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\nPractice implicationsDuring four days of observation at a therapeutic residential care (TRC) facility for adolescents with complex behavioral issues, we encountered a growing trend in the Norwegian child welfare system. High demand for institutional beds, along with reduced capacity in psychiatric services and the legal system, has led to increased reliance on the Duty to Assist obligation of the TRCs, administered by the Office for Children, Youth and Family Affairs (Bufetat) in Norway. This obligation is legally binding, ensuring the provision of justifiable treatment. Our observations of staff interactions and documentation analysis of an adolescent, Peter, revealed that staff’s ability to deliver appropriate care and manage high-risk situations is constrained by governmental standards set through law and regulation. Through the theoretical lens of power and discretion, we found that the combination of forced treatment at open institutions, with a strong emphasis on user involvement, creates a power struggle. Without clear practice standards, staff are left to rely on their own competencies in managing conflicts, resulting in inconsistent and unpredictable interactions. This inconsistency increases the likelihood that Peter will resist the care and treatment being offered. Providing staff education and training, establishing clear and predictable standards, is essential to avoid inconsistent frameworks and practices within TRC.Staff training should place greater emphasis on teaching how to wield power and authority effectively, paralleling focus on preventing violence.There is pressing need for deeper comprehension of the government-set standards implications for adolescents and staff members within TRC settings.Providing staff education and training, establishing clear and predictable standards, is essential to avoid inconsistent frameworks and practices within TRC.Staff training should place greater emphasis on teaching how to wield power and authority effectively, paralleling focus on preventing violence.There is pressing need for deeper comprehension of the government-set standards implications for adolescents and staff members within TRC settings. [ABSTRACT FROM AUTHOR]

Therapeutic residential care (TRC) is a mode of delivering out‐of‐home care (OOHC) that can help meet the needs of some of Australia's most vulnerable young people and their families. TRC programmes aim to support young people to develop positive relationship experiences in a safe and stable environment. Given that TRC is a relatively new model of intervention, to date, the alignment between its aspirational aims and the existing and evolving policy environment in which it is located has not been analysed in any depth. This paper reports on a national policy analysis exploring how TRC is constructed in policy documents. One hundred and thirty‐two relevant policy documents were analysed to identify the practices and the conditions that facilitate the development of relationships and connections. The aims of the policies underpinning TRC were consistent with the literature outlining promising trauma‐informed approaches. Findings show how the policies support the development of beneficial relationships for children and young people; however, there were also several discrepancies and silences identified, including a limited conceptualisation of children's participation. [ABSTRACT FROM AUTHOR]

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\nPractice implicationsTherapeutic residential care (TRC) provides care for young people in the welfare system that display behaviors that are unsafe to themselves or others. The intervention provided in TRC is challenging and not always effective. The goal of this exploratory study is to compare the profiles and progress of young people treated in TRC-CREI (TRC-Intensive Educational Residential Care) in Catalonia (Spain), for at least a year, aiming to identify factors explaining intervention effectiveness. Key informants provided retrospective information from 78 treated cases on the young people’s improvements in relation to behavioral problems identified on entry. Significant differences in intervention outcomes were found among profiles. Young people with better relational skills and who adapted more quickly to the program showed a greater tendency to have positive outcomes. The poorest prognosis was for young people who ran away and had a criminal record. Logistic regression indicated that runaway behaviors predict failed outcomes, while having friends among TRC-CREI peers predicts young people’s successful trajectories. The TRC-CREI program seems to be effective for cases with moderate problems, but not for those with more serious difficulties. Specific socio-emotional education programs are needed to repair affective bonds with educators, peers, and the broader social network.The TRC-CREI program is less effective for young people who have a criminal record and tend to run away.Young people with better relational skills and who adapt more quickly to the program showed a better prognosis for positive progress.Displaying runaway behaviors or having friends among TRC-CREI peers are the two factors that predict the outcomes of progress.Professionals should be aware of the benefits of healthy relationships and promote restorative emotional bonds with young people.Interventions should be evidence-based to provide high-quality therapeutic practices resulting in better outcomes for young people. [ABSTRACT FROM AUTHOR]

Children and adolescents in residential care often present with emotional and/or behavioral problems associated to previous adverse experiences such as abuse and neglect. Consequently, child welfare systems have developed therapeutic residential care (TRC) programs to address the most complex needs of this population. The aim of this study is to explore the characteristics of youths in TRC comparing them with those of youth in general residential care (GRC), and to detect the factors predicting referral to TRC programs. The sample consisted of 900 adolescents aged 12–17 years old (M = 15.57; SD = 1.33; 66.2% boys), from General Residential Care (n = 554) and Therapeutic Residential Care (n = 346). Profile information was collected through official files and an ad hoc questionnaire. Mental health problems were evaluated using the youth self-report (YSR). Significant sociodemographic differences were found between groups. Also, a higher frequency of emotional abuse and neglect, worse mental health, more breakdowns in child welfare measures and risk behaviors were found among adolescents in TRC. Sociodemographic and familial characteristics, features of the protective process and risk behaviors were associated to referral to TRC programs. Youths in GRC and TRC present with mental and behavioral problems that make it necessary to implement prevention programs and early detection procedures. Screening and evaluation of youth's mental health and establishment of concrete criteria are suggested to ensure appropriate referral to the most suitable resource according to the individual needs of adolescents. [ABSTRACT FROM AUTHOR]

