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Herbell K, Breitenstein SM, Ault S, Price M. Variation in Evidence-Based Practices Among Youth-Serving Residential Treatment Facilities. J Am Psychiatr Nurses Assoc 2024; 30:503-517. [PMID: 36028952 DOI: 10.1177/10783903221120828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Residential treatment is among the most intensive and expensive settings for children with behavioral health challenges; yet, the extent to which evidence-based practices are used in these settings is unknown. AIM The purpose of this study was to describe the extent which family therapy, case management, telehealth, peer support, and family psychoeducation are provided in residential treatment using data from the National Mental Health Services Survey (N-MHSS). Organizational factors-region, ownership, payment, licensing/accreditation, and facility size-were examined in relation to evidence-based practices to understand disparities in care. METHODS This was a secondary analysis of publicly available data from the 2018 N-MHSS. A subpopulation was created consisting of residential facilities that served children (N = 576). Descriptive statistics were used to describe the sample, and Cohen's h was calculated to determine patterns of evidence-based practice utilization. RESULTS Evidence-based practices from most to least prevalent were family therapy (76%), family psychoeducation (74%), case management (71.1%), telehealth (17.2%), and peer support (8.7%). The provision of evidence-based practices was not evenly distributed. There were primarily small to moderate differences by organizational factors, including region (i.e., Northeast, Midwest), ownership status (i.e., for-profit), payment type (i.e., self-pay, private insurance), licensing/accreditation (Department of Family and Children Services), and facility capacity (>251 clients served per year). CONCLUSION Findings demonstrate a need for research-practice partnerships to determine the barriers that prevent effective evidence-based practices from being implemented in the residential treatment setting.
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Affiliation(s)
- Kayla Herbell
- Kayla Herbell, PhD, RN, The Ohio State University, Columbus, OH, USA
| | - Susan M Breitenstein
- Susan M. Breitenstein, PhD, RN, FAAN, The Ohio State University, Columbus, OH, USA
| | - Samantha Ault
- Samantha Ault, PhD, APRN-CNP, PMHNP-BC, The Ohio State University, Columbus, OH, USA
| | - Matthew Price
- Matthew Price, MSW, LISW, University of Kentucky, Lexington, KY, USA
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Perrigo JL, Molina AP, López O, Traube D, Palinkas LA. The deinstitutionalization of children and adolescents in El Salvador's child protection system. CHILD ABUSE & NEGLECT 2024; 147:106601. [PMID: 38113572 DOI: 10.1016/j.chiabu.2023.106601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND In 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. OBJECTIVE The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. PARTICIPANTS AND SETTING The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. METHODS Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. RESULTS CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. CONCLUSIONS The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.
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Affiliation(s)
- Judith L Perrigo
- University of California, Los Angeles (UCLA), Luskin School of Public Affairs, Social Welfare Department, 3250 Public Affairs Building, Los Angeles, CA 90095-1656, USA.
| | | | - Omar López
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
| | - Dorian Traube
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
| | - Lawrence A Palinkas
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, 669 W 34(th) Street, Los Angeles, CA 90089, USA
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Stewart SL, Vasudeva AS, Mistry D, Poss JW. The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care. CHILD ABUSE & NEGLECT 2023; 139:106066. [PMID: 36791630 DOI: 10.1016/j.chiabu.2023.106066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although children with histories of maltreatment are more likely to engage with mental healthcare than non-maltreated children, few studies have examined the impact of maltreatment on children's mental health outcome improvement over time. OBJECTIVE The current study addresses this gap in the present literature by exploring the ways that histories of physical, sexual, and emotional abuse and exposure to domestic violence can influence children's improvement on mental health outcomes commonly associated with trauma. PARTICIPANTS AND SETTING De-identified routine care data from 58 community mental health agencies across Ontario, Canada, representing 16,517 children was obtained. This data represented assessments that occurred between February 2015 and December 2021. METHODS General linear models were used to illustrate the effect of each trauma type on change scores computed between baseline and follow-up assessments of externalizing behaviours, risk of harm to others, depressive symptoms, risk of suicide and self-harm, and anxiety, while adjusting for baseline scores, inpatient status, time between assessments, and select demographic variables. RESULTS When the effects of each trauma type was considered separately, children without histories of trauma consistently showed greater improvement than those with that trauma across all mental health outcomes (0.07-0.44, p < 0.01). When all trauma types were considered together, sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements. CONCLUSIONS Our findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports and research examining the impact of trauma on children's treatment responsiveness.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Aadhiya S Vasudeva
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada.
| | - Divya Mistry
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Jeffrey W Poss
- Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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Schreier A, Stenersen MR, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. CHILDREN AND YOUTH SERVICES REVIEW 2023; 147:106838. [PMID: 37719138 PMCID: PMC10501261 DOI: 10.1016/j.childyouth.2023.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.
