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PubMed1991

Critical issues for practice in residential treatment: the view from within.

A large proportion of children in residential treatment engage in extreme acting-out behavior and suffer from severe attachment disorders and abuse reactivity. At the same time, practice is increasingly alienated from theory and public policy. The challenges to practitioners posed by these difficulties are described and illustrated by vignettes, their impact on residential group care practice is discussed, and their implications for the redesign of practice and for the development of a new theoretical base are examined.

Acting Out↗
PubMed1999

Factor-based prototypes of the Millon Adolescent Clinical Inventory in adolescents referred for residential treatment.

Although well received by the clinical community, there have been few published reports on the use of the Millon Adolescent Clinical Inventory (MACI). There have been no published studies describing use of the MACI with a residential treatment population. In addition, there have been no published reports investigating the factor structure of the MACI. A principal components factor analysis was performed for all MACI scales and sex for 251 adolescents referred to a residential treatment facility. Five factors were found accounting for 77.4% of the variance. Factor-based prototypes were generated from these results: Factor 1 defines a prototype for Defiant Externalizers, Factor 2 for Intrapunitive Ambivalent Types, Factor 3 for Inadequate Avoidants, Factor 4 for Self-Deprecating Depressives, and Factor 5 for Reactive Abused Types. Prototype descriptions and clinical vignettes are included for each of the 5 factor-based prototypes. These results are consistent with our clinical experience with this population. Prototype analysis may offer a powerful way of enhancing the utility of the MACI in clinical settings.

Adolescent↗
PubMed1994

Predicting elopement from residential treatment centers.

To identify predictors of elopement in young patients in residential treatment, runaways were compared with a matched sample of nonrunaways. Runaways were more likely to have a history of elopement, a suspected history of sexual abuse, an affective disorder diagnosis, and parents whose rights had been terminated. The results suggested that the likelihood of elopement can be accurately predicted on the basis of patient characteristics known at admission.

Adolescent↗
PubMed1989

Anger control training for adolescents in residential treatment.

A group of twelve adolescents exhibiting aggressive behavior in a residential treatment center received six weeks of anger control training consisting of thought stopping, relaxation training, and rehearsal of problem-solving, self-talk patterns. The subjects were divided into two groups, and a multiple baseline design was employed. Houseparents kept daily observational records of subjects' verbal and physical aggression. Both observational data and teacher ratings indicated that nine of the subjects reduced their rates of aggression. Two did not behave aggressively during the study period. One briefly deteriorated following a major disappointment, after which his aggression rate also declined.

Adaptation, Psychological↗
PubMed1998

Rethinking the role of residential treatment for individuals with substance abuse problems.

The Substance Abuse Bureau of the Ontario Ministry of Health recently launched the Ontario Addictions Treatment Services Rationalization Project to increase the capacity of existing services and restructure the service delivery system. One of the recommended strategies was to shorten the length of stay of residential treatment from four to three weeks. Concerns have been expressed by some service providers that this policy change is not consistent with available empirical evidence. This paper reviews relevant research evidence and suggests a new role for residential treatment of substance abusers.

Alcoholism↗
PubMed1995

Staff attitudes toward family involvement in residential treatment centers for children.

OBJECTIVES: The goals of this study were to determine the extent of staff members' support for family involvement in residential treatment centers for children, to examine staff members' beliefs about families and the consequences of their involvement, and to examine the relationship between staff members' support of family involvement and their characteristics, experiences, and beliefs. METHODS: A total of 267 staff members at three residential treatment centers for children with psychiatric disorders or mental retardation or both responded to a survey about their experiences with families, beliefs about families, and support for family involvement. RESULTS: Staff members were very supportive of greater family involvement, although they showed more support for families in the role of service recipients than as decision makers. However, staff members did not believe in family reunification as a goal for the majority of children served. The strongest predictors of staff support for family involvement were positive general beliefs about clients' families, the perception that family involvement was advantageous, and the endorsement of fewer reasons to discourage family involvement. CONCLUSIONS: Residential programs seeking to create a more receptive climate for families should help staff members establish positive attitudes about the families they serve and about families' potential role in successful treatment.

Adult↗
PubMed2003

Smoking status and substance abuse severity in a residential treatment sample.

Treatment seeking substance abusers were classified as current smokers or non-smokers to identify differences between groups on psychiatric and substance use severity variables. The Addiction Severity Index (fifth edition; ASI) was administered to 313 substance abusers seeking treatment in a private, residential addictions treatment program. Since current smokers were younger and less educated than non-smokers, these variables were entered as covariates in all analyses. As measured by the ASI, current smokers experienced a significantly greater number of days with drug problems in the last 30 days and were seen as being in significantly more need of drug treatment and alcohol treatment by ASI interviewers. These findings indicate that smoking status may be a marker for greater substance use severity, although the fact that participants were not randomly assigned to groups precludes making causal interpretations of these data. Areas of future research are suggested including examining the potential mediating role of third variables such as personality and temperament.

Adolescent↗
PubMed1991

A model for predicting discharge against medical advice from adolescent residential treatment.

