Daniel L. Daly

The Changing Mental Health Needs of Youth Admitted to Residential Group Home Care: Comparing Mental Health Status at Admission in 1995 and 2004

Youth entering residential care possess significant emotional and behavioral needs; yet, it is uncertain whether these needs have remained constant or are changing over time. This study examined mental health variables from the admission files of 1,047 youth entering residential group home care in 1995 and 2004. Sequential logistical regression analyses revealed that the mental health needs of youth admitted in 2004 were greater than those for youth in 1995 with regard to having multiple psychiatric diagnoses, being prescribed two or more psychotropic medications, and using alcohol or drugs. As such, these analyses should be replicated in other group homes as well as in other placement settings within the system of care.

Residential care: A study of short- and long-term educational effects

Abstract School performance and attitudes of a group of children placed in residential care were assessed during placement and for an average of four years after discharge. A comparison group of children who were not placed in the program was also followed. The residential program emphasized both behavioral and educational treatment. Group differences were tested using Hierarchical Linear Modeling (HLM). Results indicated that the treatment group had significantly greater improvements in both school performance and attitudes during placement. These differences were also maintained after discharge. It is suggested that long-term educational effects with troubled children may require an intensive intervention over an extended period of time.

Therapeutic residential care for children and youth: a consensus statement of the International Work Group on Therapeutic Residential Care

While the focus of this consensus statement and the review volume that preceded it (Whittaker, Del Valle, & Holmes, 2014) is on therapeutic residential care (TRC), a specialized form of group care, we view our work as supportive of a much wider effort internationally concerned with the quality of care children receive when, for a variety of reasons, they need to live away from their families.

Psychotropic Medication Utilization at a Group-Home Residential Facility for Children and Adolescents

OBJECTIVE The purpose of this study was to examine psychotropic medication utilization over the course of treatment for children and adolescents admitted to a large residential group-home facility for youth with emotional and behavioral disorders. METHOD Retrospective analyses of psychotropic medication utilization at admission, during treatment, and at departure were examined for 1,010 children and adolescents consecutively admitted to the facility during 2001-2004. The relationship between psychotropic medication utilization and demographic variables, psychiatric diagnoses, objective measures of behavioral and emotional problems, in-program behavior, and ratings of program success were examined. RESULTS The overall utilization rate was 49%, and there was a significant reduction in utilization from admission (40%) to departure (26%). Reductions were evident across all medication classes (e.g., stimulants, antipsychotics, etc.). At admission, medication utilization was related to several psychosocial variables, higher scores on measures of behavioral and emotional problems, and psychiatric diagnoses (attention-deficit/hyperactivity disorder (ADHD) and mood disorders). A small percentage (16%) of youth was prescribed novel medication during stay. Being placed on medication during treatment was related to internalizing problems on the Child Behavior Checklist (CBCL) at admission, psychiatric diagnoses, higher rates of in-program behavior problems, and poorer outcomes at departure. Youth departing on medication were more likely to be male, younger, and rated as doing more poorly in the program. They also were more likely to be placed in more restrictive settings at follow-up. CONCLUSIONS There was a high rate of psychotropic medication utilization among this population, though utilization rates dropped significantly over the course of treatment.

Patterns of movement for youth within an integrated continuum of residential services.

This study examined patterns of movement for youth receiving services within a continuum of intensive and restrictive residentially-based programs. Data were collected for 701 completed episodes of care within a three-program residential continuum of care over a 5 year period, and examined time within program, movement between programs, in-program disruptive behavior, and discharge status. Results showed that most youth either remained in a stable placement in the least restrictive of the programs, or followed a pattern of placements that systematically moved them from more restrictive to less restrictive settings. Of note, transitions from more restrictive to less restrictive programs correspond to deescalating levels of problem behavior; and over 80% of the youth were stepped down to either family-based or independent living situations at the time of departure. Findings support the notion that a continuum of intensive residential services can serve the needs of youth with significant emotional and behavioral needs.

Decreasing disruptive behavior by adolescent boys in residential care by increasing their positive to negative interactional ratios

An intervention for disruptive boys in residential care involving increases in positive to negative interactional ratios is described. The target of the intervention was daily problem behavior. Results from a pooled time series analysis of the data revealed a significant decrease in behavior problems (one problem per boy per day) during the intervention for the boys as a group. Results from comparisons of mean behavior problems during baseline and intervention revealed decreases for five of the six boys. Results from a multiple baseline across boys revealed experimental control for three of the six. The results are discussed in terms of response contingent reinforcement and systemic behavior analyses. The benefits of combined group and single subject data analyses are also discussed.

The boys town residential treatment center: Treatment implementation and preliminary outcomes

A well specified residential treatment model is described, and preliminary outcome data are presented. The Boys Town Psycho-Educational Model (PEM) empowers direct care staff to be important treatment agents by training them to use systematic teaching techniques. Data obtained on youth served at the center since its inception in December 1995 indicate that the youth have had multiple prior placements and serious psychiatric disorders. The model sustains an active and positive treatment environment as documented by high levels of focused treatment occurring during the youth’s stays. To date, 94% of the youth have departed to placements that were equal to, or less restrictive than, their placements at admission to the program. Of those who had Children’s Global Assessment Scale ratings both at admission and at discharge, 84% (n=21) of the youth had better functioning at discharge.

Do children from community-based parent training programs have clinically significant behavior problems?

Alternative mental health services for children such as parent training are expanding across the country. Yet the clinical picture of the children served in these programs is incomplete. In two studies we compare scores from standardized behavior problem inventories for groups of children from a parent training class with scores from groups of children from a clinic setting and a nonclinic setting. In study one we used the Eyberg Child Behavior Inventory (ECBI), an instrument that primarily assesses externalizing problems. In study two, we used the Child Behavior Checklist (CBCL), an instrument that assesses both externalizing and internalizing problems. The results from both studies show the scores from the parent training groups were equivalent to scores from the clinic groups and were significantly higher than the scores from the nonclinic groups. These results suggest parent training classes do serve children with clinically significant problems.

Ecological Influences in Youth Crisis Shelters: Effects of Social Density and Length of Stay on Youth Problem Behaviors

For 472 consecutive days we monitored the number of youths residing in a crisis shelter for adolescents, the average length of stay for the youths residing in the shelter on each day, and the number of problem behaviors occurring within the shelter on a daily basis. We analyzed these data using a combination of time series and logistic regression techniques to fit a model that would predict the occurrence of a problem behavior on any given day. After controlling for significant time trends in the data, our results indicate that both the number of youths in the shelter and the proportion of youths who have resided in the shelter longer than 14 days are significantly associated with a problem behavior occurring on any given day. The number of youths in the shelter and the probability of a problem behavior occurring correlated significantly. However, as the proportion of youths who resided in the shelter longer than 14 days increased, the probability of a problem behavior occurring decreased.

America's children in crisis: Adolescents' requests for support from a national telephone hotline

More than 63,000 adolescents, aged 10 to 19 years, called a national crisis hotline from September 1991 through June 1992. Nearly 73% of these (N = 46,392) were coded as crisis calls. Developmental trends were identified for various aspects of support-seeking by examining differences in proportions of calls within defined categories across these years. Calls for support for issues related to relationships accounted for nearly half of all calls by these young people. Within the broad category of relationships, specific trends included decreasing numbers of calls about peer relations from age 13 through 19; decreasing calls about parent--child relations from 11 through 19; and increasing calls about marriage beginning at age 15. Calls with concerns about sexuality increased steadily to a peak at age 16, and calls with concerns about addictions increased steadily from age 13. Sex differences were found for length of calls at each age and for the various categories of support-seeking.