Residential Placement Research Articles

Self-efficacy, aspirations, and residential placement outcomes: Why belief in a prosocial self matters

PurposeWhile prior research has documented the relationship between self-efficacy and delinquency, there is a gap in the literature on how self-efficacy is related to the continuation of antisocial behavior for youth involved in the justice system. This study examines whether juvenile offenders' beliefs in their abilities to live a prosocial life predict conventional aspirations for the future. It also assesses the joint effects of self-efficacy and prosocial aspirations on length of stay in residential placement and recidivism among a sample of delinquent youth. MethodsWe examine relationships between self-efficacy, aspirations, and residential placement outcomes using a sample of 12,955 juvenile offenders who completed a juvenile justice residential placement program in Florida. A generalized structural equation model that controls for demographics and various risk factors was used to model the multiple outcomes of varying levels of measurement. ResultsYouth with higher prosocial self-efficacy report higher prosocial aspirations for their future. Self-efficacy and aspirations are also negatively related to lengths of stay in residential placement and subsequent delinquent behavior. ConclusionsJuvenile justice interventions should target youths' attitudes and beliefs related to prosocial identity. Cognitive behavioral interventions, positive reinforcement of prosocial behavior, and skill training may help prevent youth recidivism.

Factors Associated with Residential Long-Term Care Wait-List Placement in North West Ontario.

This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study's analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.

Reconciling Work and Caregiving Responsibilities among Older Workers in New Zealand.

There are 432,000 individuals in New Zealand who provide unpaid care for someone who is ill or disabled and 65% of these carers are also in paid employment. The number of older people in the paid workforce is projected to increase in the next two decades. With the median age of carers in 2013 at 49 years, the ageing of both the population and workforce suggests that many carers may still be in paid work as they themselves age. Family care is an essential part of the health care system. Informal care provides many benefits including improved patient outcomes, reduced unnecessary re-hospitalisations and residential care placements, and considerable savings in health care expenditure. However, combining paid work and informal care is problematic for many carers and can impact on their health and wellbeing, and on work-related outcomes by way of reduced work hours, absenteeism, and employment exit. Recent policy initiatives have been implemented to support family carers in New Zealand to remain in or re-enter the workforce. This paper explores the challenges presented to older New Zealanders who combine paid work with caregiving responsibilities. We provide a profile of older workers (aged 55+) who are providing care and analyse the impact of combining paid work and care on their health, wellbeing and economic living standards. Finally, we situate these findings within the policy framework in New Zealand.

Multiple Pathways to Juvenile Recidivism: Examining Parental Drug and Mental Health Problems, and Markers of Neuropsychological Deficits Among Serious Juvenile Offenders

The current study examines multiple pathways to antisocial behavior involving neurobiologically based measures and indicators of executive functioning in the interest of informing treatment and intervention services for the deepest end juvenile justice placements. Specifically, using a statewide, multiyear sample of over 11,000 male juvenile offenders completing residential commitment placements, we employ structural equation modeling (SEM) to examine whether parental drug, alcohol, and mental health problems have a direct effect on neurocognitive deficits (as measured by formal Attention-Deficit/Hyperactivity Disorder [ADHD], or formal Conduct Disorder [CD] diagnoses) and temperamental deficits (as measured by effortful control and negative emotionality), which in turn are examined for their direct effects on recidivism. Results show that parental problems were associated with an increased likelihood of formal ADHD diagnosis as well increased negative emotionality among youth. Furthermore, ADHD and temperamental deficits (both effortful control and negative emotionality) were significantly related to continued offending. These findings may be helpful in treatment planning, targeting of intervention, and discussions of primary and secondary prevention efforts.

Examining School Attachment, Social Support, and Trauma Symptomatology Among Court-Involved, Female Students

Court-involved youth (i.e., youth in the foster care and/or juvenile justice systems), and particularly those in residential placement facilities, often present with trauma histories that can impede various areas of development and functioning. These traumatic histories can negatively impact academic performance and school success, leading to poorer outcomes later in life. In particular, female youth in these systems exhibit unique responses to traumatic experiences that further complicate healthy development. This study assesses female, court-involved students (n = 141), exploring the relationship between school attachment and school involvement, school social support (from peers, teachers, and other staff), and trauma symptomatology among a sample of residential placement students exposed to a trauma-informed teaching intervention over the course of a school year. It was hypothesized that higher school attachment/involvement and social support would be associated with lower student trauma symptomatology. As expected, findings demonstrated that students in the sample had experienced high trauma exposure, as indicated by their high trauma symptomatology. Unexpectedly, they also had high school attachment. Furthermore, higher school attachment was associated with lower trauma symptoms among students. On the other hand, students reported lower levels of social support from classmates, which was associated with significantly higher trauma symptomatology. Implications for future research are addressed.

