Short-term Residential Program Research Articles

Duration of stay and rate of subsequent criminal conviction and hospitalisation for substance use among young people admitted to a short-term residential program.

This study examined the association between program duration and rate of criminal conviction and hospitalisation for substance use up to 15 years later among young people admitted to a short-term residential program for drug and alcohol use. Data were derived from linked administrative records of all clients referred to a modified therapeutic community for young people from January 2001 to December 2016 in New South Wales, Australia (n = 3059). Cox proportional hazards regression analyses examined the rate of conviction (separately for any offence, violent offence, non-violent offence and administrative offence) and hospitalisation for substance use, up to 15 years post-program among young people who attended treatment for 1-29 days, 30-59 days, 60-89 days and 90-120 days. Thirty days or more in treatment was independently associated with a lower rate of conviction for any offence and a non-violent offence, as well as hospitalisation for substance use, while 60 days or more was associated with a lower rate of conviction for a violent and administrative offence, relative to those who spent 1-29 days in the program. Additional months in the program were also associated with reduced rates of conviction and hospitalisation, although 90-120 days appeared to confer no additional benefits than 60-89 days. At least 60 days may be the minimum duration needed for short-term, therapeutic community programs to reduce the risk of conviction across all crime types and hospitalisation for substance use.

Self-Help Group Attendance-Associated Treatment Outcomes Among Individuals With Substance Use Disorder in Short-Term Residential Facilities

This study examined whether self-help group (SHG) attendance during treatment episodes in short-term residential programs increases treatment commitment among adults with substance use disorders (SUDs) in the United States. This cross-sectional study used the 2018 Treatment Episode Data Set-Discharges (TEDS-D), made available by the Substance Abuse and Mental Health Services Administration (SAMHSA). The effect of SHG attendance frequency was examined on three outcomes: (a) treatment completion and (b) retention, analyzed by multivariable logistic regression models; and (c) time-to-dropout, estimated by Cox proportional hazards regression model. Of the 75,252 discharges, 38% did not complete the planned treatment. SHG attendance frequency of eight times or more during the treatment episode had a significantly strong association with treatment completion and retention and time-to-dropout. Compared with individuals who did not attend any SHG, individuals attending SHG meetings eight or more times were more than three times as likely to complete treatment (odds ratio [OR] = 3.31, 95% CI [3.15, 3.49]). Similarly, SHG attendance frequency of eight or more times significantly reduced the dropout risk (adjusted hazard ratio [aHR] = 0.32, 95% CI [0.31, 0.34]). Among discharges that dropped out, we found a positive dose-response relationship between SHG attendance frequency and retention. Our results suggest a strong association between frequent SHG attendance of 8-30 times and improvement in treatment completion and retention, as well as a reduction in early dropout within short-term residential facilities for adults with SUDs. Expanding self-help options in short-term residential settings is warranted.

The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US

BackgroundThis study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. MethodsData were extracted from the 2015–2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. ResultsOnly 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. ConclusionsDespite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.

Peer respites: a research and practice agenda.

Peer respites are voluntary, short-term residential programs designed to support individuals experiencing or at risk of a psychiatric crisis. These programs posit that for many mental health services users, traditional psychiatric emergency department and inpatient hospital services are undesirable and avoidable when less coercive or intrusive community-based supports are available. Intended to provide a safe and homelike environment, peer respites are usually situated in residential neighborhoods. These programs are starting to spread across the United States, yet there is very little rigorous research on whether they are being implemented consistently across sites and which processes and outcomes may lead to benefits for persons experiencing psychiatric crises and for overburdened mental health systems. This Open Forum outlines implementation and research issues that peer respites face.

Adolescent Grandiose and Vulnerable Narcissism: Associations with Perceived Parenting Practices

The present study examined the relation between adolescent and parent reports of parenting practices and adolescent grandiose and vulnerable narcissism. Participants were 300 adolescents (257 males, 43 females) who were enrolled in a short-term residential program. Findings linked grandiose narcissism to adolescent reports of positive parenting practices and poor monitoring and supervision. Vulnerable narcissism was significantly positively correlated with inconsistent discipline and poor monitoring and supervision with inconsistent discipline predicting unique variance in adolescent vulnerable narcissism. The hypothesized interaction between positive reinforcement and poor monitoring and supervision in predicting grandiose narcissism was not supported. The implications of these findings as well as limitations and directions for further research on parenting and adolescent narcissism are discussed.

Gender-Sensitive Substance Abuse Treatment and Arrest Outcomes for Women

The present study links an empirically-developed quantitative measure of gender-sensitive (GS) substance abuse treatment to arrest outcomes among 5109 substance abusing women in mixed-gender short-term residential programs in Washington State. Frailty models of survival analysis and three-level hierarchical linear models were conducted to test the beneficial effects of GS treatment on decreasing criminal justice involvement. Propensity scores were used to control for the pre-existing differences among women due to the quasi-experimental nature of the study. Men's arrest outcomes were used to control for confounding at the program level. Results show that women in more GS treatment programs had a lower risk of drug-related arrests, and women in more GS treatment programs who also completed treatment had a significant reduction in overall arrests from 2years before- to 2years after treatment, above and beyond the reduction in arrests due to treatment alone. Implications and directions for future research are discussed.

