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PubMed2004

A review of clinical characteristics and residential treatments for adolescent delinquents with mental health disorders: a promising residential program.

As treatment systems throughout the country have deinstitutionalized, under-use of community-based residential treatment systems has escalated. Reliance on juvenile justice systems for the care of the mentally ill adolescent has increased. There is considerable overlap between the mentally ill adolescent population within the community-based mental health systems and the offender population within the juvenile justice systems. With the inconsistent epidemiological prevalence and longitudinal treatment data, mental health treatment providers have also begun addressing this problem. This is currently being done by designing and implementing community-based residential mental health programs for delinquent adolescents of the juvenile justice system as well as nondelinquent adolescents within the mental health treatment systems. Providers have relied on both systems' literature in establishing theoretical treatment programs. The authors review critical treatment components currently used by both the treatment and juvenile justice systems. A promising integrative program is described.

Adolescent↗

PubMed2002

Factorial validity, reliability of assessments and prevalence of ADHD behavioural symptoms in day and residential treatment centres for children with behavioural problems.

This study uses the attention deficit/hyperactivity disorder (ADHD) symptom ratings of professional care workers to estimate the prevalence of ADHD symptoms among children in day treatment centres (N = 162) and residential treatment centres (N = 195) in Holland. Although further research is needed, the study supports the suggestion that such ratings can add to reliable diagnostic outcomes when assessing the behavioural symptoms of ADHD in children in the centres. It is estimated that nearly a fifth of the children in such centres exhibit the symptoms of ADHD in the judgement of professional care workers. Model testing using confirmatory factor analysis favours a dimensional behavioural model that comprises all the three constitutional symptom dimensions of ADHD (inattention, hyperactivity and impulsivity) instead of the two-factor model as used in the DSM-IV (inattention and hyperactivity/impulsivity). However, the differences of fit between both models were only small and the hyperactivity and impulsivity factors were highly correlated. This suggests that, in practice, a two-factor model can also be appropriate. The issue of whether a two-factor or a three-factor model is more appropriate thus remains unsolved in this study.

Adolescent↗

PubMed1993

Family involvement in residential treatment of children with psychiatric disorder and mental retardation.

OBJECTIVE: The goals of the study were to determine the extent of family involvement with children in residential treatment settings, to examine whether involvement diminishes over time, and to examine the relationship between involvement and the child's diagnosis as well as the demographic characteristics of the child and the family. METHODS: Staff rated the level and frequency of family involvement with 234 children, aged five to 19 years, living in three residential treatment centers. The children were grouped according to three diagnostic categories: psychiatric disorder, mental retardation, and dual diagnosis of psychiatric disorder and mental retardation. RESULTS: Almost one-third of the children had no family contact, and about 50 percent had three or fewer contacts per year. The level of family involvement was lower with dually diagnosed children than with children who had only psychiatric disorder or mental retardation. Level of involvement was also related to the driving time between the family home and the residential facility and to socioeconomic status, variables that seemed to account for the lower level of involvement of families with dually diagnosed children. CONCLUSIONS: Greater distance between the family home and the residential treatment center and low socioeconomic status greatly limit a family's accessibility for involvement with children in out-of-home placements. These obstacles are more likely to occur in families of dually diagnosed children.

Adolescent↗

PubMed2000

Evaluating the use of psychiatric hospitalization by residential treatment centers.

OBJECTIVE: To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality. METHOD: This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. RESULTS: Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. CONCLUSIONS: The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.

Adolescent↗

PubMed2007

The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders.

AIMS: This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1-3) and longer-term (months 4-9) abstinence. DESIGN: Two-group randomized design. SETTING: Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States. PARTICIPANTS: A total of 183 adolescents, ages 12-17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. INTERVENTION: Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits. MEASUREMENTS: Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. FINDINGS: ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. CONCLUSIONS: ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study

Adolescent↗

PubMed2004

Residential treatment for smokeless tobacco use: a case series.

We developed and implemented a novel 8-day residential treatment program for smokeless tobacco (ST) use. A multidisciplinary team delivered behavioral treatment, nicotine patches were adjusted to achieve 100% replacement of baseline peak serum nicotine concentrations, and bupropion sustained-release was prescribed. Mean participant age (+/- SD) was 47.4 +/- 18.2 years. Mean nicotine patch dose at program end was 43.2 mg/day +/- 13.9 (range 14 to 66 mg/d). Median percent replacement by serum nicotine concentrations was 86.6% (IQR: 75-113.8%). At 1 year, the biochemically-confirmed (urine anabasine <2.0 ng/mL) self-reported 7-day point prevalence tobacco abstinence rate was 58% (14/24). A residential treatment program for ST users may be effective. More research is needed to replicate our findings and determine if comparable abstinence rates can be achieved with outpatient ST treatment programs using similar behavioral and pharmacotherapies.