Effectiveness of psychosocial interventions on the psychological health and wellbeing of family carers of people with dementia following residential care placement: a systematic review protocol.

The objective of this review is to identify, appraise and synthesize existing evidence regarding the effectiveness of psychosocial interventions on the psychological health and emotional wellbeing of family carers of people with dementia who have moved into residential care.More specifically, the objectives are to determine the effectiveness of psychosocial interventions on any of these family carer outcomes after placement in residential care: burden, anxiety, stress, depression, guilt, grief and loss, quality of life and satisfaction with the care of the person with dementia.

The Effects of Changes in Dynamic Risk on Reoffending among Serious Juvenile Offenders Returning from Residential Placement

This study examines whether changes in dynamic risk during juvenile justice long-term residential placement affect recidivism. Advancing the work of prior dynamic risk change analyses, we examine a large sample of 11,891 male and 1930 female juvenile offenders while taking methodological steps to ensure successful and non-successful youth (in terms of recidivism) are (statistically) identical at admission. Specifically, we employ propensity score matching on residential placement youth who recidivate post-release and non-recidivists on static risk factors and initial dynamic risk scores assessed at admission to residential placement. Post-matching, changes in dynamic risk factors from initial assessment at admission to exit assessment at release are examined with a focus on whether those changes distinguish recidivists from non-recidivists. Separate analyses are conducted for male and female juveniles. Results indicate that changes in dynamic risk do affect recidivism likelihood, but that different factors matter for males and females. These sex-specific models allow for distinct policy recommendations.

Looked after children and access to dental services and oral health in Scotland: a national data-linkage study (LAC-DENTAL)

ABSTRACTObjectivesChildren that are ‘looked after’ include those that are accommodated in foster, kinship and residential care placements, as well as those at home on compulsory supervision. They have poorer physical and mental health than their peers and there are concerns about the relatively high levels of untreated morbidity. Oral health and access to dental services among Looked After Children (LAC) has received limited attention to date. The objective of this study was to compare the oral health and access to dental services of children who are looked after by the state, with comparable children in the general population.
 ApproachSchool and Social Work datasets were able to be linked using the Scottish Exchange of Data (ScotXed) Unit. This in turn was linked with health data making use of the Scottish national record-linkage system provided by the NHS eDRIS team for the FARR Institute Scotland. All of the following datasets used in this study are complete national datasets for the time periods noted. School Pupil Census 2012: a census of children in local authority primary and secondary schools that provides each child’s age, sex and socioeconomic status as measured by the Scottish Index of Multiple Deprivation (SIMD). The other datasets cover the period 2008-2012: LAC- all children with social work referrals for various types of placement; registration with dentists; hospital discharge data for all episodes of tooth extraction; National Dental Inspection Programme (NDIP) data from Primary 1 and Primary 7 school years (dental decay). The LAC group were compared to their peers by logistic regression adjusted by SIMD, using remote access to the National Safe Haven.
 ResultsThere were 633204 subjects in the study group (10927 LAC, 622280 nonLAC). Ages ranged from four to 17 years (mean 12 LAC and 10 nonLAC); with 53% male for LAC and 51% nonLAC; and 42% in the most deprived SIMD level for LAC and 21% for non-LAC. The subjects in the LAC group were more likely to have dental decay at Primary 1, odds-ratio (OR) 2.93 (2.55, 3.38), and Primary 7, OR 1.81 (1.68, 1.94). LAC subjects were less likely to be registered with a dentist, OR 0.50 (0.43, 0.59), and more likely to have teeth extracted, OR 1.50 (1.40, 1.60). All tests p<0.001.
 ConclusionLooked after children are more likely to have dental problems and less likely to use dental services than their peers, after adjustment for socioeconomic status.

Characteristics associated with residential aged care, respite and transitional aged care placement for older people following an injury-related hospitalisation in Australia