Young people´s perspectives on service quality in Therapeutic Residential Care (TRC) are commonly excluded or overshadowed by those of adults which has led to calls for better youth self-report indicators of quality healthcare. In response, we performed a systematic review of peer-reviewed literature to identify the most important quality indicators for young people by reviewing the literature on their beliefs and experiences regarding TRC and building on the four-pronged parsimonious framework (setting, staffing, treatment approach, and safety) proposed by Farmer et al., (2017). Following PRISMA guidelines, a systematic literature search was conducted in March 2022. Of the 17, 815 records screened, 15 articles, composed of 15 samples were included. A total of five domains and 13 quality indicators were identified: 1) Setting; 2) Staffing (professional skills and access to specialist support [doctor/therapist]); 3) Treatment approach (effective transition and aftercare support, rest and time to think, life skills, behavioural improvement, access to education and farm animals as therapeutic aides); 4) Safety (staff actions and structure and stability), and 5) Milieu factor (trusting relationships, family involvement, and relationship continuity). These four domains provide a practical framework for better-oriented treatment. The additional domain identified as the milieu factor places the critical quality indicators of TRC (e.g., trusting relationships) from the perception of the youth themselves, at the centre of attention, and encourages services to assess the extent to which they have the milieu factor, so they can strategically adapt and be responsive to the needs of young people. Policy and service delivery implications are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This conceptual paper connects the literature on the experiences and needs of youth in therapeutic residential care, trauma-informed frameworks utilized in these settings, and early research on trauma-informed design to facilitate an understanding of these connections and move towards developing a blueprint for trauma-informed design in residential settings for traumatized youth. Methods: A critical literature review drawing on trauma theory, trauma-informed care, evidence-based design, and trauma-informed design was conducted to inform the argument presented in this conceptual paper. Results: While many therapeutic residential care models engage trauma-informed care approaches to support staff in promoting healing environments for youth who have histories of complex trauma, the focus has remained on the psychosocial environment of care, and has yet to be systematically applied to the design of the built environment in which these programs are implemented. By applying the principles of trauma-informed care to the built environment, trauma-informed design has the potential to reduce retraumatization and promote resiliency among youth in care. Conclusions: Ultimately, this conceptual paper illustrates the value of further developing trauma-informed design principles to apply to settings that serve traumatized youth, such as therapeutic residential care facilities. [ABSTRACT FROM AUTHOR]

Adolescents with intellectual disability in residential child care are a highly vulnerable population. The main goal of this study is to explore the characteristics of young people with intellectual disability in therapeutic residential care (TRC) in Spain and to identify the key variables associated with their referral to these services. The total sample consisted of 473 young people in residential child care in Spain (63.8% boys), aged between 12 and 17 years (M = 15.32), divided into three different groups for comparison. An ad hoc questionnaire and the Youth Self-Report were used to collect information. Participants with intellectual disability in TRC presented a higher frequency of externalising problems and risk behaviours than adolescents with disability in general residential programmes. However, it was lower than that of their peers without disability in TRC. Needs of adolescents with intellectual disability should be assessed before a referral to these facilities, in order to adapt the interventions provided. [ABSTRACT FROM AUTHOR]

The purpose for this paper is to present a measured perspective on the empirical literature examining point and level (P&L) systems in residential care settings. We review the history of P&L and eight of the most common criticisms of its use in residential care settings. The relative merits of each of the criticisms are discussed. There is no empirical research support for the criticisms of P&L when well-implemented. There are, nonetheless, barriers to success that arise when P&L program are not well-executed. Effective P&L programs are characterized by developing positive relationships, maintain high ratios of positive to negative feedback, are individualized to each youth's needs, have appropriate tolerances, and systematically fade youth off P&L in preparation for returning to their families or independent living. [ABSTRACT FROM AUTHOR]

