(WITHDRAWN) A Systematic Review of the Effectiveness of Children's Behavioral Health Interventions in Psychiatric Residential Treatment Facilities

Background/Purpose: The effective treatment of youth with significant behavioral concerns remains an essential issue in the broader national conversation on mental health. The Centers for Disease Control and Prevention report that 7.4% of children aged three to seventeen years—approximately 4.5 million—have been diagnosed with a behavioral disorder. Treatment options available for youth diagnosed with behavioral disorders vary in terms of setting, restrictiveness, and methodology. Psychiatric residential treatment facilities (PRTFs) represent a particularly restrictive and costly level of youth care. Examining the benefits and shortcomings of PRTFs as settings for intervention delivery can be difficult due to the significant variation in definitions, structure, training, staffing, format, services, and practice across sites. Consequently, judging the general effectiveness PRTFs is challenging, and efforts are warranted to identify the specific interventions and practice behaviors being implemented in these spaces, particularly those that appear to yield positive outcomes for youth. Thus, the purpose of this systematic review is to synthesize quantitative or mixed-method studies that have evaluated the efficacy of specific interventions or practice behaviors with youth in the context of PRTFs in the United States. Findings can map our current understanding of what appears to work well, or not, in the context of youth PRTFs. Findings can also point to key gaps in the literature and inform future research efforts.

Methods: Our systematic review procedures adhered to best practices as outlined by Cooper (2010) and Littell, Corcoran, and Pillai (2008). We also incorporated A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Search terms were informed via consultation with a university social science reference librarian, and four electronic databases were searched. Our search was inclusive of both published studies and studies in the gray literature. Using a priori inclusion and exclusion criteria, team-based search and screening procedures yielded a final sample of 47 relevant studies.

Results: Studies varied with respect to publication status; sample size; research design; youth gender identity; youth racial/ethnic identify; youth behavioral, psychological, and developmental or intellectual concerns at intake; outcome measures; and interventions evaluated. Evaluated interventions could be clustered into one of five categories: (a) modifications to system of treatment, (b) therapeutic modalities, (c) educational/alternative programs, (d) practice behaviors, and (e) post-discharge engagement. The majority of studies noted youth outcome improvements; however, some studies also yielded mixed, inconclusive, or null results.

Conclusions/Implications: Taken together, findings demonstrate the wide diversity of practice interventions currently deployed in youth residential treatment settings. Interventions studied ranged from more “traditional” cognitive-behavioral approaches to more “innovative” practices. They also ranged in scope, from system-level philosophy changes to practitioner-youth interactions. Overall, we would characterize the breadth and depth of research to be insufficient in providing residential programs and policymakers a clear and firm understanding of “what works” in residential treatment settings for youth. A major implication of our review is the need for more research in this area and efforts to incentivize the evaluation of ongoing practices in youth PRTFs.