Defining Group Care Programs: An Index of Reporting Standards

Accomplishing Intergroup Relations in Group Homes: A Discursive Analysis of Professionals Talking About External and Internal Stakeholders

Focusing on one of the most studied dimensions of Social Psychology, i.e., intergroup relations, this study analyzes its discursive accomplishment in a specific group-based intervention, i.e., the talk and work of an Italian group home, i.e., a small alternative care facility hosting a group of out-of-home children. Particularly, we focused on the fictionally called "Nuns' Home," a group home previously investigated for its ethnocentric bias, and its intergroup relations with "inside" and "outside" groups, such as schools, biological families, and social services. By combining a qualitative and quantitative approach in analyzing one audio-recorded ethnographic interview with the whole team of professionals, we aimed at accounting for the multitude of internal and external stakeholders that participants refer to, analyzing the discursive accomplishment of ingroup and outgroup in talk-in-interaction and investigating ingroup bias and group qualification. To do so, we detected social categorization markers and qualifying devices that participants rely on when referring to groups. Results show that, among the numerous groups recognized, participants co-construct intergroup relations and ingroup bias implying negative assessment over external groups. Being different from traditional laboratory studies illustrating substantial contraposition between ingroup and outgroup, our qualitative analysis reveals the multitude of groups by which the ingroup is formed and their internal fragmentation. To conclude, we discussed the implications of qualitatively studying intergroup relations in group homes and indicated future lines of research.

Treatment Mediators and Outcomes of Latent Classes of Youth in Psychiatric Residential Treatment

The purpose of this study was to examine differences in discharge outcomes between latent classes of youth in psychiatric residential treatment. The mediating effect of family therapy, behavioral management incidents, and length of stay on class membership and treatment outcomes were examined. The sample included 447 youth assigned to one of four classes. Guided by Thornberry and Krohn's (2005) interactional theory of continuity and change, change in functional impairment was predicted based on the composition of risk versus protective factors that comprised the latent classes. A manual 3-step approach was used to fit a latent class mixture model and estimate conditional effects on impairment at discharge. A mediation model was used to examine indirect effects of treatment factors on outcomes between latent classes. The results showed that classes with lower-level risk factors and more protective factors experienced significantly greater reductions in impairment on average. Treatment outcomes were mediated by behavioral management incidents but not length of stay or the number family therapy sessions. The results demonstrate the usefulness of person-centered approaches for conducting subgroup analyses in residential care outcomes studies; highlighting differences in outcomes between groups and treatment factors that may mediate these differences.

A Comparative Analysis of Residential Care: A Five-Country Multiple Case-Design Study

Background

Despite a global policy push toward the advancement of family- and community-based care, residential care for children and youth remains a relevant and highly utilized out-of-home care option in many countries, fulfilling functions of care and accommodation as well as education and treatment.

Objective

As part of a larger project involving five European countries (Finland, Germany, Italy, Lithuania, and Spain), the objective was “to map” the context and content of residential care in each country, thereby building a foundation for meaningful comparisons and deepened understanding of each system’s inherent logic. Within the context of global deinstitutionalization efforts, the study also aimed to understand factors that hinder or enhance the transformation of residential care.

Method

Using an embedded multiple-case design, data was gathered by each country on its residential care macro context as well as salient variables related to three units of analysis–residential care system/program features, residential care training and personnel, characteristics of youth. Cross-case synthesis was used to summarize and compare cases across relevant dimensions.

Results

The analysis highlighted areas of overlap and singularity, particularly with regard to utilization rates, concepts and methods, workforce professionalization, and characteristics of youth.

Conclusions

Findings provide a more nuanced understanding of how residential care continues to be viewed and utilized in some countries, challenging the ‘residential-care-as-a-last-resort-only’ rhetoric that is currently dominating the discourse on residential care. It further provides an understanding of historical and sociocultural factors that need to be considered when trying to transform services for children, youth, and their families.

Children’s participation and agency in Italian residential care for children: Adult-child interactions at dinnertime

This paper analyzes the impact of adults’ interactive moves and strategies on children’s participation and agency at dinnertime in two Italian residential care facilities, one of the most widely used alternative care life-context for children and youth coming from vulnerable families. Participants are 14 children and 11 educators living in two residential care facilities in Rome (Italy). Adopting an interactional and multimodal analytic approach, this paper focuses on two dinnertime activities: the routine activity of praying before eating and the very frequent one of talking about rules and transgressions. The comparative analysis of the two facilities shows how, in stable patterns of adult-child interactions recurring across different activities in the same facility, adults’ strategies and interactive maneuvers differently impact on children’s participation and agency and consequent socialization practices. In the conclusion, we emphasize the relevance and implications of this study for either research in educational sciences and for professionals operating in alternative care and related fields.