L'hospitalisation soins études de la clinique Médico-pédagogique Dupré (Fondation Santé des étudiants de France) est un dispositif original qui intègre à la fois une approche thérapeutique et éco-systémique centré sur la scolarité pour des adolescents souffrant de troubles psychiatriques. Nous évaluons certaines dimensions psychiques d'un groupe de 33 adolescents en hospitalisation soins/études sur une période de 9 mois. Une batterie de questionnaires standardisés a été proposée à une population de 70 adolescents hospitalisés en soins études. L'échantillon final comprend 33 adolescents à l'entrée et 9 mois plus tard. La batterie de questionnaires est composée de l'YSR (Youth self report), de l'ADRS (Adolescent depression rating scale), de la RSQ (Relationship scale questionnaire), de l'IPPA (Inventory of Parent and Peer Attachment), de la FACES IV (Family adaptability and cohesion evaluation scale), de l'échelle de l'estime de soi de Rosenberg, de l'échelle de niveau de conscience émotionnelle (LEAS) et de l'évaluation subjective du fonctionnement psychologique. La méthologie a reçu l'aval du comité d'éthique. Les résultats montrent une réduction significative des troubles internalisés, notamment au niveau du retrait, de l'anxiété et de la dépression à 9 mois (YSR et ADRS). Au RSQ, les patients rapportent significativement moins d'anxiété dans la relation à autrui. Les patients témoignent d'un meilleur niveau de fonctionnement global. Par contre, aucune évolution de la conscience émotionnelle ou du fonctionnement familial du point de vue de l'adolescent, n'est constatée. Sur la base de ces résultats, bien que limités, nous proposons des pistes de réflexions ciblées dans la prise en charge des adolescents tant dans le traitement des troubles émotionnels que dans le travail auprès des familles. The "care and studies" hospitalisation at the Dupré Clinic (Fondation Santé des étudiants de France; Students Health French Foundation) is an original setting that integrate a therapeutic and eco systemic residential approach with schooling for adolescents suffering from psychiatrics disorders. A selection of standardised questionaries' was proposed to a group of 70 adolescents hospitalized in "care and study". The final sample of the group was composed of 33 adolescents at the entrance and 9 months later. We compared the results between T0 and T9. The battery of questionaries' is composed of: YSR (Youth Self report), ADRS (Adolescent depression rating scale), RSQ (Relationship scale questionnaire), IPPA (Inventory of Parent and Peer Attachment), FACES IV (Family adaptability and cohesion evaluation scale), Rosenberg self esteem scale, LEAS (Level of emotional awareness scale) and a self subjective evaluation of psychological functioning. A committee of ethics and deontology approved the methodology. The results (YSR, ADRS) show a significant effect on reduction of internalised disorder at 9 months, especially in the measures of anxiety, depression and withdrawal. The RSQ results confirm significative less anxiety in the patient's relationship with others. Adolescents witness a feeling of a better global functioning. On the other hand, no evolution was observed in the measure of emotional consciousness (LEAS) and in the family functioning form an adolescent's perspective. This study offers new clinical perspective based on the results. We proposed a few reflexions in the treatment of emotional disorder and in the domain of family therapy intervention. [ABSTRACT FROM AUTHOR]

This article draws on the lived experiences and perspectives of young people and practitioners in therapeutic residential care to examine what constitutes relationship-based practice. Eight young people and twenty-six practitioners across three residential care services in Australia participated in this qualitative study. Framework analysis identifies that personalised engagement, a delicate balance between care and control, and perseverance through turbulent times are conducive to relationship-based practice in therapeutic residential care. Relationship-based practice is also found to be employed in a unique historical and relational context that demands mindful navigation through three specific professional boundary issues including self-disclosure, over-identification and physical contact. Against this context, relationship-based practice in therapeutic residential care is considered a 'double-edged sword', offering practitioners copious opportunities to build connections with young people in informal environments whilst needing to mitigate multiple ethical ambiguities. Implications for practice include the need to safeguard the 'do no harm' priority whilst resisting defensive or detached practice. Contextualising relationship-based practice within an ethical practice framework to embed ethics work in day-to-day practice becomes paramount. [ABSTRACT FROM AUTHOR]

This article focuses on how one staff member at a therapeutic residential institution negotiates his work identity, exploring how he narrates a violent incident, the formation of work identity, and how the adolescent figures within these processes. Mishler argues that when speaking, we perform identity. As social actors, we select and organise language, telling stories that fit the audience, our intentions, and the occasion. The article is framed both theoretically and methodologically through the assumption that narrative is a fundamental human way of giving meaning to our experiences. Identities are understood as being produced and performed within personal narratives. Thus, in an interview situation, narratives provide an interactive space for personal subjectivities to be expressed and enacted. Drawing on Mishler, we find three essential 'turning points' that shape Alex's work identity: (1) the violent incident, (2) the adolescent's return to the ward, and (3) Alex's subsequent change of wards. We interpret Alex's narrative as a 'narrative of resistance' that may have practical day-to-day implications for the field of institutional care and help expand the staff's clinical toolbox. Further, Alex's narrative is a vital example of stories of violence, which can be incorporated into policy documents on violence management. [ABSTRACT FROM AUTHOR]

