a perceived calming effect and substantial reductions in their BAI-S scores. The mean of the BAI-S scores for all eight patients, including two deemed as non-responders, were 15.9 at baseline pre-treatment, 8.5 at 1 h post-treatment, and 4.1 at approximately 4 h. The mean of the heart rate was reduced from 93.6 bpm pre-treatment to 77.0 bpm at 1 h post-treatment and 79.7 bpm at 4–5 h. The mean of the blood pressure decreased by 10.1 mmHg systolic and 5.3 mmHg diastolic at 1 h post-treatment and even greater at 4–5 h. The reductions in heart rate and blood pressure are consistent with the effects of the beta blocker Atenolol. The drug combination was well tolerated in all patients with minor side effects in some, i.e., dry mouth and mild sleepiness (mild sedation). The beneficial reduction in anxiety symptoms was perceived within 15–60 min and persisted for up to 8 h.

A constructivist grounded theory research project studying music therapy as an anti-oppressive practice in long-term and psychiatric residential care

Abstract Analytical emancipatory social justice and anti-oppressive practice concepts have begun to be integrated into music therapy to inform and expand the theoretical basis of practice (Sajnani et al., 2017). Anti-oppressive practices (AOP) in music therapy have been developed to expose and undo both obvious and unknown oppression to increase social justice within music therapy systems, practice, and research (Baines, 2013). Music therapy as an Anti-Oppressive Practice (Baines, 2013) was examined in two sites, 1. a long-term care facility, and 2. a secure mental health centre The study used Constructivist Grounded Theory method guided by the question: What are the experiences of residents and staff in music therapy as an anti-oppressive practice? The research revealed dilemmas, opportunities, and outcomes of music therapy research and practice processes that engage anti-oppressive analysis. Further consideration of the data revealed that an anti-oppressive practice framework for music therapy research and practice broadened client agency through integration of client preferred music experiences in all aspects of programming and increased cultural humility and competence in staff offering heightened ethical standards across both sites.

Referral patterns and implementation costs of the Partners in Recovery initiative in Gippsland: learnings for the National Disability Insurance Scheme.

The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland. Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective. Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care. Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS.

Stories of change: the text analysis of handovers in an Italian psychiatric residential care home.

Handovers assure a timely and correct information transfer while socializing workers to the service's culture; however, no study describes them as instruments to document organizational change and only a few have focused on psychiatric settings. Aim To investigate the change in the culture of an Italian psychiatric residential care home as perceived by its mental health workers (MHWs) over the course of two decades. Method Emotional text analysis (ETA) was used to analyse the MHWs' handovers completed from 1990 to 2011. Results The analysis generated four clusters and three main factors illustrating the change in the MHWs' representations of the residential care home and its occupants. The factors showed: (1) the shift from an individualistic, problem-focused view to an inclusive, community-based approach; (2) the presence of a descriptive as well as a specialized language; and (3) the presence of a double focus: on patients and professionals. Conclusions Handovers transcripts document the following changes: (1) a shift from a symptom-based to a recovery-oriented approach; (2) a modification of the MHWs values towards an holistic view of the patient; (3) a growing importance assigned to accountability, services integration and teamwork. The paper shows that handovers can be used diachronically to document organizational change.

Latent subtypes of youth in psychiatric residential care

Abstract In current practice, residential care programs in the United States are often more general than specialized with little demonstrated results of effectiveness for different types of youth. Subgroup analyses focused on developing a thorough understanding of the subpopulation of youth served in residential group care have potential to inform targeted program development. Using assessment records of a sample of 447 youth in psychiatric residential treatment, a latent class analysis was performed to identify youth subtypes. The results revealed four classes of youth characterized by severe levels of functional impairment and externalizing behavioral problems. Class distinctions were observed in the areas of psychiatric diagnoses, child behavioral problems and strengths, family characteristics, and maltreatment histories. An examination of class profiles lends support for the applicability of some general approaches across therapeutic residential programs, including the use of trauma-informed care and family-centered practice frameworks. The findings further demonstrate the need to also include program elements that are specified to the types of youth the program is designed to treat. Implications for policy and developing specified treatment protocol matched to the types of youth served in psychiatric residential programs are discussed.

Challenges in implementing an exercise intervention within residential psychiatric care: A mixed methods study

Physical exercise is increasingly recognized as an important component of psychiatric care, although the feasibility of implementing exercise in residential care settings is not well understood. We evaluated the feasibility of a 10-week intervention of weekly fitness classes (delivered by a personal trainer) and other exercise activities using a mixed-methods approach. This was offered to across four residential care services, to all 51 residents who had severe mental illness (SMI). Of these, 27.5% consented to the exercise intervention. Participants averaged 87.6 min of moderate-to-vigorous exercise per-week, although fitness classes were poorly attended, and 35.7% dropped-out over 10 weeks. Of those who completed the intervention, increased physical activity was associated with significantly reduced negative symptoms. In conclusion, implementing exercise interventions in residential psychiatric care is challenging; given that supervised exercise classes may not be appealing to many residents, while unsupervised exercise is poorly adhered to. Future interventions should consider that better tailored exercise programs are required to adequately confront motivational issues, and to account for participant preference in order to increase engagement.

Contemplative Intervention Reduces Physical Interventions for Children in Residential Psychiatric Treatment.

