Current Practices in Residential Treatment for Adolescent Sex Offenders: A Survey

SUMMARY

A list of all treatment facilities for adolescent sex offenders that described themselves as inpatient or residential was requested from the Safer Society Foundation in Brandon, Vermont. A total of 203 such facilities were identified in this manner. Each was sent a questionnaire regarding their policies and practices. Of the 50 questionnaires that were returned, 49 were usable. Items on the questionnaire dealt with major phases of operating a residential program, including number of beds, average daily census, number of males and females in treatment, testing and assessment procedures, most frequent diagnoses, average IQ of patients, abuse history, therapeutic approaches used, number and types of individual/group treatment sessions per week, qualifications of therapists, average length of treatment, and follow-up research on treatment.     

Comparison of basic data for the National Survey of Residential Group Care Facilities: 1966-1982

Major findings from this analysis of the data gathered in preparation for the 1966 and 1981 surveys of children's residential group care facilities are as follows below. In the field of residential care of pregnant adolescents, it appears that, despite an increase in the number of births to adolescent mothers since 1966, the preferred mode of serving this population is no longer residential group care. While there has been a small increase (6 facilities) in the number of residential facilities for pregnant adolescents that operate under public auspices, the 49% decrease in facilities under private auspices is the real indicator of the direction of residential services to pregnant adolescents since 1965. In the Child Welfare Stream, the most notable change between 1965 and 1981 was the decrease in the relative proportion of residential group care facilities for dependent, neglected, or abused children and youth. Overall, child welfare facilities accounted for 55% of all residential facilities listed for survey in 1965; in 1981 this percentage had fallen to 37%. As in 1965 the Child Welfare Stream was dominated by the private sector in 1981, with 83% of all child welfare facilities operating under private auspices. This pattern was found for most of the 50 individual states as well. In the Juvenile Justice Stream, the overall increase of 154% in the number of residential facilities since the 1965 listing is due in part to a notable increase in the number of private facilities in this stream of care. Although the majority of juvenile justice facilities are still public, there has been an increase of 17% since 1965 in the proportion of facilities under private auspices. An even greater increase in total number of facilities than was seen in the Juvenile Justice Stream is seen in the mental health field between 1965 and 1981. There were almost four times as many residential mental health facilities listed for survey in 1981 as in 1965. From representing about one-eighth of the total number of all residential group care facilities for children and youth with special problems or needs, the Mental Health Stream increased to a quarter of all such facilities by 1981. As in the earlier study, the Mental Health Stream was dominated by the private sector in 1981. The proportion of mental health facilities under private auspices had increased by 16% since 1965, indicating an even greater involvement of the private sector in the delivery of residential mental health services to children and youth.(ABSTRACT TRUNCATED AT 400 WORDS)     

Personal Trauma and Risk Behaviors Among Youth Entering Residential Treatment

The focus of this study was to determine the prevalence and types of traumas experienced by adolescents prior to admission to long term mental health residential care and the impact of these traumas on their risk behaviors. The research was conducted at a state-supported residential mental health treatment facility functioning under the authority of the Department of State Health Services. Client level data was extracted from social assessment forms (N = 457) in case records of clients. Results confirmed that exposure to trauma was pervasive among adolescents admitted to the facility. Findings also revealed a link between trauma and risk behaviors among youth entering residential treatment facilities. Increased trauma exposure significantly impacted the risk behaviors of youths entering the residential treatment facility. The results indicate that the total number of traumas experienced was a greater predictor of risk behaviors among these youth than the specific traumas experienced. Internalizing behaviors such as self-harm and suicide attempts also increased with the number of traumas experienced by the adolescent. The study demonstrates the need for further exploration of the complex relationship between personal trauma, mental health, and social development in adolescents.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.     

Characteristics related to family involvement in youth residential mental health treatment

This study examined family involvement among youth in residential mental health treatment facilities in Florida. Data were obtained from the provider reports from January 2005 through December 2007. Treatment episodes were divided into 30-day periods with family involvement measured by the number of contacts by all family members, the mother, and the father. In addition, we examined contacts by all family members for in-person treatment, treatment-related phone contacts, treatment planning, campus visits, and therapeutic home passes. Families averaged 3.4 contacts per 30 days for the 1333 treatment episodes. Sixty-seven percent of the contacts included mothers, while 22% of the contacts involved fathers. A majority of contacts were for family therapy, either by phone (29% of contacts) or in person (43%). Nearly twenty percent of residential stays had no family contact. After the first 30 days of treatment, contacts did not vary significantly over the course of the treatment episode, although there was some evidence that youth with longer treatment episodes had fewer contacts throughout the residential stay. Total contacts were lower for girls than boys, for blacks than whites, and for older youth, and were higher when the youth lived in the same county as the residential treatment provider. Outreach programs could target specific demographic groups with low involvement, and the alternative methods for involvement that use internet conferencing tools should be explored for parents that live far from the treatment provider.     

