Residential Treatment Center For Children Research Articles

Pharmacogenetic Testing and Therapeutic Drug Monitoring Of Sertraline at a Residential Treatment Center for Children and Adolescents: A Pilot Study.

Background: Sertraline is commonly prescribed to children for the treatment of anxiety and major depressive disorder and is metabolized in part by CYP2C19. While dosing recommendations based on CYP2C19 genotype exist, there is sparse data in children on the relationship between sertraline concentrations and CYP2C19 genotype. Additionally, although rarely utilized in the United States, therapeutic drug monitoring can also help to guide dosing. The primary objective of this pilot study was to compare sertraline concentrations with CYP2C19 genotype. Secondary objectives included exploring the feasibility of using pharmacogenetic testing and therapeutic drug monitoring in a residential treatment center for children and adolescents. Methods: This study was a prospective, open-label study of children prescribed sertraline being treated at a residential treatment center for children and adolescents. Individuals were included if they were < 18 years of age, taking sertraline for at least 2 weeks allowing them to reach steady-state concentrations, being treated through the residential treatment program, and able to understand and speak English. Results: A total of 20 participants (80% female) completed all study procedures, including pharmacogenetic testing and therapeutic drug monitoring, with an average age of 15.4 years (range: 9-17 years). Forty percent (n=8) of participants had a diagnosis of Generalized Anxiety Disorder, while 30% (n=6) had a diagnosis of Major Depressive Disorder. Overall, average sertraline and desmethylsertraline concentrations were 21.1 ng/ml (range: 1-78 ng/ml) and 52.4 ng/ml (range: 1-258 n/ml). Based on CYP2C19 genotypes, 60% (n=12) were normal metabolizers, 10% (n=2) were intermediate metabolizers, and 30% (n=6) were rapid metabolizers. Daily sertraline dose (mg/day) accounted for a significant amount of the observed variability in sertraline (p<0.0001; r2=0.62) and desmethylsertraline concentrations (p<0.001; r2=0.45). When comparing weight-based dosing by sertraline and desmethylsertraline concentrations, sertraline daily dose by weight (mg/kg/day) also accounted for a significant amount of the observed variability in sertraline (p<0.0001; r2=0.60) and desmethylsertraline (p<0.0001; r2=0.59) concentrations. Average daily and weight-based doses for CYP2C19 intermediate, normal, and rapid metabolizers were 75mg/day, 87.5mg/day, and 79.2mg/day and 1.5mg/kg/day, 1.3mg/kg/day, and 1.1mg/kg/day, though these were not significantly different. Conclusion: This small, pilot study showed sertraline dose to be significantly associated with sertraline and desmethylsertraline concentrations. No differences were noted between CYP2C19 metabolizer groups, likely due to the limited sample size. These results also suggest that ordering pharmacogenetic testing and therapeutic drug monitoring in the setting of a child and adolescent residential treatment center is feasible.

An Embodied Artistic Inquiry into Attachment-Oriented Therapeutic Relationships

In this study, I utilized an embodied artistic inquiry self-study to explore my experience of attachment in the therapeutic movement relationships (TMR) created as a dance/movement therapy intern at a psychiatric residential treatment center for children. The research was guided by three questions: How do I experience the TMR with children in a psychiatric residential treatment setting using attachment theory? How is my personal attachment style influencing and guiding the therapeutic relationship? How does my identification of salient moments relate to my own attachment style and aesthetic preference? Data were collected using journal entries that reflected on the researcher’s experience of attachment, saliency, and Tortora’s D.A.N.C.E. qualities of attachment (Clin Soc Work J 38(1):37–50, https://doi.org/10.1007/s10615-009-0254-9, 2010). I analyzed the data using discussion and Authentic Movement with a research consultant in order to synthesize and describe the experience of each salient moment. Repeated movements included grounded and unstable walking, changing of levels, core-distal movements, circling and carving arms, and recuperation. The themes that resulted from repeated movements and discussion with the research consultant include foundational movements, holding discomfort, connection to a specific client, and playfulness. These results reinforced the importance of stability and self-awareness for a therapist especially in relationship to how their movement and nonverbal preferences may have been learned from attachment relationships. Furthermore, results show the impact of saliency and the clinician’s aesthetic preference. In addition, the results reflected the strong relationship among nonverbal qualities of attachment and the TMR. These results suggested that qualities of attachment underlie the effectiveness of the TMR. Although limitations of the study prevented me from drawing correlative conclusions, the therapist may be able to strengthen the therapeutic relationship by targeting primary attachment models, and suggestions for further research are included.

