Residential Treatment Settings Research Articles

Validity of the brief executive-function assessment tool in an outpatient substance use disorder setting

The Brief Executive-function Assessment Tool (BEAT) was developed and validated for use in residential substance use disorder treatment settings, where participants are mostly abstinent. It is therefore unclear whether the BEAT is valid for use in outpatient settings, where participants may be actively using substances. The effects of acute intoxication and withdrawal have the potential to alter the results of the BEAT. The current study sought to establish construct and criterion validity of the BEAT in an outpatient substance use disorder sample and to detect its sensitivity to substance use over the previous 24 hours and also over the past month. A total of 74 clients of a New South Wales-based outpatient substance use disorder service participated in the current study. Construct validity was demonstrated by significant correlations between the BEAT and three performance-based tests of executive functioning. Criterion validity was established in that the BEAT discriminated between those deemed impaired or not on a criterion composite measure of executive functioning. Test operating characteristics (88% sensitivity, 69% specificity, 44% PPV, and 95% NPV) were also established relative to this composite measure as a reference standard. The BEAT was insensitive to use/abstinence over the previous 24 hours and the past month.

162. Similar Response and Remission Rates in Depressed Patients Receiving TMS in Outpatient and Residential Treatment Settings

162. Similar Response and Remission Rates in Depressed Patients Receiving TMS in Outpatient and Residential Treatment Settings

“We Wanted to Get Her Help”: Child-Welfare-Involved Caregivers’ Perceptions of Decision-Making When Accessing Residential Treatment

Despite increased research and policy interest in reducing the use of residential treatment settings (RTS), there have been few studies of caregivers’ experiences accessing these settings. This study aimed to explore how caregivers perceive their role in decision-making when accessing RTS for youth using interpretive phenomenological analysis. Themes included gaining a voice, losing power as services intensified, challenging journey, and inflection point. Findings suggest providers act as gateways to RTS for youth for those parents who currently do not have access to these settings. Implications for practice include increasing caregiver knowledge about how to navigate mental health service systems may improve their sense of empowerment to make decisions and that more resources are needed for caregivers.

Quality Care in Residential Care and Treatment Settings in North America: From Complex Research to Four Everyday Principles for Practice

Quality is a central topic in contemporary discussions about residential care, and specifically about group or congregate care. Such care settings have been contested in recent years specifically resulting from anecdotal evidence that quality is lacking. To this end, the response has focused on the development of quality indicators and standards. In this essay, the author argues that, although such approaches are necessary and have helped to embed evidence-based practices in residential care settings, they are not easily translated into everyday practice. Quality care must mean more than frameworks for care that are governed by professional system designs. Quality care also must include the experiences of young people living life in these settings. To this end, to help with the translation of quality care standards for residential care, the essay presents four core principles that, on the one hand, are familiar and easily translatable for youth workers and social workers in these settings, and on the other hand, honour and are congruent with core elements of almost all evidence-based practice approaches.

A Comprehensive Descriptive Analysis of Out-of-Session Meditation in a Residential Treatment Setting: Duration, Frequency, and Type of Practice

ObjectivesA nuanced examination of human behavior can yield valuable insights into whether a mindfulness-based intervention (MBI) promotes meditation practices and to what degree in various populations. This study aimed to offer a comprehensive analysis of meditation behaviors exhibited by individuals in response to a MBI in the context of an intensive residential treatment program for addiction recovery.MethodA total of 100 participants enrolled in a residential treatment program participated in an added MBI component to their routine care. We quantified the type, frequency, and duration of meditation practices outside of scheduled MBI sessions and conducted a descriptive analysis to investigate how these practices during the intervention predicted meditation behaviors 7 months later.ResultsAll seven common types of mindfulness meditation assessed, except the body scan, were performed an average of once per day during the MBI. The longest average duration of meditation practice was observed in the case of walking meditation, during both the MBI (M=20.30, SD=16.66 min) and 7-month follow-up (M=25.43, SD=20.85 min). Out-of-session meditation frequency (unstandardized beta, B=0.56, p<0.001) and duration (B=0.45, p=0.02) during the MBI significantly predicted subsequent meditation behaviors 7 months later, even after adjusting for treatment site discharge status and other clinical variables.ConclusionsMost participants in this addiction recovery sample consistently engaged in a variety of meditation practices outside of formal MBI class sessions while in residential living, performing them approximately once a day, with a particularly robust response to walking meditation. The persistence of meditation practice 7 months later suggests that the learned behaviors endure throughout addiction recovery.PreregistrationThis original trial is registered with clinicaltrials.gov (NCT02977988)

Impulsivity Dimensions Predict Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a decreased odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment.

