Secure Residential Care Research Articles

A Schema Therapy Based Milieu in Secure Residential Youth Care:Effects on Aggression, Group Climate, Repressive Staff Interventions, and Team Functioning

ABSTRACT Group care workers of residential youth care settings face the challenge of creating a warm and involved treatment climate against the demands and restrictions of the treatment setting. We tested the effects of SafePath, a milieu-based intervention based on Schema Therapy principles, during the first year of implementation on two secure residential treatment units compared to two control units. Staff’s daily reports on 139 individual patients were coded on use of schema mode language (implementation check), occurrences of aggression (primary outcome) and repressive staff interventions. In addition, repeated questionnaires were filled out by patients (n = 87) on group climate and by staff (n = 50) on team functioning. Compared to the control units, SafePath units showed higher improvements in group climate and repressive interventions. Both SafePath and control units showed decreased aggression over time. Team functioning was consistently better in the SafePath units compared to the care-as-usual units from baseline through 12 months. In conclusion, a Schema Therapy based milieu as implemented with SafePath may contribute to a warm and supportive group climate with less repressive interventions in secure residential youth care.

Looking into the crystal ball: quality of life, delinquency, and problems experienced by young male adults after discharge from a secure residential care setting in the Netherlands

BackgroundAdolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors.Aims and hypothesisThe aim of this exploratory follow-up study is to explore differences between young adults—classified in four risk profiles—in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks.MethodsFollow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults’ life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests.ResultsLife after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes.ConclusionsYoung adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients’ long-term needs.

Treatment Outcomes of a Shortened Secure Residential Stay Combined With Multisystemic Therapy: A Pilot Study.

ThuisBest is a newly developed family focused treatment that combines secure residential youth care with multisystemic therapy (MST), allowing adolescents to return home after secure residential youth care more quickly. The purpose of this pilot study was to examine treatment outcomes for adolescents in ThuisBest (n = 86, Mage = 15.2 years, 63% boys) and to what degree those treatment outcomes could be predicted by client characteristics. The results showed that externalizing behavior problems and parenting stress had decreased at the end of treatment. After ThuisBest, 83% of the adolescents did not have new police contact, 72% lived at home, and 89% attended school or work. Almost none of the treatment outcomes could be predicted by any of the client characteristics. ThuisBest seems a promising trajectory, as it reduces the length of the stay in secure residential youth care, and may, therefore, be more cost-effective than standard secure residential youth care. However, given the lack of a control-group and follow-up data, findings must be interpreted as preliminary.

Health problems and healthcare needs among youth in Swedish secure residential care

International research has consistently reported that youth in secure residential care have high rates of somatic/dental health problems. Here, we report results from the first such study in a Nordic country. An experienced paediatrician performed systematic somatic and rudimentary dental health assessments of 91 youths, age 13–17, recently admitted to four secure residential units in Sweden. Girls were oversampled. Participants were tested for sexually transmitted diseases (STD). We found large unmet needs of health/dental care, similar to reports from other countries: 75% of the girls and 53% of the boys had at least one previously known health problem that was poorly followed up or was unknown before the assessment. Over 40% of the girls had severe dental decay. Only two cases of STD were identified (Chlamydia). Some 91% of the girls and 64% of the boys were referred to a health or a dental care clinic.

Gender aspects of health‐related quality of life of youth in secure residential care in Sweden

This study examined health‐related quality of life of youth in secure residential care employing a gender perspective. The KIDSCREEN‐52 questionnaire was administered to 91 youths (46 boys and 45 girls) aged 13–17, admitted to four secure residential units in southern Sweden, in connection with a medical examination. Results were compared with a national Swedish survey from 2009 of 86,000 youths aged 15–16 years old. In age‐adjusted analyses, youth in secure residential care units reported lower levels of wellbeing for all but one KIDSCREEN measure, compared with the national survey, with moderate to large differences in effect size. In the residential care sample, female gender was associated will lower psychological wellbeing, poorer parental relations and less school satisfaction, while male gender was associated with lower self‐perception and peer relations.