Can Children Be Safe if Their Caregivers are Not?: Reflections on the “Promise” Study of Workforce Issues in a Residential Treatment Center for Children

ABSTRACT This article reviews findings from a recent ethnographic study of the workforce in a residential treatment center for children. Major threats to workers’ physical safety and psychosocial well-being were documented, including client violence and intensive and threatening regulatory oversight of practice. I show how, in this setting, the effects of client violence against workers and attempts to comply with the regulatory policy appear to have had unintended negative consequences for the safety of youth in care, as well as their caregivers. I argue that attempts to improve safety and the perception of safety for youth in care require a systemic understanding of how violence and its regulation affect the milieu as a whole, with attention to the well-being of both children and workers. I conclude with suggestions for how organizations can maximize safety for all.

Commentary on "Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents" by Green-Hennessy and Hennessy.

In their 2015 study, Sharon Green-Hennessy and Kevin D. Hennessy addressed an important gap in the literature on seclusion and restraint use in child and adolescent residential treatment centers (RTCs). Their analysis revealed that several facility-level characteristics-such as facility size and ownership-predicted the use of seclusion/restraint in child/adolescent RTCs. The authors also examined patient demographic variables that were significant predictors of seclusion/restraint in prior research on individual patients within facilities. However, Green-Hennessy and Hennessy did not find any relationship between these demographic variables and seclusion/restraint. In this commentary I argue that the null relationship between patient demographics and seclusion/restraint was a result of an ecological fallacy. Rather than attempting to use aggregate patient data to infer individual-level processes, this patient data should be used to study aggregate effects. I demonstrate that by re-conceptualizing these patient demographics as indicative of facility characteristics, rather than patient characteristics, new information can be gleaned about the types of facilities that use seclusion/restraint. The arguments presented here have broader implications for future research in this field that relies on aggregate patient data.

Play Therapy in Residential Treatment Centers for Children

ABSTRACTResidential Treatment Centers (RTCs) serve youth who have suffered extreme abuse and trauma and must reside in 24-hour facilities to receive mental health, medication, and social services. Currently, specific therapeutic interventions utilize talk therapy or cognitive therapies, which may have limited use with children due to developmental considerations, specifically children who have been through trauma that has affected their development. Child-Centered Play Therapy (CCPT) is introduced as an evidence-based expressive therapy modality that emphasizes the child’s natural language of play as a way to support emotional and psychological healing. This article discusses limitations to residential treatment center research as well as ways to implement play therapy into residential treatment settings for children who are in need of such services through the use of brief play therapy, group play therapy, and Child Parent Relationship Therapy (CPRT).

“Sense” and sensitivity: Informal apprenticeship among youth care workers in a residential treatment center for children

AbstractThis article reports findings from a 13‐month ethnographic study of knowledge use and expertise among 78 workers in a U.S. residential treatment center for children. It investigates the question of how youth care workers developed expertise in an organization that did not require graduate professional education and provided little didactic training. It demonstrates how processes of informal apprenticeship allowed some workers to develop locally recognized expertise through working alongside more experienced peers. It analyzes the puzzling initial finding that workers simultaneously attributed expertise to innate “common sense” and reported that they developed this form of expertise through informal on‐the‐job apprenticeship. Taking a cultural perspective on learning, this article conceptualizes youth‐serving organizations as communities of practice in which informal apprenticeship contributes to the development of locally valued forms of expertise and addresses the question of why youth care workers appeared to differ in their ability to make use of opportunities for such learning. It explores implications of these findings for workforce development in youth residential treatment and for social work education in general, suggesting simple methods for maximizing opportunities for situated learning.