The challenges of assessing anxiety symptoms for adolescents and young adults in residential treatment: The BHS-Anxiety and the GAD-7 Scales

ABSTRACT Anxiety symptoms are common, comorbid with other disorders, and damaging to well-being. High-quality assessment is necessary for detecting and monitoring these symptoms, especially within the context of residential treatment for psychiatric disorders. However, little is known about the psychometric accuracy of screening for anxiety symptoms within this severe, often comorbid sample. The current study examines the psychometric characteristics of two measures used in residential treatment: the Generalized Anxiety Disorder-7 (GAD-7) and the Behavioral Health Screen-Anxiety (BHS-Anxiety) scales. The sample included 5,639 adolescents and young adults admitted to residential psychiatric treatment in the United States. The sample was nearly all non-Hispanic White. Most (72.1%) were diagnosed with at least one DSM-5 anxiety disorder. Psychometric analyses revealed that the two measures were strongly correlated, and both showed good item discrimination, test information, and reliability. However, overlap with depressive symptoms was high, and classification accuracy based on preliminary anxiety diagnoses was low. The BHS-Anxiety scale showed measurement invariance across gender, age, and depression diagnosis groups, but the GAD-7 showed poor structural validity. Screening for highly comorbid symptoms within severe populations is difficult and understudied. High-quality measurement instruments, and innovative approaches to assessment, are needed to improve research and practice within residential treatment settings.

Narrative Therapy Expressive Art Group Interventions for Adolescents with Eating Disorders in Residential Treatment

ABSTRACT Eating disorders continue to impact youth at staggering rates, with 13.2% of adolescents meeting DSM-5 criteria for an eating disorder by age 20. Integrating narrative therapy expressive art interventions with the healing power of group can meet the layered developmental needs of adolescents battling anorexia, bulimia, binge eating disorder, or nonspecific eating disorders. This conceptual manuscript pulls from literature on expressive arts, adolescent eating disorders, group counseling, and residential treatment considerations using a narrative therapy theoretical approach. Expressive art interventions appropriate for serving adolescents with eating disorders in a residential treatment setting are provided.

Universal Access to Opioid Agonist Therapy in Residential Treatment Settings: The Time Is Now

Universal Access to Opioid Agonist Therapy in Residential Treatment Settings: The Time Is Now

The treatment of dissociative identity disorder in an eating disorder residential treatment setting.

Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.

Understanding subgroups of child welfare placement histories in the context of youth behavior and development: a latent class analysis

ABSTRACT This study aimed to identify latent classes of child welfare placement histories, with a focus on entry to residential treatment settings (RTS), and how youth behavior and development are associated with the probability of latent class membership. This study utilized secondary child welfare administrative data. The study found that a four-class model was the best fit for the data. The four latent classes were defined by instability while in family settings, stability in kinship care, movement through congregate care settings, and stability in non-kinship foster care. Youth behavior and developmental period were significantly associated with latent class membership.

Prevalence and services for the treatment of chronic pain at residential substance treatment centers

Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA’s treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.

Lessons learned from employing Medicaid-funded peer recovery support specialists in residential substance use treatment settings: An exploratory analysis

IntroductionThis article explores the experiences of peer recovery support specialists (PRSS) and their colleagues working in residential adult services (RAS) facilities in a rural state to better understand how the role has been implemented in this setting. In West Virginia, PRSS and RAS services have been covered by Medicaid since 2018 for the treatment of substance use disorder (SUD). Thus, the aim of this study is to uncover what has and has not worked well in the early years of service implementation from the perspectives of both PRSS and their colleagues working in the SUD field. MethodsThe study interviewed forty-eight clinical and administrative staff at RAS facilities, including nine PRSS, across fourteen focus groups between 2020 and 2021. The study asked participants about general knowledge of West Virginia's 1115 Medicaid Waiver supporting the funding of PRSS, communication among providers, transitioning patients to other providers, scope of practice, barriers and facilitators to providing services, ethical challenges, and COVID-19. Data analysis utilized a phenomenological approach to describe individuals' unique experiences. ResultsThree core themes emerged from the analysis: (i) Lived Experience as Added Value, (ii) Inadequate Funding for PRSS Position, and (iii) Role Difficulties. Participants described the lived experience of PRSS as both beneficial to the recovery journey of patients with SUD and unique in that only PRSS can provide the specific skillset that benefits these patients; these characteristics also helped facilities to connect patients to supportive resources. Two funding limitations emerged as barriers to PRSS employment: funding available through Medicaid billing was insufficient to hire staff and the corresponding hourly compensation rate was not competitive against those offered via grants. Finally, participants identified an underdeveloped hiring system and an unclear scope of practice that led to staff feeling unsupported. ConclusionPRSS's experiential expertise complements clinical expertise by producing effective health care and support for patients. Despite their high value and expertise in SUD treatment, PRSS face major challenges in the workplace, including inadequate pay, underdeveloped support structures, and narrow job eligibility requirements. Future research should further quantify PRSS's levels of expertise and identify “value-added” benefits of this position.

