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In the United States, the Boys Town Teaching Family Model, in its earliest iteration as Achievement Place, pioneered the use of applied behavior analysis in a group home setting and designated specially trained married couples (Teaching Parents) as the primary agents of intervention. From its origins in Achievement Place, the Boys Town Teaching Family Model has systematically included ongoing evaluation of all program components in its many replications both on the home campus in Omaha, Nebraska, and in many sites around the United States. Largely as the result of the corpus of this evaluation and related research, the Teaching Family Model at Boys Town, as an accredited and founding member of the Teaching Family Association, has been awarded the scientific rating of 3 (Promising Research Evidence) with “high” relevance for child welfare by the California Evidence-Based Clearinghouse for Child Welfare.

There are three recent developments in the field of therapeutic residential care (TRC) which provide a major leap forward for new policy and practice directions. These developments further promote ...

Residential care has been criticized for its high cost and limited research evidence. While recent studies and reviews of the literature suggest that a number of evidence-based practices are being implemented in residential care settings, more research is needed to develop and test empirically based practices that can be successfully implemented in residential care. In this article, we offer a promising strategy to address this issue: a long-term research partnership between a large service provider agency and a university-based research center to conduct a program of research which has resulted in translation of evidence-supported practices into service provider programs, contributions to the science of residential care, and training opportunities for young applied scientists to specialize in this important work. This evolving program of research includes four core applied research topic areas in which this collaboration has had some ongoing success: program and practice implementation fidelity, therapeutic process factors, aftercare, and psychotropic medication use. We suggest that this type of long-term collaborative research partnership is an approach for others to consider for conducting research that informs effective residential care practices.

none 32 si The International Work Group for Therapeutic Residential Care convened an International Summit on ‘Pathways to Evidence-Based Practice’ at Loughborough University (GBR), Centre for Child and Family Research on 27-29 April, 2016 with generous support from the Sir Halley Stewart Trust and in partnership with The European Scientific Association on Residential and Family Care for Children and Adolescents (NLD) (EUSARF), the International Association for Outcome-Based Evaluation and Research on Family and Children’s Services (ITA) (IAOBER) and the Association of Children’s Residential Centers (USA) and with the additional support of Action for Children (GBR) and the National Implementation Service (NIS) (GBR). Membership includes: Lisa Holmes (Chair), Director, Centre for Child and Family Research, Loughborough University (GBR); James K. Whittaker (Co-Chair), Charles O. Cressey Endowed Professor Emeritus, University of Washington, School of Social Work, Seattle (USA); Jorge Fernandez del Valle, Professor of Psychology and Director, Child and Family Research Group, University of Oviedo (ESP); Frank Ainsworth, Senior Principal Research Fellow (Adjunct), James Cook University, School of Social Work and Human Services, Townsville, Queensland (AUS); Tore Andreassen, Psychologist, The Norwegian Directorate for Children, Youth and Family Affairs (NOR); James P. Anglin, Professor, Faculty of the School of Child and Youth Care, University of Victoria (CAN); Christopher Bellonci, Board-Certified Child/Adolescent and Adult Psychiatrist; Associate Professor, Psychiatry Department, Tufts University School of Medicine, Boston, MA (USA); David Berridge, Professor of Child and Family Welfare, School for Policy Studies, University of Bristol (GBR); Amaia Bravo, Lecturer, Department of Psychology, University of Oviedo (ESP); Cinzia Canali, Senior Researcher, Fondazione Emanuela Zancan, Padova (ITA) and President, International Association of Outcome-Based Evaluation and Research in Family and Children’s Services (IAOBER); Mark Courtney, Professor, School of Social Service Administration, University of Chicago (USA); Laurah Currey, Chief Operating Officer, Pressley Ridge, Pittsburgh, PA (USA) and President, Association for Children’s Residential Centers, (USA); Daniel. L. Daly, Executive Vice President and Director of Youth Care, Father Flanagan’s Boys’ Home, Boys Town, NE (USA); Robbie Gilligan, Professor of Social Work and Social Policy, Trinity College Dublin IRE), Hans Grietens, Professor, Centre for Special Needs Education & Youth Care, University of Groningen (NLD) and President, European Scientific Association on Residential and Family Care for Children and Adolescents (EUSARF); Annemiek T. Harder, Assistant professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Martha J. Holden, Senior Extension Associate with the Bronfenbrenner Center for Translational Research and the Principal Investigator and Director of the Residential Child Care Project at Cornell University, Ithaca, NY (USA); Sigrid James, Professor, Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, CA (USA); Andrew Kendrick, Professor of Residential Child Care, School of Social Work and Social Policy at the University of Strathclyde (GBR) and Consultant at the Centre of Excellence for Looked After Children in Scotland (CELCIS) and the Centre for Youth and Criminal Justice (CYCJ) (UK); Erik J. Knorth, Professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Mette Lausten, Senior Researcher at SFI - The Danish National Centre for Social Research, Copenhagen (DNK), John S. Lyons, Senior Policy Fellow at Chapin Hall, University of Chicago, IL (USA); Eduardo Martin, Lecturer at the Department of Developmental and Educational Psychology, University of La Laguna, Tenerife (ESP); Samantha McDermid, Research Fellow, Centre for Child and Family Research, Loughborough University (GBR); Patricia McNamara, Senior Fellow (Honorary), Department of Social Work, University of Melbourne (AUS); Laura Palareti, Assistant Professor in Social Psychology, Department of Education Studies, University of Bologna (ITA); Susan Ramsey, Parent and Former Children’s Mental Health Advocate, The Walker School, Needham, MA (USA); Kari M. Sisson, Executive Director, Association of Children’s Residential Centers (USA); Richard W. Small, Walker Executive Director Emeritus, The Walker School, Needham, MA (USA); June Thoburn, Emeritus Professor of Social Work, University of East Anglia (GBR); Ronald Thompson, Senior Director, Boys Town National Research Institute for Child and Family Studies, Boys Town, NE (USA); Anat Zeira, Professor, School of Social Work and Social Welfare, Hebrew University of Jerusalem, and Head of Research and Evaluation at the Haruv Institute (ISR). Our work group wishes to thank CFRC staffer Laura Dale at Loughborough for extraordinary efforts in producing this statement in record time and for her care and assistance with all phases of our Summit activity. Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat

