Treatment Mediators and Outcomes of Latent Classes of Youth in Psychiatric Residential Treatment

Abstract

The purpose of this study was to examine differences in discharge outcomes between latent classes of youth in psychiatric residential treatment. The mediating effect of family therapy, behavioral management incidents, and length of stay on class membership and treatment outcomes were examined. The sample included 447 youth assigned to one of four classes. Guided by Thornberry and Krohn’s (2005) interactional theory of continuity and change, change in functional impairment was predicted based on the composition of risk versus protective factors that comprised the latent classes. A manual 3-step approach was used to fit a latent class mixture model and estimate conditional effects on impairment at discharge. A mediation model was used to examine indirect effects of treatment factors on outcomes between latent classes. The results showed that classes with lower-level risk factors and more protective factors experienced significantly greater reductions in impairment on average. Treatment outcomes were mediated by behavioral management incidents but not length of stay or the number family therapy sessions. The results demonstrate the usefulness of person-centered approaches for conducting subgroup analyses in residential care outcomes studies; highlighting differences in outcomes between groups and treatment factors that may mediate these differences.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Data Availability

These data are not currently available for public use to confidentiality restrictions.

References

  1. Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using M plus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329–341.

    Article  Google Scholar 

  2. Baker, A. J. L., Wulczyn, F., & Dale, N. (2005). Covariates of length of stay in residential treatment. Child Welfare, 84, 363–386.

    PubMed  Google Scholar 

  3. Bettman, J. E., & Jasperson, R. A. (2009). Adolescents in residential and inpatient treatment: A review of the outcomes literature. Child and Youth Care Forum, 38, 161–183.

    Article  Google Scholar 

  4. Breda, C. S. (1996). Methodological issues in evaluating mental health outcomes of a children’s mental health managed care demonstration. The Journal of Mental Health Administration, 23, 40–50.

  5. Brown, J. D., Barrett, K., Ireys, H. T., Allen, K., Pires, S. A., Blau, G., & Azur, M. (2012). Seclusion and restraint practices in residential treatment facilities for children and youth. American Journal of Orthopsychiatry, 82, 87–90.

    Article  Google Scholar 

  6. Bryson, S. (2013). Inpatient psychiatric care for children and youth: Predictors and precipitants of admission and readmission. Presented at Society for Social Work and Research 17th annual conference: Social work for a just society: Making visible the stakes and stakeholders. PowerPoint slides retrieved from https://sswr.confex.com/sswr/2013/webprogram/Paper19368.html

  7. Chow, W., Mettrick, J. E., Stephan, S. H., & Von Waldner, C. A. (2014). Youth in group home care: Youth characteristics and predictors of later functioning. Journal of Behavioral Health Services & Research, 41, 503–519. https://doi.org/10.1007/s11414-012-9282-2.

  8. Connor, D. F., Melloni, R. H., Miller, K. P., & Cunningham, J. A. (2002). What does getting better mean? Child improvement and measure of outcome in residential treatment. American Journal of Orthopsychiatry, 72, 110–117.

    Article  Google Scholar 

  9. Courtney, M. E., Hook, J. L., & Lee, J. S. (2012). Distinct subgroups of former foster youth during young adulthood: Implications for policy and practice. Child Care in Practice, 18(4), 409–418.

    Article  Google Scholar 

  10. Cuthbert, R., St. Pierre, J., Stewart, S. L., Cook, S., Johnson, A. M., & Leschied, A. W. (2011). Symptom persistence in seriously emotionally disordered children: Findings of two-year follow-up after residential treatment. Child & Youth Care Forum, 40, 267–208.

    Article  Google Scholar 

  11. De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011). Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. European child & adolescent psychiatry, 20, 221–230. https://doi.org/10.1007/s00787-011-0160-x.

  12. DSM-IV-TR., A. P. A. (2000). Diagnostic and statistical manual of mental disorders (pp. 70–76). Washington, DC: American Psychiatric Association.

