Residential Care Programs Research Articles

Institutional Barriers to Affording Managed Opportunities for Independence in Residential Care: Perceptions and Experiences of Child and Youth Care Workers

ABSTRACT The importance of preparing young people for independent adulthood is widely acknowledged in care-leaving literature. Within the residential care setting, child and youth care workers play a crucial role in preparing young people for life after care, by affording them managed opportunities for independence. However, preparation generally receives limited attention in residential care, due to institutional factors that hinder preparation. Research that focuses on the experiences of child and youth care workers who work with children in residential care is also limited, despite their contribution to preparing young people for independent functioning. This paper aims to describe institutional barriers experienced by child and youth care workers in their efforts to afford young people in care, managed opportunities for independence. A qualitative, grounded theory methodology was employed to collect and analyze data. Nine child and youth care workers were purposively sampled from several Child and Youth Care Centres in South Africa. Findings indicate that lack of professional credibility, inadequate mandate, possible negative consequences for child and youth care workers, and funding constraints are barriers to the practice of managed opportunities for independence in residential care. Implications for residential care program and child and youth care practice are set out.

Outcomes of a Residential Program After Successful Graduation: A Pilot Quality Improvement Study

Residential treatment is an effective way to provide care to individuals who struggle with core life skills, have a mental illness, and/or have trouble adhering to treatment plans. The environment of residential care offers alternatives to typical treatment methods and a network of support to help foster independence. This pilot study assesses the impact of one residential care program from the perspective of those who were successfully discharged. The WHO Disability Assessment Schedule 2.0, the Outcome Rating Scale, and a homelessness screening tool were used to gather data from a small sample (N = 6) of former residents who completed the program. Results indicated that half of the discharges remained at stable functioning throughout the study duration, while the other half had difficulties in multiple domains of functioning. Insights obtained about instability following discharge will inform future research on quality of care with progress data collected throughout a client’s stay.

“I hope my voice is heard.”: A mixed-methods study of youths’ perceptions of residential care

There are a lack of studies examining youth’s perspective on their experiences in residential care. Such studies may yield important contributions to quality improvement and, hence, outcomes of youth in residential care. In this mixed-methods study, we aimed to evaluate youths’ perspectives of the quality of care and experiences in residential group care. The sample (N = 450) was comprised of 50.9% females and 48.6% males with a mean age of 14.77 (±2.27). The majority were white (36.3%) and black (36.0%). The sample was drawn from 127 residential care programs in Florida. This study was approved by an Institutional Review Board. Data were collected as part of a larger statewide pilot of the Quality Standards Assessment (QSA). We used univariate analyses to describe quality ratings and a multilevel model to examine associations between QSA scores and youth and program characteristics. Youths’ care experiences were categorized using a content-analysis of their open-ended responses. Overall, youth rated the quality of their placements highly. The multilevel model revealed that quality ratings were higher among youth with family reunification as their discharge plan versus non-relative care. Youths’ open-ended responses supported positive views on their placements and connections with staff. Negative comments focused on environmental restrictions and staff/peer relations. The inclusion of youth perspectives can contribute to improved service experiences and outcomes.

Shared Family Care: Out-of-Home Care Programs for Serving Parents and Children Together

ABSTRACT Helping children and parents remain together, despite significant parent or child problems, is a key objective of child welfare services. One option is to place whole families together into out-of-home settings. We searched peer-reviewed and gray literature and solicited input from international networks to identify the range of family placement programs available. We identified three key types of “shared family care.” Shared Family Foster Care (SFFC) involves sharing of care and intensive modeling of effective parenting by a host family that engages in mentoring of the parent and parenting of the child. Shared Residential Care (SRC) programs involve sharing of care and intensive modeling of effective parenting by professional staff as they engage parents and children in what had often been child-only residential programs. Family Residential Treatment Programs (FRT) also place parents and children in residence together. FRT programs are often aligned with inpatient treatment units. Active programs that illustrate each type are described. Through this typology and detailed information of currently active shared family care programs, policymakers and program designers can consider which kinds of programs have the most potential for implementation and sustainability.

