Residential Youth Care Research Articles

Cognitieve gedragstherapie voor depressieve klachten bij jongeren in residentiële zorg met een LVB in vergelijking met normaal begaafde jongeren

Abstract Cognitive behavioural therapy and depressive symptoms among youth with and without Mild Intellectual Disability in residential care: an exploratory study investigating ‘Op Volle Kracht’ Depression is at least as prevalent in youth with a mild intellectual disability (MID) as it is in youth without disabilities. Little is known however about the etiology and treatment of depression in this group. This paper aims to investigate the possiblities for cognitive behavioural therapy in youth with MID by (1) testing the validity of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory in youth with and without a MID in residential youth care; and (2) to examine the effects of Op Volle Kracht (OVK), a CBT-based depression prevention program among youth with and without a MID in a residential treatment setting. In study 1 the relationship between negative cognitive errors (Beck), response styles (Nolen- Hoeksema) and depressive symptoms was examined in 135 adolescents (age 9-17 years) using linear regression. Study 2 was an initial cluster randomized controlled trial in which twenty residential treatment groups (including in total N=92 adolescents aged 9-17 years), half of which targeted adolescents with a MID, were randomly assigned to either treatment as usual (TAU), or a combination of TAU and the group-CBT-program Op Volle Kracht (OVK+TAU). Depressive symptoms, cognitive errors and response styles were assessed at pre-test, post-test and 3 months follow-up. The data were analyzed by mixed effects linear regression analyses with age and gender as covariates. Results Study 1 showed that only the cognitive error ‘underestimation of the ability to cope’, and a ruminative and distractive response style predicted depressive symptoms in both youth with- and without MID. The negative cognitive error ‘underestimation of the ability to cope’ was more prevalent among youth with MID than among youth without MID. Study 2 showed that the group CBT-program OVK was effective in reducing rumination, but not in reducing depressive symptoms or cognitive errors. This effect was the same for youth with and without a MID. The main premises of Beck’s cognitive theory and Nolen-Hoeksema’s response style theory of depression are applicable to both youth with and without a MID. The cognitive error ‘underestimation of the ability to cope’ poses a specific risk factor for developing a depression for youth with a MID and may require special attention in treatment and prevention of depression. The specifically adapted program OVK did not show effectiveness in reducing symptoms of depression in youth in residential care.

Psychometrics of a Brief Trauma Symptom Screen for Youth in Residential Care.

Trauma screening is an important element for providing trauma-informed services to youth in residential care. Unfortunately, lack of time and resources may deter clinicians from conducting trauma screening at intake. This study tested the psychometric properties of the Brief Trauma Symptom Screen for Youth (BTSSY), which could be used during intake into residential care. Participants included 572 youth, ages 10-18 years (M = 14.28 years, SD = 2.31), of whom 58.9% were boys, 78.7% were Caucasian, 51.7% were youth receiving services in residential care, 15.6% were youth with clinical needs, and 32.7% were typically developing youth from the local community. Participants completed the BTSSY; other questionnaires of psychopathology, childhood maltreatment, and symptomology of posttraumatic stress disorder (PTSD); and diagnostic interviews, which were conducted by licensed psychiatrists. The total BTSSY score had a good composite reliability (CR) of .80 and was valid based on a significant positive correlation, r = .64, with the UCLA PTSD-Reaction Index. The BTSSY score was also fair, area under the curve = .75, at detecting a diagnosis of PTSD from a psychiatrist. Significant group differences in the BTSSY scores were found between youth with a diagnosis of PTSD and the other two groups, with moderate-to-large effect sizes, ds = 0.73-1.22. Preliminary results indicated the BTSSY may be a useful screening tool for identifying youth at residential care intake who may need additional assessment for PTSD. Limitations and implications for future research and practice are discussed.

The Influence of Youth Gender and Complex Trauma on the Relation Between Treatment Conditions and Outcomes in Therapeutic Residential Care.

Complex trauma (CT) is the experience, or witness, of prolonged abuse or neglect that negatively affects children's emotional and psychological health. Youth in residential care experience higher incidences of complex trauma than youth in community-based care, with notable gender differences and presentation of psychological symptoms. This study examined the effects of trauma-informed residential care and the relation between CT and gender. A sample (n = 206) from an evaluation of a youth psychiatric residential facility in the Midwest that transitioned from a traditional care model to a trauma-informed care model was used. A hierarchical regression was used to model the main effects of model of care, gender, CT, length of stay, and crisis response on treatment outcomes; and the moderating effects of gender and CT. The results support the high prevalence of CT in residential care populations. The final model explained 30.2% of the variance with a statistically significant interaction between gender and length of stay in treatment, indicating that longer lengths of stay in treatment are associated with less change in functional impairment for girls than boys. Youth gender and prior trauma are important factors to consider when monitoring experiences and treatment outcomes in youth residential care.

