Improving Youth Outcomes during and after out-of-Home Treatment

Background and Purpose:  This presentation focuses on ways to ensure healthy development for youth who are placed in out-of-home treatment because of mental health and/or behavioral problems. Youth in out-of-home placements have extensive risk profiles (e.g., mental health diagnoses, extended and complex patterns of residential instability and system involvement, school problems/failure, complex family histories and exposure to a wide range of risks, child maltreatment, etc.) and high rates of problematic outcomes and recidivism. This set of study was conducted to better understand factors that contribute to improving trajectories for such youth both during out-of-home treatment and once they are discharged.

Methods:  The presentation builds from a set of studies on youth in out-of-home placements for mental health/behavior problems. Focal treatment settings include treatment foster care (TFC) and group homes (GH). The presentation focuses on samples from 3 NIMH-funded studies conducted in a southeastern state. The TFC sample includes 183 youth who participated in a longitudinal (non-intervention) study, 247 youth who participated in a randomized trial, while the GH sample includes 554 youth who participated in a quasi-experimental study. Once enrolled in the study, youth were followed every 4-6 months during their treatment in the residential placement and after discharge (up to 24 months post-discharge). Data came from interviews with caregivers, residential (TFC, GH) staff, youth, and agency records. Analyses examined changes across time in key indicators (e.g., symptoms, problems, functioning) as well as relationships between such changes and key hypothesized factors (e.g., quality of treatment during residential stay, relationships between youth and significant adults, youths’ perceptions of experiences, etc.).

Results: This sample of 984 youth resided, on average, approximately 11 months in the focal out-of-home setting (for both TFC and group homes). During their placement in TFC or group home, youth showed rapid and significant improvements from pre-admission levels of problems and symptoms. After discharge, youth showed substantially varied trajectories of placement stability and sustained improvements. Results suggest that quality of treatment while in the residential setting was associated with overall change and sustainability of gains in the post-discharge period. Improvements were also linked to youths’ perceptions of and relationships with residential staff/caregivers. Results suggest similar effects and patterns across TFC and GH – with quality of treatment being a much more significant predictor of outcomes than treatment setting.

Conclusions and Implications: Given current policy and practice issues, legislative initiatives, and agendas, it is critical to focus on quality of treatment and implications for youth, rather than focusing narrowly on setting-based interventions. Findings suggest that, on average, youth show substantial and significant improvement while they reside in out-of-home treatment, regardless of setting. Quality of practice during treatment influences outcomes both during placement and during the post-discharge period. Results suggest the importance of improving quality of care while youth are out of home, but also on supporting youth and families during the post-discharge period to maximize opportunities for youth to maintain and expand the successes they achieve during treatment.