The Impact of Familial and Youth Risk and Resiliency Factors on Youth Functioning during Residential Treatment

Background and Purpose: Higher levels of trauma are associated with less resiliency among youth. Youth in residential care have more complex trauma histories compared to youth in community-based care. Examining resiliency factors that positively impact functional impairment and treatment response among youth in residential treatment may guide intervention development. The purpose of this study was to examine whether risk and resiliency characteristics effect improvement in youth functioning during their stay in residential care. The study sought to answer the following research question: How do known familial and youth risk and resiliency factors impact change in functional impairment among youth in residential treatment?

Methods: Study sample included 444 youth 5-17 years of age receiving treatment in a residential center. Youth factors included age at admission, gender, race, emotional abuse, coping skills, compliance, problem-solving skills, respects authority, and school education. Family factors included basic needs met, coping skills, and receptive to services. First, a bivariate correlation analysis examined the relation between youth demographics and risk and resiliency factors and functional impairment at discharge. Next, youth demographics and risk and resiliency factors that accounted for significant variance in discharge impairment scores were added to a hierarchal regression in 5 steps. Model 1 tested the effect of age and functional impairment at admit on functional impairment at discharge. Model 2 tested the effect of emotional abuse on functional impairment at discharge. Model 3 tested the effect of youth compliance on functional impairment at discharge. Model 4 tested the effect of family basic needs met and family coping skills on functional impairment at discharge. Model 5 tested the interaction of functional impairment at admit and youth compliance.

Results: Significant predictors of functioning at discharge from the hierarchical regression were functional impairment at intake based on admit CAFAS scores (b= .63, t= 9.19, 95% CI [.49, .76], emotional abuse (b= 8.78, t= 2.21, 95% CI [.98, 16.57], youth compliance (b= -26.51, t= -4.06, 95% CI [-39.33, -13.68], family basic needs met (b= -12.10, t= -2.82, 95% CI [-20.54, -3.65], family coping skills (b= -10.76, t= -2.02, 95% CI [-21.29, -.28], and the interaction of youth functioning at admit to residential treatment and youth compliance (b= -.42, t= -2.34, 95% CI [-.77, -.07]. R square change was statistically significant for all 5 models. Age and impairment at admit accounted for the greatest amount of variance in impairment at discharge. The final model including all predictors and interactions accounted for 27.6% of the variance (R²= .276, F_(1,436) = 23.76, p< .001).

Conclusions and Implications:

Emotional abuse, youth compliance, family coping, and family basic needs met were significant predictors of functional impairment at discharge in the final model. The relation between functional impairment at intake and discharge varied as a function of the youth’s compliance during treatment. Results from the study suggest that providing families of youth in treatment with resources to meet basic needs and improve coping skills may increase resiliency among youth in treatment by increasing their functioning throughout the course of treatment.