Residential Care Programs Research Articles

Youths living away from families in the US mental health system

This study examines the clinical characteristics of youths who lived away from families at the time of admission to specialty mental health services, and investigates the association between type of nonfamily living situation and admission to residential versus outpatient programs. Of 3995 youths sampled from 1598 mental health programs in the United States, 14% lived away from their own families, either in foster care, group care settings, or correctional settings, or were emancipated. As a group, youths living away from families were more seriously emotionally disturbed and more likely to receive treatment in residential care programs. Youths who lived in foster care were more likely to be admitted to outpatient programs, while youths who lived in group care settings or correctional settings were more likely to be admitted to residential care programs, controlling on demographic and clinical characteristics. Targeting resources to enhance the availability and therapeutic capacity of foster care may facilitate community living, and decrease time spent in institutional settings.

Consent and Participation: Ethical Issues in the Treatment of Children in Out-of-Home Care.

Mental health service (MHS) providers confront questions of informed consent for evaluation and treatment of children in state custody who are placed in residential or foster care programs, where legal responsibility is shared between state and parent. There are ethical issues encountered by MHS providers who work with this growing population of children in placement. Matters of informed consent and access to information about treatment influence relationships with the parents, legal guardians, Child Protective Service workers, and the child. These specific concerns are addressed: informed consent, the right to be informed, and the rights of parents or foster carers to participate in a child's treatment. Recommendations for resolving dilemmas faced by MHS providers are discussed.

Implementation of a New Central Intake System in Community Care

This article identifies how the Central Intake process for the community healthcare programs within one Interior Health health services area was restructured to provide clinical screening for all referrals. The process involved complex project management to ensure the respective input from acute, residential and community care programs. The result was the development of a much more effective, clinically led intake system providing more appropriate referrals within and beyond the community programs.

Relationships between tattling, likeability, and social classification: a preliminary investigation of adolescents in residential care.

Little research has been published on tattling, even less on its social impact, and we found none directly investigating tattling by adolescents. This study assessed the extent to which tattling, as perceived by peers and caregivers of adolescents in a residential care program, was associated with various dimensions of social status and other behavioral correlates. Eighty-eight adolescent participants rated their housemates on likeability, perceived rates of tattling, and other behavioral descriptors. In addition, caretakers also rated each youth in terms of perceived tattling. On the basis of likeability ratings, participants were classified into one of five categories: popular, average, controversial, neglected, and rejected. Results showed a significant negative correlation between likeability and perceived tattling rates. In addition, youth classified as socially rejected were more likely to be perceived by both their peers and care providers as engaging in high rates of tattling.

A modification of the token economy for nonresponsive youth in family-style residential care.

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the "nonresponse" of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.

Professional caregivers for patients with dementia: predictors of job and career commitment.

The purpose of this study is to identify what factors predict job and career commitment among professional caregivers working with patients with dementia. A secondary analysis was completed using data collected from 77 professional caregivers working in residential dementia special care programs. The findings suggest that professional caregivers' commitment to their jobs and careers is most closely related to their level of involvement in the interpersonal aspects of the work, the degree to which they feel personal growth or benefit, and the level of burden that their work generates. Strategies are suggested for improving job and career longevity among professional caregivers by enhancing attachment to patients and families, fostering professional identity and personal growth, and monitoring and managing professional caregiver burden.

Australian Approaches to Resident Classification and Quality Assurance in Residential Care

Summary This paper begins with an account of the structure of Australia's residential long-term care program, which was divided into two distinct levels of hostel and nursing home care until 1997. In response to changed policy objectives, a number of measures were then taken to create an integrated residential care system. The main measures were the development of a single scale for classification of resident care need and associated funding to replace two previous separate scales, and the implementation of a new quality assurance system, which included new standards for buildings as well as revised standards for care. I give accounts of these measures and the extent to which they have achieved their intended outcomes before proposing some further developments that could see closer links among pre-admission assessment, resident classification, and quality assurance.

Health and risk behaviors over time among youth living with HIV

Health practices and transmission behaviors were examined over time among 25 disabled youth living with HIV (YLH) living in a comprehensive residential care program. YLH were aged 19–24 years (M=23·4 years); 89 per cent of males were gay, bisexual, or transgendered (60% Caucasian); all had physical and mental health problems, as well as substance abuse disorders. YLH were assessed at least four times at 3-month intervals and reported high lifetime rates of sexual and substance-use risk acts. Over four assessments, YLH improved their nutrition and hygiene and decreased their worry about their health status. YLH evidenced no decrease in the frequency of substance use and sexual risk. Depression, self-esteem, and health status also were stable over time. YLH who have a lifetime history of multiple problem behaviors are likely to change slowly over time, even when receiving comprehensive residential care.

