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Residential care has been criticized for its high cost and limited research evidence. While recent studies and reviews of the literature suggest that a number of evidence-based practices are being implemented in residential care settings, more research is needed to develop and test empirically based practices that can be successfully implemented in residential care. In this article, we offer a promising strategy to address this issue: a long-term research partnership between a large service provider agency and a university-based research center to conduct a program of research which has resulted in translation of evidence-supported practices into service provider programs, contributions to the science of residential care, and training opportunities for young applied scientists to specialize in this important work. This evolving program of research includes four core applied research topic areas in which this collaboration has had some ongoing success: program and practice implementation fidelity, therapeutic process factors, aftercare, and psychotropic medication use. We suggest that this type of long-term collaborative research partnership is an approach for others to consider for conducting research that informs effective residential care practices.

Empowerment has been established as an important factor in resilience in adolescence. It has also been deemed critical for youth with emotional and behavioral disorders to achieve successful outcomes across academic, social, and behavioral domains, especially during a major transition. There is currently one measure used to evaluate empowerment in youth with mental health difficulties, yet it is unclear if this is a reliable measure for youth in therapeutic residential care. The purpose of this study was to examine the reliability and validity of this measure of empowerment in a sample of youth departing therapeutic residential care (N = 138) and to examine whether or not specific factors contribute to varied levels of empowerment. Findings indicate that the empowerment measure is reliable and valid for use with youth departing therapeutic residential care. Overall, youth report high levels of empowerment at discharge from care. None of the predictors in the three multivariate general linear models were statistically significant. Limitations and implications are discussed.

Youth served in residential care often demonstrate significant educational and behavioral gains during treatment; however, struggles evidenced during the reunification and reintegration process underscore the importance of continued aftercare services and supports. While these needs have been widely noted in the literature, little is known about youth perceptions regarding the importance of aftercare or preferences regarding specific supports. The purpose of this study was to assess the views of youth discharging from a residential program on perceptions of transition planning and aftercare, preparedness for the reintegration, and perceptions regarding specific services and supports. One-hundred and thirty-two youth served in a large residential care facility were asked to complete a Youth Aftercare Survey prior to departure to determine youth perceptions. Overall, results revealed high levels of youth optimism about their preparedness for the upcoming transition and identified supports in education, relationships, physical health, independent living, and family as most important to the reintegration process. Although promising findings were revealed regarding youth perceptions of the importance of continued supports across broad domains, youth were less concerned about mental health supports; a factor critical to long-term success. Implications, limitations, and future research are discussed.

Youth involved in residential care programs present with significant difficulties across behavioral and mental health domains. Although this is a group that is also at considerable risk for academic failure, very little research has been done to understand the academic functioning of this population. The current study sought to expand what is known about this population and examine factors that are predictive of their levels of academic functioning. Results from 208 youth indicated that at the time of entry into residential care youth were performing in low average ranges across academic areas. While several variables were identified as predictors for level of academic functioning (e.g., IQ, age at admission, race/ethnicity, special education identification, and gender), variables particularly relevant for youth in residential care programs (e.g., behavior, number of previous schools attended) did not serve as predictors. Implications for practice and future research are discussed. (Contains 2 tables.)

Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with disabilities, one might expect that medical care usage is elevated and will continue to be a need when children return home or age out of the system. The purpose of this study was to evaluate if medical service utilization differed between youth with and without school-identified disabilities in care, and whether certain correlates (e.g., demographic characteristics and mental health functioning) would be associated with medical service use among youth with disabilities. Method: Hierarchical multiple regression models were used to explore the role of disability status in the utilization of medical services as well as to predict the effects of mental health functioning on utilization while controlling for other known factors. Results: Results indicated that medical service usage for youth with school identified disabilities was statistically higher than usage for peers without disabilities after accounting for other factors associated with utilization, and internalizing and externalizing behavior severity were significantly related to medical service utilization for youth with disabilities. Conclusions: As expected, the findings suggest that youth with disabilities use more medical services than peers without disabilities regardless of the presence of a physical health condition, but might be due to differences in the severity of the physical health conditions.

The prevalence of weight problems among youth in general and youth in out-of-home care has been well documented; however, the prevalence of obesity/overweight among youth with high-incidence disabilities in more restrictive settings, such as residential care, has not been assessed. The purpose of the present study was to evaluate the prevalence of weight problems in 245 youth with learning disabilities or emotional disturbance at entrance to residential care. Youth intake files were examined to evaluate the association between youth demographic characteristics, medical conditions, prior placements and placement settings, medication usage, and internalizing and externalizing behavioral problems and clinical weight problems. Findings revealed that over one half of the youth were overweight or obese (50.6%), and weight problems were associated with gender, medical conditions, and age. Study limitations, future research efforts, and treatment implications are discussed.