Administration, Cutaneous↗

PubMed1994

Family involvement in residential treatment of children with retardation: is there evidence of detachment?

Family involvement could be critical for successful residential treatment. Historically, however, out of home placement for children with mental retardation meant a severing of meaningful ties with their families. Today, families have greater involvement with pre-placement services and might be more involved in residential treatment as well. Families (N = 55) were interviewed twice, approximately one and two years after placement, to assess their involvement with the child and their reactions to placement. Contrary to previous findings, family involvement was high and stable; there was no evidence of behavioral detachment. Moreover, respondents primarily reported post-placement benefits to the family. Family emotional reactions were considered within a framework of "psychological tasks of placement".

Child↗

PubMed1990

Past and present trends in residential treatment.

The history of residential care for those with autism and other developmental handicaps is summarized for the past 200 years. Residential trends toward community integration in the past three decades are traced for autism in general and for one state institution in particular. Parallel cycles for residential care from previous periods are identified. Some negative side effects of current trends are identified if the needs of the population with handicaps and the community are not better integrated in the future.

Autistic Disorder↗

PubMedDate not supplied

Regional variation and clinical indicators of antipsychotic use in residential treatment: a four-state comparison.

The last decade saw an increase in psychotropic use with pediatric populations. Antipsychotic prescriptions are used frequently in residential treatment settings, with many youth receiving antipsychotics for off-label indications. Residential treatment data from 4 states were examined to determine if regional variation exists in off-label prescription and what clinicalfactors predict use. The study used clinical and pharmacological data collected via retrospective chart reviews (N = 732). The Child and Adolescent Needs and Strengths Assessment-Mental Health Version was used to measure symptom and risk severity. Of youth receiving antipsychotics, 42.9% had no history of or current psychosis. Statistical analyses resulted in significant regional variation in use across states and yielded attention deficit/impulsivity, physical aggression, elopement, sexually abusive behavior, and criminal behavior as factors associated with antipsychotic prescription in nonpsychotic youth. Antipsychotic prescription is inconsistent across states. Off-label prescription is frequent and likelihood of use increases with behavior problems.

Adolescent↗

PubMedDate not supplied

Residential treatment for youngsters with difficult-to-manage insulin dependent diabetes mellitus.

A descriptive outcome study of 52 children with insulin-dependent diabetes mellitus (IDDM) admitted to a residential treatment program over 6 years. Criteria for admission included repeated hospitalizations for diabetes-related problems, excessive school absences, and/or familial disruption. Residential treatment included individual, group, and family psychotherapy, diabetes education, and close medical supervision. The design included collection of data before, during and after treatment. Children admitted to the residential unit were compared to a population of pediatric IDDM outpatients from the same geographical area. Treatment was associated with a reduction in diabetes-related hospitalizations, improved school attendance, decreased glycosylated hemoglobin levels, weight gain, individualized insulin changes, improved knowledge about diabetes, and a normalization of attitudes towards this disease.

Absenteeism↗

PubMedDate not supplied

Caregiver understanding of adolescent development in residential treatment.

PROBLEM: Caretaker knowledge and understanding of adolescent development and its application to clinical practice with severely emotionally disturbed adolescents in residential treatment. METHODS: Twenty child-care workers and registered nurses participated in semistructured interviews analyzed using dimensional analysis, a grounded theory method. FINDINGS: Three distinct categories of caregivers were identified based on level of expertise and engagement in developmentally appropriate treatment practices: inexperienced, party-liners, and transcenders. Developmental issues identified included lack of resident preparation for puberty and staff discomfort with adolescent sexuality. CONCLUSIONS: Caregiver, institutional, and social barriers to developmentally sensitive practice were identified. Practice recommendations include direct preparation of children and adolescents in residential treatment for pubertal changes and sexual development, and careful discernment of age-appropriate and psychopathological adolescent behaviors.

Adolescent↗

PubMed2002

Voices of African American families: perspectives on residential treatment.

This article examines families' perceptions about involvement in residential treatment from the viewpoints of African American and non-African American family members. Focus group interviews found that all family members shared some common positive and negative experiences. However, unique issues remained for African American caregivers. The costs to children of being separated from their families and communities, fears regarding the use of medications, cultural dissimilarities of staff and clients, staff stereotyping, and a commitment to advocating for children other than their own were themes frequently expressed by African American family members. Implications for social services professionals serving African American families are highlighted.

Black or African American↗

PubMed2006

Residential treatment for youth: introduction and a cautionary tale.

This special issue addresses an area in child and adolescent mental health which has suffered from significant neglect, that of residential treatment. Though the American Orthopsychiatric Association contributed to the development of the principles of residential treatment fifty years ago, we find ourselves in the midst of a national crisis on how this level of care is implemented in the field. This article summarizes the major themes of the special issue, as well as reports on the editor's cautionary experience with major problems in one residential facility.