Perceived social support among adolescents in Residential Youth Care

AbstractSocial support may be of particular importance for vulnerable adolescents' development and health and can help them to cope with stressful life events. However, knowledge of perceived social support among adolescents in Residential Youth Care (RYC) is sparse. The present study therefore aimed to investigate perceived social support among adolescents in Norwegian RYC (N = 304, mean age 16.3 years, girls 57.2%), using a short form of the Social Support Questionnaire. The results were compared with adolescents in the general population. The findings revealed that adolescents in RYC reported a lower number of support persons compared with the general population. Both populations reported a decreasing number of support persons as they aged, except for girls in RYC. The adolescents in both populations were satisfied with the support perceived, especially those with the highest number of support persons. However, social support providers differed between the two populations; RYC adolescents reported their extended family, other sources of support, and the institutional staff more often and their parents less. The findings are important for adolescents living in RYC, as knowledge of their social support network could influence the current practices and ensure contact with important support persons, affecting their development and health.

Development and Preliminary Evaluation of the Reaction to Unacceptable Behavior Inventory: A Questionnaire to Measure Progress in Implementation of Non-violent Resistance

BackgroundMonitoring the implementation of new interventions, as in this study Non-violent Resistance (NVR) for the use in residential youth care settings, is mandatory in order to evaluate, adjust and refine the implementation process where necessary.ObjectiveAs there is no instrument for such monitoring of NVR available, the authors developed a new questionnaire, named Reaction to Unacceptable Behavior Inventory, (in short: RUBI).MethodThis questionnaire was completed by staff of four different residential settings in the Netherlands, at different stages of the NVR implementation process. The staff members reported on the practice of their colleagues.ResultsThe results are promising, as they show good reliability, inter-item correlations and other psychometric features for the included items. Furthermore, the results show that the RUBI seems to discriminate between trained and untrained teams, defending its use in future implementation processes and implementation research.ConclusionsThe RUBI is the first attempt to create an instrument which can be used for monitoring change during implementation of NVR, and for evaluating the degree of difference or compatibility between NVR and existing practice before implementation. Longitudinal research is needed to strengthen the documentation of validity and reliability of the RUBI in different settings, countries, and cultures. This should also be extended to the final and follow-up stages of implementation. In the future, redundant and insensitive items should be removed and standards for interpreting scale scores should be developed.

The effect of oxytocin administration on empathy and emotion recognition in residential youth: A randomized, within-subjects trial

Previous research has revealed a positive effect of oxytocin administration on several social behaviors especially in individuals with social-affective deficits. However, it is still unknown whether intranasal oxytocin administration (OT-IN) can be beneficial to residential youth who exhibit severe social-affective impairments. We conducted a randomized, double-blind, placebo-controlled, within-subjects, sequential study to examine the effect of OT-IN on empathy and emotion recognition in 100 male adolescents living in residential youth care facilities. We also explored the moderating role of callous-unemotional traits, trauma, and dissociation in the oxytocin effect. Participants self-administered one dose of 24 IU of oxytocin or placebo and performed experimental tasks on empathy and emotion recognition before and after the administration. The same procedure was performed one week later with the other substance. We found that empathy was increased after oxytocin administration compared to placebo and this effect was specific to individuals with high callous-unemotional traits. There was no effect of OT-IN on the overall emotion recognition, but there was a positive effect on accuracy of fear recognition. Trauma and dissociation did not moderate the oxytocin effect on empathy or emotion recognition. Our findings provided evidence of a beneficial effect of OT-IN on empathy and fear recognition in residential youth. We propose that a combination of OT-IN and psychological interventions merits further exploration, as it might be a novel promising direction for more tailored approaches and better treatment outcomes.

Measuring the restrictiveness of Portuguese residential care for children and youth

Restriction of living environment refers to limits, rules, and structures in place in an out‐of‐home residential placement for children/youth. This article describes the process of revising a measure of out‐of‐home living restrictiveness to be culturally congruent for Portugal, providing preliminary data on validity and reliability, and discusses the feasibility of using this measure in Portugal. The findings suggest that the Portuguese language version has acceptable reliability. The interviewers identified several additional content areas to increase coverage of the construct. Additional validity analyses are needed, but the preliminary findings suggest that measuring the restriction of living environment could provide a concise youth‐informed perspective of living environment not currently being obtained in Portugal.Key Practitioner Message: • Measuring restriction of living environment is crucial to understanding the milieu of the residential home.