Objective: This study examines characteristics associated with permanent residential aged care (RAC), respite RAC and transitional care (TC) placement for older individuals following an injury-related hospitalisation.
 Method: A retrospective analysis of individuals aged ≥65 years who had an injury-related hospitalisation and who had a linked record in RAC, TC or activities of daily living (ADL) data between 1 July 2008 and 30 June 2013 in New South Wales, Australia. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. All hospital episodes of care related to the injury were linked to form a period of care. Both new and existing admissions to RAC were examined. Multinominal logistic regression was used to examine the factors associated with new admissions to permanent RAC, respite RAC and TC compared to return to the community.
 Results: Of 191,301 injury-related hospitalisations, 41,085 (21.5%) individuals either returned or were new admissions to permanent (87.2%) or respite (12.8%) RAC and 3,218 (1.7%) individuals were admitted to TC. There were 3,864, 4,314 and 2,630 new admissions to permanent RAC, respite RAC and TC, respectively. Of the injury hospitalisations, 70,796 (37.0%) individuals had an ADL assessment. Compared to individuals who returned to the community, individuals newly admitted to permanent RAC were four times as likely to have dementia (OR: 4.36; 95%CI 4.15-4.57), those admitted to respite RAC were twice as likely to have dementia (OR: 2.37; 95%CI 2.21-2.54) and people admitted to TC people were less likely to have dementia (OR: 0.60; 95%CI 0.53-0.68). Individuals with shoulder and upper arm injuries were twice as likely (OR: 2.31; 95%CI 1.98-2.68) and individuals with knee and lower leg injuries were one and a half times as likely (OR: 1.87; 95%CI 1.60-2.18) to be admitted to TC. Overall, individuals who were admitted to permanent or respite RAC had a higher likelihood of experiencing limitations associated with their physical, cognitive or social abilities, with individuals admitted to TC having a higher likelihood of having limitations maintaining personal hygiene and mobility compared to individuals returning to the community.
 Conclusion: An understanding of the profile of which older individuals are using RAC (permanent or respite) or TC services can usefully inform current and future aged care service use.

Adult criminality among former residential school adolescents.

There is evidence from around the world that disruptive behaviour during adolescence is associated with increased risk of later criminality. Outcomes for young people placed in the Finnish residential school because of severe conduct problems are not known. Our aims were to investigate criminality after leaving a residential school placement during adolescence, and to compare trends in criminality between four successive graduate cohorts (1991, 1996, 2001 and 2006). We used official records to study complete national cohort of all 861 people who had been resident in the Finnish residential school system on the last day of each of the years 1991, 1996, 2001 and 2006. They were compared with 4255 matched general population controls. The follow-up time was up to 20 years. Two-thirds (66%) of all residential school graduates (N = 566: 448/78% men, 118/41% women) had at least one criminal conviction in adulthood, a 13-fold elevation over the general population rate. The most prevalent crime categories were violence (N = 409, 48%: 331/58% men, 78/27% women) and property crimes (N = 405: 47%: 346/60% men, 51/21% women). The risk of violent crime was 18 times that among controls; 13 of residential school males (2.3%) had a homicide conviction. Once adult, the risk of offending decreased with age. There was a significant trend for improvement in offending rates between the earliest and latest residential school cohorts. The risk of committing crimes after a residential school placement is sufficiently elevated that alternative strategies, perhaps particularly longer-term post-release supervision and aftercare, should be considered. Indications of lower crime rates in later cohorts suggest that some positive changes to the school regime and/or aftercare may have been made already. Copyright © 2017 John Wiley & Sons, Ltd.

A neuro-developmentally sensitive and trauma informed service delivery approach for child and youth mental health and psychiatry

This presentation will introduce the innovative approach to child and youth mental health and psychiatry using the neurosequential model of therapeutics (NMT). This is a neuro-developmentally sensitive and trauma informed approach and acknowledges the importance of early experiences shaping the organization of the brain. An outline of the stress response and its relevance to hyper-arousal and dissociative responses will be discussed as this impacts attachment and the reward neuro-biology. The hierarchy of brain development will be emphasized in the clinical approaches to child psychiatry especially in reference to child maltreatment and neglect. The critical role of sensory integration, self regulation, relational health and cognitive development in treatment planning will be discussed versus the categorical diagnosis of ADHD, autism, bipolar disorder and depression. This has profound economic and psychopharm practice implications in child and youth mental health treatments. Consequently the importance of these concepts in informing public policy for early child development and school mental health literacy will be emphasized. Additionally the outcome of these approaches on the reduction of staff turnover, critical incidents in schools and residential placements will be shared.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental health, substance use, and offending patterns among Native American youth in juvenile detention

ABSTRACTResearch has shown that youthful offenders in the juvenile justice system report an array of substance use and emotional and other mental health needs. The current study closely examined these issues in a large national sample (n = 539) of Native American youth drawn from the Survey of Youth in Residential Placement. Results demonstrated that frequent substance use was associated with the likelihood of being detained for a drug offense, while emotional and mental health needs were associated with detention for the most serious offenses. These results highlight the need for comprehensive substance use and other mental health assessments for Native American youth in the juvenile justice system.

Toward a successful vocational rehabilitation in adults with disabilities: Does residential arrangement matter?