Predictors of Suicidal Ideation During Residential Substance Use Treatment.

Background: Individuals with substance use disorders (SUDs) and co-occurring chronic health and/or psychiatric conditions face unique challenges in treatment and may be at a greater risk for suicidal ideation relative to persons with SUD alone.Methods: In a sample of individuals entering residential SUD treatment in 2019 and 2020 (N = 10,242), we tested adjusted and unadjusted associations between suicidal ideation and (1) psychiatric symptoms and (2) chronic health conditions at treatment intake and during treatment using logistic and generalized logistic models.Results: Over a third of the sample endorsed suicidal ideation at intake, though the prevalence of suicidal ideation decreased during treatment. In both adjusted and unadjusted models, individuals who reported past-month self-harm, those who reported a lifetime suicide attempt, and individuals who screened positive for co-occurring anxiety, depression, and/or posttraumatic stress disorder were at elevated risk of endorsing suicidal ideation at intake and during treatment (P values < .001). In unadjusted models, chronic pain (odds ratio [OR] = 1.51, P < .001) and hepatitis C virus (OR = 1.65, P < .001) were associated with an elevated risk for suicidal ideation at intake, and chronic pain was associated with elevated risk for suicidal ideation during treatment (OR = 1.59, P < .001).Conclusions: Increasing accessibility to integrated treatments (ie, those that address psychiatric and chronic health conditions) for patients experiencing suicidal ideation may be beneficial in residential SUD treatment settings. Developing predictive models to identify those most at risk of suicidal ideation in real time remains a relevant direction for future work.

Understanding the therapeutic factors of the social reintegration treatment stage in a residential treatment setting: a qualitative approach

PurposeThe purpose of this paper is to understand deeply the important elements of the reintegration phase of recovery.Design/methodology/approachThe participants were 14 people suffering from addiction to drugs, who met the criteria for substance use disorder according to the diagnostic and statistical manual of mental disorders, fifth edition. The data obtained by semi-structured interview were qualitatively analyzed by interpretive phenomenological analysis.FindingsThe results highlight the importance of relationships in therapy, identity reshaping, a deeper understanding of the causes of substance use, the importance of boundaries, the critical parameters of the transition to regularity and the important role of emotions.Originality/valueThe results are discussed on the basis of the enhancement of the therapeutic interventions that are followed at the reintegration stage, taking into account not only the peculiarities of this phase but also social factors such as stigmatization.

Sleep and substance use: Practice considerations for social workers

ABSTRACT Poor sleep health is consistently associated with the initiation of substance use, development of substance use disorders (SUDs), dropout from treatment, and return to use. Quality sleep health holds promise as a modifiable factor that can reduce the occurrence and severity of SUDs. Unfortunately, social workers typically receive little to no training in the assessment and evidence-based treatment of sleep disorders. This article, authored by an interdisciplinary team of clinicians and researchers, provides important sleep and SUD considerations for social workers. After providing a summary of the empirical literature surrounding the relationship between sleep and SUDs, we discuss the inclusion of the following in SUD treatment settings: (1) sleep health assessments, (2) psychoeducation on behaviors to promote healthy sleep, (3) referral to appropriate specialists when sleep disorders are suspected, (4) the promotion of a healthy sleep environment in residential treatment settings, and (5) evidenced-based behavioral interventions.

