Residential immersive life skills programs for youth with disabilities: a case study of youth developmental trajectories of personal growth and caregiver perspectives.

BACKGROUND: Professional support in pediatric and rehabilitation care environments has been recommended as a means to build youth competence in life skills during their transition to adulthood. Life skills are the essential psychosocial competencies and interpersonal skills needed to manage one's life. Residential immersive life skills (RILS) programs offer youth with physical disabilities enriched learning environments to acquire these skills. This study explored trajectories of personal growth in life skills and positive psychological outcomes among youth participating in a RILS program and related caregiver perspectives. METHOD: Delivered by a multidisciplinary healthcare team, The Independence Program is an intensive summer program housed in a college residence that provides realistic experiences of living away from home for small groups of youth between 17 and 21 years of age who have congenital and/or acquired physical disabilities. Using a longitudinal case study and qualitative descriptive design, four youth and their parents/guardians participated in semi-structured interviews prior to, and then 1 month, and 3 to 4 months after the program. A conventional content analysis yielded chronological narratives for each youth and caregiver dyad of their experiences, perceptions and outcomes over time. These narratives were further summarized using a 'line of development' perspective to describe individual developmental trajectories of personal growth. RESULTS: All four of the youth returned from the program with positive reports about the new life skills acquired and new behaviours they engaged in. These positive reports generally continued post-program, albeit with differing trajectories unique to each youth and varying levels of congruence with their caregivers' readiness to support, accommodate and facilitate these changes. Caregivers differed in their capacity to shift in their parenting role to support consolidation of youth life skill competencies following program participation. CONCLUSIONS: RILS programs can be transformative. Varied youth trajectories identified significant personal growth through enhanced self-determination, self-efficacy and self-advocacy. Congruence in youth and caregiver perceptions of post-program changes was an important transactional factor. Professional support addressing caregiver needs may be beneficial to facilitate developmentally appropriate shifts in parenting roles. This shift is central to a model of shared management whereby adolescents take on greater responsibility for their own care and life choices.

Implementation of Dialectical Behavior Therapy in Residential Treatment Programs: A Process Evaluation Model for a Community-Based Agency.

Dialectical behavior therapy (DBT) can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation. This paper presents a low-cost process evaluation model to assess DBT training piloted in residential programs. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches data collection to the four stages of the DBT training model. The strengths and limitations of the evaluation model are discussed.

The implementation and effect of trauma-informed care within residential youth services in rural Canada: A mixed methods case study.

OBJECTIVE: The prevalence and associated risks of trauma have led youth-serving institutions to adopt trauma-informed care (TIC). A limited research base has linked TIC with improved outcomes. Associations between TIC and vicarious traumatization (VT) are even less commonly studied. The purpose of this case study is to evaluate the implementation and effect of TIC within 1 residential youth services division in rural Canada using the curriculum-based Risking Connection (RC; Saakvitne et al., 2001) and Restorative Approach (RA; Wilcox, 2012) trauma training programs, with a focus on VT. METHOD: We used an explanatory sequential mixed methods design and a participatory action research approach to evaluate the implementation and effect of RC and RA. Study 1, the quantitative program evaluation, used a prepost design to evaluate the effect of RC and RA on staff. Study 2, the qualitative study, used participant observations and interviews to develop a deeper understanding the quantitative findings. RESULTS: This study replicated previous findings that RC improves attitudes favorable to TIC but found that staff experience of VT increased after TIC training. Qualitative findings suggested that the division was successfully implementing TIC and that increased awareness and discussion of VT were potentially responsible for increases in VT scores. CONCLUSIONS: This case study documents improvements in staff attitudes favorable to TIC post-RC and RA and presents an in-depth analysis of TIC implementation. The study also highlights the complicated relationship between TIC implementation and staff experience of VT. Finally, this study provides a blueprint for conducting program evaluations of TIC. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using dance/movement therapy to augment the effectiveness of therapeutic holding with children.

PROBLEM: Therapeutic holding is a commonly used tool for the containment of aggressive behavior in children. Although often effective, the intervention has inherent physical and emotional safety risks. Can a body-based therapy be used to limit these risks? METHODS: Research was conducted incorporating dance/movement therapy techniques (D/MT) before and after therapeutic holding to investigate this question. Volunteer residential treatment center staff participated in a 4-hour D/MT-based training workshop integrating the techniques with the intervention. Children participated via self-report. FINDINGS: D/MT training increased adult awareness, sensitivity, perspective shifting ability, and confidence in the intervention while decreasing the necessity for physicality. CONCLUSION: Integrating D/MT therapy training with therapeutic holding decreased the threat of trauma to adult participants. Further research into the integration of D/MT techniques with safe holding procedures may prove helpful in the challenge of making restraints safer for both children and adults.

Caregiver understanding of adolescent development in residential treatment.

PROBLEM: Caretaker knowledge and understanding of adolescent development and its application to clinical practice with severely emotionally disturbed adolescents in residential treatment. METHODS: Twenty child-care workers and registered nurses participated in semistructured interviews analyzed using dimensional analysis, a grounded theory method. FINDINGS: Three distinct categories of caregivers were identified based on level of expertise and engagement in developmentally appropriate treatment practices: inexperienced, party-liners, and transcenders. Developmental issues identified included lack of resident preparation for puberty and staff discomfort with adolescent sexuality. CONCLUSIONS: Caregiver, institutional, and social barriers to developmentally sensitive practice were identified. Practice recommendations include direct preparation of children and adolescents in residential treatment for pubertal changes and sexual development, and careful discernment of age-appropriate and psychopathological adolescent behaviors.

Training residence staff for child abuse treatment.

Since improved reporting laws have led to an increase in the number of children in residential facilities who are identified as victims of sexual abuse in addition to their presenting problems, one agency developed a training program that helps staff members work more effectively with these children and their families.

Estudio pre-experimental sobre conocimientos que poseen padres y familiares de niños con patologias respiratorias coronicas para continuar con los cuidados y tratamientos en el hogar: Córdoba: Período marzo a noviembre 2006 / Pre-pilot study on knowledge they hold parents and families of children with chronic respiratory pathologies for continuing care and treatment at home: Cordoba: Period March to November, 2006

Antecedentes: Los cuidados y tratamientos domiciliarios de los niños con patologías respiratorias crónica, revisten un gran valor e importancia, ya que preveienen las reagudizaciones y contribuyen a mejorar las calidad de vida de éstos niños. Objetivos: evaluar qué conocen los padres y/o familiares, acerca de los cuidados y tratamientos fisiokinésicos, que requieren los niños que padecen enfermedades respiratorias crónicas y a la vez educar y orientar a los padres mediante una intervención educativa, a fin de mejorar la práctica del cuidado y tratamiento domiciliario del niño. Métodos: Se realizó un estudio pre-experimental, longitudinal y prospectivo a padres y/o familiares de niños que presentan patologías respiratorias crónica. que estan o estuvieran internados en el Hospital de Niños de la Santísima Trinidad de la ciudad de Córdoba, con indicación de tratamiento fisiokinésico domiciliario. En el grupo de padres y/o familiares responsables se evaluaron dos momentos diferentes (Antes y Después) de una Intervencion Educativa, ya que siguiendo la metodología pre-experimental se introdujeron acciones formativas sobre los procedimientos que debían seguirse en el cuidado y el tratamiento en el hogar de los pacientes niños con las enfermedades respiratorias crónicas.