Secure Residential Youth Care Research Articles

“Surviving against the odds. The impact of peer support workers on a chronically suicidal adolescent in secure residential youth care: a single case report from the Netherlands”

ABSTRACT Background The use of peer support workers to support suicidal adolescents is underdeveloped. This study focuses on the effects of a one-year intervention with peer support workers on a chronically suicidal adolescent residing in a secure residential youth care facility in the Netherlands. Moreover, we explore the mechanisms that underpin the role of peer support workers in detail. Method This study employed a single case study design. We conducted seven semi-structured interviews with staff, peer support workers, and a chronically suicidal adolescent. The interviews were analysed using a thematic analysis. Results The results indicate that the suicidal tendencies of the adolescent decreased significantly one year after the peer support intervention compared to the initial baseline. Working mechanisms that underpinned the peer support intervention emphasized building meaningful and trust-based relationships, providing recognition and hope, and practical support from a recovery-oriented perspective. Conclusion The results suggest that peer support has a beneficial impact on the adolescent and treatment teams. Peer support workers contribute to a sense of belonging and connection, coping with suicidality, rediscovering life goals, and improving adolescent self-management. Barriers and facilitators to implementing peer support workers are also discussed.

Dr. M. van Dorp, I will stand by you: A shared journey towards seclusion reduction in secure residential youth care (Vrije Universiteit Amsterdam, 12 juni 2024)

Dr. M. van Dorp, I will stand by you: A shared journey towards seclusion reduction in secure residential youth care (Vrije Universiteit Amsterdam, 12 juni 2024)

The impact of adolescent suicide on professionals in secure residential youth care

ABSTRACT Professionals in secure residential youth care (SRYC) in the Netherlands are regularly confronted with suicides of adolescents and can be referred to as secondary victims. However, little is known about the impact of suicides on these professionals. This study explores the impact of suicides on professionals working in SRYC. Semi-structured interviews (n = 14) were conducted with professionals from several SRYC institutions. A thematic analysis of the material yielded four main themes: i) impact of suicide on a personal level, ii) impact of suicide on a vocational level, iii) impact of suicide on professional responses, and iv) facilitators and barriers that facilitated or obstructed professional resilience and the prevention of future suicides. The experience of suicide is extremely distressing for professionals. Some interviewees were traumatized by the impact. The findings suggest that most professionals draw on coercive measures for other youngsters sooner and more often after being exposed to suicide. The most commonly reported reason for doing so was the fear of experiencing a fatal incident. Professionals in SRYC require skilled and dedicated support (postvention) following a suicide to minimize its detrimental effects on personal, professional, and team functioning. Further implications for daily practice and policymaking are discussed.

Family-Centeredness in Secure Residential Treatment and Its Relationship With Parental Involvement and Adolescent Behavioural Outcomes

Various Dutch secure residential youth care (SRYC) institutions are implementing a family-centered approach aiming to increase parental involvement and improve treatment outcomes. However, it remains unclear if and how family-centeredness (FC) is related to increased parental involvement and to improved treatment outcomes of adolescents. In this study, we unravelled the relation between FC, parental involvement, and behaviour problems of adolescents in SRYC. Families of 404 adolescents admitted to one of seven participating Dutch SRYC institutions completed a survey (at the start, at the end, and at 6-months follow-up) on problem behaviour of adolescents. In addition, 411 group care workers filled out a questionnaire about their residential group’s level of FC every 6 months. Moreover, the mentor of each adolescent filled out a questionnaire about the level of parental involvement. We analysed the data using multiple mediator models. Associations were found between FC and parental involvement. However, no relation was found between FC and adolescent problem behaviour, and no mediation and no moderation effects of parental involvement were found. Overall, results showed that most parents were involved during the residential stay, and, independent of FC, adolescent problem behaviour decreased over time. Implementing FC in SRYC institutions seems to be helpful in involving parents during the residential stay, but was not found to be associated with adolescent behavioural outcomes. Our results indicate that institutions could improve their level of FC by offering more informal contact moments for parents and by addressing barriers to FC among residential staff.

How do group workers respond to suicidal behavior? Experiences and perceptions of suicidal female adolescents residing in secure residential youth care in the Netherlands.

Adolescent suicidal behavior, including non-suicidal self-injury, is increasingly prevalent in Secure Residential Youth Care (SRYC) in the Netherlands. Group workers play a vital role in the well-being and functioning of adolescents in SRYC as they interact with adolescents on a daily basis. However, we have little understanding of how adolescents perceive group workers' responses to suicidal behavior and we lack knowledge about the impact of these responses on adolescents and the group climate. The aim of this study is to explore (a) how adolescents value group workers responses towards suicidal behavior and (b) the impact of these responses on adolescents, as well as (c) on the group climate. The results can be used to develop care-policy to improve care for suicidal adolescents in SYRC. Eleven suicidal female adolescents residing in SRYC were interviewed. All adolescents had previously displayed suicidal behavior, including non-suicidal self-injury. Interviews were analyzed using grounded theory. This study presents the perceptions of suicidal female adolescents residing in SRYC about group workers' responses on suicidal behavior. Adolescents prefer group workers who react responsive to suicidal behavior. Responsive care, trust and connectedness help adolescents disclose their suicidal thoughts. Participants criticize group workers who are non-responsive as being distant, and their relationship with these group workers lacked trust, communication, a sense of connection, or personal depth. All adolescents underline the devastating impact of involuntary seclusion, and stress the importance of being able to disclose without fear of coercive consequences. Findings indicate that non-responsive reactions contribute to an increase in suicidal distress as well as a closed group climate.