Group climate and treatment motivation in secure residential and forensic youth care from the perspective of self determination theory

Treatment motivation in secure residential youth care is assumed to be a necessary condition for effective treatment, and is therefore a key element in the reduction of problem behavior and criminal recidivism. According to Self-Determination Theory (SDT) three basic psychological needs (autonomy, competence and relatedness) are essential for treatment motivation, which are characteristics of a positive residential group climate. Based on SDT, we examined whether a therapeutic (open) group climate and low levels of institutional repression were associated with treatment motivation of adolescents residing in (semi-) secure residential youth care facilities. An ethnically diverse sample was studied of 179 respondents (M = 16.2 years; SD = 1.5), in 12 Dutch (semi)secure youth care facilities and 9 forensic youth care institutions. We measured residential group climate with the PGCI and treatment motivation with the ATMQ, and fitted a Cross-Lagged Panel Model (CLPM) of residential group climate and treatment motivation. It was found that a positive group climate in the first month after placement predicted greater treatment motivation three months later.

My Path Towards Living on My Own: Voices of Youth Leaving Dutch Secure Residential Care

Youth departing from secure youth care are often not well prepared for living on their own. This study aims to provide more insight into youth’s perspectives on what they need to improve their chances for successful return to and participation in Dutch society. The study is a first necessary step on a journey to develop a tool for these youth to evaluate the development of autonomy and participation. We chose for a participatory research methodology. Youth participated as co-researchers in all steps of the research. Sixteen adolescents aged 15–20 years participated in open in-depth interviews using an autobiographical life story method. They were treated as partners and future owners of the tool to be developed. The interviews were transcribed and analysed. Realizing trustworthy social bonds appeared essential for developing autonomy. Youth started to move when they were socially connected and had found out what they value. Then they started “to do their thing” and “to find their own path”, which was their language for experiencing autonomy. An interesting new finding was the importance of rest for youth to enable them to develop self-insight and to find their own path. The findings imply that staff in secure residential care should invite youth to develop their own ideas about their life and future, stimulate exploration and reflection, and a dialogue with people around them. Opportunity for acting, trying and doing is also needed, so that youth can discover in practice what works for them.

Aggressive Incidents in Residential Youth Care.

It is assumed that group climate can have an effect on aggressive behavior in adolescents living in residential facilities, but it is largely unknown whether there are climate differences between the various types of residential institutions, and whether group climate differently affects aggression incidents among adolescents placed in institutions that differ in levels of security (and openness). In current research, the differences in perception of group climate between open, semi-secure, and secure residential youth care facilities were examined as well as the association between group climate and aggression. In total, 159 adolescents (96 males, 63 females) completed the Prison Group Climate Instrument (PGCI), and (aggressive) incidents were recorded during a period of 3 months. Perception of group climate—including support from staff, group atmosphere among adolescents, possibilities for growth, and repression—did not differ between the various types of residential care, except for possibilities for growth. Adolescents in open and semi-secure institutions experienced more possibilities for growth than their peers in secure institutions. A more positive perception of group climate in open institutions proved to be related to less aggressive incidents at the living group. For semi-secure and secure institutions, no relation between group climate and aggression was found. Also, the longer adolescents stayed in residential youth care, the more aggressive incidents occurred.

