Kristin Duppong Hurley

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.

The Child Outcomes of a Behavior Model

Within 3-tier behavioral models, universal interventions are expected to prevent the onset of problem behavior in a majority of children altogether and to sustain improvements in child outcomes by the selected and indicated interventions. A cohort longitudinal design was used to assess the extent to which a 3-tier model achieves these expected outcomes. The respective universal, selected, and indicated interventions included Behavior and Academic Support and Enhancement, First Step to Success, and MultiSystemic Therapy. A total of 407 children in Grades K-3 from 1 of 4 longitudinal cohorts participated. The results of 2-level linear growth analyses indicate that the 3-tier behavior model achieved the anticipated outcomes with respect to social behavior. The results, limitations, and implications are discussed.

The Family Characteristics of Youth Entering a Residential Care Program

Although much is known about the mental health and behavioral functioning of youth who enter residential care programs, very little research has focused on examining the family characteristics of this population. Knowledge about family characteristics is important, however, as it can aid in tailoring programs to meet the needs of families who are involved in treatment and help them address concerns in order to facilitate the transition home. Therefore, the purpose of the present study was to examine the characteristics of youths families at the time of entry into a residential care program. Using data from archived youth files, family characteristics were examined across several areas, including: (a) youth variables related to family (e.g., out-of-home placements, legal guardian), (b) family risk (e.g., substance abuse, domestic violence, financial problems), and (c) parenting (e.g., adequate supervision, discipline, communication). Findings suggested that youth entering residential care programs have families with high levels of risk and low levels of parenting skills. Implications and considerations for future research are discussed

Prevalence of Physical Health Problems Among Youth Entering Residential Treatment

OBJECTIVE: To examine the prevalence of physical health problems among youth entering residential treatment. PATIENTS AND METHODS: The sample included 1744 youth (mean age: 14.6 ± 1.8 years) entering a large residential treatment program between 2000 and 2010. Youth received an intake medical evaluation, including a review of available records, detailed medical history, and physical examination. Medical conditions present at the time of the evaluation were recorded by the examining physician and later coded by the research team. Only diagnoses recognized by the International Classification of Diseases, 10th Revision, were included in the analyses. To maintain the focus on physical health problems, behavioral and emotional disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were excluded. Obesity, acne, and allergies were also excluded. RESULTS: Approximately one-third (33.7%) of youth had a physical health diagnosis at the time of intake. Asthma was the most prevalent condition diagnosed (15.3% of the sample). Girls were significantly more likely to have a diagnosis than were boys (37.1% vs 31.5%). Age was not associated with diagnostic status. Rates of physical health conditions differed significantly by ethnicity: black (36.4%) and white (35.4%) youth had the highest rates, and Hispanic youth (23.2%) had the lowest. CONCLUSIONS: Youth who enter residential treatment have high rates of physical health conditions. These problems could complicate mental health treatment and should be considered in multidisciplinary treatment planning.

Association between Psychopathology and Physical Health Problems among Youth in Residential Treatment.

Youth in residential treatment settings often present with a complex combination of mental and physical health problems. Despite an emerging literature documenting significant associations between mental health and physical health, the relationship between these two areas of functioning has not been systematically examined in youth presenting to residential treatment. This study examines the association between youth psychopathology and physical health problems in a sample of 606 youth entering a large residential treatment program between 2003 and 2010. As a part of the intake process, youth psychopathology symptoms were assessed using the parent-report form of the Child Behavior Checklist, and youth physical health problems were assessed in a medical evaluation by a licensed child health professional. Results indicated that higher levels of youth psychopathology, particularly internalizing problems, were associated with greater risk for physical health problems and more prescription medications. Psychopathology comorbidity was also associated with physical health problems. These findings suggest an interplay between physical and mental health among youth entering residential treatment, highlighting the need for integrated assessment and intervention services that address psychological and medical needs within this population.