Although much is known about the behavioral and educational characteristics of youth at entry to residential care, little is known about youth language performance. Given the impact of language deficits on outcomes, this study assessed the specific language skills of 70 adolescents at entry to a residential treatment setting. Results revealed elevated levels of risk across Core Language and comprehensive language indexes. Areas of greatest concern were with receptive language skills with just over 75% of the sample indicating some level of impairment. Implications for treatment and practice, study limitations, and recommendations for future research are discussed. (Contains 1 table and 1 note.)

This study evaluated the characteristics related to a successful reintegration among youth from a residential facility. Specifically, this study describes the transition skills of youth at departure in five areas: (a) education and employment goals, (b) self-determination skills, (c) social support, (d) life skills, and (e) hopefulness. Further, self-report and teacher ratings of youths' self-determination and life skills were examined to determine possible differences in perception between youth and their school and Family Teachers (house-parents). One hundred four youth departing the Boys Town Treatment Family Home residential program participated in the study. The majority of youth reported average to above average skills in the five domains. However, significant differences were found between youth and schoolteacher reports of self-determination skills. The results indicate the need to provide transition services related to success post-discharge, including individualized transition plans and family involvement during treatment.

Children in residential care are a heterogeneous population, presenting various combinations of risks. Existing studies on these children suggest high variability across multiple domains (e.g., academics, behavior). Given this heterogeneity, it is important to begin to identify the combinations and patterns of multiple risks, or risk profiles, these children present. The purpose of this study was to evaluate the academic and behavioral risk profiles of children entering residential care. Cluster analysis procedures using academic and behavior variables revealed three distinct profiles of children: Group 1: "Average Janes", characterized by average academic skills, no behavior problems, and some demographic risks; Group 2: "Academic Risks", characterized by low academics and increased rule-breaking behavior; and finally Group 3: "Behavioral Risks", characterized by average academics and elevated behaviors. These preliminary finding are discussed along with limitations, directions for future research, and implications.

Purpose: Undiagnosed language impairment (LI) for youth in residential care is a concern as similar populations have shown elevated levels of language delays. Therefore, the purposes of this study were to identify the percentage of youth in residential care who are at risk for LI and to compare the demographic, academic achievement, and functional academic skills of youth with or without possible LI. Method: Participants were 80 youth in residential care. Risk for LI was determined using the Clinical Evaluation of Language Fundamentals-4 Screening Test (E. Semel, E. H. Wiig, & W. A. Secord, 2004). Independent-samples "t" tests and chi-square analyses were conducted to assess the differences between groups. Measures used included the Woodcock-Johnson Test of Achievement (R. W. Woodcock, K. S. McGrew, & N. Mather, 2001) and the Kaufman Functional Academic Skills Test (A. S. Kaufman & N. L. Kaufman, 1994). Results: More than half of the sample (54%) were identified as being at risk for LI. Statistically significant differences between youth with and without LI were found on academic variables. Specifically, youth who were at risk for LI presented academic achievement and functional academic scores in the low to low-average ranges. Conclusion: Findings suggest that there is a need to screen youth entering residential programs for possible LI. Implications for treatment and program planning are discussed.

Although females represent almost half of all youth involved in residential care in the US, very little is known about this population. In order to examine differences in characteristics of male (n = 308) and female (n = 180) youth departing from residential care, data were collected on 488 youth from a large residential treatment facility in the Midwest. Gender differences were assessed on 16 variables measured at the time of departure across family, education, behavior, and departure domains. Overall, male and female youth departing from residential care were very similar for measures collected at the time of departure. Only three variables (GPA at departure, number of school referrals during the previous 8 weeks, and planned departure) were found to be significantly different between males and females. Implications for future research and the provision of aftercare services are discussed.

Little is known about the characteristics or functioning of children with ADHD in residential care as compared to their non-ADHD peers. This study evaluated data on 538 children with (n = 125) and without (n = 413) ADHD in residential care to determine demographic, mental health, behavioral, and treatment (i.e., medication use) characteristics. Results revealed that both groups presented elevated risks, however, scores for children with ADHD indicated even greater levels of need. Specifically, differences were found between the two groups on demographics (e.g., family reunification status, restrictiveness of prior out-of-home placements), behavior (e.g., attention problems, rule-breaking and aggressive behaviors) and medication status. Findings suggest there is a need for aftercare services to help support families as children transition from care, interventions to address behavior, and medication management through assessment and monitoring.