Quality of life, delinquency and psychosocial functioning of adolescents in secure residential care: testing two assumptions of the Good Lives Model

BackgroundIn this study, two assumptions derived from the Good Lives Model were examined: whether subjective Quality of Life is related to delinquent behaviour and psychosocial problems, and whether adolescents with adequate coping skills are less likely to commit delinquent behaviour or show psychosocial problems.MethodTo this end, data of 95 adolescents with severe psychiatric problems who participated in a four-wave longitudinal study were examined. Subjective Quality of Life was assessed with the ten domains of the Lancashire Quality of Life Profile and coping skills with the Utrecht Coping List for Adolescents.ResultsResults showed that adolescents who reported a lower Quality of Life on the health domain had more psychosocial problems at follow-up. No relationship was found between Quality of Life and delinquent behaviour. In addition, active and passive coping were associated with delinquent behaviour and psychosocial functioning at follow-up.ConclusionsBased on the results of this longitudinal study, the strongest support was found for the second assumption derived from the Good Lives Model. Adolescents with adequate coping skills are less likely to commit delinquent behaviour and have fewer psychosocial problems at follow-up. The current study provides support for the use of strength-based elements in the treatment programmes for adolescents in secure residential care.

Musical Attention Control Training (MACT) in secure residential youth care: A randomised controlled pilot study

With 75% of the population in secure residential youth care diagnosed with attention-related problems, these individuals might benefit from Musical Attention Control Training (MACT). The purpose of this randomised controlled pilot study was to determine the feasibility and preliminary effects of MACT on attention outcomes for youth in secure residential care. Because of the generally low treatment motivation of this population, a non-standardised music therapy intervention (NSMT) with similar goals was included to determine if attendance and effects varied between a standardised and non-standardised intervention. Participants (n=6) were randomly assigned to MACT, NSMT or a control group (TAU). Both MACT- and NSMT-participants followed a six-week program of once-a-week-music therapy sessions of 45min. Outcomes in selective, focused, sustained and alternating attention were measured using the Trail Making Test A+B and the WISC-III Digit Span Forward and Backward, which were assessed at baseline and then at six and nine weeks. Results showed that both the interventions and the means of measurement were feasible in this population with an overall attendance rate of 97%. While attention outcomes varied with individual participants, the results demonstrate positive trends wherein more extensive research is necessary to further evaluate the effects.

Who Wants to Participate in Routine Outcome Monitoring? Differences between Youth in Secured Residential Care Who Consent or Refuse the Use of Their Clinical Data for Research and Policy Making

ABSTRACTThis study examines the external validity of a nationwide dataset, considering the fact that clients can refuse the extraction of their clinical information to aggregate datasets. Data of 949 youths (56% boys, mean age 15.6 years, SD = 1.49) from six Dutch residential institutions were included. An individual-variables and a person-oriented approach were applied to examine the extent to which the group giving permission to the use of their data for aggregate purposes (66%) is representative for the total population in secure residential youth care. Both static, non-changeable client information as well as dynamic, changeable client information were gathered. Youths who assented to the use of their information were overrepresented amongst the population of some of the participating institutions, and were more often Caucasian. Three start profiles based on the dynamic variables were distinguished. Youths who assent were overrepresented in the most problematic profile, whereas youth who did not assent were overrepresented in the least problematic profile. To improve the external validity and the value of the monitor, it is important to achieve more uniformity between institutions as far as the procedures are concerned, and to find creative ways to increase the assent levels, particularly among ethnic minorities.

Parental perspectives: Risk and protective factors associated with parenting quality for parents of adolescents in secure residential care

AbstractAlthough parental problems and poor parenting are commonly associated with adolescents' admission to secure residential care, few studies examined these parental characteristics. This study aims to identify parental problems and strengths and their association with parenting styles for 64 of these parents. We assessed perspectives of both adolescents and their parent figures shortly after admission. Parents often report high levels of psychopathology for both mothers and fathers, respectively, including depression (54.7% and 39.1%), anxiety (29.7% and 12.5%), substance dependence (14.1% and 26.6%), antisocial behaviour (1.6% and 21.1%), and psychosis (11.0% and 9.4%). Parents also report high parenting stress specifically related to the behaviour of their child. In contrast to our expectations, most parents experience a high quality of life. Living in a 1‐parent family, being unemployed and having debts are most frequently mentioned risk factor combinations. We found limited support for the hypothesis that parents with more risk and less protective factors show poorer parenting. Parents with more psychopathology and parenting stress do show poorer parenting than parents without these problems. Based on our findings, we describe several implications for engaging and supporting parents of adolescents in secure residential care.