Characteristics of adolescents discharged from a psychiatric residential treatment center were examined to create a model for predicting patient discharge against medical advice (AMA). Subjects were 81 adolescents in two consecutive cohorts discharged between 1983 and mid-1988 (N = 49 and N = 32). In both groups 41 percent of the discharges were AMA. Logistic regression analysis found that an equation based on three factors--history of juvenile court involvement, unsupportive family attitude toward treatment, and diagnosis of conduct disorder--was 69 percent accurate in predicting discharge status in group 1 and 81 percent accurate in predicting discharge status in group 2. A positive correlation between rates of staff turnover and AMA discharge was noted.

Adolescent↗
PubMedDate not supplied

Depressive symptoms in adolescents during residential treatment for substance use disorders.

This study examines the demographic and clinical correlates and time course of depressive symptoms among abstinent adolescents with substance use disorders (SUD) during residential treatment. Fifty-six adolescents were administered the Beck Depression Inventory at Weeks 1, 3, and 5 of residential treatment for SUD. Clinically significant depression persisted in a substantial minority at the time of discharge. Shorter length of stay patients reported higher baseline scores and a significant decline by Week 3. Longer length of stay patients showed significant decline in scores only at Week 5. Females, Caucasians, and high frequency cocaine/opiates users had elevated depressive symptoms, while those with shorter duration of abstinence did not.

Adolescent↗
PubMed1985

The community residential treatment service: developing a continuum of prosthetic environments for the chronically disabled.

Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large-scale project of a state facility created to respond to this tissue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes f this system have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.

Community Mental Health Services↗
PubMed2001

Clinical characteristics of youths with substance use problems and implications for residential treatment.

OBJECTIVE: Despite high rates of dual diagnosis among children and adolescents and evidence that adults with coexisting substance use disorders require specialized services, many children are placed in residential settings and are offered uniform service packages regardless of their individual clinical profiles. The authors examined the rate of substance use problems in a sample of children and adolescents with severe emotional or behavioral disturbances who were in residential treatment. Differences in clinical characteristics and placement outcomes between children with and without coexisting substance use disorders were evaluated. METHODS: This retrospective study analyzed clinical data obtained by chart review using the Child Severity of Psychiatric Illness, a rating scale for symptom severity. The study subjects were 564 children and adolescents in residential treatment and state custody in Florida and Illinois who had serious emotional or behavioral disturbances. RESULTS: Twenty-six percent of boys and 37 percent of girls had substance use problems in addition to serious emotional or behavioral disturbances. Residents with co-occurring substance use disorders were significantly more likely than those with serious emotional or behavioral disturbances only to be at risk for suicide, elopement from residential placement, delinquent behavior, and institutional discharge placement. CONCLUSIONS: Children and adolescents with coexisting substance use problems require individualized service packages to address their greater need for supervision and higher rate of risk behaviors and to facilitate community discharge placements.

Adolescent↗
PubMed2004

Rehabilitative residential treatment in patients with severe mental disorders: personality features associated with short-term outcome.

The aims of this study were to evaluate the outcome of inpatients with severe psychiatric disorders after 6 months of multimodal residential treatment. Ninety-one subjects admitted to residential prolonged treatment at an Italian rehabilitative complex were included in the study. Within 6 months, the program of treatment was effective in reducing symptoms and improving the patients' psychosocial functioning. The study of personality can be useful to "dose" symptomatic (pharmacological and psychotherapeutic) and rehabilitative treatments in the therapy program.

Adult↗
PubMed1976

Residential treatment today: the paradox of new premises.

The once-isolated world of the residential treatment center has been altered by the broad social and cultural changes of recent years. New values, especially as introduced by younger staff whose attitudes are often closer to their clients than to their administrators, have created new problems. This paper points to the need for a sensitive professional response, and the ability to embrace change and put it to new therapeutic uses.

Adolescent↗
PubMed1999

Making residential treatment available to methadone clients.

This article addresses challenges to integrating clients on methadone into residential treatment, with the goal of promoting greater access for this population. It describes the basic administrative conditions needed for success, and discusses barriers and problems within the methadone program and the residential program. Staff communication, procedures for coordination, client and staff attitudes and understanding, and ongoing education are seen as the key to creating an environment conducive to success for the client.

Adult↗
PubMed2006

Residential treatment of children and adolescents: past, present, and future.

This paper reviews the history of residential treatment, examines the central concepts that define the therapeutic modality, and shows how those concepts provide means of addressing criticisms that have been raised about it in the past and adapting residential programs to meet challenges facing them in the future.

Adolescent↗
PubMed1986

Outcome of residential treatment for abused and high-risk infants.

This paper reports the results of residential treatment plus short-term follow-up of 31 deprived infants. Also discussed are the effects of abuse and socioeconomic status (SES) on the outcome measures. Two matched comparison groups were utilized: infants with similar problems, not admitted to the Center; and infants with no history of maltreatment. All had anthropometric measures, tests on the Bayley scales, and measures of mother-baby interaction three times during the first year of life. The Time Two results were considered the best indicator of the value of treatment because Time Two marked the end of Center residence. At Time Two the experimental children had gained more in height for age. They had lost some ground on the psychomotor scale but stayed relatively equal with the others on the mental scale. On the interaction scales they clearly surpassed the comparison groups. By Time Three the living arrangements had worsened for a number of the experimental babies. Physical measurements were similar among the groups. The experimental group maintained its standing on the Bayley scales, had lost ground on the interaction scales, but still surpassed the problem comparison group. The Time Three results are discussed with respect to the gravity of infant abuse. Effects of SES were more apparent throughout than the effects of abuse.

Adaptation, Psychological↗