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There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients' readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco smoking represents a major cause for preventable death and morbidity. Results from non‐randomized studies suggest that smoking cessation therapy in a residential setting might be a new viable way to facilitate smoking abstinence. We aimed to test the effects of residential multicomponent group therapy for smoking cessation compared with outpatient group therapy. Design: Prospective parallel‐group open‐label randomized superiority trial, with assessments at baseline, 6 and 12 months. Setting: Recruitment throughout Germany via media advertisements. Participants: Adult smokers (≥10 cigarettes/day) randomly assigned to residential (n = 157) or outpatient (n = 158) therapy. 51.8% female; mean age 53.2 years; mean years of smoking 34.4. Intervention and Comparator: Residential 9‐day smoking cessation group therapy comprising six daily therapy sessions and supportive interventions for cessation and daily structure embedded in the routines of a somatic rehabilitation center, compared with weekly outpatient smoking cessation group therapy (3–7 weeks) provided in routine care courses close to the participants' places of residence, both including at least 9 h of behavioral therapy. Measurements Co‐primary outcomes were self‐reported continuous 6‐ and 12‐month abstinence (hierarchically ordered). Primary analyses were conducted in the therapy‐uptake population including participants who started therapy with sensitivity analyses in the intention‐to‐treat population of all randomized participants. Findings Intervention uptake rates were 87.3% (n = 137) in the residential and 60.1% (n = 95) in the outpatient group. In the therapy‐uptake population, abstinence rates were 46.7% in the residential versus 26.3% in the outpatient group at 6 months (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.39–4.33, P = 0.0019) and 39.4% versus 24.2% at 12 months (OR = 2.04, 95% CI = 1.14–3.64, P = 0.017). Biochemically validated abstinence rates at 12 months were 33.1% in the residential versus 17.4% in the outpatient group (OR = 2.35, 95% CI = 1.22–4.51, P = 0.011). In the intention‐to‐treat population, self‐reported and biochemically validated abstinence rates at 12 months were 34.4% in the residential versus 14.6% in the outpatient group (OR = 3.08, 95% CI = 1.77–5.34, P < 0.0001) and 28.6% versus 10.3% (OR = 3.48, 95% CI = 1.85–6.52, P = 0.0001), respectively. Conclusions: Residential therapy exclusively for smoking cessation is feasible and effective and could be a beneficial new treatment for smokers. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents in residential treatment (RT) encounter multiple obstacles upon discharge that can make maintaining treatment gains in the community challenging. This study examined relationships among parenting (sense of competence, practices), household chaos, and adolescent behavior problems in a sample of parents with adolescents in RT. Method: This exploratory cross-sectional study used convenience sampling to recruit 71 parents through Facebook. After providing informed consent, parents completed a battery of self-report instruments. Data were analyzed using descriptive statistics and linear regression. Results: Parents reported several strengths, including high involvement and consistent discipline, and low levels of corporal punishment. Parental sense of competence was relatively high, and household chaos was moderate. Adolescent inattention behaviors were positively associated with inconsistent discipline, corporal punishment, and parental sense of competence. Adolescent internalizing behaviors were positively associated with parent involvement and positive parenting and negatively associated with household chaos. Adolescent externalizing behaviors were positively associated with inconsistent discipline, corporal punishment, and parental sense of competence. Discussion: Findings suggest that there are numerous parenting strengths; however, some aspects of parenting could be promoted through evidence-based interventions such as parent training. Future research should also comprehensively study the home environment beyond self-report to understand environmental factors that may promote or inhibit adolescent behavior problems. [ABSTRACT FROM AUTHOR]

Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. Participants included 1056 individuals aged 18–69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population. • Suicide-related events were common among individuals seeking substance use treatment. • Suicide-related events were not isolated and often indicated further suicide-related events. • Factors indicating disadvantage were associated with a greater likelihood of suicidal behaviour. • Health service presentations currently represent missed opportunities for suicide prevention. • Continuing care and targeted suicide interventions are needed following substance use treatment. [ABSTRACT FROM AUTHOR]

Background: Fear of missing out (FoMO) and homesickness have been associated with a variety of negative psychosocial outcomes; however, they have rarely been studied together or with adolescents in residential settings. Objective: This study examined the potential associations of FoMO and homesickness with program outcomes in a sample of adolescents attending a military-style residential program. The residential treatment context inherently involves removal and isolation from an individual's typical living arrangements. Methods: Data were collected from 185 participants (aged 16–18) at three time points (i.e., 2 weeks after entry into the 19-week program; 9 weeks into the program; at week 18 of the program). RESULTS: Overall, FoMO and homesickness declined from initial assessment to midway through the program but rebounded just prior to exit from the program. FoMO and homesickness showed no direct correlations with participant outcomes, although both showed patterns of correlation demonstrating poor adjustment (e.g., low emotion regulation, high loneliness). Decreases in FoMO and homesickness during the program were positively correlated with distress tolerance. Conclusions: Given the negative implications of experiencing FoMO and homesickness, adolescents at risk for emotional distress tolerance may need additional support when initiating participation in residential programs. [ABSTRACT FROM AUTHOR]