Psychiatric Residential Treatment Centers for Children and Adolescents: Modeling Variation in Facility Definition Type

A national picture of residential treatment centers (RTCs) for children is lacking and this situation may be complicated by differences between facilities in how RTCs are defined. This study uses data from a national survey of mental health facilities to supplement current knowledge about variation in the definition of RTCs nationwide. Descriptive analyses using 2012 National Mental Health Services Survey (N-MHSS) data were conducted on a standard definition of an RTC from the research literature and three different variations of it. Cohen’s h was calculated to assess whether differences in proportions were meaningful. While nearly two-thirds of RTCs that serve children define themselves following a standard definition in the research literature, nearly a quarter served adults, 9% did not require that residents have a diagnosis of serious emotional disturbance (SED), and a small proportion offered inpatient care in addition to residential care. Of the 9% of RTCs that did not require an SED diagnosis, the majority of these facilities were located in the West. This finding suggests that some of these RTCs may be wilderness programs, and it may also be an indicator of lack of RTC availability. Lack of consensus in the research literature and in the field regarding the definition of an RTC makes it difficult to compare different RTC study findings with each other. Development of a consensus definition of RTCs is a necessary first step to collecting comprehensive data and assessing the current state of this important component of the mental health delivery system.

Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents.

This study identified predictors of seclusion or restraint use among licensed and/or accredited residential treatment centers (RTCs) for children and youth in the United States responding to a federally-sponsored survey of mental health services. 693 licensed and/or accredited child and adolescent RTCs responded to questions about the demographic and admission status of clients served on an identified date, services offered, size, ownership, funding, and their use of seclusion or restraint practices within the preceding 12 months. Logistic regression was used to determine factors predicting facility use of seclusion or restraint. A large majority of licensed and/or accredited child and adolescent RTCs (82 %) reported using seclusion or restraint in the prior year. Contrary to prior research, individual patient characteristics (percent of males, minorities, and involuntary admissions) did not predict the use of coercive techniques. Instead facility and funding variables accounted for approximately 27 % of the variance in the use of seclusion or restraint. Larger, privately-owned RTC's funded primarily through public monies and which offered medication and programming for SED youth were more likely to endorse having used seclusion or restraint in the previous year. Despite visible policy and advocacy efforts to reduce seclusion and restraint use over the past decade, a majority of licensed and/or accredited RTCs for children and adolescents report using such practices. Findings emphasize the importance of examining facility-level variables in predicting their use, and highlight the disconnect between nationally espoused goals and current practices regarding coercive techniques in child and adolescent RTCs.

Rethinking Decision Making: An Ethnographic Study of Worker Agency in Crisis Intervention

Building on recent literature that addresses how social workers use knowledge to make practice decisions, this ethnographic study of mental health workers in a residential treatment center for children asks what modes of agency workers enact and how they use formal training in Therapeutic Crisis Intervention (TCI) during crises. Based on 13 months of participant observation and 36 semistructured interviews, this study demonstrates that, while workers routinely employed specific intervention techniques taught in the TCI curriculum, they rarely reported using its step-by-step decision-making process. Instead, faced with an imperative to act, workers reported using a mode of agency characterized by what they term “instinct,” automaticity, physicality, and instantaneous mental simulation of possible outcomes. I discuss these findings in light of Pierre Bourdieu’s work on habitus, considering implications for crisis intervention training, prescriptive models of decision making, and the further development of contextually sensitive models of agency in social work practice.

Making clinical decisions when ‘behavior has meaning’: An ethnographic study of expertise in a residential treatment center for children and adolescents

Although social work scholars have proposed and promoted various models for making effective and ethical clinical decisions, little empirical research has addressed processes of clinical decision-making as they occur naturally in ‘real world’ mental health practice. This article briefly reviews approaches to the study of decision-making, and presents findings from an ethnographic study of the collaborative decision-making activities of mental health workers in a residential treatment center for children and adolescents. This article describes and analyzes a local theory and practice of interactional clinical decision-making in which workers provide competing interpretations of the ‘meaning’ of clients’ behaviors before committing to a particular course of clinical action. This process, which I term the ‘behavior-has-meaning’ hermeneutic, serves not only to guide clinical interventions, but as a forum for modeling, developing, and evaluating locally valued forms of clinical expertise. Implications of these findings for the implementation of prescriptive models of clinical decision-making – such as the evidence-based practice process – are discussed.