Perceived Living Conditions of Young People in Secure Residential Care: Psychometric Properties of the Best Interest of the Child \u2212 Self-Report Questionnaire (BIC-S)

The Best Interest of the Child − Self-report questionnaire (BIC-S) is designed as a tool to ensure young people in secure residential care have a voice about their living environment. The primary aim of this study was to determine the psychometric properties of the BIC-S. Second, we wanted to map the experiences of young people with their current residential living environment. Therefore, both quantitative and qualitative methods were used to assess the experiences of young people with the BIC-S instrument in this cross-sectional study. Based on a sample of 74 young people staying in secure residential care in the Netherlands (2015), we explored the construct validity and reliability of the BIC-S through a Mokken Scale Analysis. The sample consisted of 38 boys and 36 girls (mean age 15.5). After evaluating the psychometric properties of the instrument, we focused on the experiences of young people with their current residential living environment. The results show that eleven out of the fourteen BIC-S conditions form a moderate scale to measure how young people perceive the quality of their living environment (H = .40; Rho = .86). With regard to the residential environment, the participants often raise issues which relate to personal safety, to activities within the institute, or to the relationship they have with care professionals. The results indicate that the BIC-S has the potential to serve as an instrument for young people to voice opinions on their living environment while in residential care.

Feasibility of Inpatient and Outpatient Multidimensional Family Therapy for Improving Behavioral Outcomes in Adolescents Referred to Residential Youth Care

ABSTRACTIn this study, half of a cohort of adolescents referred to a secure residential youth care institution in The Netherlands was actually placed in the center where they received well-tested Multidimensional Family Therapy (MDFT). The others were offered outpatient MDFT in a last-minute effort to avert juvenile judge accorded out-of-home placement. All adolescents had problems with their family, and virtually all of them with school. Externalizing behavior problems were prevalent. As expected, both groups of adolescents benefited from MDFT on externalizing behavior, family, and school outcome measures. MDFT was well-liked by adolescents and parents.

The Inside Out? Views of Young People, Parents, and Professionals Regarding Successful Secure Residential Care

Although adolescents often seem to improve in their functioning during residential care, there still is little knowledge on what factors are important in achieving these changes. The present study aims to identify the care factors that are important for adolescents’ behavior change during secure residential care. We conducted in-depth interviews with eight adolescents, their parents, eight group care workers and seven teachers concerning their in-care experiences. Both adolescents and parents commonly attributed changes during secure residential care to the treatment environment. Group care workers and teachers did not have a clear, consistent view on the treatment aspects causing positive change with the adolescents. According to the adolescents, good professionals apply a fine balance between rules and freedom, show empathy and are available for support. The view of parents corresponds to this image. Although group care workers are perceived as available for support, adolescents tend to make little use of this help if they experience personal problems during care. The results highlight the importance of responsiveness of secure residential care professionals to the needs and perspectives of adolescents and parents.

Longitudinal Relation Between General Well-Being and Self-Esteem.

This study investigated the longitudinal relation between general well-being and self-esteem of male adolescents with severe psychiatric disorders. Moreover, the transition out of secure residential care was studied. Adolescents ( N = 172) were assessed three times with 6 months between each assessment. The sample comprised adolescents who were admitted throughout the entire study ( n = 116) and who had been discharged at 6/12 months follow-up ( n = 56). General well-being and self-esteem were stable concepts over time. The relation between general well-being and self-esteem differed for both groups. Among the admitted group general well-being positively predicted self-esteem and self-esteem negatively predicted general well-being from Time 2 to Time 3. Among the discharged adolescents, self-esteem at Time 1 positively predicted general well-being at Time 2 and general well-being at Time 2 positively predicted self-esteem at Time 3. Changing social contexts, as well as problems experienced during the transition out of secure care, might affect this relationship.