Often considered a "last resort placement," residential settings serve a broad range of children who present significant risks. While much is known about emotional and behavioral functioning, less is known about academic strengths and limitations. This study evaluated 127 children at intake into a residential care program to determine demographic, behavioral, mental health, and educational characteristics. Results indicated that children entering care present high levels of risk across domains. Primary risks were found on indicators of behavior (e.g., rule breaking, aggression), mental illness (e.g., disruptive behavior, anxiety), and academic performance (e.g., general knowledge, reading). Implications, limitations, and recommendations for future research are discussed. (Contains 3 tables.)

The Family Empowerment Scale (FES) is one of the most widely used measures for assessing the empowerment of caregivers of youth with emotional difficulties. The purpose of this study was to examine the internal factor structure, score reliability, and convergent validity of the FES scores with caregivers of youth who had recently departed therapeutic residential care. Results indicated that the hypothesized three-factor model fit the data adequately with caveats. FES scores were reliable based on coefficient alpha and omega, and evidence of convergent validity with caregiver self-efficacy was moderate to strong. [ABSTRACT FROM AUTHOR]

Background: There is a growing emphasis of evidence-based program requirements being integrated into social welfare policies for youth care services in the U.S. This trend highlights the need for increased practitioner understanding and involvement in the research process to develop and implement evidence-based programs for youth with emotional and behavioral disorders who receive residential services. Objective: The purpose of this review was to provide residential care practitioners and researchers with an understanding of a transdisciplinary translational research approach for social service agencies and the research activities that can be included. Method: A review of the literature from a collaborative project between a social service agency and university that resulted in the development and testing of an aftercare intervention for youth departing residential programs was used to explain the framework. Result: The DO BETTER framework outlines a process that (1) focuses on input from practitioners and consumers to help determine problems that impact youth and families, (2) involves research and practitioner partnerships to conduct a variety of research activities to create solutions and (3) provides results that are useful for practitioners. The research activities of the project illustrate the iterative processes of practice to research and back to practice that included youth, caregivers, practitioners, researchers, and experts from other disciplines. Conclusion: The framework is provided to help researchers plan for collaborative research with social service agencies, and to help non-researchers in agencies become more familiar with research activities to increase their involvement in program design, testing, implementation and sustainability. [ABSTRACT FROM AUTHOR]

Although newly passed federal regulations mandate the provision of family-based aftercare supports for adolescents served in therapeutic residential care, very little research has been conducted to determine best practice. This efficacy and replication study compares the outcomes of youths and caregivers randomly assigned to On the Way Home (OTWH; n = 98) or traditional aftercare supports (n = 89) following discharge from therapeutic residential care (TRC). Findings were mixed. At posttest (12-months) no significant differences were found between groups on indicators of placement stability and school involvement, however, significant differences were found between groups on several indicators of caregiver empowerment and self-efficacy, with caregivers in OTWH reporting greater levels of self-efficacy and empowerment across the domains of family and community. At follow-up (21-months), moderate to large differences were found between groups on indicators of placement stability and school involvement, with odds ratios indicating youths in OTWH were 2 and 3 times more likely to be engaged in school and living in the community, respectively. Implications, limitations, and future research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Aftercare services have been suggested to improve reintegration for youth departing residential care programs. The purpose of this study was to collect views from legal professionals about the challenges youth and families face during reintegration and solutions to improve stability. Views were collected from 14 legal professionals (e.g., guardian ad litem, legal counsel) through a survey and 90‐minute nominal group technique focus group. Results indicated parent expectations about re‐entry and lack of services, supports and resources were challenges. Solutions suggested by participants included family, mental health and educational supports, and transition planning. Study limitations and future implications are discussed. [ABSTRACT FROM AUTHOR]

Multiple placements in therapeutic residential care is expensive, and is associated with poor outcomes; thus, identifying barriers to successful reintegration into the home and community school settings is essential for developing appropriate post-discharge supports, and reducing societal costs. Participants were seven youth (four female; three White/Caucasian, one Black/African American, one Hispanic/Latino, two multi-racial) recently readmitted to a therapeutic residential care program and five of their primary caregivers (four female; four White/Caucasian, one Black/African American). Through semi-structured interviews with caregivers and youth, this exploratory study investigated (1) the perceptions of preparedness for the youth’s successful transition from therapeutic residential care to the home setting, (2) the post-discharge factors that contributed to the youth’s return to care, and (3) the lessons learned about the youth’s transition from therapeutic residential care to home. The results of this exploratory, qualitative study revealed rich information about youth and their caregivers’ perspectives about their experiences prior to returning to care, such as the importance of healthy relationships (family and peers), transition planning, and post-discharge supports at the individual, family, and school levels. [ABSTRACT FROM AUTHOR]