The group care quality standards assessment: A framework for assessment, quality improvement, and effectiveness

Concerns about the quality of residential care for children and youth are longstanding. These concerns prompted a Florida-based initiative aimed at transforming residential care through the integration of research-informed practice standards, on-going assessment, and continuous quality improvement. The initiative resulted in the development of the Group Care Quality Standards and the Group Care Quality Standards Assessment (GCQSA) as mechanisms for guiding transformation efforts. In this article, we elaborate on the conceptual and implementation frameworks guiding the development and efforts to scale up the GCQSA throughout Florida. We begin by summarizing empirical sources that informed the guiding frameworks. Next, we describe the project phases highlighting the aims, methods and summarizing results where relevant. The aim of this article is to offer a working blue print to guide the adaptation of quality initiatives in other child welfare organizations or jurisdictions while taking into consideration the fit of such initiatives within the service environment and the complexities of system-wide change.

School satisfaction among youth in residential care: A multi-source analysis

Formal education is a key factor for overcoming the inequalities and social vulnerability that young people in residential care endure. However, recent research shows an important gap between children in care (especially those living in residential homes) and the general student population in terms of their academic outcomes and inclusion in education. The aim of this article is to analyse the evaluations made by the main stakeholders involved in the school situation of young people in residential care and propose an explanatory model of their level of school satisfaction (SS) based on variables related to the youngsters' subjective well-being. The sample was composed of 219 subjects from five European countries, including 75 young people (78.7% boys, Mage = 15 years old), 75 caregivers (64% women) and 69 teachers (79.7% women). An equivalent questionnaire was designed for each stakeholder for the purpose of data collection. The results show that school satisfaction expressed by youngsters is significantly higher than that attributed to them by the professionals. The multi-source analysis suggests that there is agreement among stakeholders that social relationships are key elements for youngsters' subjective wellbeing influencing their school satisfaction (SS). The analysis of the different perceptions among stakeholders allows us to have a deeper understanding of the phenomenon, leading the practitioners and policy-makers to suggest more appropriate interventions.

Det dubbla utanförskapet

A twofold exclusion – interviews about bullying with young people in residential careYouth in residential care are at risk of living in twofold exclusion when stigmatization and bullying in school become part of their everyday life. The article presents results from semi-structured interviews with ten young people in residential care. The young people’s reflections on bullying are analysed in relation to different explanatory models of bullying. Experiences of bullying are very common among youth placed in out of home care, which calls for research on bullying and youth in residential care. The aim of the study was to present understandings of bullying among youth placed in residential care and to investigate why youth in residential care report victimization to a higher degree than young people living at home. The research questions were: 1. What descriptions do young people give of the term bullying? 2. What insights can the young people’s descriptions of bullying give to the high victimization among youth in residential care? 3. How can the young people’s descriptions of bullying be understood in relation to different understandings of bullying? The main findings are the young people’s sense of exclusion. They feel stigmatized due to their placement in care and believe they have to be secretive in school about being placed in care because of the risk of bullying. Three suggestions to decrease the twofold exclusion are presented. 1. Based on knowledge that frequent changes in groups are a risk factor in regard to bullying, placement changes need to be reduced to a minimum. 2. Schools (teachers and pupils) need education concerning care environments. 3. Young people are often placed in care due to behavioural problems and therefore residential units need advantageous conditions to work with the young people’s behaviour on both individual and group level.

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.

The Social Image of Families of Children and Youth in Residential Care: A Characterization and Comparison With Mainstream Families With Different Socioeconomic Status

The literature suggests that families of children and youths in residential care are often associated with negative social images. These images may shape prejudiced attitudes and behavior toward them and, when shared by care professionals, compromise the effectiveness of family intervention and reintegration. This study explored these social images in a sample of 176 participants with and without professional contact with this population. Participants were asked to indicate five attributes describing families of children or youths living in residential care or in mainstream environments with low or medium socioeconomic status (SES). Results indicated that both families of children and youths in residential care and families of low SES were predominantly described with negative attributes. However, only the former were characterized by dysfunctional parenting-related attributes. Medium SES families were overall described with positive attributes. Furthermore, these social images were organized in different profiles. Implications for family intervention and reintegration are discussed

Implementing the START:AV in a Dutch residential youth facility: Outcomes of success.