Stability and change in subjective quality of life of adolescents in secure residential care

Subjective quality of life (QoL) is an outcome measure often used in the field of psychiatry. While upcoming strength-based rehabilitation theories place strong emphasis on subjective QoL, it has hardly ever been investigated in adolescents with severe psychiatric problems who are admitted to secure residential care. Therefore, the aim of this study was to investigate the stability and change of subjective QoL of adolescents with severe psychiatric problems. Additionally, the effect of discharge and re-entering society on subjective QoL was studied. In a four-wave longitudinal study, the subjective QoL of 172 male adolescents with severe psychiatric problems was examined. Five subjective QoL domains remained stable over time, while five other domains changed. A decrease in satisfaction with family relations and social participation was observed for discharged adolescents. These results warrant for continuing guidance of adolescents in order for them to positively adapt to a new life outside secure residential care.

Does punishment in secure residential youth care work? An overview of the evidence

Purpose– Violence is a common problem in secure residential units for young people. Group workers often think that young people have to learn to behave by means of punishment. The purpose of this paper is to investigate whether this approach is effective in these settings, and, if so, under what circumstances. Furthermore, it aims to provide alternatives to punishment when dealing with violence.Design/methodology/approach– Recent evidence on the effectiveness of punishment in secure residential units is reviewed. In addition, methods which are promising in dealing with violence are described.Findings– The review shows that punishment is often used to regain control by group workers or, alternatively, is a result of professional helplessness in the face of escalating problems. Only when the living group climate is marked by trust and cooperation can punishment be effective.Originality/value– Punishment in secure residential settings can have severe negative consequences. Nevertheless, group workers are tempted to use it as a response to violence in an attempt to gain control.

Adolescents in secure residential care: the role of active and passive coping on general well-being and self-esteem.

Coping, general well-being and self-esteem play an important role during the process of adaptation to turning points in life-course. This study aimed to investigate the effect of coping on both the development of general well-being and self-esteem of adolescents with severe psychiatric problems in secure residential care. In addition, risk and protective factors were taken into account. Adolescents between the age of 16 and 18 (N = 172) were followed for 1.5 years. General well-being and self-esteem were assessed with the Lancashire Quality of Life Profile and the Self-Perception Profile for Adolescents, respectively. In addition, the Utrecht Coping List for Adolescents and the Structured Assessment of Violence Risk in Youth were administered. Results showed that the longitudinal relation between general well-being and self-esteem is no longer significant after adding active and passive coping to the model. The use of active coping strategies was associated with a higher self-esteem. The use of passive coping strategies was associated with a lower self-esteem and also a lower perceived general well-being. Having multiple risks in the individual and/or social/contextual domain affected the developmental pattern of general well-being. During treatment of adolescents with severe psychiatric problems in secure residential care, attention should be paid for enhancing those capabilities and skills, like coping, which help adolescents to fulfill their needs and consequently enhance their well-being. Enhancing the well-being of adolescents might in the long run decrease the chance of reoffending and/or psychiatric relapse.

Risky or Needy? Dynamic Risk Factors and Delinquent Behavior of Adolescents in Secure Residential Youth Care.

Although it is known that adolescents in secure residential care often show multiple behavior problems, it is largely unknown which dynamic risk factors are associated with their problems. The aim of the present study is to examine dynamic risk factors for 164 Dutch adolescents in secure residential care. Results show that a majority reports multiple risk factors in both an individual and contextual domain but that about a fifth shows relatively few risk factors. Substance abuse and delinquent friends were among the five most prevalent risk factors and predicted the seriousness of the adolescents' delinquent behavior prior to admission. The four groups that were found by cluster analysis could be distinguished by problem type and seriousness. The findings indicate that treatment for some adolescents should be mainly focused on their individual needs, while other adolescents need intensive, multimodal treatment focusing on both risks in the individual, family, and peer domains.