Assessing the Needs of Victimized Adolescents in Therapeutic Residential Care in Spain

Children and adolescents in residential care often present with emotional and/or behavioral problems associated to previous adverse experiences such as abuse and neglect. Consequently, child welfare systems have developed therapeutic residential care (TRC) programs to address the most complex needs of this population. The aim of this study is to explore the characteristics of youths in TRC comparing them with those of youth in general residential care (GRC), and to detect the factors predicting referral to TRC programs. The sample consisted of 900 adolescents aged 12–17 years old (M = 15.57; SD = 1.33; 66.2% boys), from General Residential Care (n = 554) and Therapeutic Residential Care (n = 346). Profile information was collected through official files and an ad hoc questionnaire. Mental health problems were evaluated using the youth self-report (YSR). Significant sociodemographic differences were found between groups. Also, a higher frequency of emotional abuse and neglect, worse mental health, more breakdowns in child welfare measures and risk behaviors were found among adolescents in TRC. Sociodemographic and familial characteristics, features of the protective process and risk behaviors were associated to referral to TRC programs. Youths in GRC and TRC present with mental and behavioral problems that make it necessary to implement prevention programs and early detection procedures. Screening and evaluation of youth’s mental health and establishment of concrete criteria are suggested to ensure appropriate referral to the most suitable resource according to the individual needs of adolescents.

Mental Health, Quality of Life and Coping Strategies in Vulnerable Children During the COVID-19 Pandemic.

The coronavirus pandemic has led to a situation without precedent in modern history. The aim of this study is to analyse the consequences after one year of the pandemic on a group of children and adolescents assessed at the beginning of the pandemic in 2020 and to determine the most effective ways of psychologically coping with this pandemic. Two different, but equivalent, groups with a total of 604 (study I, 2020) and 743 (study II, 2021) children and adolescents in residential care, foster families, kinship families or family strengthening programs in Spain were evaluated using the SDQ (mental health measure), KIDSCREEN-10 index (quality of life measure) and Kidcope (coping behaviour measure). An independent sample t-test and a decision tree analysis were used. The mental health of children and adolescents decreased by 9.7%, and Self-Perceived quality of life did not change after one year of the COVID-19 pandemic. Nonactive coping strategies predicted worse mental health and worse quality of life. Problem solving served as a protective factor. One year after, the COVID-19 pandemic has an effect on the psychological wellbeing of children and adolescents, and the consequences can be reduced if proper coping strategies are used.

Cost-Utility Analysis of Malaysian Elderlies Living in Public Long-Term Care Institutions

This research compares the quality of life of Malaysian elderlies living in public formal long-term care institutions, including residential care and nursing home care. It provides evidence of the cost-effectiveness of both programs. The sample of Malaysian elderlies aged 60 years and above was collected from the World Health Survey, including five dimensions of health status: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. Each of the dimensions has three levels, including 1 (“no problems”), 2 (“some problems”) and 3 (“major problem”). The quality-adjusted life-years (QALYs) of elderlies living in both institutions are estimated using a generic health-related measurement method, EQ-5D. In addition, cost-utility analysis is adopted to compare the effectiveness of programs in allocating resources. The QALY of those living in nursing home care is reasonably lower than those in residential care due to their worse chronic health conditions. The majority are categorised as severely disabled. The cost-effectiveness evaluation of each public long-term care model suggests that the residential care program is cost-effective, with the cost per QALY being MYR22 945. At the same time, a nursing home for disabled people is not effective as the cost per QALY is MYR57 822, falls outside the willingness to pay (WTP) range between (MYR 19,929–MYR 28,470).

Assessment of Somatosensory Function and Self-harm in Adolescents

Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). Participants were tested using a standardized QST protocol to establish baseline somatosensory function. Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: -1.03 [95% CI, -1.47 to -0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: -1.73; 95% CI, -2.62 to -0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

‘They became my second family’: Children's relational lives and relationship‐based practice in residential care in the Philippines

AbstractDespite the widespread utilization of residential care in the Philippines, little is known about the lives and circumstances of children living within these contexts. In response, this article presents an analysis of children and young people's experiences of living in residential care, specifically focusing on their social networks, relationships and the relationship‐based practices of their caregivers. Drawing on 50 qualitative interviews with children and young people currently or previously living in residential care, as well as a range of social workers and programme staff, this study identifies the highly relational lives of children and young people who cite extensive and close relationships with residential care staff, peers and family. Analysis reveals that children conceptualize ‘family’ as embodied in their residential care programme, drawing attention to the collective support and security offered, while also detailing the role of their spirituality as an important support. Relationship‐based practices are utilized by caregivers who offer long‐term, emotionally close and stable relationships with children to support their well‐being. These findings highlight the centrality of relationship‐based interventions and the maintenance of children's relational lives as a core practice, offering insights into the development of practice in these settings.

Risk of Nursing Home Use Among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function.

Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. We used 8 waves (1998-2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998-2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06-1.51, p < .01), net the effects of life course variables. Furthermore, "low-declining" (SHR 2.255, 95% CI 1.70-2.99, p < .001) and "medium-declining" (2.103, 95% CI 1.69-2.61, p < .001) trajectories predicted increased risk of nursing home use. Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.

Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness

Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.

Psychiatric History and Trajectories of Cognitive Change Predict Risk of Nursing Home Residence

Previous research indicates that a history of psychiatric, emotional or nervous problems can affect cognitive function at age 65 and cognitive trajectories over time. To explore the potential impact of this relationship on nursing home use, we applied latent class growth curve models to five waves (1998-2008) of Health and Retirement Study data to identify four classes of cognition trajectories, defined by baseline cognitive function scores (low, medium, high) and rate of change (stable or declining). We then ran survival analyses using HRS years 2008 to 2016 to determine risk of nursing home residence based on psychiatric history and cognition trajectory class. We hypothesized that self-reported history of psychiatric, emotional or nervous problems will be associated with greater risk of nursing home residence, and that self-reported history of psychiatric, emotional and nervous problems will interact with cognition trajectories to predict level of risk of nursing home residence. Results indicate that psychiatric history is independently associated with greater risk of nursing home residence, net the effects of a variety of life course variables in the model. Further, psychiatric history interacts with “low cognition declining” and “medium cognition declining” trajectories to increase the risk of nursing home residence. Evidence of the relationship between psychiatric history, cognitive decline, and nursing home residence can be used to enhance public understanding of the impact psychiatric history has on the long-term care system, and to educate policy-makers and providers about the need for appropriate psychiatric training for staff in community-based and residential long term care programs.

Implementing, researching and evaluating a Wales-wide arts in residential care programme: Reflections from the cARTrefu programme

Implementing, researching and evaluating a Wales-wide arts in residential care programme: Reflections from the cARTrefu programme

A House Burden Score: Measuring the Workload in Therapeutic Residential Care for Young People

ABSTRACT This article is about using data from the Strengths and Difficulties questionnaire to develop a house burden score as a way of measuring the workload of a therapeutic residential care program. The development of the score ensures that residential placement selection is based on empirical data rather than on the often-used criteria of ‘where is there a vacancy?’ It may also curb comments by inexperienced staff such as ‘our house has the most difficult young people, whereas yours are easy’. The aim of the score is to ensure that a residential program is not overburdened with too many children and young people with complex emotional and behavioral difficulties to the extent that this result is a sub-standard service for all young people.

Addressing the most damaged adolescents in the child protection system: An analysis of the profiles of young people in therapeutic residential care

In many countries, adolescents in the child protection system present with serious emotional and behavioral problems. In order to address their specific needs, therapeutic residential care (TRC) programs have been created. The goal of this study is to analyze the profile of 353 adolescents in TRC in Spain. Data on family history, high-risk behaviors and their process of intervention in the child welfare system were collected, as well as the clinical profile through the Youth Self-Report (YSR). Results showed a high frequency of high-risk behaviours, especially violent behaviours, substance abuse, running away and suicidal behaviors. About 90% of the sample had a history of continuous mental health treatments starting at an average of 10 years old. About 70% of the sample scored above the clinical threshold of the YSR. Girls exhibited a specific pattern of risk behaviors and mental health needs, showing greater psychological distress and a more complex profile.

Affective life, “vulnerable” youths, and international volunteering in a residential care programme in Cusco, Peru

This paper critically engages with the implications of the “affect turn” in the geographies of development and volunteering. By way of considering “affective life” at a residential youth care centre in Peru through an ethnographic study, we aim to contribute to current discussions of “(self‐)transformation” taking place through affectivity in the experience of volunteering. Conceptually, our approach to investigating “affective life” and volunteering involves two steps. First, we critically review this body of work's recent focus on the individualistic mode of volunteer self‐transformation in encountering “vulnerable others.” We identify the need to think about affect and embodiment also from the perspectives of the “vulnerable” groups whose lives are entangled with the presence of international volunteering. Second, we argue for an affect‐informed approach to socio‐politically shaped vulnerability, with a particular emphasis on lived experiences and affective capacities related to enduring social and material conditions. Against the backdrop of marginalisation of adolescent mothers from rural and indigenous backgrounds, many of whom are survivors of sexual abuse, we analyse the experiences of these youths living at a specific residential care centre and interacting with volunteers on a daily basis. In doing so, we employ a series of perspectives from the residents, while taking into account the organisational environment. We also show the complex ways in which resident–volunteer encounters are at play in life‐enhancing affective states, capacities, and relations emerging among the residents. Our findings on the residents' self‐ and shared capacity of transformation highlights the importance of attending to the spatialities of affective life in academic work focused on the contemporary geographies of international volunteering.