A key barrier to conducting research involving children and families is the difficulty of creating partnerships among researchers, treatment agencies, and schools. This article describes several key factors that were essential to establishing an effective research collaboration between practitioners and university-based researchers, including a mutual respect for the unique needs of research and practice; a strategy for joint decision making; a partnership model of incremental growth; a plan for mentoring junior faculty and students; a format for regular contact between the partners; and a plan for long-term sustainability. This collaboration has conducted over a dozen evaluation studies, as well as examined best practice issues surrounding the needs of children and families with serious emotional and behavioral needs. Even more important has been the lines of research that have been developed from this partnership which keeps the collaboration focused. The lessons learned from this research partnership should inform other collaborations.

Youth entering residential care possess significant emotional and behavioral needs; yet, it is uncertain whether these needs have remained constant or are changing over time. This study examined mental health variables from the admission files of 1,047 youth entering residential group home care in 1995 and 2004. Sequential logistical regression analyses revealed that the mental health needs of youth admitted in 2004 were greater than those for youth in 1995 with regard to having multiple psychiatric diagnoses, being prescribed two or more psychotropic medications, and using alcohol or drugs. As such, these analyses should be replicated in other group homes as well as in other placement settings within the system of care.

Little is known about the characteristics or functioning of children with ADHD in residential care as compared to their non-ADHD peers. This study evaluated data on 538 children with (n = 125) and without (n = 413) ADHD in residential care to determine demographic, mental health, behavioral, and treatment (i.e., medication use) characteristics. Results revealed that both groups presented elevated risks, however, scores for children with ADHD indicated even greater levels of need. Specifically, differences were found between the two groups on demographics (e.g., family reunification status, restrictiveness of prior out-of-home placements), behavior (e.g., attention problems, rule-breaking and aggressive behaviors) and medication status. Findings suggest there is a need for aftercare services to help support families as children transition from care, interventions to address behavior, and medication management through assessment and monitoring.

This study compares the On the Way Home (OTWH) aftercare program to traditional aftercare supports on placement and school stability for 82 youth (43 treatment, 39 control) with disabilities discharging from residential care. One-year-post-discharge results revealed that negative event occurrence (i.e., returning to care or discontinuing enrollment in the community school) was three to over five times less likely for OTWH youth compared to youth in the control condition.

