Measuring youth connections: A component of relational permanence for foster youth

This article presents the development and preliminary validation of the Youth Connections Scale, a measure of youth connectedness as a component of relational permanence for youth in out-of-home placement. The instrument measures different domains of youth's connectedness, including the number and strength of connections to caring adults and the types of support perceived by youth. Results of a pilot validation study of the instrument, with a sample of 53 adolescents in out-of-home care, indicate good concurrent validity and high test–retest reliability. Child welfare and youth-serving agencies can use this instrument in their efforts to strengthen and measure the connectedness and relational permanence of youth.     

Exploring the specific needs of an understudied group: Children with intellectual disability in residential child care

Children and adolescents who live in out of home care in the child protection system are considered to be vulnerable to manifesting mental health disorders as well as other types of difficulties. This risk is greater in the case of children who display any type of disability. The aim of this study is to profile the state of health and well-being of a group of children presenting intellectual disability who live in residential care in a Spanish autonomous community and to compare these results with their non-disabled peers.     

Planned treatment and outcomes in residential youth care: Evidence from Sweden

A recurring theme in evaluations of Swedish residential youth care is that treatment is often unplanned. Using a data set of teenagers placed in youth care in 1991 (N = 357), we show that planned treatment — in the sense of a known expected duration of treatment — is strongly positively associated with treatment outcomes. In the short term, teenagers with planned treatment are 32% less likely to experience a treatment breakdown and 25% less likely to be reassigned to other forms of residential care after completed treatment. In the long term, teenagers with planned treatment are 21% less likely to engage in criminal behavior and 40% less likely to be hospitalized for mental health problems. The results are robust to controlling for a rich set of potentially confounding factors: Even though observable pre-treatment teenager characteristics explain about one fifth of the variation in criminal behavior 5-10 years after treatment, they have almost no predictive power for whether treatment is planned or unplanned.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.     

Staff and youth views on autonomy and emancipation from residential care: A participatory research study

The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n = 10) and 4 focus groups with youth (n = 21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy – a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).     

Reclaiming complexity: beneath the surface in residential child care

ABSTRACT

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff.     

Effectiveness and implementation of evidence-based practices in residential care settings

Purpose

Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS?

Methods

Evidence-based psychosocial interventions and respective outcome studies, published from 1990 to 2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool.

Results

Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers.

Conclusion

The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results.     

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.     

Cultural diversity competencies in child and youth care services in Portugal: Development of two measures and a brief training program

Few researchers have examined the training of child care workers in cultural diversity competencies, despite the growing number of ethnic minority children and youth in residential care. The present paper reports two studies. In study 1, we aimed to adapt and develop two measures of cultural diversity competencies—a self-report questionnaire and an objective measure based on a case vignette (n = 51). In study 2, we proposed a brief training program. A quasi-experimental design (n = 30) was used, with cultural competencies being evaluated before and after the training. Results revealed that (1) child care workers tended to over-estimate their self-perceived competence and that (2) the experimental group was more capable of including cultural elements in their definition of strategies and relational aspects of intervention after a brief training than the group that received no training (control). Implications of this study are discussed for further development of cultural diversity competencies in professionals working in residential child care.     

The voice of troubled youth: Children's and adolescents' ideas on helpful elements of care

This article presents the findings of a qualitative study in a Flemish centre for children and adolescents with emotional and behavioural disorders. The aim of this study was twofold. First, we wanted to examine how youth reflect on their own behaviour and that of their peers'. Secondly, we wanted to know what, according to the youth, are the most significant helpful elements of treatment. Analysis shows a continuum of negative behaviour, ranging from relatively ‘normal’ disruptive behaviour such as arguing, up to serious disruptive behaviour such as physical aggression. This behaviour has a negative influence on the climate of the organization. ‘Availability of staff’, ‘nearness of staff’, ‘a clear set of rules and boundaries’, and ‘some time on my own/some alone time’ are perceived as helpful elements of treatment. ‘Strictness’, ‘not listening’, and ‘inappropriate staff attitudes and interventions’ are perceived as counterproductive elements of treatment. Results are discussed and recommendations both on the orthopedagogical as well as on the scientific level are formulated.     