This research explored the effectiveness of a manualized contemplative intervention among children receiving intensive residential psychiatric care. Ten children with severe psychiatric disabilities received 12 sessions (30-45min) of "Mindful Life: Schools" (MLS) over the course of a month. Facility-reported data on the use of physical intervention (i.e., seclusions and restraints) were analyzed. Acceptability questionnaires and broad-band behavioral questionnaire data were also collected from children and their primary clinicians. Robust logistic regression analyses were conducted on person-period data for the 10 children to explore the timing of incidents resulting in the use of physical intervention. Incidents within each person-period were regressed on indicators of days of contemplative practice and days without contemplative practice. Results indicated that during the 24-h period following MLS class, relative to a comparison 24-h period, children had significantly reduced odds of receiving a physical intervention (OR = 0.3; 95% CI 0.2, 0.5; p < 0.001). Behavioral questionnaires did not indicate significant contemplative intervention effects (ps >0.05), and MLS was found to be generally acceptable in this population and setting. These data indicate that contemplative practices acutely reduced the utilization of physical interventions. Clinicians seeking to implement preventative strategies to reduce the necessity of physical intervention in response to dangerous behavior should consider contemplative practices. Those wishing to empirically evaluate the effectiveness of contemplative practices should consider evaluating objective measures, such as utilization of physical intervention strategies, as oppose to subjective reports.

Feelings Thermometer: An Early Intervention Scale for Seclusion/Restraint Reduction Among Children and Adolescents in Residential Psychiatric Care.

Restraints and/or seclusions (R/S) are events that have the potential to cause patient injury, staff injury, re-traumatization, and even death. There is a gap in available data regarding alternative strategies for reducing R/S. A 140-bed children and adolescent residential treatment hospital implemented a "Feelings Thermometer Scale" on each unit. The "Feelings Thermometer" allowed the resident to point to a face on the scale to rate how they were feeling from "Cool" to "On Fire!" Once the resident identified with a feeling and rating, options were offered for alternative cool down locations corresponding to each level of escalation. Data were analyzed 6 weeks before and 6 weeks after implementation of the "Feelings Thermometer." There were 129 R/S during the 6-week period prior to the implementation of the "Feelings Thermometer." There were a total of 91 R/S during the 6-week period postimplementation of the "Feelings Thermometer." Overall, a 29.1% decrease in R/S was experienced throughout the hospital. The findings of this study suggest that further investigation may be warranted to promote alternative R/S reduction strategies.

Results of forensic assertive community treatment in Belgium after 33 months

IntroductionForensic adaptations of assertive community treatment (ACT) remain understudied in Europe, whereas promising results emerge from the United States. There is a need for research into the effectiveness of ForACT outside the United States, as Europe differs greatly in terms of organisation of mental health and judicial system.ObjectiveInvestigating effectiveness of forensic adaptations of ACT in the area of Flanders, Belgium. Outcome measures are divided into forensic, like arrests or incarcerations, and non-forensic, like admissions and length of stay.AimsInvestigating effectiveness of ForACT on forensic and non-forensic outcome measures as well as factors related to outcome. A third outcome is community tenure, which is the actual number of days divided by the potential number of days spent in the community.MethodsA controlled cohort study was designed over with first results at 33 months. The experimental group consists of a new ForACT team in the area of Flanders, Belgium (n = 70). Patients are admitted from prison, psychiatric hospitals or other community-based care. The control group consists of mentally ill offenders in community-based treatment after release from prison (n = 56).ResultsResults on forensic measures and community tenure are promising in favour of the ForACT team. In contrast, clients are often, though shortly, readmitted into psychiatric residential care. Substance use emerges as the main reason for admissions.ConclusionsA local forensic adaptation of ACT reveals promising results on forensic outcome measures, yet suffers a large number of admissions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Provider Perspectives on Involving Families in Children's Residential Psychiatric Care

Over time, residential mental health treatment programs for youth with serious emotional and behavioral disorders have shifted to a more family-focused paradigm that stresses the importance of family involvement during children's psychiatric care. Findings are presented from an in-depth qualitative examination of the factors that facilitate and hinder family involvement as well as expectations for family involvement from the perspective of providers at five residential youth treatment facilities in Florida. Results indicate that family involvement is facilitated by offering transportation assistance and flexible scheduling, fostering communication, and empowering families through education and support. Suggestions for future research are also offered.

Patient Opinions on the Helpfulness of External Rehabilitative Activities in Residential Psychiatric Care: A Pilot Study

Introduction:This study explores the patient opinions about the helpfulness of the External Rehabilitative Activities (ERA) delivered in two residential facilities for psychiatric rehabilitation.Methods:We administered a Questionnaire developed to assess general helpfulness, helpfulness of specific therapeutic processes and satisfaction with the ERA to a sample of 46 psychiatric patients participating in at least three external activities.Results:The External Rehabilitative Activities, tested by the ERA-Questionnaire, were considered helpful or very helpful by most of the patients. The therapeutic process with the highest score was “relaxation”, followed by “general helpfulness”, “socialization”, “knowledge of social context”, “community integration”. The least-valued process was “autonomy”. Conclusion:This pilot study has shown that psychiatric patients consider ERA helpful and rate more helpful the specific therapeutic processes, such as relaxation and socialization, that assure symptomatic relief and interaction with the outside world.