Residential care and cure:Achieving long-term effectiveness by using a Self-Determination, Common Factors and Motivational Interviewing approach

Residential treatment for youth includes both care, such as basic care-taking tasks and pedagogical child-rearing tasks, and cure elements, such as the therapeutic milieu and individual treatment plans. With these elements, residential treatment aims to achieve a healthy development and a decrease of the present problems with youth. However, achieving enduring change with youth after they have left residential treatment is a great challenge. This challenge can be explained by care workers’ difficulties to establish good, genuine therapeutic relationships with individual youth. Furthermore, it can be explained by the commonly used treatment approach to achieve behavior change with youth during residential care. In this paper, I suggest that higher long-term effectiveness of residential treatment can be achieved by applying a combination of three treatment approaches. First, by focusing on youth’s individual needs and intrinsic motivations using the Self-Determination Theory (SDT) perspective. Second, by using the Common Factors model as residential care element to promote professionals’ interpersonal skills and good, genuine therapeutic relationships with youth. Third, by applying the Motivational Interviewing (MI) approach as a residential cure element. By integrating these approaches as intervention components, it is very likely that residential treatment will contribute to more enduring behavior changes with youth

Feeling better:Experiences and needs of adolescents and professionals regarding their mentoring relationship in residential youth care

Purpose: In residential youth care, group care workers and teachers often serve as a mentor for individual adolescents. Research suggests that favorable mentoring relationships are associated with positive adolescent outcomes. However, few studies examined the role of mentoring in residential youth care. The present study aims to assess adolescents’, care workers’ and teachers’ mentoring relationship needs in terms of their one-on-one conversations during residential care. Method: Interviews with eleven adolescents, ten group care workers and two teachers show that all are rather satisfied with their conversations, which are often concerned with how it’s going with the adolescent. Results: Adolescents mostly consider their family and situation at home as difficult topics, while care workers mostly consider sexuality as a difficult topic to talk about. Although the aim is often ‘improvement’ with the youth, most adolescents report that they do not (know if they) show changes as a result of these conversations. Moreover, only one of the twelve professionals thinks that it is his core task to achieve behavior change with the young person. According to the professionals, conversations often aim at building a good relationship, coaching, determining treatment goals, and gaining insight into the adolescent. Adolescents prefer a mentor who is calm, has respect, listens, and is reluctant in giving advice. Most professionals do not use a specific treatment protocol or method and doubt whether they want to have conversations according to a manual, protocol or support tool. Discussion: Despite being rather satisfied, adolescents and professionals indicate several points for improvement of one-on-one conversations

Professionalizing care workers:Outcomes of a ‘Motivational Interviewing’ Training in residential youth care

Behavioral change in adolescents is often an important aim of residential youth care, but difficult to achieve. Care workers can increase the intrinsic motivation of adolescents to change their behavior by applying Motivational Interviewing (MI). The aim of this study is to investigate whether there is a difference in workers’ performance vis-à-vis adolescents before and after an MI training course. To measure this difference, we coded transcripts of audio recordings of one-on-one conversations between adolescents and workers, using the MITI 4.2.1 and MISC 2.5. We compared the transcripts made before the MI training course with the transcripts made after the training course. The results show that the 13 workers made significantly more use of MI adherent behaviors after the training course. Moreover, a trend toward using fewer MI non-adherent behaviors after the training was observed. The results suggest that workers are able to evoke more ‘change talk’ with adolescents after a training course. In conclusion, after attending a training course, workers are able to engage in conversations that are more in line with the MI-spirit. However, these are still not “real” MI conversations yet. We recommend to train workers more intensively in how to apply MI