Mental Health in Our Future Cities: Maudsley Monograph 42

Back to table of contents Previous article Next article Book Forum: Community Health CareFull AccessMental Health in Our Future Cities: Maudsley Monograph 42WAYNE S. FENTON, M.D., WAYNE S. FENTONSearch for more papers by this author, M.D., Bethesda, Md.Published Online:1 May 2001https://doi.org/10.1176/appi.ajp.158.5.831AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Aiming to outline best practices from around the world, contributors to this book take a hard look at urban mental health systems in 10 international settings. Prepared by local mental health planners for presentation at a 1997 Maudsley conference, both relatively resource-rich (Copenhagen and Amsterdam) and resource-poor (Bangalore, India; Alegre, Brazil) service settings are described in considerable detail.Cross-national disparities in health care expenditures provide one context for understanding differences in service organization and delivery. In India, the annual public spending on health is $3 per person per year (compared with Denmark at approximately $2,100 per person per year, or the United States at nearly $4,000 per person per year). In Bangalore there is no coordinated public health structure, and no attempt is made to link services in the city by any system: “A large factor in the use of a service is the economic status of the patient” (p. 83). At the same time, all major general hospitals in Bangalore have psychiatric units, the National Institute of Mental Health and Neurosciences is the largest postgraduate psychiatric training center in India, and Bangalore is home to seven halfway houses for people with mental illness: 75% of all such facilities in India.Integrating mental health knowledge into primary care is the major public mental health strategy in developing world cities. Throughout Iran, for example, multipurpose health workers (called “behvarz”) deliver care in approximately 15,000 rural health houses or urban health posts throughout the country. The behvarz are expected to have sufficient familiarity with psychiatric conditions to initiate referral for specialized assessment and provide aftercare for psychiatric patients evaluated by specialists. Through a regionalized system, health houses operate under the supervision of a provincial medical university, where psychiatry is taught as an independent medical specialty.Health systems in the United States and other developed countries (United Kingdom, Japan, Australia, Italy, Denmark, Holland) struggle with the concentration of mentally ill individuals in urban areas, where poverty, substance abuse, and inadequate treatment resources too often yield homelessness, victimization, and criminalization. Both an increasing number of older individuals and growing young urban immigrant populations are at high risk for these adverse outcomes. The collapse of a humane infrastructure for the seriously mentally ill is greatest where funding is inconsistent, health and social service systems are poorly integrated, and mental health services are fragmented in a manner that discourages continuity of care for the individual patient.What emerges across the world is a picture of contrasts and commonalities. Cultural contexts, expenditure levels, availability of trained manpower, and extent of central service coordination differ widely. Yet mental illness itself and the needs of the seriously mentally ill are remarkably consistent. Hospital care is the single largest budget item in each of the mental health systems described, and, in each, savings from the reduction of inpatient beds are applied to develop community-based hospital alternatives. These include residential care, day treatment, rehabilitation, community domiciles, and nonhospital acute care programs. Along with a worldwide shift away from the large institution is the widespread organization of families, patients, consumers, and users for greater participation in the planning, design, and operation of new services.The United States spends a greater proportion of its gross national product on health care than any other country (14%), but only here do we lack a national health service where health care is a right of all citizens and its provision a core obligation of government. In an international context, it becomes painfully obvious that far too much of our health expenditures support inefficient administrative functions that move and track funds through layers of middlemen (1). As a result, it is a cruel irony that we are unable widely to implement innovative U.S.-designed delivery configurations such as those developed in Madison, Wis., and Baltimore (2).For those interested in the organization of mental health services, this volume provides a unique and fascinating world view.Edited by David Goldberg and Graham Thornicroft. Philadelphia, Psychology Press, 1998, 304 pp., $59.95.

After ideology: The effectiveness of residential programs for ‘at risk’ adolescents

This article reviews recent research evidence about the effectiveness of residential care, education and treatment programs, singularly referred to as treatment programs, for ‘at risk’ adolescents. This evidence is drawn from child welfare, mental health services and education studies. The national and international evidence is that foster care is in crisis and is unable to provide stable and continuous placements for many of our most difficult youth. It is time to reconsider residential alternatives. The research suggests that these alternatives are not ‘all bad’ and that they have an important place in the continuum of child and family services.

Questioning the Continuum of Care: Toward a Reconceptualization of Child Welfare Services

SUMMARY The notion of a “continuum of care” and the associated idea of residential care and treatment programs for children and youth as “last resort” interventions are endemic in the child welfare literature (Whittaker, 1979; Beker, 1981). The purpose of this paper is to question the utility of both of these notions. Indeed, it will be argued that the construct of a continuum of care as it plays out in practice is fundamentally problematic, inhibiting the use of appropriately intensive interventions even when they are in the best interests of children and families, and inhibiting rather than promoting family reunification in many complex cases.

Reducing psychiatric hospitalization among mentally ill veterans living in board-and-care homes.