Patients with severe or treatment-refractory obsessive–compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive–compulsive symptoms in patients with OCD. PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and—if available—at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive–compulsive symptoms decreased from admission to discharge with large effect sizes (g = −1.59, 95%CI [−1.76; −1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [−0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are—on average—maintained after discharge. [ABSTRACT FROM AUTHOR]

This study aims to describe secure institutional youth care homes in Sweden in terms of the conditions of their spatial environment (i.e. physical design and objects) and the individual characteristics of the youths placed there. Data were collected through a survey and from the Swedish National Board of Institutional Care. The study population consisted of 18 units and 1,859 youths in secure institutions in Sweden from 2006 to the end of 2016. The results showed that 74.1% of the youths were enrolled under acute circumstances. They often present with physical and mental health problems, such as sleep disturbance and lack of impulse control; the young people are placed in a restricted environment with little possibility to maintain a sense of security. Due to their previous traumatic experiences, this can be problematic in terms of care and treatment. The results show a tension between different aspects of control, highlighting the importance of offering care environments that both offer the staff "control functions" (i.e. functions facilitating observation and control over the environment) and offer the youths "control opportunities." Such environments need to be as homelike as possible, while simultaneously maintaining safe care for young people and a safe working environment for staff. [ABSTRACT FROM AUTHOR]

A better understanding of how childhood adversity (CA) patterns influence the effectiveness of Trauma Informed Care (TIC) for youth in residential programs is needed. Utilizing a longitudinal design, the study examined how CA patterns influenced aggression and self-injurious behavior during treatment and emotional and conduct outcomes for 1,343 racially diverse adolescents in a TIC residential program. Latent class analysis identified five CA patterns. Subsequent mixed, two-factor ANCOVAs indicated youth from all CA patterns experienced parallel decreases in emotional problems from intake to discharge while changes in conduct problems during this same period differed by CA pattern. Likewise, Hierarchical Linear Modeling revealed that youths' self-injurious behavior and aggressive behaviors over the first 12 months of the program also differed by CA pattern. Some demographic differences based on sex and race were found, which are discussed in turn. Findings indicate that while the program is functioning as TIC, more tailored support is needed for youth with specific CA patterns and demographics. Trauma-informed practices are important for improving emotional well-being in residential care. Tailored interventions for youth with specific trauma histories may help reduce self-injurious behavior and behavior problems. TIC programs may better serve youth with a variety of trauma histories by incorporating interventions that target social development. [ABSTRACT FROM AUTHOR]

BACKGROUND: Depression and anxiety are two of the top five mental illnesses veterans report. Treatment for depression and anxiety includes medications and psychiatric treatment in inpatient, outpatient, and residential treatment programs; the use of complementary and alternative medicine (CAM) can have beneficial results by decreasing symptoms, recognize patients' preference for CAM, and be cost-effective. AIM: This study aimed to evaluate the effects of Tai Chi on depression and anxiety symptoms on inpatient psychosocial or substance use disorder (SUD) rehabilitation treatment program residents since little evidence exists regarding the effectiveness of Tai Chi on participants in residential mental health treatment programs. METHOD: A mixed-method, cohort design with 88 participants (41 usual treatment without Tai Chi, 47 intervention) used a demographic survey, Hamilton Anxiety Scale, Quick Inventory of Depressive Symptomatology, self-report, and the Patient Health Questionnaire-9 at Weeks 1 and 4 of the treatment program. After Week 4, the intervention group responded to six open-ended questions about Tai Chi's effects on their overall depression and anxiety. RESULTS: The anxiety level of the intervention group was significantly decreased, as evidenced by the Hamilton Anxiety Scale scores (p =.02). However, the measures of depression did not differ between the groups. Two themes, mindfulness and satisfaction, were identified from the written responses regarding the Tai Chi intervention. CONCLUSION: Tai Chi effectively reduced symptoms of anxiety that varied by age and ethnicity. This study increased the insight regarding the benefit of including Tai Chi as a complementary therapy for those participating in residential treatment programs. [ABSTRACT FROM AUTHOR]

Satisfaction with an intervention influences the uptake of behavior changes and the long-term efficacy of the intervention. Therefore, it is crucial to assess satisfaction by participant profile when creating and adapting behavior interventions for minoritized populations. Qualitative and quantitative data on participant trauma symptom severity and intervention satisfaction were collected through self-report surveys from 54 women. The sample was 59.3% Hispanic, with an average age of 33.21 (SD = 10.42), who were in residential treatment for substance use disorders (SUDs) and participated in a 12-session mindfulnessbased intervention. Qualitative responses were coded using thematic analysis, and an integrative mixed-methods approach was used to compare qualitative theme frequency between high-trauma (N = 28) and low-trauma (N = 26) groups at session 2 and session 11. High- and low-trauma groups were determined by interquartile ranges (bottom 25% = low; top 75% = high). In session 2, the lowtrauma group reported significantly higher satisfaction (M = 4.20, SD = 0.55) than the high-trauma group (M = 3.77, SD = 0.89); t(43) = 1.90, p = 0.03. In session 11, there was no significant difference between groups. The mixed-methods analysis revealed that "trouble focusing" appeared more frequently in the hightrauma group than in the low-trauma group during session 2, but the theme was not present in either group at session 11, suggesting that this might pose an initial barrier for individuals with high trauma but subsides as the intervention progresses. This speaks to the importance of retention strategies tailored for participants with SUDs and high trauma while they adjust to the intervention. Assessing initial challenges with satisfaction may help facilitators intervene to increase participant satisfaction. [ABSTRACT FROM AUTHOR]

