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PubMed1991

Adolescent residential treatment: a one to three year follow-up.

Considerable difficulties have been encountered in the residential treatment of adolescents with psychiatric disorders. Few of these programs have been successful. This study describes the long term effectiveness of a residential treatment program for disturbed adolescents. This program was particularly successful in returning severely disturbed adolescents to the community. None of the adolescents needed intensive residential treatment during the follow-up period. Three objective measures (Global Assessment Scale, Level of Functioning Scale, Adolescent Functioning Scale) were used at three specific times (admission, discharge and long term follow-up) to determine the level of psychosocial functioning of each adolescent. A significant improvement was found in the adolescents' level of functioning. These treatment gains were maintained at the time of long term follow-up (one to three years).

Adolescent↗
PubMedDate not supplied

Orem's theory applied to pediatric residential treatment.

Nurses working in multidisciplinary pediatric residential treatment facilities must maintain a clarity of domain. The Orem Self-Care Model is evaluated for the use in settings of this kind and shown to be both appropriate and adaptable.

Adolescent↗
PubMed1985

Residential treatment of adolescents: a treatment model.

This paper outlines a residential treatment model for adolescents. An essential component of this model is its emphasis on rehabilitation. Thus, community involvement and, therefore, treatment within the community is a cornerstone of patient management. The model is currently operating with emotionally disturbed adolescents, some with concurrent chronic medical disabilities. Research protocol, evaluating its effectiveness, is in place and will be documented in a future paper.

Adolescent↗
PubMed2004

Pediatric psychopharmacology for the major psychiatric disorders found in the residential treatment setting.

Intensive measures of rehabilitation are effective for treating the chronic course of the major pediatric psychiatric diagnoses. The treatment of these dis-orders in a residential treatment setting involves a coordinated team approach with components individually tailored to meet patient needs. Whereas milieu,group, and individual psychotherapy are important aspects of treatment, along with educational programming and behavior management, psychopharmacology currently plays an integral role in the treatment of children and adolescents with chronic mental illness in the residential treatment setting. Pharmacologic interventions in chronic psychiatric illnesses have decreased suffering and improved the quality of life for countless children and adolescents. In many cases, we still do not know what kind of pharmacologic treatment is best for each individual patient. Despite the progress of the past decade, further clinical research is needed with well-designed clinical trials for chronic psychiatric illnesses in children and adolescents.

Adolescent↗
PubMedDate not supplied

Characteristics of youth and young adults seeking residential treatment for substance use problems: an exploratory study.

In a convenience sample of young people (aged 12-25) seeking help for substance use, those preferring residential treatment had more mental health and addiction problems than those preferring nonresidential treatment. Those seeking residential treatment were also more likely to have had previous treatment experiences. Some clinical and research implications are noted.

Adolescent↗
PubMed1986

Comparisons of perceptions of the environments of adolescent drug treatment residential and outpatient programs by staff versus clients and by sex of staff and clients.

The Moos Community Oriented Program Environment Scale (COPES) was administered to 482 adolescent clients and 291 drug counselors in 30 outpatient and 27 residential drug treatment programs. Both clients and staff of residential programs were found to rate their programs more positively than did clients and staff of outpatient programs in the following specific ways: "encourage and provide more support"; "provide more practical help", such as training; "more concern with clients' personal problems"; and "encourage clients to argue, express anger, and display aggressive behavior". The only COPES factor on which the outpatient programs were perceived as superior to residential programs was "spontaneity" ("The program encourages clients to act openly and to express their feelings openly"). Across both types of programs, staff perceived the programs significantly more positively than did clients. The male staff ratings were the most positive of the ratings of the four subgroups. Female clients rated the program environments more positively than did male clients, but female staff did not rate the program environments more positively relative to male staff. Since the female staff ratings tend to be somewhat more similar to the ratings of the clients, both male and female, than did the male staff ratings, it might seem reasonable to hypothesize that the female staff ratings are more valid than the male staff ratings.

Adolescent↗
PubMed1990

A theoretical model for the practice of residential treatment.

This paper presents a theoretical model describing the practice of psychiatric residential treatment for children and adolescents. The emphasis is on forty practice principles, guiding concepts which dictate the specific treatment techniques and administrative procedures for the Southern Oregon Adolescent Study and Treatment Center. These principles are grouped into six clusters, each a critical area of concern for residential treatment: program organization, physical environment, program personnel, clinical practices, therapeutic milieu, and interpersonal relationships.

Adolescent↗
PubMed2003

Retention of court-referred youths in residential treatment programs: client characteristics and treatment process effects.

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.

Adolescent↗
PubMed2005

Forecasting length of stay in child residential treatment.