Toward a Definition of Assisted-Living

The purpose of this research was to identify the concept of assisted-living (A.L.) by the physical characteristics of the setting, services offered therein, and functional competence of residents and to ascertain its position within an existing continuum of care typology. Ten A.L. facilities in southeastern Florida participated in this study. Photographic documentation, informal interviews, and promotional literature generated the data for content analysis. Response to a survey questionnaire provided additional information. Findings show that physical characteristics of facilities focus on creating a residential milieu. Services include meals, personal care, medical assistance, housekeeping, utilities, social activities, scheduled transportation, and security. Residents are semi-independent. They do not require skilled care. Placement of A.L. within an existing continuum of care typology is considered to be on the same level as homes for the aged, also called adult homes or personal care homes. From this standpoint A.L. is considered to be an old concept made new.     

Therapeutic crisis intervention system in residential care for children and youth: Staff knowledge,attitudes, and coping styles

About ten years ago, several residential treatment facilities for children and youth in Israel were given approval to use the Therapeutic Crisis Intervention System (TCI, ‘holding’) technique in order to proactively restrain violent behavior. The purpose of the current study was to examine attitudes toward TCI among staff of residential facilities for children and youth and the association between staff attitudes and between their knowledge and coping strategies with stressful daily situations. A unique aspect of this study is its emphasis on the staff's coping style in stressful situations and the relationship between their coping style and their use of TCI. The research population consisted of staff members who work in residential facilities for children and youth at risk (n = 100), half of whom had been trained to perform TCI and to implement the method in their work. No differences in knowledge were found between participants who had been trained and those who had not, while the former even displayed incomplete knowledge and unwillingness to perform TCI when necessary. In addition, the more problem-oriented the coping style the less positive the attitude toward use of TCI and the less the tool was used. No relationship was found between emotion-oriented coping style and attitudes and frequency of using TCI as a means of intervention. The study shows the complexity involved in introducing the method of TCI as well as the necessary caution that must be taken before deciding to use it.     

Differences between Sexually Victimized and Nonsexually Victimized Male Adolescent Sexual Abusers: Developmental Antecedents and Behavioral Comparisons

This study compares sexually victimized and nonsexually victimized male adolescent sexual abusers on a number of variables. Self-report measures were administered to 325 male sexually abusive youth (average age 16) in six residential facilities in the Midwest, 55% of whom reported sexual victimization. The results indicate that the sexually victimized sexual abusers have more severe developmental antecedents (trauma, family characteristics, early exposure to pornography and personality) and recent behavioral difficulties (characteristics of sexual aggression, sexual arousal, use of pornography, and nonsexual criminal behavior) than the nonsexually victimized group. Results are contrasted with recent typological research, which found no relationship between sexual victimization and subtype membership. Treatment, research, and theoretical implications are discussed.     

Editorial

This study aims to analyze the environmental elements of residential facilities for elderly people by using Antonovsky's salutogenic concept. The relationship between the environment and health is clearly identified. This information facilitates the presentation and development of residential facilities with healthy living conditions for elderly people in South Korea. The concept includes providing a residential environment that is safe from a variety of dangers by applying a barrier-free concept to address the physical changes of elderly people. It also provides an environment equipped with a continuous protection system that considers both the physical and sociopsychological aspects of this particular treatment environment.     

Differences between sexually victimized and nonsexually victimized male adolescent sexual abusers: developmental antecedents and behavioral comparisons

This study compares sexually victimized and nonsexually victimized male adolescent sexual abusers on a number of variables. Self-report measures were administered to 325 male sexually abusive youth (average age 16) in six residential facilities in the Midwest, 55% of whom reported sexual victimization. The results indicate that the sexually victimized sexual abusers have more severe developmental antecedents (trauma, family characteristics, early exposure to pornography and personality) and recent behavioral difficulties (characteristics of sexual aggression, sexual arousal, use of pornography, and nonsexual criminal behavior) than the nonsexually victimized group. Results are contrasted with recent typological research, which found no relationship between sexual victimization and subtype membership. Treatment, research, and theoretical implications are discussed.     

