The Interplay of Youth and Care Characteristics with a Positive Social Climate in Therapeutic Residential Youth Care

Background: Limited research exists on how therapeutic residential youth care (TRC) achieves treatment outcomes. More specifically, little is known about the association between contextual factors such as treatment organization, youth characteristics, and experienced social climate in TRC. Therefore, this study aims to investigate differences between latent classes of TRC and youth characteristics and their association with a positive perceived social TRC climate. Method: We applied a person-centered approach in a cross-sectional design with a sample of 400 adolescents and 142 staff leaders. We analyzed youth and TRC characteristics in a latent class analysis and established associations with social climate for these two groupings. Results: The two types of TRC settings we found, i.e., larger TRC settings and family-style TRC settings, show small differences in social climate. These settings only differed on youth activities and staff shifts type (more cohabitation and unorganized activities outside TRC in family-style TRC). We identified four adolescent classes: A severe problems group, youth with incidental problems, family problems, and a migrant background group. The migrant background group showed the most positive perceptions of social climate, followed by youth with incidental problems, family problems, and severe problems. Conclusions: TRC staff should acknowledge how perceived social climate is connected to TRC characteristics and the heterogeneity of adolescents in care. As social climate is subjective and dynamic, a continuous dialogue about TRC social climate between staff and youth is recommended. Future research should investigate how these aspects are associated with treatment outcomes to increase our understanding of achieving positive outcomes in TRC

Determinants and Outcomes of Social Climate in Therapeutic Residential Youth Care: A Systematic Review

Background: Previous studies on effectiveness of therapeutic residential youth care (TRC) have indicated that, compared to short-term effects, long-term effects are less convincing. Moreover, there is limited evidence on how TRC achieves treatment goals: TRC remains too much of a “black box”. To gain durable treatment results we need to know more about how results are achieved, rather than investigating the achieved results itself. One of the factors associated with this process of change is the social climate within TRC institutions. Up until now, no literature reviews about how social climate is affect by institution and youth characteristics, and how social climate affects outcomes has been performed. Objective: To provide an overview of the literature on associations between determinants and social climate and between social climate and outcomes in TRC. Method: We searched multiple databases with a predetermined set of search criteria in the years 1990 and March 2017. We identified 8408 studies and reduced the final sample to 36 studies. Most studies were empirical assessments with a correlational design and were conducted in Western countries. Results: Effect sizes for the studies ranged from small to large and varied between and within studies. Most associations were found between social climate and positive outcomes. The most mentioned social climate constructs were: an open climate, support, and autonomy. Conclusions: The results are challenging to summarize due to variations in the concepts and operationalizations of social climate. The organizational culture must support a social climate which is supportive, structured and caring, and provide youth with an environment to grow. A positive social climate must constantly be evaluated and recreated based on combining the perspectives of residents, staff and external perspectives

Development and Preliminary Evaluation of the Reaction to Unacceptable Behavior Inventory

__Background__ Monitoring the implementation of new interventions, as in this study Nonviolent Resistance (NVR) for the use in residential youth care settings, is mandatory in order to evaluate, adjust and refine the implementation process where necessary. Objective As there is no instrument for such monitoring of NVR available, the authors developed a new questionnaire, named Reaction to Unacceptable Behavior Inventory, (in short: RUBI). __Method__ This questionnaire was completed by staff of four different residential settings in the Netherlands, at different stages of the NVR implementation process. The staff members reported on the practice of their colleagues. __Results__ The results are promising, as they show good reliability, inter-item correlations and other psychometric features for the included items. Furthermore, the results show that the RUBI seems to discriminate between trained and untrained teams, defending its use in future implementation processes and implementation research. __Conclusions__ The RUBI is the first attempt to create an instrument which can be used for monitoring change during implementation of NVR, and for evaluating the degree of difference or compatibility between NVR and existing practice before implementation. Longitudinal research is needed to strengthen the documentation of validity and reliability of the RUBI in different settings, countries, and cultures. This should also be extended to the final and follow-up stages of implementation. In the future, redundant and insensitive items should be removed and standards for interpreting scale scores should be developed

Institutional Determinants of Social Climate in Therapeutic Residential Care: A Systematic Review and Empirical Follow-up Study

Introduction Therapeutic Residential Youth Care (TRC) concerns the treatment and care of young people outside their family environment and aims to provide services to protect, care, and prepare young people for returning to life out-side the institution. However, there is limited evidence on how TRC achieves its treatment goals: TRC remains too much of a “black box”. To gain more durable treatment results, we need to know more about how results are achieved, rather than investigating the achieved results. By examining more closely the process of change during TRC treatment, we could be able to more accurately identify factors associated with facilitation or ob-struction of a positive outcome. The interpersonal environment (hereafter social climate), where adolescents and staff members are continuously part of, is one of the most basic elements that are necessary for treatment success. Up until now, no review studies have been available summarizing the current state of knowledge about and evidence of the effects of the qualities of social climate. Such a review could be a first step in understanding and improving processes and outcomes of TRC. Objectives The main aim of the study is to formulate “what works for whom” principles regarding good quality of TRC for adolescents with psychosocial problem. The first objective of this study is to systematically identify which insti-tutional factors contribute to a positive social climate. The second objective is to verify these identified variables in a more detailed empirical study and to investigate potential other institutional variables that contribute to a positive social climate. Methods We carried out a systematic review search and included peer-reviewed studies from 1990 until 2016. Studies had to include a measure of social climate and focused on youth between the ages of 12 to 23 in TRC. Three researchers searched ten databases with a selection of keywords to identify the person, institution type, social climate, determinants, and outcomes. Exclusion criteria were studies that focused on foster care, school settings, medical care, outpatient care, or a combination of outpatient care and TRC. In order to test and extend the variables in the systematic review we conducted an empirical study and analyzed data from a large study with 400 adolescents (12-20 years old) admitted to Norwegian TRC. To measure social climate, we used the Community Oriented Programs Environment Scale (COPES), which consists of ten subscales measuring a broad array of social climate factors. To measure institutional factors, we used a self-constructed questionnaire measuring leadership background, institutional characteristics, routines, and free time division. In addition, we measured adolescents’ psychiatric characteristics and treatment history. We performed a multilevel structural equation modeling (SEM) analysis and regressed determinant variables on social climate subscales. Results Preliminary results from the review indicated moderate to high effect sizes for associations between a strength based treatment program and support, expressiveness, clarity, and autonomy. Furthermore, qualitative studies in the review indicated that a small size, less emotionally charged, and supervised program contributes to a safe environment. Preliminary results from the empirical study indicate that financing method, staff-patient ratio, use of coercive measures, and level of education and experience years of staff show significant association withsocial climate scales of the COPES. More detailed results of these associations will be presented at the conference. Conclusions The systematic review findings highlight the importance in shaping environments that match the need for the heterogeneous groups of adolescents living in different types of TRC. Policy makers and leaders of TRC insti-tutions can implement the coming results regarding flexibility, staff training and supervision, the use of non-coercive methods, and group size in constructing a more positive experienced social climate