Karen Frensch

Treatment of Choice or a Last Resort? A Review of Residential Mental Health Placements for Children and Youth

Residential treatment programs serve troubled youth who tend to first fail in other treatment programs. Residential treatment is often regarded as a treatment of ‘last resorts.’ A review of available studies of the effectiveness of residential treatment delivered in group home settings and residential treatment centres concludes that, despite methodological shortcomings and variability in programming, residential services do improve functioning for some, but not all, youth. However, gains made during treatment are not easily maintained and tend to dissipate over time. The level of family involvement in treatment is generally regarded as predictive of posttreatment patterns of adjustment. Successful posttreatment patterns of adjustment also depend on posttreatment environmental factors such as available support and residential stability. Continued long-term followup of youth in residential treatment is critical to our understanding of the types of individuals for whom residential settings are a particularly good match.

Parent–Child Relationships and Family Functioning of Children and Youth Discharged from Residential Mental Health Treatment or a Home-Based Alternative

This report stems from a larger study on the outcomes of children and youth who accessed residential treatment or a home-based alternative. In this report an analysis of family descriptive information, the nature of family relationships, and indicators of family functioning for children and youth who have participated in childrens mental health services are presented. Results suggest that youth accessing residential treatment have very different family experiences than youth accessing the home-based alternative. Furthermore, the functioning of youth at home improved significantly from admission to discharge, and family functioning was considered “healthy” at follow up; however, family relationships remained problematic. In qualitative interviews with a subsample of youth, varied and complex family relationships were described, and many youth revealed aspirations for positive family engagements. Implications for practice and research are presented.

Outcomes of Children Participating in Mental Health Residential and Intensive Family Services: Preliminary Findings

It has been estimated that approximately 20% of children experience some form of mental health problem, with 14% in the clinical range. Residential mental health treatment is often reserved for those with the most severe presentation of disorder, and intensive home-based alternatives have been developed to cope with increasing demand. The purpose of this study was to examine the long-term developmental trajectories, personal functioning, and life circumstances of the children and youth who accessed residential mental health treatment or the home-based alternative along a number of domains (e.g., clinical outcomes, school personal well-being), and determine if differences between the groups exist.

Mental Health Outcomes of Children and Youth Accessing Residential Programs or a Home-Based Alternative

In Ontario, Canada, a wide range of services has been developed to support children and youth with severe mental health problems. After services have ended, many of these children continue to live with emotional and behavioral challenges. However, the clinical outcomes of children discharged from residential mental health centers and home-based alternatives are not well known. The purpose of this report was to document mental health outcomes from standardized measures of symptom severity and functioning of children and youth involved in residential treatment or a home-based alternative. In general, some clinical and psychosocial improvements from admission to discharge and follow up were revealed, although not all measures were statistically significant. Furthermore, many youth continued to function within the clinical range of impairment. Implications for mental health services are discussed.

Community Adaptation of Youth Accessing Residential Programs or a Home-Based Alternative: Contact With the Law and Delinquent Activities

This article presents the findings from a longitudinal investigation of the prevalence of negative contact with the law for a sample of youth 12–18 months after graduating from residential and intensive childrens mental health programming. Results of this study suggest serious community adaptation difficulties face many youth graduating from these childrens mental health programs. This study suggests that delinquency outcomes may be particularly problematic for older males who are transitioning out of treatment programs, as well as for youth with prior contact with the law, and greater challenges adapting to school at program admission.

Confirmatory Factor Analysis of the Maslach Burnout Inventory

Abstract Although the Maslach Burnout Inventory (MBI) is widely used to assess burnout in human service workers, doubt has been cast on the usefulness of the conceptualization on which it is based and the independence of its subscales. A confirmatory factor analysis using the methodology employed in a previous study of child welfare workers revealed that the final model had only a minimally adequate fit and the constructs of emotional exhaustion and depersonalization were not separate and unique. The findings suggest that research in child welfare settings should avoid continued reliance on the MBI for the assessment of burnout. Scales that are balanced in terms of positive and negative items and where each dimension represents a distinct construct need to be developed.

Perceptions of Personal Well-Being among Youth Accessing Residential or Intensive Home-Based Treatment.

The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youths perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youths mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental health disorders, depression in particular, though youth also reported a sense of well-being and a positive outlook for the future. Many youth were able to articulate the improvements in their mental health and functioning after accessing intensive mental health treatment. Youth also divulged perceptions of their treatment and care. Implications are discussed.

Emerging Adults Post Discharge from Residential Treatment: Subgroup Profiles of Substance Use

ABSTRACT The outcomes of youth who accessed Residential Treatment are varied; many do not fare well in early adulthood. The purpose for this report was to compare subgroups of substance use behavior among emerging adults who had accessed RT as a child/adolescent on life domains and symptoms gathered by interviews and gleaned from agency files. Of the 59 emerging adults, 11 were categorized as having persistent substance use, 19 as moderate use and 26 as no/minimal use. The mean age at the time of the interview was 19.96 years (SD 1.84), and most (n= 33; 61%) were male. By discharge, the persistent substance use group had significantly greater impairment in functioning in school, home, and self-harm subscales and overall functioning than the other two groups. Fewer participants in the persistent group were employed as emerging adults, and a greater number were self-medicating compared to the other two groups. These results suggest that youth who accessed RT with substance use concerns continue to have difficulties as emerging adults with functioning, symptom severity and life domains. An exploration of specialized programs to address these difficulties appears warranted.

Employment Experiences of Frontline Child Protection Service Providers in Accessible and Central Service Delivery Settings

This study compared the employment experiences of frontline child protection service employees in central and accessible service delivery settings. Accessible sites were located in local schools or neighborhood centers close to their clientele. Data sources included frontline employment questionnaires (n = 115), semi-structured individual interviews with child protection supervisors and managers (n = 17), and focus group interviews for frontline child protection service providers (n = 18, 150 participants). Employees at accessible and central sites provided contrasting narratives about what made their everyday work worthwhile. Both groups had shared frustrations with formal child protection system expectations and comparable intentions to leave their jobs.

Exploring Perceptions of Social and Emotional Health in Socially Isolated Emerging Adults Who Accessed Residential Treatment

ABSTRACT The current report is part of a larger study on the perceptions of emerging adults who accessed residential treatment during adolescence. Interviews with a subsample of participants who self-identified as socially isolated were analyzed to explore social development and emotional health. The findings of this study include three themes regarding social difficulties: problems trusting other people, general dislike of other people, and problems in social interactions. Concerns with emotional health such as difficulty managing symptoms of depression and anxiety were reported. The ongoing struggles perceived by socially isolated emerging adults contribute to previous research on the enduring symptoms of mental health disorder.