Dilemmas in planning for the protection of children and youths in residential facilities

Protection of children and youths after placement must be given increased emphasis because deinstitutionalized care is itself not harm-free and also because the needs of many children for care, control, and treatment are likely to be met in residential facilities for the foreseeable future. However, the diverse and often incompatible views of advocates and providers of child care about the issues affecting the protection of residents in institutions loom as obstacles to planning for the protection of children and youths after placement. Both of the extreme views of institutional abuse and neglect issues deny the need for child protection after placement. The first holds that since the child or youth is being protected and/or treated, no ongoing child protection is necessary. The other view holds that any child protection effort short of closing residential facilities is futile and therefore without merit. Underreporting of abuse or neglect is widespread; accountability of facilities for the protection of residents is, as a result, unevenly established. These conditions are attributable in part to the inadequate statutory base for protecting children in institutions. At the same time, because of the lack of a planned approach to protection within facilities, and between facilities and child protection agencies, residential facilities are likely to suffer negative public exposure when moderate or serious incidents of maltreatment become public. The absence of procedures for facilities themselves to recognize abuse and neglect invites exposure of incidents by staff and residents. The ad hoc manner in which incidents are managed by external agencies often inflicts unwarranted costs on the reputations of residential facilities that in many cases may have only one or two serious incidents a year. Finally, the use of "last resort" placements may be putting some children and youths into situations of unacceptable risk. Despite the existence of differing views in the residential care field, we have identified areas of agreement between the child protection agencies and residential facilities upon which public policy might build. The problem may not be so much that these attitudes exist, as that the states have not responded in a planned and credible way to the problem of institutional abuse and neglect. Nevertheless, development of a planned and credible approach must deal with these areas of difference if protection of children after placement is to be improved.     

Peer violence in adolescent residential care: A qualitative examination of contextual and peer factors

This research examined the way contextual and peer factors influence peer violence in adolescent residential care. One hundred and twenty residents aged 11–21 from 20 residential care facilities participated in 20 focus groups about peer violence in care. The results demonstrated that four, mutually interrelated themes, contributed to explanations of violence amongst residents: 1) residential peer culture; 2) vulnerability at the beginning of institutionalization; 3) deprivation, stigmatization and frustration; and 4) poor relationship with staff. The results are discussed with reference to the existing residential care and prison-based research on bullying and peer violence and a number of research and policy recommendations are provided.     

Parental involvement in children's residential treatment: From preplacement to aftercare

Policy reforms and empirical evidence supporting family focused care for children have increased parental involvement in children's residential treatment. Reasons for encouraging family involvement in children's out-of-home care and factors that inhibit parents from participating in children's residential care are outlined. Methods used by treatment facilities to encourage family participation in children's preplacement, treatment, and aftercare stages of placement are reviewed. Important questions nd research necessary to increase parental involvement in children's residential treatment are identified.     

城市外围大型居住区的公共服务配置与居民生活满意度——-以北京市为例

近年来,特大城市为了缓解内城人口压力,在城市周边地区建立了一批大型居住区,与此同时,这些居住区中的公共服务资源的配置情况也成为了社区居民们的关注焦点。本文采用定量研究方法,以北京市为例,对其外围六个大型居住区的公共服务资源配置情况及其居民生活满意度进行调查,分析得出了影响城市居民生活满意度的如教育资源、交通状况、文娱设施等5个主要因素。     

Collaborative Treatment for Sexual Behavior Problems in an Adolescent Residential Center

Abstract

Many residential treatment and sex offender programs for adolescents historically have used coercion-based interventions. Treatment programs employing coercive techniques often replicate the same destructive and intrusive behaviors they seek to eliminate. Tension between departments coupled with poor communication and discomfort around sexual behavior issues within the staff of residential treatment centers are more likely to inhibit the progress of the youths they serve.

Collaboration among residential, educational, and clinical components enables staff to work in a direct, genuine, and respectful fashion with students who have histories of sexually abusive behavior. It further assists in maintaining a safe and predictable environment for these students. Finally, it helps students eliminate destructive behaviors by directly and consistently addressing four key areas: sexually abusive behavior, antisocial attitudes, social/emotional functioning, and overall self-care. It is not the author's intention to hold Bennington School, Inc.up as a model residential treatment program or to criticize other residential facilities. Rather, it is hoped that what is working in Bennington may be helpful to others.