Empowerment has been established as an important factor in resilience in adolescence. It has also been deemed critical for youth with emotional and behavioral disorders to achieve successful outcomes across academic, social, and behavioral domains, especially during a major transition. There is currently one measure used to evaluate empowerment in youth with mental health difficulties, yet it is unclear if this is a reliable measure for youth in therapeutic residential care. The purpose of this study was to examine the reliability and validity of this measure of empowerment in a sample of youth departing therapeutic residential care (N = 138) and to examine whether or not specific factors contribute to varied levels of empowerment. Findings indicate that the empowerment measure is reliable and valid for use with youth departing therapeutic residential care. Overall, youth report high levels of empowerment at discharge from care. None of the predictors in the three multivariate general linear models were statistically significant. Limitations and implications are discussed. [ABSTRACT FROM AUTHOR]

Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status. [ABSTRACT FROM PUBLISHER]

Residential care has been criticized for its high cost and limited research evidence. While recent studies and reviews of the literature suggest that a number of evidence-based practices are being implemented in residential care settings, more research is needed to develop and test empirically based practices that can be successfully implemented in residential care. In this article, we offer a promising strategy to address this issue: a long-term research partnership between a large service provider agency and a university-based research center to conduct a program of research which has resulted in translation of evidence-supported practices into service provider programs, contributions to the science of residential care, and training opportunities for young applied scientists to specialize in this important work. This evolving program of research includes four core applied research topic areas in which this collaboration has had some ongoing success: program and practice implementation fidelity, therapeutic process factors, aftercare, and psychotropic medication use. We suggest that this type of long-term collaborative research partnership is an approach for others to consider for conducting research that informs effective residential care practices. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted to compare parent and family teacher ratings of perceptions of aftercare services for youth. Participants in the study included parents of youth undergoing treatment in a residential Treatment Family Home (TFH), and family teachers working at the TFH. The study concluded that large number of differences were identified between family teachers and parents, due to which treatment providers should increase communication between them.

The provision of aftercare services for youth and families is an important topic in residential care. Focus groups were conducted with seven service professionals working with youth in residential care in the United States. Providers responded to two questions: Based on your involvement in residential care 1) what barriers do providers experience when trying to access aftercare services for youth who are departing residential care; and 2) what solutions have providers attempted or recommended to overcome barriers so that aftercare services are made available to youth? Common themes for barriers included: 1) Youth/Family barriers to engagement; 2) Aftercare programming issues and concerns; 3) State, local, and agency policy; 4) Lack of funding; and 5) Lack of interagency collaboration. Common themes for solutions included: 1) Continuity of care; 2) State, local, and agency policy recommendations; 3) Family engagement; 4) Funding solutions; 5) Discharge planning; 6) Agency collaboration; and 7) Technology. Study limitations, future research, and implications are discussed. [ABSTRACT FROM PUBLISHER]

The prevalence of weight problems among youth in general and youth in out-of-home care has been well documented; however, the prevalence of obesity/overweight among youth with high-incidence disabilities in more restrictive settings, such as residential care, has not been assessed. The purpose of the present study was to evaluate the prevalence of weight problems in 245 youth with learning disabilities or emotional disturbance at entrance to residential care. Youth intake files were examined to evaluate the association between youth demographic characteristics, medical conditions, prior placements and placement settings, medication usage, and internalizing and externalizing behavioral problems and clinical weight problems. Findings revealed that over one half of the youth were overweight or obese {50.6%), and weight problems were associated with gender, medical conditions, and age. Study limitations, future research efforts, and treatment implications are discussed. [ABSTRACT FROM AUTHOR]

Although previous studies have demonstrated that children in out-of-home care present with elevated levels of mental and physical health, educational, and behavioral problems, little is known about youth's ability to manage health care needs or access health information and support. This study evaluates the health literacy skills of 229 youth served in a residential setting. Results revealed that the majority of youth demonstrated some level of risk, and anywhere from one-quarter to one-third demonstrated significant health literacy deficits suggesting a need for additional research and treatment intervention. Implications, study limitations, and recommendations for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Research has indicated that youth eligible for special education services in residential centers are at an increased risk across many areas including overall health, medication use, academic, behavioral, and familial functioning. Yet it remains unknown how well they are able to read, understand, and use health-related information. The purpose of this study was to investigate the health literacy status of youth receiving special education (N= 61) services at a large residential care facility in the Midwest. Results indicate youth with disabilities are at increased risk of low health literacy in areas of reading recognition and comprehension. Specifically, well over 50% of the sample scored in the possible to likely limited health literacy level. Study limitations, future research, and implications are provided. [ABSTRACT FROM AUTHOR]