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist–Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction p s < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (p s < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (p s < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment. • Latent profile analysis (LPA) of 282 service members in residential PTSD treatment. • Four latent classes best fit data: Distressed, Moderate, Avoidant, and Depressive. • Treatment response differed among classes for both PTSD and depression outcomes. • Moderate class reported least PTSD symptom reduction. • Distressed and Depressive classes reported greatest depression symptom reduction. [ABSTRACT FROM AUTHOR]

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child's unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

AbstractThe Unified Protocol (UP) is a flexible, transdiagnostic form of cognitive behavioral therapy that effectively treats diverse psychiatric conditions in children, adolescents and adults. However, the UP has not been rigorously evaluated among children who have experienced severe trauma and may have limited caregiver involvement in their life. The present research project was a single arm, open trial examining the feasibility of utilizing the UP within a residential treatment facility in Calgary, Canada for children involved with child welfare authorities who often have limited caregiver involvement. Children (n = 19; age 9–13) and their caregivers (n = 18; age 32–60) participated in 15 weekly therapy sessions of the UP for Children with minor structural and content modifications. Trauma exposure was high among children, especially physical neglect and emotional abuse (89% exposed to each). Fidelity to the manualized intervention was high (88% for children; 89% for caregivers), indicating the intervention was feasible to deliver and that the adaptations did not interfere with fidelity. All children and caregivers completed the intervention, suggesting high acceptability for recipients. Improvements over time in maladaptive cognitions and behaviors (among children and caregivers) provide preliminary evidence for efficacy. The present study provides support for the notion that the UP for Children can be utilized for children who live in residential care and/or those who have experienced high levels of trauma. [ABSTRACT FROM AUTHOR]

Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a decreased odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) affect over 35 million individuals worldwide and are associated with significant harms. Residential treatment is an essential component of Canada's approach to combating SUDs, offering highly intensive and specialized acute services. Historically, residential treatment facilities have quantified the success of their program(s) solely based on program completion. However, there has been a recent movement toward empirically evaluating programs using standardized measures of distress. The purpose of this study was to evaluate whether the inpatient residential program for SUDs at Edgewood Treatment Centre is effective in providing substantive improvement of a range of addiction and mental health symptoms. The current study assessed both addiction related and psychological outcomes. Specifically, we examined whether patients improved on various measures of functional impairment, addiction-related symptoms, traumatic stress, and psychological distress, following completion of the 7-week inpatient addiction program. Findings suggested that there were significant improvements in emotion regulation, and decreases in substance dependence, substance cravings, anxiety, depressive symptoms, and traumatic stress between admission and discharge. [ABSTRACT FROM AUTHOR]

Direct care staff provide 24/7 care and supervision in residential treatment for youth; vacancy rates for these positions increased significantly during the COVID-19 pandemic. This study used multi-level, two-stage least squares regression to examine the relationship between staff vacancies and adverse events experienced by 1352 youth in Illinois child welfare residential care during October 2019-February 2022. Hierarchical cluster analysis was used to explore whether particular adverse event clusters were differentially related to vacancy rates. We hypothesized that direct care staff vacancies would be related to an increased number of adverse events overall and a specific increase in safety-related events. Although direct care staff vacancies were not significantly related to the overall number of adverse events, they were significantly associated with the magnitude of adverse events related to school suspensions, substance use, and law enforcement encounters. Several other novel, unanticipated findings emerged, with various youth- and facility-level factors (e.g. race, age, length of admission, facility level of clinical acuity) showing significant relationships with the magnitude of adverse events. This study fills a notable gap in the literature in its novel empirical approach to exploring administrative data capturing direct care staffing and adverse events in child welfare residential care. [ABSTRACT FROM AUTHOR]