  13. Eisengart, J., Martinovich, Z., & Lyons, J. S. (2008). Discharge due to running away from residential treatment: Youth and setting effects. Residential Treatment for Children and Youth, 24, 327–343.

    Article  Google Scholar 

  14. Farmer, E. M. Z., Seifert, H., Wagner, R., Burns, B., & J., & Murray, M. (2017). Does model matter? Examining change across time for youth in group homes. Journal of Emotional and Behavioral Disorders, 25, 119–128.

    Article  Google Scholar 

  15. Gorkse, T. T., Srebalus, D. J., & Walls, R. T. (2003). Adolescents in residential centers: Characteristics and treatment outcome. Children and Youth Services Review, 25, 317–326.

    Article  Google Scholar 

  16. Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: A review of research from 1993 to 2003. Journal of Child and Family Studies, 14, 551–575.

    Article  Google Scholar 

  17. Hoagwood, K., & Cunningham, M. (1992). Outcomes of children with emotional disturbance in residential treatment for educational purposes. Journal of Child and Family Studies, 1, 129–140.

  18. Hodges, K. (2004). Child and adolescent functional assessment scale (CAFAS). The use of psychological testing for treatment planning and outcome assessment, 3, 405–441.

    Google Scholar 

  19. Hodges, K., & Wong, M. M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The child and adolescent functional assessment scale. Journal of Child and Family Studies, 5, 445–467.

    Article  Google Scholar 

  20. Hodges, K., Wong, M. M., & Latessa, M. (1998). Use of the child and adolescent functional assessment scale (CAFAS) as an outcome measure in clinical settings. The Journal of Behavioral Health Services & Research, 25(3), 325–336.

    Article  Google Scholar 

  21. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  22. Huefner, J. C., Pick, R. M., Smith, G. L., Stevens, A. L., & Mason, A. W. (2015). Parental involvement in residential care: Distance, frequency of contact, and youth outcomes. Journal of Child and Family Studies, 24, 1481–1489.

    Article  Google Scholar 

  23. Hussey, D. L., & Guo, S. (2002). Profile characteristics and Behavioral change trajectories of young residential children. Journal of Child and Family Studies, 11, 401–410.

    Article  Google Scholar 

  24. Knorth, E., Harder, A., Zandberg, T., & Kendrick, A. (2008). Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review, 30, 123–140.

    Article  Google Scholar 

  25. Landsman, M. J., Groza, V., Tyler, M., & Malone, K. (2001). Outcomes of family-centered residential treatment. Child Welfare, 80, 351–379.

    PubMed  Google Scholar 

  26. LeBel, J., Huckshorn, A. K., & Caldwell, B. (2010). Restraint use in residential programs: Why are best practices ignored? Child Welfare, 89, 169–187.

    PubMed  Google Scholar 

  27. Lee, L. J. (2011). Adult visitation and permanency for children following residential treatment. Children and Youth Services Review, 33, 1288–1297. https://doi.org/10.1016/j.childyouth.2011.03.002.

  28. Lee, B. R., & Barth, R. P. (2011). Defining group care programs: An index of reporting standards. Child & Youth Care Forum, 40, 253–266.

    Article  Google Scholar 

  29. Lee, B. R., Chmelka, M. B., & Thompson, R. (2009). Does what happens in group care stay in group care? The relationship between problem behaviour trajectories during care and post-placement functioning. Child & Family Social Work, 15, 286–296.

    Article  Google Scholar 

  30. Loughran, T. A., Mulvey, E. P., Schubert, C. A., Fagan, C. A., Piquero, J., & Losoya, S. H. (2009). Estimating a dose-response relationship between length of stay and future recidivism in serious juvenile offenders. Criminology, 47, 699–740.

    Article  Google Scholar 

  31. McLarnon, M. J. W., & O’Neill, T. A. (2018). Extensions of auxiliary variable approaches for the investigation of mediation, moderation, and conditional effects mixture models. Organizational Research Methods, 21, 955–982.