This article is about using data from the Strengths and Difficulties questionnaire to develop a house burden score as a way of measuring the workload of a therapeutic residential care program. The development of the score ensures that residential placement selection is based on empirical data rather than on the often-used criteria of 'where is there a vacancy?' It may also curb comments by inexperienced staff such as 'our house has the most difficult young people, whereas yours are easy'. The aim of the score is to ensure that a residential program is not overburdened with too many children and young people with complex emotional and behavioral difficulties to the extent that this result is a sub-standard service for all young people. [ABSTRACT FROM AUTHOR]

The Family Empowerment Scale (FES) is one of the most widely used measures for assessing the empowerment of caregivers of youth with emotional difficulties. The purpose of this study was to examine the internal factor structure, score reliability, and convergent validity of the FES scores with caregivers of youth who had recently departed therapeutic residential care. Results indicated that the hypothesized three-factor model fit the data adequately with caveats. FES scores were reliable based on coefficient alpha and omega, and evidence of convergent validity with caregiver self-efficacy was moderate to strong. [ABSTRACT FROM AUTHOR]

Early psychosocial rehabilitation of young people presenting mental disorders is a major challenge. In France, the therapeutic residential care called “soins-études,” combining care and educational provision, in the Fondation Santé des Etudiants de France (FSEF) can have a role in this rehabilitation. After recalling the history and the concept underpinning soins-études in psychiatry, we performed a systematic review of the literature based on the PRISMA statement via a search for quantitative studies on soins-études facilities. Eleven quantitative studies on 10 different samples of young people hospitalised in psychiatry in FSEF were identified between the opening of the first unit in 1956 and 2016. The young people involved were mostly aged 16–20 years, which reflects the curricula covered in the FSEF establishments. These young people generally presented severe chronic psychiatric disorders. Their previous care trajectory had lasted for more than 3 years and 24–55% of them had attempted suicide at least once. Their stays lasted more than 6 months. Depending on the severity of the disorders, 44–63% of the young people were considered to have improved at discharge. The contribution of soins-études appears valuable for these young people, since there was a clinical improvement for 54–74% of them 1–15 years after their hospitalisation, with resumption of schooling, professional training or entry into employment in 60–75% of the cases. These results are compared with data in the international literature concerning therapeutic residential care, and lines for future research are identified.

Therapeutic residential care differs markedly from other forms of out-of-home care for children and youth. Support for the view that therapeutic residential care needs to be a milieu approach that leverages all interactions in the living environment to achieve a beneficial emotional and behavioral experience for children and youth is presented. A therapeutic milieu has the advantage of maintaining focus on what is in the best clinical interest for a child by aligning and coordinating all interactions and activities. We provide a rationale for a milieu-based foundation for therapeutic residential care that consists of five elements: care, treatment, nurturing, teaching, and order. Attending to milieu as defined will provide a sound foundation upon which effective and well-implemented treatment can be fully expressed. [ABSTRACT FROM AUTHOR]

Early psychosocial rehabilitation of young people presenting mental disorders is a major challenge. In France, the therapeutic residential care called " soins-études ," combining care and educational provision, in the Fondation Santé des Etudiants de France (FSEF) can have a role in this rehabilitation. After recalling the history and the concept underpinning soins-études in psychiatry, we performed a systematic review of the literature based on the PRISMA statement via a search for quantitative studies on soins-études facilities. Eleven quantitative studies on 10 different samples of young people hospitalised in psychiatry in FSEF were identified between the opening of the first unit in 1956 and 2016. The young people involved were mostly aged 16–20 years, which reflects the curricula covered in the FSEF establishments. These young people generally presented severe chronic psychiatric disorders. Their previous care trajectory had lasted for more than 3 years and 24–55% of them had attempted suicide at least once. Their stays lasted more than 6 months. Depending on the severity of the disorders, 44–63% of the young people were considered to have improved at discharge. The contribution of soins-études appears valuable for these young people, since there was a clinical improvement for 54–74% of them 1–15 years after their hospitalisation, with resumption of schooling, professional training or entry into employment in 60–75% of the cases. These results are compared with data in the international literature concerning therapeutic residential care, and lines for future research are identified. [ABSTRACT FROM AUTHOR]

Complex trauma (CT) is the experience, or witness, of prolonged abuse or neglect that negatively affects children's emotional and psychological health. Youth in residential care experience higher incidences of complex trauma than youth in community-based care, with notable gender differences and presentation of psychological symptoms. This study examined the effects of trauma-informed residential care and the relation between CT and gender. A sample (n = 206) from an evaluation of a youth psychiatric residential facility in the Midwest that transitioned from a traditional care model to a trauma-informed care model was used. A hierarchical regression was used to model the main effects of model of care, gender, CT, length of stay, and crisis response on treatment outcomes; and the moderating effects of gender and CT. The results support the high prevalence of CT in residential care populations. The final model explained 30.2% of the variance with a statistically significant interaction between gender and length of stay in treatment, indicating that longer lengths of stay in treatment are associated with less change in functional impairment for girls than boys. Youth gender and prior trauma are important factors to consider when monitoring experiences and treatment outcomes in youth residential care. [ABSTRACT FROM AUTHOR]