A sample of 126 consecutively admitted residential treatment children (mean age = 9.86, SD=1.84; 70.6% male; 42.1% African American; 50% Caucasian) were studied over a five-year period to identify predictors of length-of-stay. Cox regression was the primary statistical method used to analyze psychiatric and behavioral rating data for children assessed by teachers and treatment staff using the Devereux Scales of Mental Disorders (DSMD). Parental alcohol abuse, and children's age, medication status, race, initial DSMD total and critical pathology scores, were predictive of length-of-stay. Residential length-of-stay was strongly linked to initial levels of psychiatric symptomatology. Models that can help forecast length of stay are vital tools in helping to improve both clinical and utilization management strategies.

Child↗
PubMed2001

Medicaid program; use of restraint and seclusion in psychiatric residential treatment facilities providing psychiatric services to individuals under age 21. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.

This interim final rule with comment period establishes a definition of a "psychiatric residential treatment facility" that is not a hospital and that may furnish covered Medicaid inpatient psychiatric services for individuals under age 21. This rule also sets forth a Condition of Participation (CoP) that psychiatric residential treatment facilities that are not hospitals must meet to provide, or to continue to provide, the Medicaid inpatient psychiatric services benefit to individuals under age 21. Specifically, this rule establishes standards for the use of restraint or seclusion that psychiatric residential treatment facilities must have in place to protect the health and safety of residents. This CoP acknowledges a resident's right to be free from restraint or seclusion except in emergency safety situations. We are requiring psychiatric residential treatment facilities to notify a resident (and, in the case of a minor, his or her parent(s) or legal guardian(s)) of the facility's policy regarding the use of restraint or seclusion during an emergency safety situation that occurs while the resident is in the program. We believe these added requirements will protect residents against the inappropriate use of restraint or seclusion.

Adolescent↗
PubMedDate not supplied

Residential treatment: linkage with community drug treatment programs.

The realization that the program and services offered at the residential treatment center were not fully effective for some clients with multiple problems was an emotionally wrenching, but unavoidable, process. As the need for outside community substance-abuse referrals continues, it is important that ongoing relationships among agencies be established and nurtured. Dilemmas in creating these relationships have to be expected by all involved. Ways to resolve these problems must be put in place as quickly as they occur. Windows of opportunity to help residential treatment center clients with drug and alcohol problems must be recognized early on in treatment to ensure optimal services. Agencies must coordinate and cooperate with each other to be in position to seize these opportunities when they arise.

Adolescent↗
PubMed1998

Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment.

The prevalence and patterns of use of psychiatric and anticonvulsant medications were studied in 83 seriously emotionally disturbed children and adolescents at the time of their admission to a residential treatment facility. Youths (aged 5-19, mean = 13.6 years), consecutively admitted over 17 months, were assessed for the prevalence and patterns of use of psychotropic and anticonvulsant treatments. At admission, 76% of the youths were receiving psychiatric pharmacotherapy, 40% with more than one psychiatric agent, and 15% with a combination of psychotropic and anticonvulsant medications. Frequently prescribed medications were neuroleptics (35 % of the medicated youths), sedative-hypnotics (26 %), and anticonvulsants (15%). Psychostimulants (16%) and antidepressants (22%) were under-prescribed relative to their diagnostic indications. Over 50 different medication combinations were used. The neuroleptic + lithium combination was most common (25 % of the polypharmacological treatments). Neuroleptics were the most commonly prescribed medication and mostly used for nonpsychotic, nontic, and nonbipolar indications (55% of neuroleptic trials). Neuroleptics were used primarily for aggression regardless of diagnosis. Neuroleptics were used more in symptomatic treatments than in treatments for indicated diagnoses. The high prevalence of psychiatric and antiepileptic medication use in children and adolescents admitted to a residential treatment facility, and especially the pattern of their use, raises questions about prescribing practices for youths entering residential treatment and about pediatric psychopharmacotherapy in general.

Adolescent↗
PubMed1975

Humanistic behaviorism: a model for rapprochement in residential treatment milieus.

In the operational policies and treatment methodologies employed by most residential treatment milieus, contrasting theoretical and methodological approaches enjoy an uneasy coexistence. The medical model with its emphasis on treatment planning growing naturally from categorical diagnostic thinking is contrasted with the applied behavior analysis model with its proliferation of token economies, point systems, and behavior contracting. Judgmental errors flow naturally from the exclusive reliance on either model. Humanistic behaviorism provides a theoretical rapprochement by proposing that approaches growing from each model can be complementary.

Attitude of Health Personnel↗
PubMed1987

Residential treatment of disturbed delinquents: description of a centre and identification of therapeutic factors.

Residential treatment for disturbed, particularly delinquent, adolescents has been described several decades ago by the founders and leaders of institutions. Theoretical considerations in treatment were prominent. The importance of structured milieu and the control of aggression came to acquire recognition. This study describes a structured centre, known to be effective in treating disturbed delinquents, using data gathered over twelve years of clinical work, observation and research. Factors considered essential in defining this institution are isolated and made compatible with the factors indicated by Rutter in his review of the residential treatment of delinquents. These factors are being used in a further study which compares the effectiveness of different types of facilities for a range of diagnostic categories.

Adolescent↗