A well specified residential treatment model is described, and preliminary outcome data are presented. The Boys Town Psycho-Educational Model (PEM) empowers direct care staff to be important treatment agents by training them to use systematic teaching techniques. Data obtained on youth served at the center since its inception in December 1995 indicate that the youth have had multiple prior placements and serious psychiatric disorders. The model sustains an active and positive treatment environment as documented by high levels of focused treatment occurring during the youth’s stays. To date, 94% of the youth have departed to placements that were equal to, or less restrictive than, their placements at admission to the program. Of those who had Children’s Global Assessment Scale ratings both at admission and at discharge, 84% (n=21) of the youth had better functioning at discharge.

The purpose of this study was to examine the correlates of post-shelter maternal family satisfaction in a group of youth who were reunified with their families following a shelter stay. Findings indicated that higher ratings of family satisfaction were related to greater maternal problem solving skill and less family conflict.

An intervention for disruptive boys in residential care involving increases in positive to negative interactional ratios is described. The target of the intervention was daily problem behavior. Results from a pooled time series analysis of the data revealed a significant decrease in behavior problems (one problem per boy per day) during the intervention for the boys as a group. Results from comparisons of mean behavior problems during baseline and intervention revealed decreases for five of the six boys. Results from a multiple baseline across boys revealed experimental control for three of the six. The results are discussed in terms of response contingent reinforcement and systemic behavior analyses. The benefits of combined group and single subject data analyses are also discussed.

To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The interviews included five scales reflecting youths' views about important aspects of their lives in placement: (1) Delivery of Helpful Treatment, (2) Satisfaction with Supervising Adults, (3) Isolation from Family, (4) Isolation from Friends, and (5) Sense of Personal Control. Hierarchical linear modeling allowed us to estimate group differences while controlling for developmental trends, demographic factors, and prior differences between groups. The two groups were equivalent on all scales before the study. During the following placement, however, the treatment group's ratings were significantly more positive than the comparison group on four of the five scales and approached significance on the fifth. These findings suggest that negative beliefs about life in residential placement for adolescents may not apply to all programs.

School performance and attitudes of a group of children placed in residential care were assessed during placement and for an average of four years after discharge. A comparison group of children who were not placed in the program was also followed. The residential program emphasized both behavioral and educational treatment. Group differences were tested using Hierarchical Linear Modeling (HLM). Results indicated that the treatment group had significantly greater improvements in both school performance and attitudes during placement. These differences were also maintained after discharge. It is suggested that long-term educational effects with troubled children may require an intensive intervention over an extended period of time.

For 472 consecutive days we monitored the number of youths residing in a crisis shelter for adolescents, the average length of stay for the youths residing in the shelter on each day, and the number of problem behaviors occurring within the shelter on a daily basis. We analyzed these data using a combination of time series and logistic regression techniques to fit a model that would predict the occurrence of a problem behavior on any given day. After controlling for significant time trends in the data, our results indicate that both the number of youths in the shelter and the proportion of youths who have resided in the shelter longer than 14 days are significantly associated with a problem behavior occurring on any given day. The number of youths in the shelter and the probability of a problem behavior occurring correlated significantly. However, as the proportion of youths who resided in the shelter longer than 14 days increased, the probability of a problem behavior occurring decreased.

More than 63,000 adolescents, aged 10 to 19 years, called a national crisis hotline from September 1991 through June 1992. Nearly 73% of these (N = 46,392) were coded as crisis calls. Developmental trends were identified for various aspects of support-seeking by examining differences in proportions of calls within defined categories across these years. Calls for support for issues related to relationships accounted for nearly half of all calls by these young people. Within the broad category of relationships, specific trends included decreasing numbers of calls about peer relations from age 13 through 19; decreasing calls about parent--child relations from 11 through 19; and increasing calls about marriage beginning at age 15. Calls with concerns about sexuality increased steadily to a peak at age 16, and calls with concerns about addictions increased steadily from age 13. Sex differences were found for length of calls at each age and for the various categories of support-seeking.

The study assessed the effect of the Boys Town psychoeducational treatment model on the therapeutic milieu of a state-operated psychiatric hospital serving children and adolescents.Direct care staff from two units for adolescents and one unit for children were trained to implement the model, which guides staff in planned and spontaneous interactions with patients. Patients rated their satisfaction with direct care staff immediately before the model was implemented and one year later. Staff perceptions of changes in the treatment environment were assessed by retrospective interviews.Patients in two of the three units indicated significantly greater satisfaction with direct care staff after the psychoeducational treatment model was implemented. Results from retrospective interviews with staff showed statistically significant improvements in their perceptions of the therapeutic milieu. Staff comments recorded during the interviews supported the quantitative results.Training direct care staff at a children's psychiatric hospital to use the Boys Town psychoeducational treatment model significantly improved perceptions of the therapeutic milieu among both staff and patients.