Après l'amélioration du pronostic de la tuberculose grâce aux antibiotiques, la Fondation Santé des Etudiants de France a reconverti ses sanatoriums destinés aux étudiants en établissements « soins-études » pour permettre aux élèves du secondaire et aux étudiants souffrant de troubles psychiatriques de poursuivre leurs études durant leurs soins. La spécificité de ces cliniques soins-études est la présence dans chaque établissement d'équipes de l'Éducation nationale. Les études sont coordonnées au projet thérapeutique et sont envisagées comme une des médiations thérapeutiques permettant au jeune de renforcer ses ressources et ses compétences. Les enjeux de cette collaboration entre soignants et enseignants sont le rétablissement et l'autonomie des jeunes. Nous avons effectué une revue systématique de la littérature pour rassembler les études évaluant les services de soins-études en psychiatrie depuis l'ouverture du premier service en 1956 et avons retrouvé 11 études quantitatives. Les jeunes accueillis en soins-études ont le plus souvent entre 16 et 22 ans, ce qui correspond aux possibilités de scolarité dans la plupart des établissements. Ils présentent des troubles chroniques et leur parcours de soins antérieur a souvent été long et marqué par un ou plusieurs gestes auto-agressifs. Les séjours durent en moyenne plus de 6 mois. En fonction de la sévérité des troubles dans les échantillons, les jeunes considérés comme améliorés à leur sortie des cliniques sont 44 % à 63 %. Une amélioration clinique ainsi qu'une reprise d'un projet de formation sont aussi constatées chez près de deux-tiers d'entre eux plus de 5 ans après leur prise en charge. Since 1956, and thanks to a better prognosis of tuberculosis, the Fondation Santé des Etudiants de France (FSEF i.e.: Students Health French Foundation) converted its sanatoriums into "soins-études" ("care and studies") institutions to allow students with psychiatric disorders to continue their studies while receiving care. These therapeutic residential care centers were designed as open psychiatric institutions to avoid social withdrawal and possible iatrogenic effects. The specificity of these therapeutic residential facilities is the presence of national education teachers who enable high school and university students to continue or resume their schooling. The objectives of this collaboration between caregivers and teachers are the recovery and autonomy of young people. All admissions in French therapeutic residential care are based on medical indication of continuation of psychiatric hospital care. The FSEF's authors described the care as integrating "treatment through environment": the institutional psychotherapy allowing multiple vectors of transference, different forms of identifications, and alternative social relations. The studies are coordinated with the therapeutic program and are considered as one of the therapeutic mediations allowing the young person to strengthen his resources and skills. They participate in resocialisation and empowerment of hospitalized young people. We conducted a systematic review of the literature to collect quantitative studies evaluating FSEF French therapeutic residential care in psychiatry since the opening of the first service in 1956. We found 11 quantitative studies carried out in the FSEF therapeutic residential care. Young people in therapeutic residential programs are most often between the ages of 16 and 22, which corresponds to the schooling opportunities in most FSEF institutions. The evolution of the gender ratio observed in favor of girls corresponds to observed gender ratio in the population of French high school students. Young people in French therapeutic residential care generally have chronic disorders. Their previous care pathway has often been long and scarred by one or more suicide attempts. Length of stay in therapeutic residential care was more than six months on average. Depending on the severity of the disorders presented in the samples, the young people who leave the therapeutic residential care were considered to be improved in 44% to 63% of cases. A majority of young people had a school activity during the hospitalization and after discharge. The young people who did not return to school established an alternative training project. Almost two thirds of them were also clinically improved and had established a training project more than 5 years after discharge. The contribution of therapeutic residential care seems very interesting for adolescent and young adult with chronic mental disorders. [ABSTRACT FROM AUTHOR]

Concerns of maltreatment and poor outcomes persist in residential care despite numerous government inquiries and recommendations. Young people in residential care continue to be the most vulnerable and marginalized group in the out‐of‐home care population. Young people's voices are also underrepresented in research. Existing studies predominantly focus on service evaluations in which individual voices of young people are overshadowed by adults' perspectives. Other studies examine the perspectives of young people in out‐of‐home care as a homogenous population, limiting understandings of the subjective experiences of young people in residential care. This study focused exclusively on young people's lived experiences in Australian therapeutic residential care, utilizing interpretative phenomenological analysis. The young people in this study revealed experiences of peer victimization, ambiguous loss and uncertainty during transitions. These findings suggest that more work is required in order to provide safe and healing environments and experiences for young people in therapeutic residential care. Each individual voice captured in this study offers valuable insights into how residential care practitioners can strengthen practice to enhance protection, engagement, connection with families and leaving care support. [ABSTRACT FROM AUTHOR]

