Secure Residential Youth Care Research Articles

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.

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.

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.

‘Nothing works’ in secure residential youth care?

A debate about the effectiveness of secure residential youth care is currently going on. While some continue to support secure residential youth care, others conclude that ‘nothing works’ in secure residential youth care, and argue that non-residential treatment is superior to secure residential treatment. This article reviews recent research on this topic. The conclusion is that evidence for the effectiveness of non-residential treatment for youth with severe behavioural problems and/or criminal behaviour is sparse if considered as an alternative for secure residential youth care. Secure residential treatment shows a modest, but positive effect. We need to overhaul the myth that ‘nothing works’ in secure residential youth care, and focus on how to optimise the effects of secure residential youth care.

Education Secured? The School Performance of Adolescents in Secure Residential Youth Care

Background Despite poor school performance by adolescents in secure residential care and the potential importance of education during care, little is known about how to achieve academic success with these adolescents.

A secure base? The adolescent–staff relationship in secure residential youth care

ABSTRACTThe client–therapist relationship is recognized as an important factor contributing to outcomes of child and youth care. Particularly in secure residential youth care, in which adolescents with mainly externalizing behaviour problems are often placed coercively, the client–staff relationship seems to be important for the achievement of positive outcomes. The present study aims to assess the client–staff relationship for a group of 135 adolescents in secure residential care and factors associated with a positive relationship. The results show that adolescents, group care workers and teachers experience a limited affective bond in their relationship 2 months after the adolescents were admitted to the secure care centre. Adolescents do tend to use care workers and teachers as a secure attachment figure, which suggests that an affective bond is no precondition for the adolescents to experience staff as a secure base. Main predictors of a good relationship are the positive treatment skills of both group care workers and teachers. These findings point to the need for training of care workers and teachers so that they are better prepared for working with these adolescents.

Securing the Downside Up: Client and Care Factors Associated with Outcomes of Secure Residential Youth Care.

BackgroundAlthough secure residential care has the potential of reducing young people’s behavioral problems, it is often difficult to achieve positive outcomes. Research suggests that there are several common success factors of treatment, of which the client’s motivation for treatment and the quality of the therapeutic relationship between clients and therapists might be especially relevant and important in the context of secure residential care.ObjectiveThe objective of the present study was to explore the association of these potential success factors with secure residential care outcomes.MethodsA repeated measures research design was applied in the study, including a group of adolescents in a secure residential care center that was followed up on three measurements in time. Interviews and questionnaires concerning care outcomes in terms of adolescents’ behavior change during care were administered to 22 adolescents and 27 group care workers. Outcomes in terms of adolescents’ treatment satisfaction were assessed by the use of questionnaires, which were completed by 51 adolescents.ResultsAdolescents reported some positive changes in their treatment motivation, but those who were more likely to be motivated at admission were also more likely to deteriorate in treatment motivation from admission to departure. Treatment satisfaction was associated with better treatment motivation at admission and with a positive adolescent-group care worker relationship.ConclusionsThe results suggest that outcomes can be improved by a more explicit treatment focus on improving the adolescent’s treatment motivation and the quality of the adolescent-care worker relationship during secure residential care.

Restraint and seclusion: a review of the literature

The author reviewed the literature published since 1972 concerning restraint and seclusion. The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.