Relationship of time in residence to outcome for adolescent female residential treatment
Deborah Augenbraun (2004)
A program evaluation was conducted in a group home for female adolescents. The theoretical approach to treatment represented an object relations and relational model. Archival data were evaluated for 38 former residents between the ages of 13-18 years. Length of stay at the group home ranged from 8 months 3 weeks to 47 months (M = 17.47, SD = 9.46, Mdn = 14). Problem behaviors such as aggression, anxiety, depression, rule violations, relational conflicts, running away, suicidal and self-harming behaviors were assessed over time using data gathered from a review of archival records. Data were analyzed using two different time periods. The first time period included the client's first nine months of treatment, while the second time period included data from the client's entire length of stay. Data analyzed using repeated measures analysis of variance and pairwise comparison t-tests revealed several significant findings: a reduction in the number of internalizing problem behaviors (anxiety, depression, eating disorder symptoms, psychiatric hospitalizations, somatic complaints and suicide) across all residents; reductions in depressive symptoms (depressed mood, insomnia, feelings of worthlessness, withdrawal or isolation) and suicidal behaviors (self-mutilization, suicidal ideation, suicidal gestures) for residents diagnosed with major depression; and improvements in interpersonal skills across all residents. The significant improvement in interpersonal problems occurred after nine months. However, significant improvements concerning major depression and internalizing problem behaviors were found only when entire length of stay was considered. These findings have larger implications concerning treatment duration (dose-effect) for those suffering from internalizing problems and major depression. No change in behaviors related to externalizing problem behaviors were evident. Overall, female adolescents suffering from internalizing problem behaviors showed improved behavior under this treatment model. Suggestions for enhanced program and outcome evaluation included: modification of treatment approach dependent upon diagnosis; improvement of record keeping procedures; standardization of outcome measures; addition of pre-and posttesting; and collection of follow-up data. Recommendations for future research include: identifying successful treatment models for female adolescents suffering from externalizing problem behaviors, examining length of treatment and its effect on different diagnoses, and the efficacy of relational treatment with different populations in different treatment settings.