Rural-Urban Differences in Outcomes from Group Home Treatment for Youth

Background and Purpose:  This paper compares mental health treatment experiences and outcomes for youth from rural and urban areas. Children’s mental health services research has focused predominantly on services for youth living in urban areas. This is understandable, based on where the majority of America’s youth live and the complex system-level issues involved in urban areas. However, this emphasis has resulted in a lack of knowledge about issues related to children’s mental health services and outcomes in non-urban areas and for rural youth. Data on rural areas suggests a mixed set of strengths and challenges – with potential benefits around social relationships and social capital in the local community, but corresponding challenges of increasing levels of poverty, substance use/abuse, lower rates of insurance coverage and education, lack of proximity to treatment services, and belief systems that may stigmatize mental health disorders and treatment. Therefore, it is important to expand knowledge of treatment services and outcomes for rural youth.

Methods: Data come from a longitudinal study of youth receiving group home treatment in a southeastern state. Data come from 554 youth who were served across 56 homes within 14 agencies. Data are available on the location and rurality of both the participating agencies and the youth’s primary residence (immediately before placement). Data were collected at baseline, every 4 months while the youth resided in the group home, and at 4- and 8-months post-discharge. These include data on youths’ symptoms, functioning across a range of settings, services received, relationships between youth and key adults, and youths’ assessments of their experiences in the group homes.  

Results: Data on homes show that 36% of group homes were located in urban areas, while only 19% of the youth placed in these homes came from urban areas. Urban and rural youth did not show significantly different levels of mental health symptoms at the time of placement (20.1 v. 18.7 on the Strengths and Difficulties Questionnaire, p>.05) and approximately 25% of rural and urban youth had a psychiatric hospitalization at some point prior to their focal placement in a group home. However, rural youth showed significantly better outcomes in the post-discharge period than their urban counterparts, both in terms of symptom scores on the SDQ and caregivers’ subjective evaluations of how well the youth was doing (both p<.01)). Additional analyses explore the relationships between services received during treatment, youths’ relationships with adults (in and after group home treatment), and potential influences of services and community involvement in the post-discharge period.

Conclusions and Implications: These data on youth in group homes suggest that rural youth do not differ on severity of problems at the time of placement into group homes, but that they show more substantial and lasting improvements after such treatment. Further understanding the processes, factors, and relationships that underlie these different outcomes may provide important directions for more effectively serving youth in rural areas and identifying potential modifications for affecting outcomes for youth in more urban communities.