The effectiveness of a community-based case management program at the Veterans Affairs West Los Angeles Healthcare Center in reducing hospital readmission of mentally ill veterans living in privately operated board-and-care homes was evaluated. A retrospective cohort design was used. The sample consisted of 321 patients identified by hospital records as living in one of 24 board-and-care homes in the Los Angeles area that were approved by the community residential care program. A total of 214 subjects who received monthly home visits from case managers (program group) were compared with 107 subjects who did not receive monthly home visits (comparison group). The median number of psychiatric bed-days used was calculated for the two years before and after follow-up. The number of days from the start of follow-up to the first psychiatric hospitalization was also calculated. Among subjects in the program group, the median number of psychiatric bed-days used decreased significantly, from 59 days to 50 days. No significant change in the median number was observed for comparison subjects. Comparison subjects were rehospitalized 1.7 times more often than program subjects. Overall, program subjects under age 62 (younger subjects) were rehospitalized 2.5 times more often than older subjects. In the program group, those who had received home visits for more than two years were hospitalized three times more often than those who had received visits for less than two years, and younger subjects were rehospitalized 1.8 times more often than older subjects. The findings suggest that home visits conducted by case managers in a community residential care program helped reduce psychiatric hospitalization among veteran patients living in privately operated board-and-care homes.

HIV/AIDS and long-term care: a state perspective.

Long-term care services for people with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) were fostered in New York State by passage of HIV-specific regulations that set program standards and authorized reimbursement rates sufficient to support these standards. A rapid expansion of HIV-specific capacity has occurred. Demographic and selected clinical characteristics of the populations in AIDS residential health care facilities and AIDS adult day health care programs in New York State are presented. Aspects of the service models for these two program types that have changed to meet new needs are discussed.

Program review of community residential care.

This article provides an overview of the Department of Veterans Affairs Community Residential Care Program and summarizes key literature about programs developed in the United States. Descriptive data for 1995 and 1996 are provided to assist program planners in comparing and contrasting client characteristics and services. The authors conclude that, in addition to being cost effective, the residential care program strengthens relationships between the health care facility and the community it serves.

PROGRAM REVIEW OF COMMUNITY RESIDENTIAL CARE

This article provides an overview of the Department of Veterans Affairs Community Residential Care Program and summarizes key literature about programs developed in the United States Descriptive data for 1995 and 1996 are provided to assist program planners in comparing and contrasting client characteristics and services. The authors conclude that, in addition to being cost effective, the residential care program strengthens relationships between the health care facility and the community it serves.

Community-Based Residential Child and Youth Care Work: Opportunity or Oxymoron?

The two articles that comprise this symposium both come from Israel, but their substantive connection to each other may not be immediately apparent. Shlomo Romi reports on sex differences in the attitudes of high school and college students concerning the integration of "detached" youth in normative youth service programs. Mordecai Arieli, on the other hand, examines the implications of admitting day students from the neighboring community to residential schools serving primarily socially disadvantaged youth. But taken together, they illuminate a significant current issue—perhaps the significant current issue—in North American child and youth care work: How can such programs serve as normalizing influences in the lives of the young people involved? Residential group care, education, and treatment programs for young people continue to attract vigorous criticism in professional and lay circles and enjoy relatively little support. On one level, this appears to reflect individualistic ideological predilections, particularly in the United States, with consequent distrust of group-based, communally oriented approaches. Closer to the surface, the argument is often couched in terms of relative costs and cost effectiveness and the idea that residential settings are frequently and perhaps even intrinsically abusive (Beker, 1994; Schwartz, 1994). It seems clear that the results of many North American residential programs have been disappointing, but little attention has been given to the reasons for these failures and to the evidence that such approaches typically enjoy at least relative success elsewhere. Compari-

Multiple Dimensions of Family-Centered Practice in Residential Group Care: Implications Regarding the Roles of Stakeholders

This article summarizes findings of a dissertation study (Johnson, 1994) that examined efforts of residential group care programs to involve families. Results disclosed six independent dimensions of these family engagement practices. The author suggests that these factors may be most easily interpreted as they relate to the roles and functions of various stakeholders, including direct care staff, program social workers, team leaders, administrators, and Department of Social Services workers.

Family engagement practices in residential group care: Differences between public and private cases

This article reports on findings from a survey of residential group care programs in a southeastern state. The study documented differences in program efforts to engage families whose children are placed through public agencies, and those families who retain control over the placement of their children. Statistically significant differences were found in the areas of shared decision making, expectations of the families in relation to case planning activities, and expectations of families to continue or resume parenting responsibilities.

Residential Education in the Unites States

The authors explore some of the crucial issues on which the future success of residential group care programs for children and youth in the United States depends, including funding, legal considerations, race and culture, the role of religion, and evaluation.

Parent education and training or family therapy: Does it matter which comes first?

This paper raises questions about the appropriate focus for residential group care programs as they work with parents (including single parents) of children in care. Many programs, in their efforts to claim status as treatment centers, have broadened their range of services and now include therapeutic services for parents, in particular family therapy. However, there has not been a serious examination of whether therapeutic approaches to work with families fit the group care service context. This paper will address concerns about using family therapy in group care programs and will suggest that parent education and training is a more effective alternative.