Design of ISD-1: an instrument for social diagnosis in care homes for older persons*

This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries.     

Runaway behavior among adolescents in residential care: The role of personal characteristics,victimization experiences while in care,social climate,and institutional factors

Existing research on runaway behavior among young people in care is severely limited, based mainly on small-scale samples, adult reports and administrative data. The research to date focuses mainly on children's characteristics and pre-care experiences rather than on placement-centered correlates. The present study examines the occurence and multilevel correlates of runaway behavior among Israeli Arab and Jewish adolescents aged 11 to 19 in residential care for at-risk children.     

Unlicensed care homes in the United States: a clandestine sector of long-term care

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 17 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies, and practices that might influence UCH prevalence are discussed.     

Youth aging out of residential care in Israel: Readiness for independent living and need for help

Youth leaving state care are a vulnerable group. It is important to examine their status and needs before they leave care, so that policies and practices are designed to address their needs. The aim of this study is to assess readiness for independent living of youth on the verge of leaving residential care in Israel, and to identify the life domains in which they need further help. Further, the study examines personal and interpersonal resources that may predict levels of readiness and needs before leaving care.     

Knowledge translation and implementation of housing first in Canada: A qualitative assessment of capacity building needs for an evidence-based program

We examined communities’ expressed needs for capacity building in the implementation of Housing First (HF) for persons experiencing homelessness. The findings are based on thematic analyses of qualitative data obtained from participants (n = 77) in 11 focus groups conducted in seven Canadian cities. We identified capacity building needs in the areas of training (e.g., HF principles, clinical services, landlord engagement) and technical assistance (e.g., intake coordination, client prioritization, fidelity assessment). These findings were used to tailor training and technical assessment (TTA) to the stages of HF implementation in these cities. Limitations and implications for future theory, research, and practice are discussed.     

Comparative well being of Israeli youngsters in residential care with and without siblings

This paper presents the findings of a study comparing the well being and self-esteem of young adolescents (age 12-14) who were placed together with their siblings in residential facilities (intact care) in Israel and of youngsters who were placed without their siblings (separate care). The study examines the contribution of sibling relations, frequency of the meetings between the siblings, parental favoritism, age rank, time in care, self-esteem and perception of parents' economic status to the well being of the youngsters in the two groups. The findings show that the youngsters in intact care (N = 91) reported greater well being than those in separate care (N = 103), but have no other significant differences. Greater self-esteem and sibling closeness improved the well being of both groups of youngsters, but the other predictor variables functioned differently in the two groups. Greater frequency of meetings improved the well being only of the youngsters in intact care, while the other variables examined improved the well being only of those in separate care. Moreover, the examined variables accounted for a greater proportion of the variance in the youngsters' well being when the sibling was absent than when he or she was present. Practical implications are suggested.     

Community health needs assessment and action planning in seven Dominican bateyes

Haitians and persons of Haitian descent living in the Dominican Republic are often relegated to living in deeply impoverished communities called bateyes. Despite obvious needs and some NGO presence in the bateyes, little assessment has been done to identify specific needs as understood and experienced by community members themselves. This article describes a community health needs assessment and action planning process developed and implemented by university researchers, NGO staff, and community members to identify needed areas for community-based health intervention in seven Dominican bateyes. Surveys and focus groups were used to collect data about the needs and assets of the bateyes and their residents around the following broad topics: demographics, health, education, financial/economy, legal issues, and transportation/infrastructure. These data were then used to guide an action-planning process that identified clean water, access to food and nutritional diversity, and economic development as primary and immediate needs in the communities. The process, its outcomes, and lessons learned are discussed.