Currently, implementation research in the field of forensic risk assessment is limited and consensus on “implementation success” is lacking. This study applies outcomes of success from implementation science to the implementation evaluation of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) in a residential youth care facility in the Netherlands. Staff perceptions on the implementation and the instrument were assessed using 5 implementation outcomes in a longitudinal multimethod design: acceptability, adoption, appropriateness, feasibility, and penetration. As anticipated, the majority of staff perceived START:AV core constructs as useful for treatment (appropriateness). However, satisfaction with the instrument decreased over time (acceptability). This was likely due to an increased workload (feasibility). Despite this dissatisfaction, the completion rate was acceptable (adoption). Lastly, staff reported a lack of integration of the START:AV findings in clinical case conferences (penetration). The implementation outcomes aid in identifying areas for improvement, which in turn can lead to an increased and more consistent uptake of structured risk assessment into routine practice

Effectiveness and Costs of a Therapeutic Residential Care Program for Adolescents with a Serious Behavior Problem (MultifunC). Short-Term Results of a Non-Randomized Controlled Trial

ABSTRACT Although research has repeatedly shown that residential care for youth with a serious behavior problem has little rehabilitation success, there is a group of youth for whom residential care in a locked setting is necessary. In this article, a manualized therapeutic residential treatment model for adolescents with serious behavior problems, MultifunC, is evaluated. The program theory of MultifunC is based on a review of the literature and synthesis effective treatment components. This study included 80 youth aged 15–17 years with a medium high or high risk for reoffending. Half of the participants received MultifunC, and half treatment as usual (TAU). Although non-randomized, the two groups were found to be equivalent on important background variables. After 24 months, this first evaluation of MultifunC demonstrated that youth participating in MultifunC had a reduced need for residential care in a locked setting as well as out-of-home placement in general compared to youth in the TAU group. The economic analysis found MultifunC to be a cost-effective alternative to TAU due to the reduced need of residential care in locked settings. There were no significant effects on reoffending or psychiatric care.

One size does not fit all: A systematic review of training outcomes on residential youth care professionals' skills

Despite the importance of training residential youth care professionals to increase their professional competences, little attention has been paid so far to the influence of training on the behaviour and skills of residential professionals. This study aims to gain greater insight into the effects of training on the skills of these professionals.We conducted a systematic literature review using the PsycINFO, Eric, SocIndex and Academic Search Premier databases. Within the 12 studies retrieved, the outcomes of nine different training programme were examined. These nine training programmes include The Solution Strategy (TSS), (Professional) Skills for Residential Child Care Workers (PSRCCW/SRCCW), Therapeutic Crisis Intervention (for Youth Care Worker) (TCIYCW/TCI), Child Teacher Relationship Training (CTRT), a Brief Training Program (BTP), Social Skills Training (SST), Behavior Analysis Services Program (BASP), Mental Health Training (MHT) and a Brief Training Manual (BTM).Our results demonstrate that some training programmes may produce positive outcomes for professionals after a training course. TSS (in both studies), PSFCCW, SRCCW, TCI, CTRT, BTP, SST, BASP and BTM programmes are associated with positive outcomes regarding improvements in professional's individual characteristics or improvements in the work environment. However, two studies also found negative outcomes with regard to decreases in the perceived recognition of youth care workers' value to the agency and a decrease in the knowledge and skills that they learned through training after 6 months (TSS [Hickey, 1994] and PSRCCW). In addition, the most common ‘other’ outcome was a variable effect of training on the professionals' skills.Although we did find positive and negative training outcomes on the professionals' skills, none of the studies specified the training elements which caused these changes. More thorough empirical studies using an experimental or repeated case study design are needed to identify effective training elements which could further improve the effectiveness of interventions targeting youths in residential youth care.

Dissociation and psychopathology in residential youth: a brief report

ABSTRACTAlthough dissociative symptoms are observed in several psychiatric disorders and linked to antisocial behavior and offending, the relation between dissociation and psychopathology or comorbidity has not been consistently investigated in residential youth yet. This brief report documented prevalence and comorbidity rates of several psychiatric disorders and examined their relation to dissociation in residential youth. The study included 100 male adolescents (Mage = 16.51) admitted to residential youth care facilities. Psychopathology was assessed with the Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID) and dissociation was measured with the Adolescent Dissociative Experiences Scale (A-DES). Externalizing problems (conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder) were the most prevalent (81%) followed by substance abuse/dependence (71%), manic/hypomanic symptoms (40%), anxiety (35%), and depression (33%). High comorbidity was also observed in externalizing problems with alcohol/substance abuse/dependence (67%), manic/hypomanic symptoms (35%), depression (31%), and anxiety (30%). Logistic regression analyses revealed a significant link between dissociation and externalizing problems, depression, and manic/hypomanic symptoms, as well as comorbid externalizing problems and depression or manic/hypomanic symptoms. The findings highlight the need to assess dissociation in order to better understand the multifaceted individual profile of residential youth and incorporate it in the treatment plan.