Profiles of Children Served in Early Intervention Programs for Behavioral Disorders Early Literacy and Behavioral Characteristics

Special education legislation has placed an increased emphasis on early intervention programs for children at risk for early literacy delays and behavioral disorders. Given this trend, it is important to understand the characteristics of students identified and served in at-risk programs. This study presents the findings from a cluster analysis on the early literacy and behavioral characteristics of 195 children screened at risk for behavioral disorders served in an early intervention program. Clustered variables included behavioral measures from the Early Screening Project (ESP; Walker, Severson, & Feil, 1995), Systematic Screening for Behavior Disorders (SSBD; Walker & Severson, 1992), and measures of early reading development from the Woodcock Reading Mastery Tests—Revised (WRMT-R; Woodcock, 1998). Split-half procedures and external criteria were used to validate results. Five distinct subgroups were revealed: Broad Risks, Academic Achievers, Primarily Behavior, Primarily Academic, and Extreme Behaviors. Results indicate heterogeneous characteristics and clear areas of behavioral and early reading risk between subgroups within the greater sample. Implications, limitations, and future research are discussed.

Examining Change in Therapeutic Alliance to Predict Youth Mental Health Outcomes

The objective of the study was to examine the link between therapeutic alliance and youth outcomes. The study was conducted at a group home with 112 youth with a disruptive-behavior diagnosis. Therapeutic alliance was collected routinely via youth and staff report. Outcome data were collected using youth and staff reports of externalizing behavior as well as behavioral incidents occurring during care. Outcome data were collected following intake into services and at 6 and 12 months of care. Data were analyzed to examine (a) whether youth behavior problems at intake were predictive of therapeutic alliance and (b) whether changes in alliance were predictive of subsequent youth outcomes. These were conducted with a 6-month service-delivery model and replicated with a 12-month model. There was some support for the first hypothesis, that initial levels of youth externalizing behavior would be related to alliance ratings; however, most of the effects were marginally significant. The second hypothesis, that changes in therapeutic alliance would be related to subsequent youth outcomes, was supported for the 6-month model, but not the 12-month model. Changes in therapeutic alliance may be predictive of youth outcomes during care. Additional research into examining therapeutic alliance trajectories is warranted to improve mental health services for youth.

Creating and Sustaining Effective Partnerships to Advance Research on Youth With Serious Emotional and Behavioral Disorders

A key barrier to conducting research involving children and families is the difficulty of creating partnerships among researchers, treatment agencies, and schools. This article describes several key factors that were essential to establishing an effective research collaboration between practitioners and university-based researchers, including a mutual respect for the unique needs of research and practice; a strategy for joint decision making; a partnership model of incremental growth; a plan for mentoring junior faculty and students; a format for regular contact between the partners; and a plan for long-term sustainability. This collaboration has conducted over a dozen evaluation studies, as well as examined best practice issues surrounding the needs of children and families with serious emotional and behavioral needs. Even more important has been the lines of research that have been developed from this partnership which keeps the collaboration focused. The lessons learned from this research partnership should inform other collaborations.

The Role of Therapeutic Alliance and Fidelity in Predicting Youth Outcomes During Therapeutic Residential Care

There is a gap in understanding how the treatment fidelity aspects of adherence and quality, along with common process factors such as therapeutic alliance, impact outcomes for youth. Few studies have examined both constructs of implementation and process factors simultaneously in regard to their relationship to client outcomes. This study examined the role of (a) youth ratings of implementation quality for a provider of therapeutic residential care, (b) the records of staff ratios of positive to negative statements to youth as reported for a token economy system, and (c) youth ratings of therapeutic alliance in relation to youth emotional and behavioral functioning at 6 months into therapeutic residential services. The study included data collection activities with 112 youth and staff at intake into residential group care through 6 months into residential services. Both youth ratings of therapeutic alliance and the ratio of positive to negative staff interactions with youth were related to improved youth emotional and behavioral functioning, as reported by staff using the Child Behavior Checklist. These findings suggest that it is important to consider both implementation and common process factors when looking to improve the quality of care for youth in therapeutic residential care.

Convergent Validity of the Strength-Based Behavioral and Emotional Rating Scale with Youth in a Residential Setting

Strength-based assessment has been identified as an appropriate approach to use in planning treatment and evaluating outcomes of youth in residential settings. In previous research, the Behavioral and Emotional Rating Scale-2, a standardized and norm-referenced strength-based measure, has demonstrated adequate reliability and validity with youth served in community and educational settings. The purpose of the present study was to examine the internal reliability and convergent validity of the BERS-2 by comparing the test to the Child Behavior Checklist and the Symptoms and Functioning Severity Scale. The results indicate that the scores from the BERS-2 are internally consistent and converge with other behavioral and emotional measures which, taken together, suggest that the BERS-2 could be acceptable for assessing the emotional and behavioral strengths of youth in residential settings. Study limitations and future research directions are identified.