Elementary School-Aged Children in Therapeutic Residential Care: Examining Latent Classes, Service Provision, and Outcomes

BACKGROUND

Approximately one-third of children in residential care are elementary-school aged. Yet, little is known about the subset of younger children in residential care and the nature of these placements.

OBJECTIVE

This study identified latent classes of younger children in residential care and compared the purposes for placement, treatment processes, and outcomes across classes.

PARTICIPANTS AND SETTING

The sample included 216 children (ages 5-10) placed in therapeutic residential care.

METHODS

A three-step latent class model was used to estimate conditional effects of class membership on impairment at discharge, length of stay, and discharge placement. A content analysis of a randomly selected sample of case records from each class was used to explore placement processes.

RESULTS

There were three classes identified (class 1: child welfare/multi-problem families; class 2: mental-health/angry-oppositional; class 3: strong families/attachment). All classes experienced large improvements in functioning. Children in class 3 were in care longer (CI_95% 1.72, 15.48) and experienced greater reductions in impairment (CI_95% -11.17, -32.06) than class 2. Classes did not differ in rates of discharge to family-based care, however, more children in classes 1 (20.9%) and 3 (21.6%) discharged to group-based placements than class 2 (11.1%). The content analysis revealed similarities in reasons for placement and treatment processes across classes with some distinctions. Service goals were similar across classes and focused on emotional management, social skills, and developing trust.

CONCLUSION

The results supported individualized approaches to facilitate discharge to stable, family-based care and reduced risks for re-entry and prolonged out-of-home care for younger children.

Differences in care provided to children with behavioral and emotional problems in a delineated region by using the Taxonomy of Care for Youth (TOCFY)

Behavioral and emotional problems can lead to severe restrictions in the functioning of children and to an impaired development. The types of support for children vary greatly between care providers. The aim of this study is to apply the Taxonomy of Care for Youth (TOCFY) and to make an inventory of the core elements and program elements of the various types of support for children with behavioral and emotional problems that were offered overall and per main types of providers in a delineated region. We assessed the types of support to children (N = 621) by applying TOCFY. The study showed that by using Tocfy we could make an inventory of the various types of support offered. 'Individual child support' and 'family support' were provided most often, and therefore, most interventions were aimed at the child or at the child and his/her parents/caretakers. Support was mostly provided without judicial interference and within an ambulatory/outpatient or home-based setting. TOCFY could be helpful by mapping of information on the support offered to children across various types of care providers. More information on the core and program elements of these types of support may help to optimize care for children and their families.

Does Model Matter? Examining Change Across Time for Youth in Group Homes

Group homes are a frequently used but controversial treatment setting for youth with mental health problems. Within the relatively sparse literature on group homes, there is some evidence that some models of treatment may be associated with more positive outcomes for youth. This article explores this possibility by examining differences across time for youth served in group homes utilizing the Teaching Family Model (TFM) and geographically proximate homes using more eclectic approaches. Data come from a longitudinal quasi-experimental study that included 554 youth. Results suggest that youth showed, on average, significant and rapid improvement during initial months in a group home. Improvement did not differ for TFM and non-TFM homes during this initial period. Post-discharge results, though, show that TFM was associated with continued improvement after discharge and significantly better outcomes by 8 months post-discharge. Results also discuss youth-level factors that may influence outcomes as well as need for additional work to more fully understand processes and practices that are key for maximizing and maintaining youths' positive outcomes during and after group home placements.

Who Goes Where? Exploring Factors Related to Placement Among Group Homes

Despite their widespread use as a placement option for youth with mental health problems, there is relatively little research on group homes for youth. Available data highlight concerns with practices and treatment within group homes and mixed results on youth-level outcomes. However, existing research appears to collapse a wide range of group residential settings into a single amorphous category. This article explores potential variations among group homes to examine whether different programs are systematically serving different types of youth. It examines, in particular, placement in homes using the teaching family model (TFM) versus homes that do not. Findings suggest that demographics are not significantly associated with TFM placement. However, custody status, types of mental health problems, and use of psychotropic medications are. Homes appear to be serving distinct niches within a geographic area. Implications for future research and policy/practice are discussed.