Objective: Treatment guidelines on borderline personality disorder (BPD) recommend day-hospital or residential treatments for patients with BPD who cannot tolerate outpatient treatment (American Psychiatric Association, 2010; National Health & Medical Research Council, 2013). However, the current literature suggests that evidence-based treatment for BPD may be difficult to access (Lohman et al., 2017). The present study aims to characterize the accessibility of dialectical behavioral therapy (DBT) in day-treatment and residential programs in the United States in the last 7 years and examines whether day-treatment and residential programs that accept state benefits (i.e., Medicaid) are significantly less likely to offer DBT. Method: Using mixed logistic regression, we examined trends in the National Mental Health Services Survey data from 2014 to 2021, a survey of U.S. mental health facilities which tracks whether facilities provide DBT. Results: We found that the likelihood that a residential or day-hospital facility offers DBT has been growing over time at the national level (ORday-treatment = 1.07, SE =.03, z = 1.90, p =.05; ORresidential = 1.08, SE =.05, z = 1.77, p =.08). We also found significant variability in these trends at the state level. In addition, we found that facilities accepting state benefits were less likely to offer DBT (ORday-treatment =.66, SE =.021, z = −1.93, p =.05; ORresidential =.67, SE =.21, z = −1.91, p =.06). Conclusion: Consistent with previous literature, our study suggests that these programs are very scarce across the United States and difficult to access for those with Medicaid. What is the public health significance of this article?: The present study is the first to evaluate whether residential and day-hospital programs in the United States have become more likely to provide evidence-based treatment for borderline personality disorder (BPD) over time. Our findings suggest that the likelihood that residential and day-hospital programs provide dialectical behavioral therapy (DBT) has grown nationally since 2014. However, some states show significantly less growth relative to other states in the likelihood of residential and day-hospital programs to provide DBT, suggesting areas of disparity for patients with BPD needing a higher level of care. Our findings also suggest that residential and day-treatment programs which accept state benefits (i.e., Medicaid) tend to be significantly less likely to offer DBT. Targeting states with slower growth rates in these programs and states which have a greater number of consumers with Medicaid may increase access and reduce treatment disparities. [ABSTRACT FROM AUTHOR]

Objective: Major depressive disorder (MDD) and bipolar disorder (BD) are commonly comorbid with eating disorders (EDs). However, there is limited data about the clinical features of such patients, especially their association with traumatic histories and PTSD, which occur commonly in patients admitted to residential treatment. Methods: Adults (≥18 years, 91% female, n = 2155) admitted to residential ED treatment were evaluated upon admission for DSM‐5 defined MDD and BD. Patients were divided into three groups based on an admission diagnosis of no mood disorder (NMD), MDD, and BD (types I and II) and compared on a number of demographic variables, clinical features and assessments. Results: Mood disorders occurred in 76.4% of participants. There were statistically significant differences across groups in most measures with the BD group showing higher rates and doses of traumatic events; higher current PTSD; higher BMIs; higher severity of ED, depression and state‐trait anxiety symptoms; worse quality of life; and higher rates of substance use disorders. Similarly, the MDD group had higher rates than the NMD group on most measures. Conclusions: These findings have important implications for prevention, treatment and long‐term follow‐up and highlight the need for early trauma‐focused treatment of ED patients with comorbid mood disorders and PTSD. Highlights: In 2155 ED patients in residential care, 76.4% had current mood disorders (7.6% bipolar d/o, 68.9% MDD).Bipolar d/o patients had the highest rates of PTSD; greatest severity of PTSD, depressive and ED symptoms; highest BMI; and worst quality of life, followed by MDD patients.PTSD often needs to be treated in ED patients, especially those with mood disorders. [ABSTRACT FROM AUTHOR]

Satisfaction with an intervention influences the uptake of behavior changes and the long-term efficacy of the intervention. Therefore, it is crucial to assess satisfaction by participant profile when creating and adapting behavior interventions for minoritized populations. Qualitative and quantitative data on participant trauma symptom severity and intervention satisfaction were collected through self-report surveys from 54 women. The sample was 59.3% Hispanic, with an average age of 33.21 (SD = 10.42), who were in residential treatment for substance use disorders (SUDs) and participated in a 12-session mindfulness-based intervention. Qualitative responses were coded using thematic analysis, and an integrative mixed-methods approach was used to compare qualitative theme frequency between high-trauma (N = 28) and low-trauma (N = 26) groups at session 2 and session 11. High- and low-trauma groups were determined by interquartile ranges (bottom 25% = low; top 75% = high). In session 2, the low-trauma group reported significantly higher satisfaction (M = 4.20, SD = 0.55) than the high-trauma group (M = 3.77, SD = 0.89); t(43) = 1.90, p = 0.03. In session 11, there was no significant difference between groups. The mixed-methods analysis revealed that “trouble focusing” appeared more frequently in the high-trauma group than in the low-trauma group during session 2, but the theme was not present in either group at session 11, suggesting that this might pose an initial barrier for individuals with high trauma but subsides as the intervention progresses. This speaks to the importance of retention strategies tailored for participants with SUDs and high trauma while they adjust to the intervention. Assessing initial challenges with satisfaction may help facilitators intervene to increase participant satisfaction.