The Effects of Aggression Replacement Training on Periodicities in Antisocial Behavior in a Short-Term Shelter for Adolescents

Adolescent antisocial behavior is a significant problem. Aggression Replacement Training (ART) is a multicomponent intervention developed to treat adolescent antisocial behavior. However, to date, no research has focused on the extent to which ART affects the cycles of antisocial behavior among youth in short-term residential programs. This article describes and reports results of a study investigating the relationship between ART and periodicities in antisocial behavior in a short-term shelter for adolescents. Time series data (519 days) on the antisocial behavior of 522 adolescents are analyzed using two methods: spectral analysis and harmonic regression analysis. Results suggest periodicities exist in the antisocial behavior in the facility of 154, 103, 51, and 30 days during a 310-day baseline. Results further suggest that the 154- and 30-day cycles ceased entirely concomitant with the start of the ART program. These results imply that ART may be an effective intervention for reducing or eliminating cycles of adolescent antisocial behavior in short-term residential programs. Recommendations are discussed for future research that is needed to confirm the potential utility of ART.

Modified Therapeutic Communities and Adherence to Traditional Elements

Traditional therapeutic communities (TCs) are characterized by confrontational group therapy, treatment phases, a tenure-based resident hierarchy, and long-term residential care. Many TCs have modified the structure and intensity of the traditional model, tailored services for specific client populations, and hired more professionally trained staff. This study examines the extent to which modified TCs are able to retain the underlying core technology of the TC. Using data from a nationally representative sample of 380 self-identified TCs, six traditional TC elements are identified. Results from a structural equation model indicate that offering services for specific populations and professionalization of staff has limited impact on the six TC elements. Modifications to structure and intensity of TC programming evidenced the strongest effect. Specifically, outpatient-only TCs showed significantly lower adherence to five of the six elements. Short-term residential programs showed a similar negative trend. Findings suggest selected modifications are possible without significantly impacting the TC model's core technology.

The value of acupuncture detoxification programs in a substance abuse treatment system.

Our purpose is to compare baseline characteristics and detoxification readmission rates of clients treated at outpatient acupuncture programs and at short-term residential programs, two options available to persons seeking substance abuse detoxification. This was a retrospective cohort study using data on clients discharged from publicly funded detoxification programs in Boston between January 1993 and September 1994. Multivariate models were used to examine the effect on 6-month detoxification readmission rates of treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients) after adjusting for baseline differences. Acupuncture clients were less likely to be readmitted for detoxification within 6 months (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.53-0.95). Similar results were found when the analysis was performed on a subsample of clients that were relatively similar in terms of baseline characteristics (OR 0.61, 95% CI 0.39-0.94). We determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system.

Outcome of short-term hospitalization for children with severe asthma

This study presents results of a family-centered, short-term residential program in which medical, behavioral, and treatment assessments were provided to the child with severe asthma and the family. After a median stay of 15 days, forty-four consecutively admitted children with severe asthma achieved a 93% reduction in hospital days (median, 7 hospital days for the year before treatment versus median 0 hospital days per patient per year at 20 1/2-month follow-up; p less than 0.001) and an 81% reduction in emergency care (median, 4 visits for the year previously versus median, 0.4 visits per patient per year at follow-up; p less than 0.01). There was also a significant reduction in corticosteroid bursts and improvement in FEV1. Unique to this program was mandatory family participation focusing on the child's and family's adaptation to severe asthma and development of family-specific interventions to promote compliance with the treatment regimen. Child and family functioning was assessed at admission and follow-up. Hospital use at follow-up was greater for children from dysfunctional families. Families demonstrating difficulties in disciplining the child with asthma required more hospital days both before admission and at follow-up. Short-term hospitalization for children with severe asthma is associated with significant improvement in pulmonary morbidity when the family of the child is included in assessment and treatment.

Treatment Services for Alcohol and Drug Abuse in Ontario and Quebec: A Comparison of Provincial Surveys

As in most parts of the developed world, Canada has experienced a considerable expansion in specialized services for the treatment of alcohol and drug abuse since the 1960s. This paper contrasts the addiction treatment system within two of Canada's largest provinces — Ontario and Quebec. Within the limitations of descriptive survey data, some of the similarities and differences between these treatment networks during the mid-1980s are discussed. For example, the Quebec system was characterized by more private fee-for-service programs and larger facilities that provided a range of services along the continuum of care. In Ontario, there were more separate programs, but they tended to be smaller and more specialized within the treatment continuum. Quebec had a higher rate of participation in outpatient, day treatment and short-term residential programs.