Many who have worked on the front lines of residential treatment with sexually abusive adolescents have received training in elements specific to sexually abusive behavior. The origins of treatment for youth who have sexually abused were noteworthy for their lack of offense-specific interventions (National Adolescent Perpetration Network, 1993). However, a wealth of literature soon emerged addressing the need for assessment and treatment techniques specific to this population (Perry & Orchard, 1992; Barbaree, Marshall & Hudson, 1993). Much of this literature made assumptions regarding high levels of chronicity (Perry & Orchard,1992) while other contributions stressed the role of denial and minimization (Barbaree & Cortoni, 1993). As a result, while many issue-specific forms of assessment and treatment were developed, they often did not take into account other developmental needs and issues in the lives of sexually abusive youths (Lane, 1997).

Concurrent with this emerging research was a substantial increase in the number of treatment programs for juvenile sex offenders (National Adolescent Perpetration Network, 1993). In this context, it is not surprising that many treatment programs relied heavily on treatment targeting denial, minimization, and perceived sexual deviance without taking into account other treatment needs of youths. Although a recent literature review of adolescent residential programs (Curwen, 2000) notes a trend away from shame-based approaches, there appears to be less clarity on specific criteria on which to base residential treatment of adolescents who have sexually abused (Curwen, 2000).

Finally, recent research shows that among adult populations, accepting responsibility for abusive behavior in treatment is more likely to result from a warm, genuine, and empathic treatment style (Marshall, Fernandez, & Anderson, 1999). Group therapy participation, similarly, results from encouragement, open questions, and nonconfrontational challenge. The emerging themes of recent trends and research should inspire those at the front lines of residential treatment to reconsider not just basic treatment approaches, but the most minute elements of their interactions with youths.     

The therapeutic dilemma with Canadian native youth in residential care

The purpose of this paper is to examine the conceptual framework and subsequent treatment strategies that seem to inadvertently create a psychological dichotomization in Canadian Indian young people who are placed in mainstream residential care facilities. Based on a non-Native value system, conventional treatment approaches attempt to alter the young person's attitude and behavior to an acceptable standard defined by the dominant society. Unfortunately, these efforts often result in the opposite effect. This paper will draw upon distinctions that exist between Native and non-Native cultures, while integrating Freud's position regarding the conflict of realities and ego-splitting. Finally, implications of providing mainstream residential services to the Native population will be addressed.     

A review of satisfaction instruments used in long-term care settings

We review studies in the published literature using satisfaction surveys in long-term care settings. These settings include nursing homes, assisted living facilities, hospital long-term care units, and residential care homes. Rather than simply describe instruments in existence, we compare and contrast the format, content, and administration of these instruments. We identified 50 studies that have either developed or used satisfaction instruments in long-term care facilities. However, we also show that satisfaction instruments in the published literature vary greatly in numerous ways, including the number of questions they contain, the number of respondents included in the study, assessment of psychometric properties, and in the number of domains used.     

Does family reunification from residential care facilities serve children's best interest? A propensity-score matching approach in Ghana

The U.N. Convention on the Rights of the Child declares that children are entitled to grow up in a family environment with love, happiness and understanding. Governments and international child welfare agencies have promoted the reintegration of children currently in residential care facilities with family or other caregivers. We assess whether 157 children who spent time in a Ghanaian residential care facility but who have been reunified with their families scored differently on a battery of standardized child wellbeing measures than 204 children still living in residential care facilities using propensity score matching models. Results suggest that outcomes, including overall hope (as well as hope pathways and hope agency) and access to basic resources as measured on the Child Status Index, differ between children who were and were not reunified. These results underline the importance of supporting children's physical and psychosocial developmental needs. Children who were reunified with family members or other kin may require additional support regarding access to basic resources whereas interventions designed to increase hope in the future may benefit children in residential care. We urge a redoubling of efforts to care for children under carefully designed national schemes providing resources, trained personnel, and sustained case management.     

Elder Abuse in Residential Settings in Israel—Myth or Reality?

ABSTRACT

The article tries to answer the question: Is elder abuse in residential care in Israel a myth or a reality? A broad definition of abuse was used, including the ‘classical’ forms presented in the literature, and also violation of rights and any act that infringes on quality of life of residents. As no data exist which directly explored this issue, the analysis was based on: recent laws mandating the report of abuse, governmental surveillance data, court cases, media clippings, and data from quality of life studies. Findings reveal that abuse in its ‘classical’ form exists only in a limited number of small private unlicensed facilities. However, when using the broader definition, abuse is a reality in many settings, exercised mainly by nurses' aides.