Background: Within residential treatment, medication for opioid use disorder (MOUD) is rarely offered, so little is known about group differences by MOUD status. This study characterizes samples of women receiving and not receiving MOUD and explores postdischarge outcomes. Methods: This is a secondary exploratory analysis of a residential clinical trial comparing women receiving treatment as usual (TAU) with those who also received computer-based training for cognitive behavioral therapy (CBT4CBT). Participants were N?=?41 adult women with substance use disorder (SUD) who self-reported lifetime polysubstance use. Because 59.0% were prescribed MOUD (MOUD n?=?24, no MOUD n?=?17), baseline variables were compared by MOUD status; outcomes at 12 weeks postdischarge were compared by MOUD status and treatment condition using chi square and Mann?Whitney U tests. Results: Participants were middle-aged (41.7???11.6 years) and non-Latinx Black (80.4%). Most used substances in the No MOUD group were alcohol, cocaine, and cannabis, and in the MOUD group, most used substances were opioids, cannabis, and cocaine. Women in the MOUD group tended to have more severe SUD. Postdischarge substance use recurrence rates were twice as high in the MOUD group than in the No MOUD group. Among the women in the No MOUD group, those in the CBT4CBT condition increased the number of coping strategies twice as much as those receiving TAU. Conclusion: Postdischarge substance use recurrence differed by MOUD status. CBT4CBT may be a helpful adjunct to personalized residential SUD treatment. The parent study is registered at [www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03678051)].

Abstract Background Ontario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options. Methods Between May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program’s OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively. Results A total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice. Conclusions Findings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.

BackgroundAcross the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs.MethodsWe conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts.FindingsThemes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services.ConclusionTo support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.

Empirical research exploring treatment outcomes among children in residential treatment centers (RTCs) is rare. Consequentially, there is an increasing demand for more studies examining such outcomes, particularly as they pertain to an individual’s experience leaving an RTC. This transitional period is believed to be a salient component impacting mental health treatment outcomes. Yet, little is known about how this residential treatment component is experienced and whether it impacts individuals long-term. This narrative qualitative study aimed to understand the experience of young adults who transitioned out of an RTC as a child. Participants recounted their experiences before, during, and after this transition. Six participants who resided in an RTC as a child for at least six consecutive months recounted their life experiences, producing 26 hours of interview data. Data were transcribed, coded, and written in narrative and thematic form. Our analysis produced three themes: learned and used effective coping skills, developed impactful relationships, and difficult adjustment post-discharge. [ABSTRACT FROM AUTHOR]

Community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, which has been hypothesized to be due to the variability of program offerings across treatments. Therefore, the purpose of the present study was to develop a realist program theory of a community-based residential treatment centre to understand which components of treatment are most effective, who benefits from treatment, and why. The study was completed in collaboration with a community-based residential treatment program located in Canada. A realist evaluation was conducted using qualitative interviews (N = 27) with program stakeholders. Transcripts were analyzed using thematic analysis to identify Context-Mechanism-Outcome (CMO) configurations that create the program theory. The analysis identified an overarching organizational context and 11 CMO configurations that comprise the program theory. The CMOs were grouped into three themes (i.e. relational, psychological, and diversity), underscoring the multiple pathways in which recovery is achieved for individuals with SUDs. Across the themes, the importance of building peer recovery relationships, creating structure, and inter-agency collaborations were highlighted. The results of the present study offer a contribution to the literature in understanding how, why, and for whom community-based residential treatment for SUDs is effective while offering specific recommendations to best tailor treatments to individuals. [ABSTRACT FROM AUTHOR]

Objective: Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co‐occurrence generally is associated with greater morbidity, self‐harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. Method: We report our experience with a case series of 18 patients with DSM‐5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state–trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma‐focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence‐based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t‐tests. Results: Following integrated, trauma‐focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. Discussion: These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma‐focused ED program at higher levels of care. Public Significance: EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma‐focused ED program. [ABSTRACT FROM AUTHOR]

Background: In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory—Revised (GCI‐R) is a new measure to assess group climate perceptions. Method: Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI‐R. Results: The results indicate support for the five‐factor structure of the GCI‐R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good (α:.72–.87; ω:.76–.86). Conclusion: The GCI‐R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities. [ABSTRACT FROM AUTHOR]

This study presents a tiered conceptualization of family partnership developed by the Family-Run Executive Director Leadership Association (FREDLA) with examples of strategies from the literature. This sub-study was part of an overarching systematic review project that aimed to review the literature on family partnership in relation to youth outcomes. The tiers of family partnership include family involvement (i.e. family's inclusion in their child's care); family engagement (i.e. collaboration between TRC and families); family-driven (i.e. families as full partners). This review included thirty studies (n = 23 family involvement, n = 7 family engagement, n = 0 family-driven). The most common family involvement methods were family therapy and family visits to the program, primarily, delivered face-to-face. The most common family engagement method was activities, therapies, and skill building occurring at the home with family present. Methods of measuring family partnership primarily included the use of administrative data. Implications for research and practice include the provision of research that evaluates the effects of family partnership on outcomes important in the TRC setting and the development of research-practice and family-research collaborations to increase the uptake of effective family partnering methods. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco use disorder is a major public health issue, and novel smoking cessation approaches are urgently needed. Residential treatment programs have been suggested as a potentially effective treatment for tobacco use disorder. However, there is limited literature on residential treatment programs for patientswho are exclusively dependent on nicotine. Aim: The aim of this study is to review the literature on residential treatment programs for patients admitted exclusively for tobacco use disorder. Methods: A literature search was conducted in PubMed with the aim of identifying relevant articles on residential treatment exclusively for tobacco use disorder from inception until February 2023. References in retrieved articles were screened for additional relevant articles. Results: Fourteen studies on residential treatment programs for tobacco use disorder were identified. The duration of the residential cessation programs ranged from 3 days to 3 weeks. Individualized or group cognitive behavioral therapy and tailored pharmacotherapy were the key components of the programs. Eligibility criteria for the programs included moderate to severe tobacco use disorder as measured by Fagerström or Diagnostic and StatisticalManual of Mental Disorders (DSM), consistent relapses, smoking-related comorbidities (eg, cardiovascular or pulmonary diseases), and daily use of (smokeless) tobacco. The 6- and 12-month 7-day point prevalence rate ranged from 58% to 26%, whereas the 6- and 12-month continuous abstinence rate ranged from 52% to 29%. Conclusions: Based on the literature we reviewed, residential smoking cessation programs targeted exclusively at individuals with tobacco use disorder have shown effectiveness, particularly for thosewho are highly dependent on tobacco and have a history of relapse. However, more research is needed to further explore the effectiveness of these programs and to determine the optimal program components and duration. [ABSTRACT FROM AUTHOR]