ABSTRACTThe objective of this study was to assess whether successful vocational rehabilitation (that is, obtaining employment) among people with disabilities was affected by residential arrangement. Five groups of residential placement were considered: individuals living in a private residence, community or group residential, correctional and rehabilitation facilities, nursing home/mental health facilities, and homeless/shelter/other type of residential arrangement. The study involved a total of 46,570 vocational rehabilitation consumers aged 18 to 65 at referral in a Midwestern state. Statistical modeling was performed using quasibinomial logistic regression. It was found that compared to individuals living in private residences, those in correctional or rehabilitation facilities were at increased odds of successful rehabilitation, whereas those living in homeless/shelter/other residential arrangement and those living in nursing homes/mental health facilities were in significantly decreased odds of being rehabilitated. Individuals living in community or group residential, however, had no statistical difference in vocational rehabilitation outcomes compared to individuals living in private residences. The implications for rehabilitation research and practice are discussed.

The Racial and Gender Differences in the Impact of Adverse Childhood Experiences on Juvenile Residential Placement

Research has demonstrated a relationship between adverse childhood experiences (ACEs) and a variety of juvenile offending outcomes. No study to date, however, has examined the relationship between ACEs and juvenile residential placement. The current study utilized a large sample of 4,733 adjudicated juveniles in Florida in order to examine the relationship between ACEs and residential placement across gender and race/ethnicity. For the entire study sample, ACEs significantly increased the odds of residential placement by age 17. For males, ACEs significantly increased the odds of residential placement for Black and Hispanic males but had a null effect on White males. For females, ACEs were predictive of residential placement for Black females but not for White or Hispanic females. Consistent predictors of residential placement across demographic groups included the presence of antisocial peers, substance abuse issues, and anger problems.

Therapeutic Programs for Students with Behavior Disorders in Public Schools

The Department of Justice has a responsibility to ensure that all programs serving students with emotional and behavioral disorders (EBD) abide by laws, as do state governments. This study took a close look at a Department of Justice’s investigation of the appropriateness of a behavior intervention program (that is, the Georgia Network for Educational and Therapeutic Support; GNETS) and how the state government responded to inquiries. This study further explored how students with behavior disorders learned in a GNETS Program and what their progress was within an assessment and across assessments. Due to the fact that government-funded therapeutic services typically are more cost-efficient than private therapeutic services and may prevent students from being placed in residential or more restrictive placements, this study will help improve not just the services of GNETS programs but also the services of related programs for students with EBD in public school settings.

Challenging mass incarceration in the City of Care: Punishment, community, and residential placement

Challenges to mass incarceration often come from places seeking to bolster “community” sanctions and community-based alternatives to punishment. In the City of Care, local community activists challenged growing rates of juvenile incarceration and the overrepresentation of youth of color in juvenile detention by advocating for a community-based “circle of care”. These efforts resulted in the local juvenile court embracing the “least restrictive interventions”. In cases where juveniles could not be helped “in the community”, residential placement replaced the practices of sending young people to juvenile hall or the California Youth Authority. This article examines how the use of placement sought to unseat the ethos of punishment, but inadvertently incentivized young people to stay in juvenile hall. Thus, in the City of Care the extension of “community-based” services is often no different from practices of punishment, and must be interrogated as part of the state repertoire of control and exclusion.

Measuring Complexity for Autism Interventions: Tcfd’s Inventory of Neuroeducational Complexity

Autism is a complex condition, whether viewed from etiology, comorbidities, functioning, or interventions. There are numerous approaches for measuring complexity in children and adolescents with neurodevelopmental or medical diagnoses. Interventions, however, create the need for broader and deeper assessment—including the environments in which the young person lives. The Center for Discovery, New York state’s Center of Excellence for Developmental Disabilities, (TCFD) implemented an Assessment, Support, Education and Training (ASSET) grant from the New York Office for People with Developmental Disabilities. This paper will describe the Assessment activity. A major goal was to develop a tool for assessing the characteristics of the young person and pivotal environments. The objective was to promote the delay of or prevent movement to a more restrictive placement including residential placement. The pilot tool was developed over nine months and includes six areas for evaluation—medical/ impairments (8 items), functional profile (11 items), educational profile (5 items), home/family environment (9 items), school environment (6 items), and community environment (4 items). Implementation of CfD’s Inventory of Neuro-educational Complexity (INC) was able to distinguish among 30 pilot subjects those likely to use family and school interventions to maintain family living from those most likely needing at least short term residential placement. The INC is of substantial heuristic value in this time of great interest in effective and resource focused interventions with this population.