Although research has repeatedly shown that residential care for youth with a serious behavior problem has little rehabilitation success, there is a group of youth for whom residential care in a locked setting is necessary. In this article, a manualized therapeutic residential treatment model for adolescents with serious behavior problems, MultifunC, is evaluated. The program theory of MultifunC is based on a review of the literature and synthesis effective treatment components. This study included 80 youth aged 15–17 years with a medium high or high risk for reoffending. Half of the participants received MultifunC, and half treatment as usual (TAU). Although non-randomized, the two groups were found to be equivalent on important background variables. After 24 months, this first evaluation of MultifunC demonstrated that youth participating in MultifunC had a reduced need for residential care in a locked setting as well as out-of-home placement in general compared to youth in the TAU group. The economic analysis found MultifunC to be a cost-effective alternative to TAU due to the reduced need of residential care in locked settings. There were no significant effects on reoffending or psychiatric care. [ABSTRACT FROM AUTHOR]

Children and young people in residential care have often lived lives saturated with loss, neglect, rejection, and traumatic experiences. Children express the pain of trauma in various ways, namely pain-based behaviors manifesting in ways that often leave their care givers confused, frustrated, frightened, angry or exhausted. For residential caregivers to respond to children and young people in a consistent and therapeutic manner, residential environments must provide an ethos of respect, caring, and trust, creating a safe place for children and staff to live and learn together. This paper describes the Children and Residential Experiences (CARE) model, its implementation, and evidence for its effectiveness. CARE is a trauma-informed, principle-based, multi-component program designed to enhance the social dynamics in group care settings and help agencies create a living environment that provides developmentally enriching experiences for children in their care. By incorporating the CARE principles throughout all levels of the organization and into daily practice, the CARE program model has been shown to improve the capacity of staff to establish positive developmental relationships with the children in their care, offer developmentally enriching experiences and a “sense of normality”, and create cohesion and congruence throughout the organization. Through consistent and predictable compassionate and responsive interactions with adults, as well as opportunities to overcome challenges and to experience successful learning opportunities, children can grow, develop and thrive.

Children and young people with backgrounds of trauma, and supported in residential programs (group care, residential treatment, wilderness therapy, and outdoor behavioral healthcare), require interventions underpinned by trauma-informed science. While there is much optimism that trauma-informed services are being integrated into residential care settings, there is evidence of a science to practice gap in how these components are implemented across real-world settings. The purpose of the paper is to introduce 'intentional practice' and growth-focused logic modeling (Life Buoyancy Model; LBM) as a possible method to strengthen the delivery of trauma-informed services at the program level. The paper provides an overview of the modeling and describes how the approach seeks to reduce the science to practice gap in the implementation of trauma-informed service delivery. To aid this process, five core intervention components are proposed to provide a more nuanced understanding of how trauma-informed practice can be implemented. Key considerations are offered for residential care program leaders and program developers to design, refine or review the delivery of locally contextualized program models. [ABSTRACT FROM AUTHOR]

Background: Residential child care is a very complex measure and has been the subject of heated debate in many countries. However, there is a paucity of studies that examine quality assessments of these services, much less that have asked the children and young people receiving those services about their own evaluations. Method: This study interviewed 209 young people between 11 and 20 years of age, in 21 residential facilities, about their degree of satisfaction with the care they receive. These residential facilities are differentiated into three types of programs that will be compared: preparation for adult life (PAL), therapeutic care for behavioral problems (TRC) and general programs for children and young people without any specific profile (GRC). The instrument used is an interview that includes both quantitative and qualitative assessments. Results: The results show a trend toward positive average scores on practically all aspects, highlighting the support from as well as the connection they feel with the educators who care for them. On the other hand, young people in TRC displayed lower scores on almost all aspects evaluated while those in PAL were the most positive. Conclusions: The main implications for the practice will be discussed from these youths' perspective. [ABSTRACT FROM AUTHOR]

The institutionalization of children and young people has been improved in the course of time in order to respond to the children needs. The reasons for the residential care for the majority of children and young people are mainly related to situations of negligence, maltreatment or abandonment by caregivers (including their parents), often associated with risk behaviors of children themselves. Having in mind this concern, Casa Pia de Lisboa (CPL) is trying to follow a more direct intervention towards the children needs, in order to change the residential care paradigm, becoming more and more a therapeutic care. Nowadays the residential care at CPL, aims to respond, to the emotional needs of children and young people, promoting the internal emotional, behavior and social change. This communication intend to present some of the tools used in the daily intervention with children and young people, with therapeutic intention and some of the indicators that allow monitoring the work developed, like their satisfaction with the residential care at Casa Pia in Lisbon. [ABSTRACT FROM AUTHOR]