Background: Ontario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options. Methods: Between May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program's OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively. Results: A total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice. Conclusions: Findings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province. [ABSTRACT FROM AUTHOR]

AbstractIndigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms. [ABSTRACT FROM AUTHOR]

Objectives: In recent years, various treatment programs have been implemented in Iran aimed at rehabilitation and improvement of drug-dependent patients but so far, few studies have been conducted on the effectiveness of different treatment programs in terms of different outcomes. This study was conducted to determine the differences among patients participating in three therapeutic programs, outpatient, mid-term residential program, and therapeutic community (TC) in terms of social, psychological, economic, and therapeutic outcomes. Methods: The present study was conducted using a descriptive design and ex post facto method. Data were collected from patients participating in three treatment plans (outpatient treatment=49; mid-term residential treatment=49; and TC plan=49). Patients participating in the TC program were all enumerated and patients participating in the outpatient and mid-term residency treatment plan were selected by random sampling. Data collection tools were a socio-demographic characteristics checklist, researcher-made questionnaire for relapse, a general health questionnaire (GHQ), a world health organization quality of life (WHOQOL) questionnaire, and a family relationship index (FRI). The data were analyzed by one-way analysis of variance (ANOVA), chi-square, and Scheffe’s post hoc test. Results: Significant differences were observed between the three treatments in terms of the rate of relapse (P

BACKGROUND: In a randomized controlled 8-week trial, we examined the efficacy of aerobic and resistance exercise in reducing craving for methamphetamine (MA) among individuals with MA-use disorder during residential treatment. METHODS: Individuals with MA use disorder (138) who were newly enrolled in residential treatment volunteered for random assignment to either an 8-week exercise intervention (EX) or health education control (HE), with both conditions meeting 3 times weekly; 3 dropped out of the trial, bringing the analysis sample to 135. The majority of participants were male (80%), and 48% were Latino/Hispanic. The mean age of the sample was 31.7 (SD = 6.9) years. Using multivariate mixed models, differences between conditions were examined in: (1) craving for MA, measured by self-reported ratings on a Visual Analog Scale over the 8-week trial and, (2) MA use, measured by self-report and urine drug screens at baseline and 30 and 60 days after discharge from the 8-week study. RESULTS: Results revealed significantly lower craving scores among the participants in the EX group than those in the HE group over the 8-week trial (median daily craving score for EX = 13.5, for HE = 21.8; p = .009). In addition, participants with less craving during treatment had significantly lower rates of MA use after discharge than participants with high craving measured at 30-days (p = .004) and 60-days post-discharge (p

BackgroundObstructive sleep apnea (OSA) is often comorbid with both substance use disorders (SUD) and posttraumatic stress disorder (PTSD), yet frequently goes undiagnosed and untreated. We present data on the feasibility and acceptability of objective OSA diagnosis procedures, findings on OSA prevalence, and the relationship between OSA and baseline SUD/PTSD symptoms among veterans in residential treatment for comorbid PTSD/SUD.MethodsParticipants were 47 veterans admitted to residential PTSD/SUD treatment. Participants completed questionnaires assessing PTSD and sleep symptoms, and filled out a sleep diary for seven days. Apnea-hypopnea index (AHI) was recorded using the overnight Home Sleep Apnea test (HSAT; OSA was diagnosed with AHI ≥ 5).ResultsObjective OSA diagnostic testing was successfully completed in 95.7% of participants. Of the 45 veterans who went through HSAT, 46.7% had no OSA, 35.6% received a new OSA diagnosis, and 8.9% were previously diagnosed with OSA and were using positive airway pressure treatment (PAP); an additional 8.9% were previously diagnosed with OSA, reconfirmed with the HSAT, but were not using PAP. One hundred percent of respondents during follow-up deemed the testing protocol's usefulness as "Good" or "Excellent."ConclusionOSA diagnostic testing on the residential unit was feasible and acceptable by participants and was effective in diagnosing OSA. OSA testing should be considered for everyone entering a SUD and PTSD residential unit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This paper presents findings from a qualitative case study of staff participating in the reflective practices and processes available at an English children's home and specialist school. Researchers conducted a thematic analysis of 18 semi-structured interviews, 2 focus groups and 16 journal-based training assignments. Key themes identified in the data are outlined and a composite vignette conveys the lived experience of participating in the organization's reflective practice provision. Staff highlight the personal intensity of their ongoing reflective work, which is "like therapy but not therapy," and the challenges and benefits of learning to use and contribute to a reflective milieu. The concluding discussion widens findings by Heine Steinkopf and colleagues concerning the need for a regulating working environment and trustworthy theoretical model and suggests that "epistemic trust" in an organizational culture is key to effective teamwork and personal growth in role. [ABSTRACT FROM AUTHOR]