Behavioural problems of adolescents in secure residential youth care: Gender differences and risk factors

AbstractAdolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted.

Change over time: the use of seclusion in secure residential youth care in The Netherlands

ABSTRACT Seclusion can be harmful for children and adolescents. Hence, all locations for secure residential youth care in the Netherlands are committed to reduce its use by implementing monitoring and feedback as a seclusion reduction intervention. This study examined change over time in the use of seclusion in secure residential youth care in the Netherlands using a broad conceptualization of seclusion and by analyzing four variables (frequency, duration, room, reason). During two six months periods, seclusions were registered in 19 locations. Every month, all locations received feedback on the use of seclusion. Negative binomial mixed model analyses were used to investigate change over time in frequency and duration of seclusion. Logistic mixed model analyses were used to identify change over time in reason for use and type of room used for seclusion. Results showed that seclusion frequency significantly decreased (RR = 0.92, p < .001). Further, duration of placement in a seclusion room significantly increased (RR = 1.04, p < .001). This change was only significant in seclusion in response to aggression (RR = 1.06, p < .001). The results emphasize the need for future studies to examine reduction using a broad conceptualization of seclusion.

Associations between Secure Residential Care and Positive Behavioral Change in Adolescent Boys and Girls

ABSTRACT Secure residential youth care facilities try to optimize their help by offering gender-specific treatment, in an attempt to achieve positive behavioral change in adolescents. In this study, we examined behavioral change in a sample of 239 Dutch adolescents (M age = 15.59 years, SD = 1.36 years, 54.9% girls) in secure residential care. Pretest, posttest and follow-up measurements were carried out for behavioral problems, PTSD symptoms, emotion regulation, perceived competence and family problems. Comparisons were made between girls in gender-specific care, and girls and boys in regular care. Missing data analyses revealed the dataset contained many missing values. Analyses were performed at group level, using MANCOVA, ANCOVA’s and bootstrapped planned contrast, and at case level, using the Reliable Change Index. At group level, results revealed higher effectiveness of gender-specific care for girls compared to regular care for girls, only in diminishing externalizing behavioral problems. Overall, there were more similarities than differences in the effectiveness of gender-specific versus regular help. At individual level, 0–58% of the adolescents improved during their stay in secure residential care. However, most adolescents showed no change (25–88%) or even deterioration (0–39%). These results strongly emphasize the need for alternative interventions.

The Effects of a Virtual Reality-Based Training Program for Adolescents With Disruptive Behavior Problems on Cognitive Distortions and Treatment Motivation: Protocol for a Multiple Baseline Single-Case Experimental Design.

BackgroundSerious disruptive behavior among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behavior problems react less hostile and aggressive. In order to create a treatment environment in which behavioral change can be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioral change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behavior problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective–taking, adolescents are encouraged to reflect on both their own behavior and that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely, mentalizing (ie, reflective functioning).ObjectiveThe aim of this study is to describe the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely, the repeated single-case experimental design (SCED).MethodsThe effects of ST are studied through a multiple baseline SCED, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care facilities and secondary special education schools are randomly assigned to 1 of the 3 different baseline conditions. Throughout the baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks), and follow-up phase (1, 2, or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention, and after follow-up. Qualitative data are collected after intervention, as well as at 3 months and 6 months after the intervention.ResultsData collection for this study started in November 2021 and is planned to be completed by August 2023. The results will be published in peer-reviewed journals and presented at national and international conferences.ConclusionsST aims to improve the disruptive behavior problems of adolescents. This study will be the first to gain insights into the effectiveness of ST. The strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. The implications for practice are discussed.Trial RegistrationCentral Committee on Research Involving Human Subjects NL75545.029.20. Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639International Registered Report Identifier (IRRID)PRR1-10.2196/33555

Children’s Rights in Secure Residential Youth Care in the Netherlands

Abstract This study examines the extent to which secure residential youth care in the Netherlands complies with children’s rights as laid down in the United Nations Convention on the Rights of the Child (uncrc) and the Dutch Youth Act. Residential group climate was measured with the Prison Group Climate Instrument (pgci), which assesses quality of group care from the perspective of the three basic needs for human self-determination: contact, autonomy and competence. Results indicate that children’s rights are a subsidiary issue in secure residential youth care in The Netherlands, because groups workers and staff have insufficient understanding of children’s rights and Dutch legislation on youth care. Dutch law allows secure facilities to make their own policy on youth care delivery, but it seems that policies are insufficiently explicit about children’s rights. Results of this study can be used to work on the fulfilment of children’s rights in secure residential youth care.