Experiencia de la aplicacion del protocolo de evaluación de buenas prácticas en parentalidad positiva en el programa de acogimiento residencial de menores gestionado por la entidad Mensajeros de la Paz- Canarias

Teniendo como fin alcanzar una mejora del servicio de atención a las familias en el programa de Acogimiento residencial de menores gestionado por la entidad Mensajeros de la Paz Canarias, la cual gestiona en la actualidad 12 hogares de protección de menores en la isla de Gran Canaria, se ha realizado una evaluación a través del protocolo de Buenas Prácticas desde el enfoque de la Parentalidad Positiva considerando que el servicio requiere intervenir con las familias desde este enfoque como forma de profesionalizar el servicio y a su vez ofrecer desde la entidad una atención de calidad que permita crear y mantener una relación de ayuda favorable y lograr la reunificación familiar cuando el Plan de Caso así lo requiera.Tras la aplicación del protocolo a través de un proceso riguroso con la participación de los profesionales que intervienen tanto de manera directa como indirecta en los casos y siguiendo las fases de aplicación tal y como recomienda la Guía de Buenas Prácticas en Parentalidad Positiva se han obtenido resultados relativos al servicio que requieren ser mejorados. Se ha elaborado un plan de mejora que en la actualidad la entidad se encuentra en el proceso de implementación, no obstante, estos cambios ya están produciendo mejoras tanto en las respuestas a las intervenciones de las propias familias como en el trabajo diario de los profesionales poniendo en marcha una metodología de trabajo rigurosa, consensuada y conjunta por parte de todo el equipo.

Intentional Practice as a Method to Reduce the Implementation Gap Between Science and Practice in the Delivery of Trauma-Informed Residential Care

ABSTRACTChildren and young people with backgrounds of trauma, and supported in residential programs (group care, residential treatment, wilderness therapy, and outdoor behavioral healthcare), require interventions underpinned by trauma-informed science. While there is much optimism that trauma-informed services are being integrated into residential care settings, there is evidence of a science to practice gap in how these components are implemented across real-world settings. The purpose of the paper is to introduce ‘intentional practice’ and growth-focused logic modeling (Life Buoyancy Model; LBM) as a possible method to strengthen the delivery of trauma-informed services at the program level. The paper provides an overview of the modeling and describes how the approach seeks to reduce the science to practice gap in the implementation of trauma-informed service delivery. To aid this process, five core intervention components are proposed to provide a more nuanced understanding of how trauma-informed practice can be implemented. Key considerations are offered for residential care program leaders and program developers to design, refine or review the delivery of locally contextualized program models.

Effectiveness and Costs of a Therapeutic Residential Care Program for Adolescents with a Serious Behavior Problem (MultifunC). Short-Term Results of a Non-Randomized Controlled Trial

ABSTRACT Although research has repeatedly shown that residential care for youth with a serious behavior problem has little rehabilitation success, there is a group of youth for whom residential care in a locked setting is necessary. In this article, a manualized therapeutic residential treatment model for adolescents with serious behavior problems, MultifunC, is evaluated. The program theory of MultifunC is based on a review of the literature and synthesis effective treatment components. This study included 80 youth aged 15–17 years with a medium high or high risk for reoffending. Half of the participants received MultifunC, and half treatment as usual (TAU). Although non-randomized, the two groups were found to be equivalent on important background variables. After 24 months, this first evaluation of MultifunC demonstrated that youth participating in MultifunC had a reduced need for residential care in a locked setting as well as out-of-home placement in general compared to youth in the TAU group. The economic analysis found MultifunC to be a cost-effective alternative to TAU due to the reduced need of residential care in locked settings. There were no significant effects on reoffending or psychiatric care.

Developing Quality Standards and Performance Measures for Residential Group Care: Translating Theory to Practice

ABSTRACTWith the increased emphasis on accountability at the federal and state levels, efforts to identify and address issues impacting the quality and effectiveness of residential care programs are needed. Establishing quality practice standards with measurable performance indicators is a useful means for promoting and evaluating the quality of care in residential programs and informing a process of continuous quality improvement. In this article, we describe a state-wide initiative to enhance the quality of residential group care in Florida. Specifically, we describe efforts to establish a set of quality standards for residential programs and to operationalize the standards by developing and piloting an assessment designed to measure the extent to which group home practices align with the standards. In addition to describing steps taken, we highlight important conceptual and practical considerations for translating standards generated from extant research, best practices, and field experts into clearly defined domains and measurable standards that can be meaningfully transported into a complex practice setting. Finally, we discuss lessons learned and recommendations that may guide similar efforts beyond the state of Florida.