This study compares the On the Way Home (OTWH) aftercare program to traditional aftercare supports on placement and school stability for 82 youth (43 treatment, 39 control) with disabilities discharging from residential care. One-year-post-discharge results revealed that negative event occurrence (i.e., returning to care or discontinuing enrollment in the community school) was three to over five times less likely for OTWH youth compared to youth in the control condition. [ABSTRACT FROM AUTHOR]

This study evaluated the characteristics related to a successful reintegration among youth from a residential facility. Specifically, this study describes the transition skills of youth at departure in five areas: (a) education and employment goals, (b) self-determination skills, (c) social support, (d) life skills, and (e) hopefulness. Further, self-report and teacher ratings of youths' self-determination and life skills were examined to determine possible differences in perception between youth and their school and Family Teachers (house-parents). One hundred four youth departing the Boys Town Treatment Family Home residential program participated in the study. The majority of youth reported average to above average skills in the five domains. However, significant differences were found between youth and schoolteacher reports of self-determination skills. The results indicate the need to provide transition services related to success post-discharge, including individualized transition plans and family involvement during treatment. [ABSTRACT FROM AUTHOR]

Purpose: Undiagnosed language impairment (LI) for youth in residential care is a concern as similar populations have shown elevated levels of language delays. Therefore, the purposes of this study were to identify the percentage of youth in residential carewho are at risk for LI and to compare the demographic, academic achievement, and functional academic skills of youth with or without possible LI. Method: Participants were 80 youth in residential care. Risk for LI was determined using the Clinical Evaluation of Language Fundamentals-4 Screening Test (E. Semel, E. H. Wiig, & W. A. Secord, 2004). Independent-samples t tests and chi-square analyses were conducted to assess the differences between groups. Measures used included the Woodcock-Johnson Test of Achievement (R. W. Woodcock, K. S. McGrew, & N. Mather, 2001) and the Kaufman Functional Academic Skills Test (A. S. Kaufman & N. L. Kaufman, 1994). Results: More than half of the sample (54%) were identified as being at risk for LI. Statistically significant differences between youth with and without LI were found on academic variables. Specifically, youth who were at risk for LI presented academic achievement and functional academic scores in the low to low-average ranges. Conclusion: Findings suggest that there is a need to screen youth entering residential programs for possible LI. Implications for treatment and program planning are discussed. [ABSTRACT FROM AUTHOR]

Youth involved in residential care programs present with significant difficulties across behavioral and mental health domains. Although this is a group that is also at considerable risk for academic failure. very little research has been done to understand the academic functioning of this population. The current study sought to expand what is known about this population and examine factors that are predictive of their levels of academic functioning. Results from 208 youth indicated that at the time of entry into residential care youth were performing in low average ranges across academic areas. While several variables were identified as predictors for level of academic functioning (e.g.. IQ, age at admission, race/ethnicity. special education identification, and gender). variables particularly relevantfor youth in residential care programs (e.g.. behavior, number of previous schools attended) did not serve as predictors. Implications for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe the health-related quality of life (HRQoL) of adolescents in residential care and to examine selected correlates. A sample of 229 adolescents (mean age = 17 years) living in a residential care setting completed a validated measure of HRQoL (PedsQL 4.0 Generic Scales). Mean-level scores for Total HRQoL, Physical HRQoL, and Psychosocial HRQoL were examined, and the percentage of youth scoring below a clinical cutoff value was reported. Demographic and psychotropic medication data for each youth were accessed from an electronic database maintained by the residential care program and used to examine correlates of HRQoL. Approximately 25% of youth had at least 1 HRQoL score in the "at risk" range, indicating a significant proportion of youth in residential care have significant impairments in HRQoL. Younger age and female gender were associated with poorer HRQoL. Psychotropic medication prescriptions were associated with poorer HRQoL. A significant percentage of adolescents in residential care may experience suboptimal HRQoL, and certain demographic and clinical factors appear to be associated with greater risk. Systematic assessment of HRQoL is recommended for youth in residential care, and interventions to promote better HRQoL among youth at particularly high risk may be beneficial. [ABSTRACT FROM AUTHOR]