Differences between adolescents in secure residential care and non-residential educational facilities

Summary In this cross-sectional study, we examined differences between 351 adolescents allocated to secure residential youth care and the non-residential alternative educational facility School2Care (12–18 years old, 63% boys). Data were collected by means of the official school registration system and standardized questionnaires. Findings Results showed that adolescents in both settings had severe problems. Emergency situations, problems in daily functioning in all life domains, and previous out-of-home placements were found to be associated with allocation to secure residential youth care instead of non-residential alternative education. These three factors may be considered risk factors for secure residential placement of adolescents with complex needs. Applications This study provides input for the prevention of secure residential youth care, because the two dynamic (changeable) risk factors for residential out-of-home placement (i.e., emergency situations and adolescent’s daily life functioning) should be considered as intervention targets in non-residential care, while static factors (i.e., history of out-of-home placement) can be used to improve risk assessment of residential out-of-home placement, with higher risk requiring more intensive treatment according to the risk-need-responsivity model for effective mandated treatment.

With Connection, Less Correction: Gender-Specific Needs of Girls’ Residential Group Climate—A Mixed Method Non-randomized Case-Study

A need-supportive group climate is a prerequisite for successful treatment in secure residential youth care. For girls, positive relationships with peers are an essential part of the group climate. Relational aggression threatens the residential group climate. This study explored whether a group counseling program can actively promote the quality of the interrelationships between girls in a residential group in the Netherlands; the aim is to elucidate how residential group climate affects treatment results. The girls in this single-gender residential group had been admitted because of (suspicions of) commercial sexual exploitation. The study combined participatory observations with a case-based time-series design. For 18 weeks, changes in the residential group climate and the interrelationships between the girls and achievement of treatment goals over time were measured. The residential group climate in this group was negative initially; much relational aggression between girls was found. Considering treatment, some girls were making significant progress, but others mainly deteriorated. Moderate improvement of residential group climate was visible after a group social worker was permanently present. A group counseling program aimed at improving interrelationships cannot cure an overall negative residential group climate. This article offers implications for preventing and recognizing deterioration of residential group climate and improving girls' residential group climate.

Defining Seclusion: A Qualitative Multiphase Study Based on the Perspectives of Youth and Professionals in Secure Residential Youth Care in the Netherlands

ABSTRACT Using seclusion in youth mental health care is controversial, as it can have physical and psychological consequences for youth and professionals. Notably, there is a wide disparity in how seclusion is defined in literature and practice. This leads to a diffuse image of what seclusion comprises, complicates measuring its prevalence, and hampers initiatives to reduce its use. Therefore, the objective of this study was to establish an unambiguous and measurable definition of seclusion supported by youth and professionals in secure residential youth care in the Netherlands. A qualitative multiphase approach was used to examine which elements of the definition are essential and receive consensus among youth and professionals. After a brief literature review, a Delphi survey and focus groups were performed. In total, 11 (ex-)clients and 33 professionals with extensive experience in secure residential youth care participated. Youth and professionals arrived at the following definition: “an involuntary placement in a room or area the client is not allowed or able to leave”. During the implementation process, observations showed broad support for the definition by youth and professionals. With this, a foundation has been provided to monitor and reduce the use of seclusion in secure residential youth care in the Netherlands.

Residential Youth Care Combined with Systemic Interventions: Exploring Relationships between Family-Centered Care and Outcomes

ABSTRACT Family-centered care, in terms of parental involvement and family-centered staff attitude and behavior during placement in secure residential youth care, is increasingly being combined with systemic interventions. Little is known, however, about this combination of family-centered residential care and systemic interventions. This study assessed whether levels of parental involvement or family-centered staff attitude and behavior during placement predicted outcomes of systemic interventions. We first assessed the outcomes in the full sample of families receiving systemic interventions and thereafter in families receiving systemic interventions with a strong evidence base (Multidimensional Family Therapy, Multisystemic Therapy [specializing in treatment of individuals with an intellectual disability/with problem sexual behavior], Relational Family Therapy [MDFT, MST(-ID/-PSB), RGT]) and systemic interventions with a less strong evidence base (Attachment Based Family Therapy, Flexible Assertive Community Treatment [FACT], FamilyFACT, Forensic Ambulant Systemic Therapy, Systemic Therapy [ABFT, (Family)FACT, FAST, ST]). Results revealed that higher levels of parental involvement predicted less family empowerment and a longer duration of the systemic intervention. Higher levels of family-centered staff attitude and behavior predicted more parental distress, a shorter duration of the residential placement and a shorter duration of the systemic intervention. Combinations of secure residential youth care with different systemic interventions of different evidence bases resulted in different outcomes. Future research is needed to establish which components of family-centered care or systemic interventions contribute to adolescent outcomes.

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.

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.

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.

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.

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.