Patterns of maltreatment and diagnosis across levels of care in group homes

Patterns of Axis I psychiatric diagnosis and maltreatment history were explored among youth in group homes, including match of clinical need to level or restrictiveness of care. Data on demographics, diagnoses, maltreatment, and group home level of care (Level I, II, or III homes, representing lower to higher intensity of supervision and treatment) were obtained from 523 youth who participated in a quasi-experimental study of group homes. Three quarters of youth had a diagnosis and two-thirds of youth had a maltreatment history. Youth in higher level homes had more diagnoses and higher rates of all disorders except adjustment disorders. Youth in Level I homes had a history of more maltreatment types, particularly high rates of neglect. Sexual abuse, physical abuse, and emotional abuse were most common among youth in higher level homes. Regardless of diagnosis history, comparable proportions of youth had a maltreatment history, and similar patterns were found across levels of care. Together, findings indicate that group homes with varying degrees of restrictiveness serve youth with different psychiatric diagnosis and maltreatment histories. Youth triaged to higher level homes had more diagnoses, while youth placed in the least restrictive homes had a history of more maltreatment subtypes. Further, distinct patterns of diagnosis types and maltreatment subtypes were seen across homes. Implications include the importance of assessing unique clinical needs of youth to promote an appropriate match to level of care and treatment plan.

The Associations between Structural Treatment Characteristics and Post-Treatment Functioning in Compulsory Residential Youth Care

BACKGROUND: In 2005 a new compulsory residential treatment program was developed for adolescents in need for protection against themselves or their environment. OBJECTIVE: The aim of the present study was to examine the association of structural treatment characteristics of this new residential treatment program (i.e., duration of treatment, discharge status, and group composition in terms of sex) with post-treatment functioning. Additionally, the number of pre-treatment risk factors was included in the model. METHOD: A total of 301 adolescents (174 boys, 127 girls), with a mean age at time of admittance of 15.50 (SD = 1.26) participated in this study. The number of risk factors was derived from treatment files of the adolescents at time of entrance. Six months after discharge, adolescents participated in a telephone interview to measure ten post-treatment variables indicating how well they were doing. RESULTS: The results showed that duration of treatment was related to post-treatment living situation, in that adolescents who were in treatment for shorter durations were more likely to live on their own after treatment. For discharge status, findings suggested that adolescents who were regularly discharged had more frequent contact with their family; however, they also showed higher alcohol consumption 6 months after treatment. Group composition was related to the girls' official offending, indicating that girls placed in mixed-sex groups showed significantly fewer official police contacts than did girls in girls-only treatment groups. CONCLUSION: Overall, structural treatment characteristics were hardly related to the adolescents' functioning after treatment. Suggestions for future research are discussed.

Technology in Treatment: Are Adolescents and Counselors Interested in Online Relapse Prevention?

BACKGROUND

Approximately 75% of adolescents who receive substance abuse treatment relapse within one year; therefore, it is important to have effective, easily accessible aftercare resources to support them while they are in recovery.

OBJECTIVE

The goal of this study was twofold: 1) to find out from adolescents and counselors if an online relapse prevention program was feasible and of interest and 2) to solicit ideas for content for this program regarding peer relationships during early recovery.

METHODS

Sixteen counselors were interviewed about peer relationship-related content and features this program should include then asked to sort and rate the responses using an online concept mapping program. The development of an interactive prototype of the proposed program was informed by these results. This prototype was shown to the 16 counselors and 24 adolescents in substance abuse treatment (M age=15.8 years) for feedback. Then the adolescents participated in focus groups in which they discussed their use of technology and peer relationship-related challenges in recovery.

RESULTS

The concepts that were rated highest by counselors were Setting Boundaries in Peer Relationships (M = 4.38), How to Follow Through with Decisions (M = 4.23), and Figuring Out What You Really Want (M = 4.18). Pre-established criteria for satisfaction were exceeded with both adolescents (M = 84%) and counselors (M = 86%). In the focus groups, adolescents said that they would be interested in using technology to meet challenges in recovery.

CONCLUSIONS

The online relapse prevention program concept has feasibility according to these key stakeholders.