Intensive oversight of youth residential treatment: Staff perspectives on the New York State Justice Center for the Protection of People with Special Needs.

Youth care workers in U.S. residential treatment centers (RTCs) provide 24-h care to youth whose significant psychosocial needs cannot be managed in a less restrictive setting. They have sometimes abused or neglected youth in their care. This study investigates staff perspectives on a new form of intensive oversight developed in New York State to prevent maltreatment of youth in care facilities. It asks: How does intensive oversight and investigation mandated by a state-run agency for the protection of people in care affect residential youth care workers in RTCs? Derived from a 15-month ethnographic study of an RTC serving a child welfare population conducted in 2015 and 2016, these results suggest that intensive oversight may have unanticipated consequences for RTCs, the youth care workforce, and youth in care. Consistent with other studies of regulation and surveillance in risk societies, participants reported that fear of prolonged and intimidating investigations, false allegations, and unavoidable violations of policy negatively affected their practice and contributed to staff turnover. Organizational consequences included serious staffing challenges and increased costs of overtime and administrative management of compliance. Some participants suggested that the form of intensive oversight studied here may have reduced the quality of care received by youth by disrupting therapeutic relationships, causing youth to be cared for by unfamiliar workers, and compelling workers to act defensively to prevent allegations rather than in the best interest of youth. We suggest that, under conditions of intensive oversight, youth care workers, like their clients, should be considered an at risk population whose well being is essential for the provision of high quality care. We conclude with modest recommendations to organizations and jurisdictions using or considering intensive oversight practices to protect the rights and safety of youth in RTCs.

Measuring Youth Residential Care Provider Attitudes

Abstract. In this study the 15-item Evidence-Based Practices Attitude Scale (EBPAS), a measure designed to assess attitudes toward the adoption of EBPs, was collected from administrators of residential care facilities for youth in the United States. As the EBPAS was administered to a different sample for which it was originally developed (i.e., community mental health), we conducted a Confirmatory Factor Analysis (CFA) to investigate if its factor structure was maintained. Results confirm the factor structure of the EBPAS as a valid measure of attitude toward evidence-based practice among youth residential care providers. Limitations and areas of future research are discussed.

Determinants and outcomes of social climate in therapeutic residential youth care: A systematic review

BackgroundPrevious studies on effectiveness of therapeutic residential youth care (TRC) have indicated that, compared to short-term effects, long-term effects are less convincing. Moreover, there is limited evidence on how TRC achieves treatment goals: TRC remains too much of a “black box”. To gain durable treatment results we need to know more about how results are achieved, rather than investigating the achieved results itself. One of the factors associated with this process of change is the social climate within TRC institutions. Up until now, no literature reviews about how social climate is affected by institution and youth characteristics, and how social climate affects outcomes has been performed. ObjectiveTo provide an overview of the literature on associations between determinants and social climate and between social climate and outcomes in TRC. MethodWe searched multiple databases with a predetermined set of search criteria in the years 1990 and March 2017. We identified 8408 studies and reduced the final sample to 36 studies. Most studies were empirical assessments with a correlational design and were conducted in Western countries. ResultsEffect sizes for the studies ranged from small to large and varied between and within studies. Most associations were found between social climate and positive outcomes. The most mentioned social climate constructs were: an open climate, support, and autonomy. ConclusionsThe results are challenging to summarize due to variations in the concepts and operationalizations of social climate. The organizational culture must support a social climate which is supportive, structured and caring, and provide youth with an environment to grow. A positive social climate must constantly be evaluated and recreated based on combining the perspectives of residents, staff and external perspectives.

Emotional and Behavioral Problems and Psychosocial Skills in Adolescents in Residential Care

Research suggests that mental health problems in adolescents in residential care (RC) are more prevalent than for youth in the community, and that psychosocial competencies are protective factors of mental health. This study compared adolescents in RC in Portugal, with a Portuguese community sample on the incidence of mental health problems and psychosocial skills, explored gender differences and the relationships between mental health problems and psychosocial competencies. Four hundred and forty-three adolescents in RC participated. Results showed that the RC adolescents had higher levels of mental health problems lower academic achievement, a poorer social support network, but were more involved in sports and hobbies, household chores than the adolescents in the normative sample. Gender differences were observed. Psychosocial skills were negatively correlated with mental health problems. These findings indicate an urgent need in Portugal for early screening of mental health problems and socio-cognitive interventions for youth in RC.