Adolescent↗

PubMed2001

A comparison of long-term and short-term residential treatment programs for dual diagnosis patients.

The authors compared measures of process and six-month outcomes for 45 individuals who were treated in a long-term residential treatment program for patients with dual diagnoses with measures for 39 individuals who were treated in a short-term program. They also compared outcomes for individuals within each group. Those who received long-term treatment experienced improvements between entry into the program and six-month follow-up, and they were more likely to have engaged in treatment than individuals in the short-term group. At follow-up, individuals in the long-term residential treatment group were more likely to have maintained abstinence and less likely to have experienced homelessness than those in the short-term group.

Adult↗

PubMed2004

Psychotherapy in residential treatment: historical development and critical issues.

In a time of concern with policies of managed care, more limited financial resources, and reduced lengths of residential treatment for troubled children and adolescents in the United States, we seem to be confronted ironically with an ever larger number of children who are growing up in circumstances of social dis-organization and personal despair. Faced with this dilemma, considerations of issues related to the provision of therapeutic services within residential treatment were provided by an examination of the historical development of the concepts of the milieu and residential care in the United States. The historical review revealed how the emergence of differing theories of psychotherapy has influenced the creation of various models of residential care. Several tensions have persisted over the years in the effort to provide therapy services within the broader residential setting. Behavioral and cognitive-behavioral methodologies currently have come to the forefront in many aspects of milieu treatment in group care for children and adolescents in the United States. This article concluded with a critique of some potential impacts associated with those perspectives on individual and group treatment and on our views of the individual and culture in general. This discussion did not attempt to provide answers to all the stresses that can emerge in a residential setting that strives to provide a range of mental health services, nor was it intended to present an exclusively rejecting, strident criticism of the medical model or behaviorally oriented therapies. The intent was to point out some of the limitations of relying exclusively on those perspectives and to show that an amalgamation of treatment models can have real consequences for children in group care. A continued awareness of those potential consequences is essential to mitigate their potentially antitherapeutic effects.

Adolescent↗

PubMed1991

Interpersonal dependency and locus of control as personality correlates among adult male alcoholics undergoing residential treatment.

The Interpersonal Dependency Inventory and the I-E Control Scale were administered to 22 male alcoholics in residential treatment. Contrary to prediction, subjects had normal dependency scores and external locus of control orientation. These findings contradict currently held assumptions about levels of dependence and the directionality of control orientation among inpatient alcoholics. Subjects were further examined for the influence of previous inpatient alcoholism treatment. Significant correlations were found between interpersonal dependency and control orientation scores for 14 alcoholics who were in residential treatment for the first time. Clinical implications for treatment concerning dependency factors and locus of control in inpatient populations are also discussed.

Adolescent↗

PubMed1984

Evaluation of a residential treatment center for emotionally disturbed adolescents.

This study examines a residential treatment center for emotionally disturbed female adolescents by comparing changes in personality as measured by objective tests given while in residence and by a questionnaire sent to former residents at least six months after release. Two hypotheses were tested. The first was that the girls would be successful when they returned to their communities. "Success" was defined by a number of variables on a questionnaire. Responses to the questions indicate that the girls are doing well. The second hypothesis was that the girls would show significant improvement in their scores on two personality tests taken at the time they were admitted and at the time of their release. A comparison of the mean scores of the various factors on each test showed significant improvement.

Adolescent↗

PubMed1999

Homeless veterans' satisfaction with residential treatment.

OBJECTIVE: Because little is known about homeless individuals' satisfaction with mental health services or the association between satisfaction and measures of treatment outcome, the study examined those issues in a group of homeless veterans. METHODS: Demographic and clinical data were obtained from intake assessments conducted before veterans' admission to residential treatment facilities under contract with the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program. Clients completed a satisfaction survey and the Community-Oriented Programs Environment Scale, which asks them to rate dimensions of the treatment environment. Outcome data came from discharge outcome summaries completed by VA case managers. RESULTS: Overall satisfaction with residential treatment services was high among the 1,048 veterans surveyed. Greater satisfaction was associated with more days of drug abuse and more days spent institutionalized in the month before intake and with an intake diagnosis of drug abuse. Regression analyses indicated that satisfaction was most strongly related to clients' perceptions of several factors in the treatment environment. Policy clarity, clients' involvement in the program, an emphasis on order, a practical orientation, and peer support were positively related to satisfaction; staff control and clients' expression of anger were negatively related. Satisfaction was significantly associated with case managers' discharge ratings of clinical improvement of drug problems and psychiatric problems. CONCLUSIONS: Homeless veterans are more satisfied in environments they perceive to be supportive, orderly, and focused on practical solutions. The results indicate that client satisfaction is not related to treatment outcomes strongly enough to serve as a substitute for other outcome measures.

Adult↗