Adult visitation and permanency for children following residential treatment

The absence of parents for foster children in residential treatment undermines the known positive effects of parental visits during treatment on children's permanency. To date, little attention has been given to the scope and role of visitation by non-parental adults. This study utilized clinical data from a residential treatment center for children to examine the patterns of adult visitation during treatment and their effects on children's permanency at and 6 months following discharge. Different types of relationships including parents, extended family and non-family adults, and various measures of visitation, such as frequency and regularity of visits, were included in descriptive and logistic regression analyses. Results showed that while children had the most number of visits from parents compared to other visitors, non-family visitors were just as likely to visit regularly. Logistic regression analysis indicated that having parent visitors only as opposed to having parents and other visitors was positively associated with permanency at and 6 months after discharge. In addition, controlling for composition of visitors and age at discharge, more visits by non-family increased the likelihood of permanency. Implications for practice and theory are discussed.

Predictors of Burnout in Children's Residential Treatment Center Staff

SUMMARY This study explored burnout among frontline staff within a children's residential treatment center (RTC) population. Data were collected from 375 full-time, frontline, children's RTC staff employed at 21 RTCs in Illinois. Using hierarchical linear modeling (HLM), results indicated that frontline staff age, training, empathic concern, communicative responsiveness, neuroticism, extraversion, job satisfaction, and managerial support were associated with subscales of the Maslach Burnout Inventory (MBI). Further, burnout scores varied significantly at the provider level of analysis for the Emotional Exhaustion and Personal Accomplishment subscales of the MBI, lending support to the hypothesis that organizational variables may be associated with workers' burnout experiences. These findings have implications for personnel hiring, burnout prevention, and future research on the organizational correlates of burnout.

Behavioral Managed Care and its Effects in the Readmission to a Children's Residential Treatment Center

ABSTRACT The current study examined factors influencing recidivism at a children's residential treatment center (RTC). Data were collected on 89 children and adolescents, ages 5–17, from a RTC in Albuquerque, New Mexico. Patients who were readmitted to the hospital following their RTC stay were more severely impaired in their functioning at discharge, had shorter lengths of stay and previous hospitalizations. Knowing what factors put child and adolescent patients at risk for future acute or RTC admissions can help to decrease the number of rehospitalizations within this population. Findings suggest that giving children and adolescents sufficient time in a RTC to reach their treatment goals and to be emotionally stable prior to discharge may protect against recidivism.

The Therapeutic Healing of a Reunion

Introduction In May 2005, ninety-four former staff and students from the Sonia Shankman Orthogenic School of Chicago came together for a reunion. The persons present had commenced at the school between 1948 and 1976. The Orthogenic School (O School) was and still is a residential treatment center for children perceived/diagnosed to have significant psychological difficulties. Children were admitted from the ages of six to sixteen with diagnoses of autism, childhood schizophrenia, and other labels of psychological and emotional disturbance. The school at one time experienced great fame because of the high profile of its director, the charismatic and controversial personality Professor Bruno Bettelheim (Dr. B). Much has been written throughout the years about his style of treatment, his approach to childhood autism and the parents of autistic children, and his many books on cultural phenomena. To the students and staff of the school, of course, he was a personality to be related to rather than a public figure. Whatever the controversies, and there are still angry students who no doubt resented his patriarchal and dictatorial ways, the school was, for better or worse, their home and as such could be related to only as a real experience. For staff there always linger two questions that any worker with children should confront on a daily basis: Did I do my best for the children? Could I have done better? To some, his methods are deeply discredited, and most, if not all, have rejected his theories of the aetiology of childhood autism. For

Applying an Antiracist Framework to a Residential Treatment Center

SUMMARY This article addresses the impact of systemic racism and White privilege in a residential treatment center for children who are referred by the child welfare and juvenile justice systems. The chosen treatment approach, the Sanctuary(r) Model, addresses all forms of oppression through the core concepts of therapeutic community, safety, and trauma theory.