Digital media use is central for youth as a means to facilitate identity development, social connection, and vocational competence. Emerging literature suggests that the influence of digital media use is more nuanced than the contemporary risk/benefit discourse, particularly for youth who experience social and emotional vulnerability. This youth-centered, developmentally informed study attends to the gap in literature addressing the digital media use experiences among youth in residential treatment (RT). McCracken's Long Interview Method was utilized to conduct and analyze in-depth interviews with youth (n = 15) aged 13 to 18 in RT. The analysis involved movement from particular to general coding, applying categorical observations, and thematic comparison of transcripts. Consistent with existing literature on other youth populations, participants reported that digital media use had both beneficial and problematic implications for their well-being. Internet access decreased experiences of isolation and stigma and increased capacity to contend with marginalized identities (e.g., disability, Lesbian, Gay, Bisexual, Transgendered, Queer, Two Spirited Plus [LGBTQ2S+], child welfare guardianship). They reported that following an initial digital disconnect and stabilization, digital media use facilitated pathways toward agency, leadership, and community engagement (e.g., LGBTQ2S+ community, recovery blogs, animal advocacy). The findings suggest that supporting youth in RT to identify their online opportunities and needs can encourage individual growth, wellness, and participation in social change. [ABSTRACT FROM AUTHOR]

Objectives: In recent years, various treatment programs have been implemented in Iran aimed at rehabilitation and improvement of drug-dependent patients but so far, few studies have been conducted on the effectiveness of different treatment programs in terms of different outcomes. This study was conducted to determine the differences among patients participating in three therapeutic programs, outpatient, mid-term residential program, and therapeutic community (TC) in terms of social, psychological, economic, and therapeutic outcomes. Methods: The present study was conducted using a descriptive design and ex post facto method. Data were collected from patients participating in three treatment plans (outpatient treatment=49; mid-term residential treatment=49; and TC plan=49). Patients participating in the TC program were all enumerated and patients participating in the outpatient and midterm residency treatment plan were selected by random sampling. Data collection tools were a socio-demographic characteristics checklist, researcher-made questionnaire for relapse, a general health questionnaire (GHQ), a world health organization quality of life (WHOQOL) questionnaire, and a family relationship index (FRI). The data were analyzed by one-way analysis of variance (ANOVA), chi-square, and Scheffe’s post hoc test. Results: Significant differences were observed between the three treatments in terms of the rate of relapse (P<0.01), participation in criminal activities (P<0.01), changes in drug use in the treatment process or after treatment (P<0.01), employment status (P<0.01), mental health (P<0.01), quality of life (P<0.01), and family relationships index (FRI) (P<0.01). Discussion: The TC program showed more positive outcomes in terms of the rate of relapse and quality of life compared to the other two therapeutic programs. The outpatient treatment program was more effective in terms of participation in criminal activities, changes in drug use, employment, and quality of family relationships. The mid-term residency program showed a low or negative impact on all studied outcomes. Therefore, it is necessary to reevaluate the programs presented in the mid-term residential program. [ABSTRACT FROM AUTHOR]

BackgroundIndividuals with a substance use disorder (SUD) are at a significantly higher risk for coronavirus disease-19 (COVID-19) and have higher rates of COVID-19 related hospitalization and death than those without SUD. This study assessed COVID-19 vaccine trust, transmission awareness, risk and protective behaviors, and effects of COVID-19 on mental health and smoking among a sample of clients in California residential SUD treatment programs and identified factors associated with vaccine trust.MethodsA multi-site sample of SUD treatment clients (n = 265) completed a cross-sectional survey. Multivariable logistic regression was used to identify factors associated with COVID-19 vaccine trust.ResultsParticipants were predominantly male (82.3 %) and racially/ethnically diverse (33.3 % Non-Hispanic White). Most participants were aware of COVID-19 modes of transmission, however, only 39.5 % trusted a COVID-19 vaccine would be safe and effective. Factors independently associated with trust in a COVID-19 vaccine included age (AOR = 1.03, 95 % CI = 1.02, 1.05, p = 0.0001) and wearing a mask all the time (AOR = 2.48, 95 % CI = 1.86, 3.31, p = 0.0001). African Americans were less likely than White participants to trust that a COVID-19 vaccine is safe and effective (AOR = 0.41, 95 % CI = 0.23, 0.70, p = 0.001).ConclusionSUD treatment clients were aware of COVID-19 modes of transmission; however, fewer than half trusted that a COVID-19 vaccine would be safe and effective. Health communication about COVID-19 for people with SUD should use a multipronged approach to address COVID-19 vaccine mistrust and transmission risk behaviors.

