Listening to Youth: The Importance of Youth Perspectives in Understanding Perceptions of Safety and Outcomes in Group Homes

Background and Purpose: There has been a great deal of concern about group homes for youth with mental health problems. Policy makers, practitioners, and researchers have raised concerns about safety, effectiveness, costs, and appropriateness of such placements. Recent research has suggested that group homes result in outcomes that are very similar to other forms of intensive treatment and that variations in aggregate outcomes among group homes are related to quality of treatment, care, and structure within these settings. Beyond these large-scale program-level variables, there is relatively little known about what factors are related to differential outcomes for individual youth within and across group homes.

Methods: Data come from a large-scale quasi-experimental NIMH-funded study of group homes in a southeastern state. The study included 44 homes across 14 agencies. During the 2-year recruiting period, 554 youth were recruited into the study. Data were collected via in-person interviews with group home staff and youth; telephone interviews with pre- and post-discharge caregivers; record reviews; and in-home observations. Longitudinal data are available to cover the period immediately preceding placement, every 4 months during treatment in the group home, and at 4 and 8 months post-discharge. Data include measures of symptoms, functioning, program implementation, quality of relationships, and youth perceptions of the program. Analyses include longitudinal modeling of change across time to examine relationships of program-level, relational-level, individual-level, and perceptual-level factors on outcomes.

Results:  The sample included a broad range of youth who were diverse on age, race, and sex (age ranged 6-21 [mean=14.7], 44% of the sample were youth of color, and 49% were female). Overall, youth in group homes showed significant improvement during their time in the homes. Utilization of an evidence-informed model of care (in this case the Teaching Family Model) was associated with a range of increased measures of quality of care and more sustained improvements after discharge. This proposed presentation focuses on factors beyond these basic indicators of implementation to identify potentially modifiable factors related to improved outcomes. Analyses show that these include: youth perceptions of staff fairness, helpfulness, and caring; better quality of youth-staff relationships; youth perceptions of safety; and prohibitions against use of restraint (all significant at p<.05).

Conclusions and Implications:  There is a great deal of focus on reducing use of group homes for youth – both in terms of number of youth placed and lengths of stay. Ongoing policy initiatives (e.g., Families First Prevention Services Act) suggest that this push away from group residential treatment will intensify in the near future. However, there are not currently viable alternatives to serve the number of youth with serious mental health and behavioral issues who are currently in group homes. Hence, it is imperative to learn what factors are associated with positive and negative outcomes for youth in group homes so that policy and practice can reflect empirically-supported approaches to improving youth outcomes and trajectories.