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Affiliation(s)
- Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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Herbell KS, Breitenstein SM. Parenting a Child in Residential Treatment: Mother's Perceptions of Programming Needs. Issues Ment Health Nurs 2021; 42:639-648. [PMID: 33108233 DOI: 10.1080/01612840.2020.1836536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to describe the experiences and perspectives of mothers with children in residential treatment (RT) regarding parenting, discharge planning, and home-based safety. One-hour interviews were conducted over the phone with 15 mothers. Transcripts were analyzed using a content analysis approach. Three themes were generated including parenting a child in RT, unprepared for discharge, and crisis intervention in the home. This study contributes insight into the lives of an underserved population with implications to inform future research interventions and clinical guidelines to address the needs of families with children in RT.
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Affiliation(s)
- Kayla S Herbell
- Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Susan M Breitenstein
- Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus, Ohio, USA
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Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1575-1586. [PMID: 31098773 DOI: 10.1007/s00127-019-01724-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/07/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay. METHODS Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11-18 years. Comparisons with a school sample were conducted. RESULTS Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology. CONCLUSIONS The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association.
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Sunseri PA. Hidden Figures: Is Improving Family Functioning a Key to Better Treatment Outcomes for Seriously Mentally Ill Children? ACTA ACUST UNITED AC 2019. [DOI: 10.1080/0886571x.2019.1589405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Paul A. Sunseri
- New Horizons Child & Family Services, El Dorado Hills, California, USA
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Development of the Child Dissociation Assessment System using a narrative story stem task: A preliminary study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Exploration of Coping Strategies of Youth Accessing Residential and Day Treatment Programs. CONTEMPORARY FAMILY THERAPY 2016. [DOI: 10.1007/s10591-015-9372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harder AT, Knorth EJ, Kalverboer ME. Risky or Needy? Dynamic Risk Factors and Delinquent Behavior of Adolescents in Secure Residential Youth Care. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:1047-1065. [PMID: 24752639 DOI: 10.1177/0306624x14531036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although it is known that adolescents in secure residential care often show multiple behavior problems, it is largely unknown which dynamic risk factors are associated with their problems. The aim of the present study is to examine dynamic risk factors for 164 Dutch adolescents in secure residential care. Results show that a majority reports multiple risk factors in both an individual and contextual domain but that about a fifth shows relatively few risk factors. Substance abuse and delinquent friends were among the five most prevalent risk factors and predicted the seriousness of the adolescents' delinquent behavior prior to admission. The four groups that were found by cluster analysis could be distinguished by problem type and seriousness. The findings indicate that treatment for some adolescents should be mainly focused on their individual needs, while other adolescents need intensive, multimodal treatment focusing on both risks in the individual, family, and peer domains.
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Nelson TD, Haugen KA, Resetar Volz JL, Zhe EJ, Axelrod MI, Spear Filigno S, Stevens AL, Lundahl A. Overweight and Obesity Among Youth Entering Residential Care: Prevalence and Correlates. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/0886571x.2015.1043786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nelson TD, Smith TR, Pick R, Epstein MH, Thompson RW, Tonniges TF. Psychopathology as a Predictor of Medical Service Utilization for Youth in Residential Treatment. J Behav Health Serv Res 2012; 40:36-45. [DOI: 10.1007/s11414-012-9301-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nelson TD, Smith TR, Thompson RW, Epstein MH, Griffith AK, Hurley KD, Tonniges TF. Prevalence of physical health problems among youth entering residential treatment. Pediatrics 2011; 128:e1226-32. [PMID: 22007007 DOI: 10.1542/peds.2010-3609] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska, Lincoln, NE 68588-0308, USA.
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Bettmann JE, Lundahl BW, Wright R, Jasperson RA, McRoberts CH. Who are They? A Descriptive Study of Adolescents in Wilderness and Residential Programs. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/0886571x.2011.596735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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