IntroductionThe COVID-19 pandemic may present special challenges for residential substance use disorder (SUD) treatment facilities, which may lack infrastructure and support to implement infection control protocols while maintaining on-site treatment services. However, little is known about how residential SUD treatment programs are impacted by the COVID-19 pandemic.MethodsThe research team conducted semi-structured interviews with 17 directors of 20 residential SUD treatment programs across California during the state's shelter-in-place order. The researchers then analyzed qualitative interview data thematically and coded them using ATLAS.ti software.FindingsThematic analyses identified six major themes: program-level impacts, staff impacts, client impacts, use of telehealth, program needs, and positive effects. "Program-level impacts" were decreased revenue from diminished client censuses and insufficient resources to implement infection control measures. "Staff impacts" included layoffs, furloughs, and increased physical and emotional fatigue. "Client impacts" were delayed treatment initiation; receipt of fewer services while in treatment; lower retention; and economic and psychosocial barriers to community re-entry. "Use of telehealth" included technical and interpersonal challenges associated with telehealth visits. "Program needs" were personal protective equipment (PPE), stimulus funding, hazard pay, and consistent public health guidance. "Positive effects" of the pandemic response included increased attention to hygiene and health, telehealth expansion, operational improvements, and official recognition of SUD treatment as an essential health care service.ConclusionStudy findings highlight COVID-related threats to the survival of residential SUD treatment programs; retention of the SUD treatment workforce; and clients' SUD treatment outcomes. These findings also identify opportunities to improve SUD service delivery and suggest avenues of support for residential SUD treatment facilities during and after the COVID-19 pandemic.

Plain English Summary Posttraumatic stress disorder (PTSD) is common in patients with eating disorders and is associated with higher severity of symptoms and worse outcomes. However, this has not been studied extensively in patients admitted to higher levels of care, such as residential treatment. Using an integrated clinical approach based upon principles of cognitive processing therapy (CPT) and other evidence-based treatments, we studied outcomes at discharge and 6 months following discharge in 609 patients [96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD. All patients improved significantly and remained improved at follow-up compared to admission. However, all measured symptoms, including those of eating disorder, major depression, and state and trait anxiety, and a measure of quality of life, were worse in patients with PTSD at every time point (admission, discharge, and follow-up). The only significant worsening observed was for symptoms of major depression between discharge and follow-up. In conclusion, integrated treatment approaches that address PTSD and related problems can be successfully delivered in residential treatment and are associated with sustained improvements at 6 months following discharge. Improving strategies to prevent post-discharge recurrence of depressive symptoms is an important and challenging area of future work.

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child’s unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy.

This evaluation inspected the degree of symptom improvement associated with the Developmental Trauma and Attachment Program for decreasing disruptive behavior symptoms among youth in residential treatment following traumatic experiences within domestic and international adoption and foster care systems. Participants were 82 youth (Mage = 14.03 years) who were predominately born in the United States (n = 55) with 27 identifying with international domiciles. Analyses of pre–post data contrasts indicated statistically significant decreases in disruptive behavior symptoms from admission to discharge associated with small and medium effect sizes. Nearly 1 in 4 participants reported clinically significant changes associated with treatment, with about 1 in 3 reporting improvements, but not within the clinically significant range. Limitations to the generalization of findings and recommendations for future investigations are provided. [ABSTRACT FROM AUTHOR]

• PTSD is common in individuals seeking substance use treatment. • Case series describes concurrent treatment of PTSD with an adaptation of written exposure therapy (WET) during residential substance use treatment for three individuals. • Biweekly group delivery of an adaptation of WET was associated with favorable PTSD symptom outcomes in all three cases. Written exposure therapy (WET) is a brief intervention for posttraumatic stress disorder (PTSD) with promising and continually emerging research support. Given its efficiency in reducing symptom severity and resolving diagnoses, there is great interest in application to novel populations and settings. The current case series focuses on application of an adaptation of WET to three individuals participating in a residential substance use disorder treatment program in a group setting. The individuals had varying substance problems and trauma histories and all showed a favorable response. The series highlights the promise of an adaptation of WET as a concurrent treatment for PTSD in residential substance use treatment. Moreover, the case series suggests that an adaptation of WET has the potential to be successfully adapted to deliver services in a group environment and delivered in 2.5 weeks, thereby demonstrating the possibility of using an adaptation of WET as a means of maximizing the utilization of scarce resources to successfully treat a large number of individuals with PTSD in a time-limited residential treatment context. [ABSTRACT FROM AUTHOR]

Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16–29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement. [ABSTRACT FROM AUTHOR]