The Child in Residential Treatment: A Follow-Up Study

Abstract

The Problem. The problem of this study was to determine whether certain variables relating to the child requiring placement in a residential treatment center were associated with the child's eventual positive or negative adaptation within the community. Such variables consisted of preadmission characteristics, selected activities during residential treatment and the discharge phase. The Health and Sickness Scale (HSS) was used at point of discharge to predict eventual adaptation. The selected variables were compared with the nature of the child's adaptation, either positive or negative, at the time of follow-up. Procedure. A total of 199 youths had been placed in the Orchard Place programs since its inception in 1965. Of these, 138 could be located and were included in this study. Two judges reviewed the casefiles of each youth and recorded data pertaining to age at admission, number of preadmission foster home placements, whether the child had received any group care placements prior to the Orchard Place admission, whether the child was living with parent(s) prior to admission, the actual length of the residential care received, the frequency of parental contact during the child's residential treatment and the disposition of the case at point of discharge. Additionally, the Health Sickness Scale (HSS) was used by the judges at point of the child's discharge to measure the outcome of the treatment experience. Contact was then made with the former subject or with relatives or social agencies requesting participation in the study. A structured questionnaire was used to collect responses from participants regarding the subject's adaptation to the community since the time the subject was discharged from Orchard Place. Each subject was evaluated as either positive adaptation (+) or negative adaptation (-) depending upon selected criteria. The responses on adaptation were compared with each of the hypotheses of the study and Chi-Square tests were applied to test at (p <. 05) for independence of each hypotheses. The structured questionnaire additionally included other questions including such items as school adjustment and current grade placement, if any, highest educational level attained, church affiliation, friendships, overall current adjustment status, and involvement in psychiatric outpatient counseling. An attempt was also made to assess when a negative adaptation occurred from point of Orchard Place discharge. Findings. The results of the study indicated that of the seven hypotheses three were statistically significant with adaptation: preadmission group care with adaptation (p <.001), whether the subject was with parents(s) prior to admission (p <.001) and disposition at discharge (p <.001). No statistically significant relationship was found for length of care, frequency of family involvement, age at admission and preadmission foster family care. The HSS was found significant with adaptation (p <.001). In terms of educational questions it was found that those rated at (+) adaptations tended to do better in school, attain higher levels of educational achievement and if in school, fewer of the (+) group were found to be in special educational programs. Adaptation with church attendance (p <.05) and friendships (p <.01) were found to be significant. Overall or global assessment of the subjects' current status was significant with adaptation at (p <.001). Involvement with further outpatient psychiatric counseling was not significant with adaptation. Another finding was that of those who were evaluated as manifesting (-) adaptations about 45% occurred within the first three months following the discharge. Conclusions. The preadmission experiences of the children apparently hold much significance for eventual adaptation. The HSS was found to be useful in this study and has application for assessing adaptation if used at point of subject discharge. Returning the child home following treatment was a significant factor in long range adaptation. An (+) adaptation rate of 69.34% was computed for the target group and those who were evaluated as (-) adaptations may represent a special population group who require intensive services. Recommendations. Further effort must be made by the agency to assess and meet the needs of troubled youths who are found in residential programs. Of particular import is the time soon after discharge when attention needs to be given to the process of re-entry into the community and family. Consideration should be given to expanding use of the HSS as part of future assessment efforts and further attention should be focused on what were the essential factors in assisting the (+) group to successfully adapt to the community following the residential experience.