Wearable Stress Sensors for Children With Autism Spectrum Disorder With In Situ Alerts to Caregivers via a Mobile Phone

Background: Children with autism spectrum disorder (ASD) often exhibit unexpected and difficult to manage self-injurious, aggressive, and/or disruptive and challenging behaviors. These behaviors can lead to restrictive care settings including hospitalizations and lifelong residential care placement. Because children with ASD have significant impairments in social communication skills including lack of facial expression, an inability to clearly articulate feelings, and atypical body language, caregivers could benefit tremendously by knowing when a child is becoming stressed. Objective: To develop a set of customized features in a wearable sensor and mobile app that monitors stress reactivity of children with autism in real time and automatically triggers in situ alerts to a caregiver via a mobile handheld device. Methods: The Center for Discovery (CFD) is a not-for-profit internationally recognized service provider for people with complex developmental disabilities, including a large population of children and adults with autism. Neumitra Inc., is a start-up technology vendor specializing in wearable stress monitoring. Neumitra’s wearable sensor called neuma featured an embedded system with automated scoring of electrodermal activity, a well-established method for recording physiological stress responses. The sensor was accompanied by a mobile app for users to self-monitor their own stress levels. The app provided a 10-point color gradient scale as an interpretation of real-time stress and arousal levels. CFD collaborated with Neumitra’s development team to develop a set of customized features amenable to the use case presented by caring for children with autism. The research team at CFD trialed the neuma system extensively, developed use case scenarios, and identified the features necessary to successfully implement in situ alerts to caregivers and track stress events to review for patterns of stress. Results: The resulting system is neuma-CFD, a coordinated technological system for in situ monitoring of stress levels to identify correlations in the user’s stress increases and contextual events. The system delivers in situ alerts to caregivers via a smartphone or similar handheld devices. A new interface for the mobile app was customized to minimize user burden. The home screen now allows users to create high-frequency calendar events in only two taps. These events include common challenging behaviors and common intervention techniques. Thus, upon review, stress responses can be viewed relevant to both challenging behavioral episodes and intervention techniques. To enhance clinical review, the app now logs the detection of stress events into the calendar. Users can also access an increased granular review of electrodermal activity within a calendar event, such as behavior episodes or classroom routines. Conclusions: In field testing, in situ alerts were reported by caregivers to be beneficial. Furthermore, the integration of color-coding calendar events and routines in an intuitive interface allows multiple users to review the contextual events correlated to stress responses with minimal training. Wear tolerance, a challenging human factor common in ASD, can be addressed through behavioral shaping protocols. The hardware form factor was not amenable to this population due impulsive behaviors including pulling on the device to remove it, causing hardware damage. Exposure to water during handwashing was another challenge in hardware. These concerns are being revised in future versions of hardware. This system can also benefit other healthcare populations, such as patients with anxiety, posttraumatic stress disorder or any other condition for which understanding patterns of stress offers improved health outcomes.

A necessary evil: Residential placement of people with intellectual disability among the Palestinian minority in Israel

Among the Palestinian minority in Israel, residential placement of people with intellectual disabilities [ID] is relatively new and steadily increasing, but poorly studied. A qualitative design was used to explore the process of residential placement decision by 18 parents of people with ID through semi-structured interviews. Sampling was purposive and data was analyzed thematically. Four main themes emerged representing parents’ perceptions and experiences along the placement decision-making process, together indicating an experience of deeply ‘conflicted parenting’: (a) initial resistance to placement and its perception as abandonment and parental failure; (b) attrition following cumulative difficulties and lack of assistance; (c) resignation and reframing of placement as a necessary evil; (d) relief mixed with guilt, pain, and ambivalence following placement. Residential placement process proved to be linked primarily to lack of resources and of accessible culturally-competent services within the community. Parents’ experience and behavior along the placement decision process reflect relentless efforts to practice “good parenting”. This concept is culturally specific and in the present case entails commitment to consider the individual child’s wellbeing together with the family’s as a whole. Implications for practice are suggested.

Juvenile Court Practitioners’ Construction of and Response to Sex Trafficking of Justice System Involved Girls

ABSTRACTThe commercial sexual exploitation of children (CSEC) is a growing domestic health and policy concern. Exploited girls may be at heightened risk for entering the juvenile justice system. The purpose of this study was to explore the needs of CSEC victims and resources available for system-involved girls. The data from this study included semistructured interviews, case discussions, and residential placement meeting observations with juvenile justice personnel. Findings revealed labeling issues related to (1) how court workers construct female victims of CSEC through exploitation myths, (2) the importance of trauma history and relational contexts, and (3) system-level barriers. Recommendations for practice are discussed.