Children and young people in residential care have often lived lives saturated with loss, neglect, rejection, and traumatic experiences. Children express the pain of trauma in various ways, namely pain-based behaviors manifesting in ways that often leave their care givers confused, frustrated, frightened, angry or exhausted. For residential caregivers to respond to children and young people in a consistent and therapeutic manner, residential environments must provide an ethos of respect, caring, and trust, creating a safe place for children and staff to live and learn together. This paper describes the Children and Residential Experiences (CARE) model, its implementation, and evidence for its effectiveness. CARE is a trauma-informed, principle-based, multi-component program designed to enhance the social dynamics in group care settings and help agencies create a living environment that provides developmentally enriching experiences for children in their care. By incorporating the CARE principles throughout all levels of the organization and into daily practice, the CARE program model has been shown to improve the capacity of staff to establish positive developmental relationships with the children in their care, offer developmentally enriching experiences and a "sense of normality", and create cohesion and congruence throughout the organization. Through consistent and predictable compassionate and responsive interactions with adults, as well as opportunities to overcome challenges and to experience successful learning opportunities, children can grow, develop and thrive. [ABSTRACT FROM AUTHOR]

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 TRC as an essential component in the system of care for youth services. First, an international consensus statement provides a definition on what are key elements for the TRC level for the first time. Second, research reviews documenting the effectiveness of TRC practices and models provide a clear base for determining current program quality and establishing future research, program development, and policy directions. Third a public/private partnership involving providers, lead agencies, research leaders and state agencies is establishing new quality standards for out-of-home care in Florida. These standards draw on both the consensus statement and the TRC empirical base and seek to elevate the quality of individual TRC programs as well as out-of-home care statewide. We provide the experience of one agency, which is a national provider of TRC using a model of care with promising research evidence, to suggest that these three developments give practitioners, policy makers, and researchers a fresh perspective on how to fit TRC programs into an integrated continuum of care. [ABSTRACT FROM AUTHOR]

Adolescents who reside in residential care are exposed to a variety of therapeutic methods, including equine-assisted therapy. This study examines the subjective experience of therapeutic horseback riding (THR) among adolescents at risk. It explores whether the nature of their backgrounds and the level of risk they face generate specific therapeutic experiences in equine-assisted therapy. Using a qualitative research method, 19 adolescents aged 14-19 were interviewed from two different groups: adolescents living in therapeutic residential care and adolescents living in educational residential care. Based on the contexts of personal, familial, and educational contexts, the study examined the outcomes of the therapeutic intervention in both groups. Further, five riding instructors from both groups were interviewed in order to provide validity to the comparison between the two groups. The findings of this study revealed similarities and differences in the therapeutic riding experiences of adolescents from both groups. An analysis of the data revealed three main themes separating the two groups: autonomy in riding, relationships with instructors, and therapeutic riding outcomes. It is important to take into consideration the differences found between the two groups when planning and customizing interventions to meet the needs of adolescents with varying risk profiles and backgrounds in order to meet their specific needs. [ABSTRACT FROM AUTHOR]

This article explores how trauma theory has become influential in recent years in the fields of child welfare, out-of-home care and youth justice. It argues that this has brought with it some serious concerns. These include a belief that trauma informed approaches provide the answer to most or even all the challenges faced in human service delivery and that it applies equally across a diverse range of clients. There is also a lack of clarity about the definitions and nature of trauma including the conflation of different types of adversity, and some evidence of rigid, unthinking applications of theory, research findings and clinical propositions.

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: “Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioral needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources”. The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Spanish translation, comprises interalia five basic principles of care that according to the Work Group on Therapeutic Residental Care should be guiding for residential youth care provided at any time. [ABSTRACT FROM AUTHOR]

This article provides data about the national usage of residential care services for children and young people in Australia. A number of definitions of therapeutic residential care are then considered. Next details of the debate in New South Wales and elsewhere in Australia are reviewed. The focus then moves to the identification of the characteristics of those children and young people who may need 24/7 therapeutic residential care. The final section is about the difficulty of transitioning standard or generic residential care programs into therapeutic residential care. [ABSTRACT FROM PUBLISHER]

In current practice, residential care programs in the United States are often more general than specialized with little demonstrated results of effectiveness for different types of youth. Subgroup analyses focused on developing a thorough understanding of the subpopulation of youth served in residential group care have potential to inform targeted program development. Using assessment records of a sample of 447 youth in psychiatric residential treatment, a latent class analysis was performed to identify youth subtypes. The results revealed four classes of youth characterized by severe levels of functional impairment and externalizing behavioral problems. Class distinctions were observed in the areas of psychiatric diagnoses, child behavioral problems and strengths, family characteristics, and maltreatment histories. An examination of class profiles lends support for the applicability of some general approaches across therapeutic residential programs, including the use of trauma-informed care and family-centered practice frameworks. The findings further demonstrate the need to also include program elements that are specified to the types of youth the program is designed to treat. Implications for policy and developing specified treatment protocol matched to the types of youth served in psychiatric residential programs are discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses therapeutic residential care (TRC) which is considered a neglected area of child mental health (CMH) intervention. Topics include the various contributions made by researchers in this field that offer a progressive outlook on the child and family interventions which has also received recognition from the California Evidence-Based Clearinghouse for Child Welfare (CEBC).