    Article  Google Scholar 

  32. Pecora, P. J., & English, D. J. (2016). Elements of effective practice for children and youth served by therapeutic residential care. Seattle, WA: Case family programs. Retrieved December, 1, 2016 from: http://www.casey.org/residential-care/

  33. Pecora, P. J., Wittaker, J., Maluccio, A. N., Barth, R. P., DePanfilis, D., & Plotnick, R. D. (2010). The child welfare challenge: Policy, practice, and research (3rd ed.). Somerset: Transaction Publishers.

    Google Scholar 

  34. Pfeiffer, S. I., & Strzelecki, S. (1990). Inpatient psychiatric treatment of children and adolescents: A review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 847–853.

    Article  Google Scholar 

  35. Piquero, A. R. (2008). Taking stock of developmental trajectories of criminal activity over the life course. In A. M. Liberman (Ed.), The long view of crime: A synthesis of longitudinal research. Washington, DC: Springer.

    Google Scholar 

  36. Rebbe, R., Nurius, P. S., Ahrens, K. R., & Courtney, M. E. (2017). Adverse childhood experiences among youth aging out of foster care: A latent class analysis. Children and Youth Services Review, 74, 108–116.

    Article  Google Scholar 

  37. Robst, J., Rohrer, L., Armstrong, M., Dollard, N., Sharrock, P., Batsche, C., & Reader, S. (2013). Family involvement and changes in child behavior during residential mental health treatment. Child and Youth Care Forum, 42, 225–238.

    Article  Google Scholar 

  38. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.

    Article  Google Scholar 

  39. Stage, S. A. (1999). Predicting adolescents’ discharge status following residential treatment. Residential Treatment for Children & Youth, 16, 37–56.

    Article  Google Scholar 

  40. Sunseri, P. (2001). The prediction of unplanned discharge from residential treatment. Child & Youth Care Forum, 30, 283–303.

    Article  Google Scholar 

  41. Sunseri, P. (2004). Family functioning and residential treatment outcomes. Residential Treatment for Children & Youth, 22, 33–53.

    Article  Google Scholar 

  42. Thornberry, T. P., & Krohn, M. D. (2005). Applying interactional theory to the explanation of continuity and change in antisocial behavior. In D. P. Farrington (Ed.), Integrated developmental & life-course theories of offending (Vol. 14, pp. 166–183). New Brunswick: Transaction Publisher.

    Google Scholar 

  43. Whittaker, J. K., Holmes, L., del Valle, J. F., Ainsworth, F., Andreassen, T., Anglin, J., et al. (2016). Therapeutic residential care for children and youth: A consensus statement of the international work group on therapeutic residential care. Residential Treatment for Children & Youth, 33, 89–106.

    Article  Google Scholar 

  44. Wulczyn, F., Chen, L., & Hislop, K. B. (2007). Foster care dynamics, 2000–2005: A report from the multistate foster care data archive. Chapin Hall Center for Children at the University of Chicago.

  45. Yampolskaya, S., Mowery, D., & Dollard, N. (2014). Profiles of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care. American Journal of Orthopsychiatry, 3, 234–243.

    Article  Google Scholar 

  46. Zinn, A., & Havlicek, J. (2014). Pathways to residential care: Latent class and confirmatory analyses of adolescents’ adverse placement event histories. Social Service Review, 88, 367–406.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Shamra M. Boel-Studt.

Ethics declarations

Conflict of Interest

The author has no conflicts of interest to disclose.

Code Availability

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Boel-Studt, S.M. Treatment Mediators and Outcomes of Latent Classes of Youth in Psychiatric Residential Treatment. Journ Child Adol Trauma (2021). https://doi.org/10.1007/s40653-021-00344-2

Download citation

Keywords

  • Residential group care
  • Person-centered analysis
  • Intervention research
  • Juvenile justice
  • Child welfare