Treatment and Posttreatment Effects of Residential Treatment Using a Re-education Model

This study examined preliminary effectiveness of one of the first Project Re-ED (Re-education of Emotionally Disturbed children) residential treatment centers for children. Data were collected at admission, at discharge, and up to 6 months postdischarge. Findings show substantial decreases in problem behaviors and improvements in personal strengths during treatment for children ages 6-12. Despite some deterioration of outcomes in the postdischarge period, improvement compared to baseline continued to be evident at 6 months postdischarge. Multivariate analysis showed that relatively few factors were associated with differential change while in treatment. Younger age, however, was related to more substantial change during treatment and longer length of stay was associated with more positive outcomes by 6 months postdischarge.

Parental Involvement as a Factor in the Readmission to a Residential Treatment Center

ABSTRACT Parental involvement during treatment is examined as a factor in the recidivism to a children's residential treatment center (RTC). Data was collected on 89 children and adolescents from 5 to 17 years old from the University of New Mexico's Children's Psychiatric Center. Patients with greater parental involvement (attendance in family therapy, number of weekly parent visits, telephone calls, and arranged therapeutic absences) showed a lower recidivism rate than those patients with lower levels of parental involvement. Patients with higher levels of parental involvement were also found to have better family functioning and less severe impairments in their own functioning at discharge.

Psychotherapy in Residential Treatment: The Human Toll of Scientism and Managed Care

SUMMARY This paper briefly reviews the intentions of some of the early founders of residential treatment centers for children, and then presents a discussion of contemporary efforts to comply with the insistence upon proof of treatment efficacy for group care and individual psychotherapy. The demands for empirical evaluation are considered in terms of the body of scientistic attacks upon the conceptual foundations of psychoanalysis and verbal psychotherapy, and in light of the historical emergence of managed care as a delimiting power in mental health care. The discussion concludes with a reconsideration of those attacks in light of contemporary refinements of psychoanalytic theory and technique, and then examines the implications of the objectivist perspective with regard to our broader conceptions of the treatment process, the human mind, and ideas about modern culture.

Designing an Orientation Program for the Direct Care Staff of a Children's Residential Treatment Center

ABSTRACT Direct care staff in children's residential treatment centers are crucial to consistency in program implementation, and establishing a therapeutic treatment milieu. However, the orientation process provided to child care workers is often inadequate, and leaves these staff ill-prepared to execute the responsibilities of the job. This leads to frustration, low morale, and a high turnover rate of direct care staff. A comprehensive orientation process was developed and implemented for the direct care staff at a residential treatment center for children located in the midwest. While the established outcome measures were not met, a high degree of satisfaction with the process by both direct care staff and supervisors was achieved. More study is needed, over time, to determine if this process has a positive impact on the turnover rate of child care workers.

Staff attitudes toward family involvement in residential treatment centers for children

The goals of this study were to determine the extent of staff members' support for family involvement in residential treatment centers for children, to examine staff members' beliefs about families and the consequences of their involvement, and to examine the relationship between staff members' support of family involvement and their characteristics, experiences, and beliefs. A total of 267 staff members at three residential treatment centers for children with psychiatric disorders or mental retardation or both responded to a survey about their experiences with families, beliefs about families, and support for family involvement. Staff members were very supportive of greater family involvement, although they showed more support for families in the role of service recipients than as decision makers. However, staff members did not believe in family reunification as a goal for the majority of children served. The strongest predictors of staff support for family involvement were positive general beliefs about clients' families, the perception that family involvement was advantageous, and the endorsement of fewer reasons to discourage family involvement. Residential programs seeking to create a more receptive climate for families should help staff members establish positive attitudes about the families they serve and about families' potential role in successful treatment.