• Six non-specific treatment factors and five specific treatment factors identified. • One specific and four non-specific treatment factors appear in multiple studies. • More research is required to replicate findings. • TRC should include general components and specified approaches to sub-groups. There is limited evidence on how Therapeutic Residential Care (TRC) achieves treatment goals: TRC remains too much of a "black box". We need to know more about how results are achieved, rather than merely investigating the achieved results. This systematic review aimed to synthesize quantitative literature regarding the associations between non-specific and specific treatment factors and lower or greater internalising and externalising symptoms. Following PRISMA guidelines, a systematic literature search was conducted in July 2021. Of the 2,409 records screened, 40 articles, composed of 38 samples were included. A total of six non-specific treatment factors (individual, family, academic history, symptoms, abuse and trauma history and relationships) and five specific treatment factors (treatment model, therapeutic intervention, placement decision making, environment and staffing) were reported. Only four non–specific treatment factors and one specific treatment factor appeared in multiple studies while all other factors and sub-factors were not replicated. More research is required to replicate and explore possible specific and non-specific treatment factors associated with internalising and externalising symptoms. The reviewed literature suggested that TRC should target a myriad of non-specific and specific treatment factors to increase the likelihood of success and that family involvement may be a particularly crucial component. Future research should focus on longitudinal studies that explore the long-term impact of non-specific and specific treatment factors on youth during placement and beyond. [ABSTRACT FROM AUTHOR]

This article explores how trauma theory has become influential in recent years in the fields of child welfare, out-of-home care and youth justice. It argues that this has brought with it some serious concerns. These include a belief that trauma-informed approaches provide the answer to most or even all the challenges faced in human service delivery and that it applies equally across a diverse range of clients. There is also a lack of clarity about the definitions and nature of trauma including the conflation of different types of adversity, and some evidence of rigid, unthinking applications of theory, research findings and clinical propositions. [ABSTRACT FROM AUTHOR]

This article will address a brief history of the nature and definition of translational research and introduce several relevant debates within the field of translational research, specifically the relationship between practice-based knowledge and research in therapeutic residential child care. We offer a model of translational research developed by Hamilton (2014), particularly for work related to youth development that has the potential to bring the child care practitioner to the centre of the process to improve the outcomes of high-needs children. Finally, we provide some lessons learned from the implementation and evaluation of two major programmes designed to improve the quality of therapeutic residential care.

Australian Red Cross Young Parents Program works to ensure best outcomes for children and families by improving the capacity of young parents with complex needs, aged 13 to 25, to live and parent independently. The program is funded through a range of government and philanthropic sources including the New South Wales (NSW) Department of Family and Community Services (FACS) and the Ministry of Health. [ABSTRACT FROM AUTHOR]

• A strong consensus from the research participants that therapeutic residential care should be trauma-informed. However, how it should be operationalized in practice is understood differently by the research participants. • Crisis-driven practice in therapeutic residential care also generates a paradox: there is a risk of re-traumatizing young people in a care environment that aims to foster safety. • Workforce insufficiency including inadequate clinical support to staff and young people, along with the emotional cost of care hinder the implementation of therapeutic residentialcare. • The barriers identified in this study call into question the extent to which therapeutic residential care is implemented as intended. • To fully actualize the full potential of therapeutic residential care, substantial work is needed to provide a more translatable practice framework, strengthen referral and assessment processes, revitalize the workforce and elevate the implementation efforts to a systemic level. Repeated inquiries into residential care for children and young people in out-of-home care have documented persistent service inadequacies. Calls for reforming residential care into therapeutic care have received growing attention in recent years. However, limited research exists to inform how therapeutic care can be optimally implemented in residential care settings. This research draws on the first-hand experience of residential care practitioners to examine the barriers they experienced when implementing therapeutic care. Twenty-six practitioners across five different service strata (senior managers, therapeutic specialists, caseworkers, team leaders and direct care workers) from three Australian residential care organizations participated in semi-structured interviews. Framework analysis of the interview data indicated, whilst there was a strong consensus that therapeutic residential care should be underpinned by trauma-informed knowledge, its implementation was constrained by six barriers: (1) inconsistent understandings of how therapeutic care should be operationalized; (2) crisis-driven referrals and assessments; (3) problematic placement configuration and client mix; (4) inadequate workforce development; (5) the emotional cost of care; and (6) atrophied clinical support. These barriers call into question the extent to which therapeutic residential care is implemented as intended. Findings indicate that, to actualize the full potential of therapeutic residential care, substantial work is needed to provide a more translatable practice framework, strengthen referral and assessment processes, revitalize the workforce and elevate implementation efforts to a systemic level, bringing closer alignment between different service systems to jointly avert re-traumatization and enhance consistency in service delivery. [ABSTRACT FROM AUTHOR]