Therapeutic residential care in Spain. Population treated and therapeutic coverage

Therapeutic residential care (TRC) is the name given to specialized children's homes for treating cases with severe emotional and behavioural problems that have been placed in residential care. A recent international review has revealed great diversity in the referral criteria of cases and in the models of intervention carried out. The goal of this study is to describe the population treated in these types of facilities in Spain and the therapeutic coverage given. The sample is made up of 215 young people in children's homes, of whom 93 are in TRC. The cases referred to TRC have been in residential care for less time but have gone through a greater number of placements. These young people also exhibit more problems of drug use, and there is a larger percentage of clinical‐range cases in the Child Behaviour Checklist scales of attention problems and aggressive behaviour. Nevertheless, the results of logistic regression indicate that the only variables that significantly increase the probability of being referred to TRC are drug use and changes of care placements. With regard to therapeutic care, there is a higher percentage in the TRC group receiving psychiatric care, and the sessions are also more frequent.     

Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

Age and gender differences in emotional and behavioural problems during the transition to residential treatment: the Odyssey Project

Utilising a national sample of 1,167 young people in residential treatment, this study explored whether the behav-ioural problems exhibited during the transition to residential treatment varied depending upon the age and gender of the youngsters. Specifically, we asked whether those who were admitted to residential treatment centres (RTCs) aged under 12 had a different set of behavioural problems from those who were 12 years and older when admitted, and whether boys had different characteristics than girls. The 11 scales of the Achenbach Child Behavior Checklist were examined. The results revealed statistically significant patterns of associations by age and gender. As populations shift within agencies and across time, knowledge of the behavioural problems associated with age and gender groups can be used to facilitate agency planning and staff training.     

Determining socio-demographic predictors of treatment dropout: results in a therapeutic community

This article presents a study of a number of socio-demographic factors that predict treatment dropout from a residential substance use disorder programme in Spain ( Proyecto Hombre Therapeutic Community). A sample of 430 patients (173 who completed treatment and 257 who dropped out of treatment) was assessed at entry to the therapeutic community programme in order to collect information on socio-demographic characteristics of the participants. According to the results obtained, factors that predicted treatment dropout included younger age, male gender and previous treatment history in the Proyecto Hombre therapeutic community. Patients with these characteristics were at significantly greater risk of dropping out of treatment. The implications of these results for further research and clinical practice are commented upon.     

Coping Strategies and Relapse of Substance Abusers: A Case Study of the Therapeutic Community Program in Indonesia

The present study examined the ability of people with substance‐dependence problems to cope with stressful events and refrain from resuming alcohol drinking and the use of drugs. This study specifically examined the length of time that substance abusing‐residents spent in a state‐owned, residential‐based therapeutic community program at Lembang‐Bandung, West Java, Indonesia. A study sample of 68 residents completed a questionnaire with four sections. The results of this study showed no significant differences in the scores rating the coping behavior of the residents according to the length of stay in the program. This study also found no significant differences in the Coping Behavioral Inventory scores of the residents according to the level scores of total Coping Strategy Inventory. It is important for social workers to understand the relationship between the length of stay of residents and their ability to cope so that they can effectively engage in intervention work with individuals with substance‐dependence issues who participate in the therapeutic community.     

Residential Treatment: Contextual Learning and Demand for Work from a Social Group Work Perspective

ABSTRACT

This paper examines the implications of integrating social group work theory to residential treatment facilities in order to improve therapeutic engagement of clientele. This examination focuses on the natural and serendipitous construction of groups within residential treatment facilities. These natural groups provide frontline workers with constellations that are symmetrical to the knowledge-base of social group work theory. In addition, this paper incorporates the initial phases of social group work stage theory as a means of providing opportunity for contextual learning to residential clientele as well as planning appropriate demand for work within these settings.     

