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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. [ABSTRACT FROM AUTHOR]

This article proposes and examines a parsimonious framework for assessing quality in therapeutic residential care. The synthesized conceptual framework includes four potentially critical domains of quality: setting, staffing, safety, and treatment. Data from a recently completed quasi-experimental study of group homes were used to examine prevalence of various key indicators within each of these domains and to explore relationships between these indicators and youth-level outcomes. Findings suggest that, among this sample of licensed homes in a southeastern state, licensure may be an initial indicator of baseline quality. Beyond this most basic level, utilization of an evidence-informed model (in this case, the teaching family model) was associated with better outcomes. Net of model, findings suggest that positively focused motivational systems, youth’s perceptions of staff’s fairness and helpfulness, provision of age/interest-appropriate toys/books/games, more preservice training, and prohibition of physical restraint were all associated with better outcomes for youth. Additional work is needed to assess the generalizability and utility of this framework for assessing quality in group homes. [ABSTRACT FROM AUTHOR]

There is a gap in understanding how the treatment fidelity aspects of adherence and quality, along with common process factors such as therapeutic alliance, impact outcomes for youth. Few studies have examined both constructs of implementation and process factors simultaneously in regard to their relationship to client outcomes. This study examined the role of (a) youth ratings of implementation quality for a provider of therapeutic residential care, (b) the records of staff ratios of positive to negative statements to youth as reported for a token economy system, and (c) youth ratings of therapeutic alliance in relation to youth emotional and behavioral functioning at 6 months into therapeutic residential services. The study included data collection activities with 112 youth and staff at intake into residential group care through 6 months into residential services. Both youth ratings of therapeutic alliance and the ratio of positive to negative staff interactions with youth were related to improved youth emotional and behavioral functioning, as reported by staff using the Child Behavior Checklist. These findings suggest that it is important to consider both implementation and common process factors when looking to improve the quality of care for youth in therapeutic residential care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Recent work suggests that out-of-home placements continue to be relatively common for youth with mental health problems, even within systems of care. The current work examines rates and predictors of movement back home and stability of reunifications. During the focal period, 1,778 youths experienced out-of-home placements; 61% moved back home, and 22% of those reunited were placed out of home again. Race was related to likelihood of reunification and instability: American Indian youth were least likely to return home, whereas Hispanic youth were at increased risk of unstable reunifications. Older youth and boys were more likely to return home, whereas youth from families with higher incomes were slightly more likely to be placed out of home but also most likely to be stably reunited. Higher (i.e., worse) total Child Behavior Checklist score was related to moving back home, whereas decreased strengths and more child-level risk factors predicted instability of reunification. [ABSTRACT FROM AUTHOR]

This article examines out-of-home placements for youth with mental health problems in community-based systems of care. Longitudinal data come from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. One third of youth residing at home when they enrolled in the system of care were placed out of home during the 2-year follow-up period. As expected, youth who were placed out of home displayed more problems, fewer strengths, and more risk factors than youth who remained at home. However, results suggested few differences between youth placed in foster care and those placed in more restrictive settings. In addition, there was increased placement instability for Hispanic and older youth. Findings suggest that out-of-home placements remain a common component in systems of care. This suggests the immediate need for additional work on effectiveness of these settings for youth within systems of care. [ABSTRACT FROM AUTHOR]

The authors consider school violence from a dynamic systems conceptualization of aggression. This perspective suggests that aggression and school violence involve the contributions of both school social dynamics and the developmental histories of youth who are at risk for involvement in antisocial behavior. The authors present the concept of correlated constraints to describe the systematic alignment of developmental factors and their role in behavioral continuity and realignment. Building from this perspective, the authors present a theoretical framework that complements public health models of prevention to guide the establishment of comprehensive programs for preventing aggressive and violent behavior in schools. This framework suggests that three distinct but complementary levels of intervention are required to effectively reduce school violence: (a) universal strategies to address contextual factors, including the social dynamics of aggression and the activities of "conventional" peers that promote interpersonal conflict; (b) selective strategies for supporting the strengths of at-risk youth to prevent the negative reorganization of their developmental systems; and (c) indicated strategies involving coordinated services from multiple providers to reorganize the developmental systems of high-risk youth (i.e.,youth with emotional and behavioral disorders). [ABSTRACT FROM AUTHOR]

Current views of the role of social relations in the development of aggressive and disruptive behavior are presented, and advances in social development research are summarized. The primary points of the articles in this special issue are considered against this backdrop and synthesized with regard to implications for the development of preventative interventions and positive behavioral supports for aggressive youth with or at risk of emotional and behavioral disorders. Together these articles suggest that the social growth of such youth is highly complex and involves multiple factors, including the social goals and characteristics of the student, the affiliative patterns and social roles of the student, and the interactional dynamics among students and between students and teachers. School-based interventions should focus not only on the behavior of the student, but also on social-cognitive processes and social contextual factors that support aggressive and disruptive behavior. [ABSTRACT FROM AUTHOR]

The author reflects on different views, techniques and researches on therapeutic residential care (TRC) conducted by several researchers.