This study examined patterns of movement for youth receiving services within a continuum of intensive and restrictive residentially-based programs. Data were collected for 701 completed episodes of care within a three-program residential continuum of care over a 5 year period, and examined time within program, movement between programs, in-program disruptive behavior, and discharge status. Results showed that most youth either remained in a stable placement in the least restrictive of the programs, or followed a pattern of placements that systematically moved them from more restrictive to less restrictive settings. Of note, transitions from more restrictive to less restrictive programs correspond to deescalating levels of problem behavior; and over 80% of the youth were stepped down to either family-based or independent living situations at the time of departure. Findings support the notion that a continuum of intensive residential services can serve the needs of youth with significant emotional and behavioral needs.

The purpose of this study was to examine psychotropic medication utilization over the course of treatment for children and adolescents admitted to a large residential group-home facility for youth with emotional and behavioral disorders.Retrospective analyses of psychotropic medication utilization at admission, during treatment, and at departure were examined for 1,010 children and adolescents consecutively admitted to the facility during 2001-2004. The relationship between psychotropic medication utilization and demographic variables, psychiatric diagnoses, objective measures of behavioral and emotional problems, in-program behavior, and ratings of program success were examined.The overall utilization rate was 49%, and there was a significant reduction in utilization from admission (40%) to departure (26%). Reductions were evident across all medication classes (e.g., stimulants, antipsychotics, etc.). At admission, medication utilization was related to several psychosocial variables, higher scores on measures of behavioral and emotional problems, and psychiatric diagnoses (attention-deficit/hyperactivity disorder (ADHD) and mood disorders). A small percentage (16%) of youth was prescribed novel medication during stay. Being placed on medication during treatment was related to internalizing problems on the Child Behavior Checklist (CBCL) at admission, psychiatric diagnoses, higher rates of in-program behavior problems, and poorer outcomes at departure. Youth departing on medication were more likely to be male, younger, and rated as doing more poorly in the program. They also were more likely to be placed in more restrictive settings at follow-up.There was a high rate of psychotropic medication utilization among this population, though utilization rates dropped significantly over the course of treatment.

Parent training programs have been an effective intervention for middle-income families with children w1zo have developmental, learning, and behavioral problems. Results have been mixed with low-income families, however. In the cuirrenrt study a practicalparenting program was tested with both middleand low-income parents. Results indicate significant improvements for fimilies of both income groups. These effects were maintained at 3 months follow-ulp. Implications for parenting programs andfurther research are discussed.

Four hospitalized female schizophrenics performed self-ratings on a battery of variables for 60 consecutive days. The variables were factored, separately for each subject, and the factors were then rotated to solutions which were maximally invariant from each other. Factor matching among subjects was then assessed by congruence coefficients. The factors which replicated over persons appeared to be broad, second-order dimensions identifiable as Social Desirability, Extraversion and Anxiety. The results are discussed in relation to nomothetic vs. idiographic systems of psychology and the study of intraindividual change by P-technique as a methodology of clinical interest.

Father Flanagan’s Boys’ Home, or “Boys Town,” as it is popularly known, was founded in 1917 by Father Edward J. Flanagan. Father Flanagan started the program to provide shelter and care for young boys who were orphans or in trouble. Eventually, they moved to what was then known as Overlook Farm, several miles west of Omaha, where there was space enough to care for dozens of boys. Father Flanagan’s Boys’ Home had become Boys Town, an incorporated village with its own schools, homes for boys, police and fire departments, and post office.

The relationship between self-described personality (Leary's system) and self-disclosure was explored. Dominance/Submission and Love/Hate related significantly to reported disclosure (Jourard's scale), but only Love/Hate was significantly associated with a behavioral measure. Self-descriptions of dominance and interpersonal closeness predicted high levels of reported disclosure, whereas the Hate end of the Love/Hate dimension was associated with the high levels of behavioral disclosiveness. Females reported more disclosure than males, but little relationship was shown between sex and disclosing behavior.