Research That Matters (January 17 - 20, 2008)

Background and Purpose: Youths in residential treatment centers (RTCs) are among the most disadvantaged clients in child welfare. To best meet these youths' needs, service providers in RTCs argue that services should be individualized as much as possible and that staff should target treatment interventions to particular needs or outcome goals. Researchers, however, have found that youths in RTCs often receive a “uniform pattern” of services rather than services tailored to needs, even while matching strategies applied in other residential settings have shown that better outcomes can result when service needs are matched to treatment components. This study contributes to the literature on service matching for youths in RTCs by assessing need-service matches from youths' perspectives and over time. Methods: The study uses data from a longitudinal study of youths (n = 130) in two residential treatment centers. Data for the longitudinal study were collected at four points in time: at intake, midway through the stay, prior to discharge, and four months post-discharge. This study uses data from the first two waves. Needs are indicated by youths' responses to items assessing psychological symptoms, risky behaviors, self efficacy, and future orientation. Services, or intervention approaches, are indicated by youths' responses to items assessing staff members': use of future focusing activities, challenges to negative thoughts (i.e., use of cognitive interventions), and provision of new roles and experiences. Need-service matches are first assessed through bivariate associations between needs at intake and interventions received by the midpoint of the residential stay. Multivariate linear regression models are conducted to assess whether relationships between needs and logically matched interventions are related to other youth characteristics, such as age, race, academic achievement, or early engagement in treatment. Results: Bivariate relationships between youths' identified needs and logically matched interventions are largely consistent with a “needs-service gap.” Needs are either unrelated to logically matched interventions or are related in the opposite direction of a matched service response. For example, youths with lower future orientation at intake report receiving fewer future focusing activities from staff at Wave 2. Multivariate models reveal, however, that certain needs are indeed matched with interventions, but the matching relationship is suppressed by the important role played by early engagement in treatment. Youths with more psychological symptoms, for example, also receive more matched cognitive interventions once youths' early engagement is controlled for in multivariate models. Conclusion and Implications: This study opens further part of the “black box” of youths' experiences in residential treatment. The study is unique in measuring needs and treatment interventions from the youths' perspective, as continuous variables, and at two points in time during a residential stay. Results show some, albeit mixed, success in matching services to needs in two RTCs and underscore the importance of early treatment engagement in these settings. Social workers can further advance research in this area by addressing whether matched services lead to better outcomes for youths in RTCs.