A secure base? The adolescent–staff relationship in secure residential youth care

The client–therapist relationship is recognized as an important factor contributing to outcomes of child and youth care. Particularly in secure residential youth care, in which adolescents with mainly externalizing behaviour problems are often placed coercively, the client–staff relationship seems to be important for the achievement of positive outcomes. The present study aims to assess the client–staff relationship for a group of 135 adolescents in secure residential care and factors associated with a positive relationship. The results show that adolescents, group care workers and teachers experience a limited affective bond in their relationship 2 months after the adolescents were admitted to the secure care centre. Adolescents do tend to use care workers and teachers as a secure attachment figure, which suggests that an affective bond is no precondition for the adolescents to experience staff as a secure base. Main predictors of a good relationship are the positive treatment skills of both group care workers and teachers. These findings point to the need for training of care workers and teachers so that they are better prepared for working with these adolescents.     

Time-Limited Cognitive-Behavioral Group Interventions with Suicidal Adolescents

ABSTRACT

Suicide is the third leading cause of death in adolescents in the United States-following accidents and homicide. This paper reports on group based activities using a cognitive-behavioral therapy (CBT) framework targeted at variables most highly correlated with suicidal ideation and behaviors, including problems associated with self-esteem, cognitive rigidity, social skills deficits, and substance use. Instead of focusing exclusively on treatment of depressive symptoms, this paper presents a series of structured group activities applicable to time-limited groups and designed to increase self-esteem, reduce negative thinking, enhance coping abilities, delimit substance use, and reintroduce the ability to seek and enjoy pleasurable activities with peers. The activities are derived from experiences with adolescents in treatment and are devised to foster rapid group stage development for use in time-limited groups.     

Quality of experience in residential care programmes: Retrospective perspectives of former youth participants

This exploratory study examined perceptions of care quality within parent‐pay youth treatment programmes such as therapeutic boarding schools, residential treatment centres, wilderness therapy programmes, and intensive outpatient programmes. Reflecting on their personal experiences as youths, 214 adults reported on a total of 75 different treatment settings. Two indices developed for this study measured participants' perceptions of quality of experience and the totalistic programme characteristics of their care settings. Regression analyses and ANOVA tests of means indicated a negative relationship between totalistic programme characteristics and quality of experience index scores. Significant relationships were not found between quality of experience and forcible transport, intake decade, or the amount of time in treatment.     

Involvement in the Juvenile Justice System for African American Adolescents: Examining Associations with Behavioral Health Problems

While researchers have found that African American youth experience higher levels of juvenile justice involvement at every system level (arrest, sentencing, and incarceration) relative to their other ethnic counterparts, few studies have explored how juvenile justice involvement and number of contacts might be correlated with this broad range of problems. A convenience sample of 638 African American adolescents living in predominantly low-income, urban communities participated in a survey related to juvenile justice involvement. Major findings using logistic regression models indicated that adolescents who reported juvenile justice system involvement versus no involvement were 2.3 times as likely to report mental health problems, substance abuse, and delinquent or youth offending behaviors. Additional findings documented that the higher the number of juvenile justice system contacts, the higher the rates of delinquent behaviors, alcohol and marijuana use, sex while high on drugs, and commercial sex. These findings suggest that identifying and targeting youth who have multiple juvenile justice system contacts, especially those in low-resourced communities for early intervention services, may be beneficial. Future research should examine whether peer network norms might mediate the relationships between juvenile justice involvement and youth problem behaviors.     

Predictors of gambling problems among male adolescents

The study concerns prediction of gambling problems in 178 male adolescents (aged 16 and 18 years) who completed a questionnaire, which included the South Oaks Gambling Screen (SOGS), a version of the Temperament and Character Inventory and a number of questions concerning social background, emotional and life-style factors. About 27% of the boys gamble at least weekly. As many as 16% qualify as probable pathological gamblers according to the SOGS. Another 7% are at risk. None of the social background factors are related to severity of gambling problems. The only significant family factor is parental substance misuse. The optimal multivariate model predicts about 30% of the variance in gambling problems. The strongest factor is frequency of alcohol drinking. Several factors indicate a personality with problems in relations to others. Another factor indicates a dreamy personality. Unexpectedly, impulsiveness is not related to gambling. In conclusion, problem gambling among male adolescents is related to life-style and personality, especially in relation to others, but not to usual social background factors. Gamblers are asocial rather than impulsive. The nature of this finding should be further explored, since an asocial personality may point at genetics as well as to early social influences, as may the finding on the relation between gambling and parental drinking.     

Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Peer relationships during late childhood in internationally adopted and institutionalized children

The aim of this study was to analyse the interpersonal relationships in the school context of children living in different care settings (adoptive families, residential care centres, birth families). Participants were 76 children between eight and fourteen years of age (M = 10.78, SD = 1.38), belonging to one of three groups: international adoptees, children living in residential care in Spanish institutions, and a comparison sample of Spanish children living with their birth families with no connection with child protection. Sociometric information was collected in the classroom of each child during school hours. Internationally adopted children from Russia showed considerable difficulties in their relationships with peers; they were more likely to be rejected and their peers described them as less prosocial and somewhat more aggressive. With a better sociometric position than the adoptees, children in residential care were rated by their peers as more aggressive and less prosocial than the normative population. Coordination and integrated work between the family, protection centres, schools, and other social services should be a strategic priority in the promotion of healthy social development in these groups of children.     

Population Redistribution in Australia: The Problem of Competing Location Preferences

Results from an exploratory survey are used to indicate the importance of the subjective dimension in relocation decisions and policies directed towards population redistribution. The competition between alternative residential location preferences amongst the sample surveyed indicates possible obstacles to the implementation of selective decentralization programmes and the rapid development of designated growth centres.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Sticks and Stones: The Effects of Teasing on Psychosocial Functioning in an Overweight Treatment-seeking Sample

This self-report and observational study explores the relationship between perceptions of different kinds of teasing experiences and psychosocial functioning in an overweight treatment-seeking adolescent population. Participants were 96 adolescents enrolled in a residential weight-loss camp program. Prior to the start of treatment, participants' weight status was measured by trained program staff, and participants' perceptions of teasing experiences and psychosocial functioning were assessed through self-report questionnaires. Controlling for body mass index, more frequent and upsetting weight-related teasing experiences were associated with worse psychological functioning. Adolescents most distressed by weight-related teasing exhibited lower self-esteem and higher depressive symptoms regardless of reported frequency of weight-related teasing. Competence-related teasing was also associated with more worries about weight, greater depressive symptoms, and more negative anti-fat attitudes. Weight-related teasing, but not competence-related teasing, was associated with lower levels of program and social involvement for heavier adolescents.     

Alcohol abuse, compulsory treatment and successive aftercare: a qualitative study of client perspectives

In Sweden, the social welfare boards have a statutory duty to provide aftercare for compulsorily treated substance abusers. However, there are no data on how the aftercare is organised and how clients perceive this phase of the compulsory treatment process. The aim of the study is to analyse how a sample of compulsorily treated alcohol abusers ( n  = 12) characterise the current coercive treatment episode and evaluate previously experienced and forthcoming aftercare interventions. Qualitative interview-data were coded into themes and sub-themes encompassing relevant client perspectives. Results show that the alcohol abusers claimed to want (but be denied) adequate help for their problems, both during primary treatment and after discharge. Their perspectives on coercive care and aftercare interventions appeared related to their views on their own problems and on being incarcerated. For instance, those who recognised their own alcohol problems emphasised the importance of quitting consumption and were dissatisfied with interventions offered during and subsequent to compulsory treatment referrals.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

Interpretative phenomenological analysis of young people's lived experiences of therapeutic residential care

Concerns of maltreatment and poor outcomes persist in residential care despite numerous government inquiries and recommendations. Young people in residential care continue to be the most vulnerable and marginalized group in the out‐of‐home care population. Young people's voices are also underrepresented in research. Existing studies predominantly focus on service evaluations in which individual voices of young people are overshadowed by adults' perspectives. Other studies examine the perspectives of young people in out‐of‐home care as a homogenous population, limiting understandings of the subjective experiences of young people in residential care. This study focused exclusively on young people's lived experiences in Australian therapeutic residential care, utilizing interpretative phenomenological analysis. The young people in this study revealed experiences of peer victimization, ambiguous loss and uncertainty during transitions. These findings suggest that more work is required in order to provide safe and healing environments and experiences for young people in therapeutic residential care. Each individual voice captured in this study offers valuable insights into how residential care practitioners can strengthen practice to enhance protection, engagement, connection with families and leaving care support.