Virtual Reality in Korsakoff’s Syndrome

Purpose - Korsakoff’s syndrome (KS) is a severe neuropsychiatric disorder following thiamine deficiency often resulting from chronic alcohol consumption. KS is characterized by cognitive problems, such as impaired memory, decreased organization and planning skills, and confabulations. Patients diagnosed with KS often require long-term care, because of the severity of their cognitive problems and psychiatric problems. Case description - In this project, virtual reality techniques were administered to a Korsakoff’s syndrome population in a long-term (residential) treatment setting. Following an overview of the technique, three vignettes that illustrate how virtual reality techniques can ameliorate the mood, felt sense of control and activity levels of KS patients. Outcomes - Actively engaging in virtual reality settings encouraged KS patients to decrease their apathy, matched their individual needs, and increased laughing behavior. Conclusions – Virtual reality techniques can actively engage patients diagnosed with KS in activities that are normally not initiated because of apathy. More systematic research on virtual reality techniques in KS should be conducted to test for possible benefits on quality of life, autonomy and reduction in neuropsychiatric symptoms

Using the Performance Diagnostic Checklist-Human Services (PDC-HS) to Enhance Data Collection Procedures in Residential Treatment Settings for Clients with Significant Behavioral Challenges

ABSTRACT Staff members working in three residential homes serving persons with developmental disabilities participated in the current study. Each residence was selected based upon poor staff performances related to consistent, accurate data collection. Written daily narratives compiled by the staff on each shift were compared to designated behavioral data collection forms in each residence to determine the degree of correspondence between the two measures. The written measures were entered digitally in the intranet system that was accessed by all staff. The Performance Diagnostic Checklist- Human Services (PDC-HS) was used to assess each of the environments with respect to their data collection behavior. The PDC-HS indicated the use of antecedent based strategies with the staff in the homes in order to increase their data collection behavior. A multiple baseline design across three separate residences was employed to examine the efficacy of the identified interventions. The results demonstrated significant increases in data collection across each of the residences that participated in the study.

Termination From Substance Use Disorder Treatment in the United States: Residential and Outpatient Settings.

As rates of noncompletion in substance use treatment remain high and consequences of noncompletion can be severe, research regarding individual and environmental factors associated with specific types of discharge is crucial. The current study used data from the Treatment Episodes Dataset-Discharge (TEDS-D) 2015-2017 in the United States to investigate the impact of social determinants of health on discharge from treatment due to termination by the treatment facility in both outpatient/intensive outpatient and residential treatment settings. A multinomial logistic regression was conducted examining the likelihood of discharge due to termination compared with discharge because of dropout or incarceration. Results revealed differences in termination based on treatment setting, race, income, criminal justice referral, and mental health diagnoses, among others. Broadly across settings, people of color were significantly more likely to be terminated from treatment than to drop out compared with their White counterparts. Further, with little exception, individuals with less financial security (i.e., those who were unemployed, those with low/no income, those with no insurance) were less likely to drop out and more likely to be discharged due to termination across treatment settings. The results of the current study further solidify the need for nuanced examination of the reason individuals do not complete substance use treatment and extend the impact of social determinants of health to involuntary termination from substance use treatment.

P099 Feasibility of assessing environmental factors in residential treatment settings: Preliminary associations between objective sleep and mental health outcomes

Abstract Introduction Circadian dysregulation is implicated in substance use and comorbid mental health problems, but is also exacerbated by these states. In addition to conventional treatment, environmental factors (light, temperature) are potential targets for improving sleep, circadian functioning, and recovery outcomes. This study explored the feasibility of objective sleep and environmental monitoring for recovering substance users in residential treatment, and also examined the relationship between objectively measured sleep-wake rhythms and mental health outcomes. Methods Fifty-two (Mage=38, SD=9.6; 56% female) individuals receiving treatment for substance use were included. Environmental light exposure, temperature, and activity data were collected via wrist-worn actigraphy, and in-room sensors for a minimum of 1-week of stay within a 6-week program. Actigraphy derived sleep-wake patterns were used to calculate Interdaily Stability (IS). Data were linked to routinely collected clinical measures of mental health. Results No individuals opted out of the environmental monitoring aspect of the study, indicating acceptability and feasibility. Environmental loggers mounted in individual rooms recorded average nightly temperatures &amp;gt;21 degrees for 5/8 months. Objectively measured IS (M=.79; 95%CI=.67-.73) was negatively associated with Anxiety (r=-.33, p=.024) and Depression (r=-.36, p=.012), while sleep duration was not. Relationships between participant-level light exposure and clinical outcomes were also examined. Discussion Preliminary results indicate that circadian regularity appears important for mental health outcomes in this population and setting. The structured residential environment provides opportunities for regulating sleep-wake rhythms via scheduling of activities at circadian-appropriate times. This research suggests that optimising circadian- appropriate lighting and thermal comfort may lead to improved individual outcomes.