On August 12, 2006, Ellen Behrens, PhD, Canyon Research & Consulting, Salt Lake City, UT, 801-205-2330, was interviewed by Lon Woodbury, President of Woodbury Reports Inc. and Kathy Nussberger, Co-editor of Places for Struggling Teens, www.strugglingteens.com, to discuss her research findings from Phase One of her Outcome Study on the effectiveness of private parent-choice Residential schools and programs. This study is the first systematic exploration of outcomes of private parent-choice residential treatment.
Ellen explained that she had just completed Phase One of her research on these programs with nearly one thousand families participating in the study. She emphasized that she "wanted to clarify that we are not done, the current research data includes just the first of a two phase study."
"In Phase One, we collected data surrounding admission, discharge, how the children functioned and how they changed during and immediately after treatment," Ellen explained. "In Phase Two, we are looking at the student's progress for up to a year after leaving the program and how it differs from their functioning at the time of discharge. The first Phase explores whether residential treatment works in both the kids and parent's opinion. The next question in Phase Two, which will be released in the first quarter of 2007, is does it last? In other words, do the changes during treatment get better, stay the same, get worse or lose their power after discharge?"
Ellen added that most of the available literature shows that young people graduate, take a dive and then pick themselves up, but the problem with that data, at least the published data, is that it was largely gathered from public residential care. "This data shows improvement in their overall functioning at discharge, a dip about three months later with them beginning to pull themselves back up at about six months, and normally by twelve months they are at or above the level they were at when discharged. Published qualitative reports from Menninger's show the same patterns."
Ellen says her study, with nearly one thousand families participating, is larger than most comparable studies and large enough to provide fairly reliable results. "An interesting factor to the Phase One results of the study showed how in some instances the youth actually reported more problems at discharge than their parents. It is unclear whether those scores were because the youth were more sensitized or more aware after spending almost a year in rigorous treatment, or because the parents had not lived with them and were not yet aware of the real changes. However, the majority of both parents and youth indicated nearly the same level of change on their rating scores at discharge."
Ellen said she thinks Phase Two is where the long-term post-discharge data will flush out the differences between youth and parent reports at discharge as well as predict any long-term functioning and hypothesis about some of the subtle differences. "We also tried to eliminate all students discharged from the programs before graduation because the clinical staff thought it was actually an inappropriate placement, or when they felt the program couldn't be helpful to the child. As a result, the operating assumption of the study is that the students included in the analyzed data were those who were appropriately placed."
In Phase Two, Ellen is studying the children's progress on three different intervals over a 12-month period with the goal of providing additional information on the overall trajectory of change. "People change by learning something new, testing it, stumbling, regaining their footing and moving on, but I don't think it has anything to do with the efficacy of our care, it is simply how change happens to people."
Ellen is also collecting some data in Phase Two regarding the correlation of the quality and quantity of aftercare by the participating programs to how well the youth succeed after discharge. "When we created this study four years ago, there were so many things we wanted to include that we decided to throw out a broad net and use this as a first step As a first step, we tried to maintain a reasonable amount of data collection because we didn't want to overwhelm the respondents."
Ellen explained that what makes this outcome study unique is that it is longitudinal with a large sample size and included multiple programs. "Therefore, it has given us our first glimpse into the outcomes of private parent-choice residential care, and we think it's fairly indicative of what happens in a treatment setting. We found that the types of youth we tend to serve appear to be those with multiple problems. In fact approximately 85 percent of the youth in this sample had more than one serious problem for which they were treated and tended to be equally male and female. This is noteworthy because there is an assumption in the published literature that residential programs do not have a good gender balance. In reality from the multiple programs in our study, there was a good balance. About 95% of the youth in our study had received and "failed" prior treatment at other levels of care and/ or types of treatment."
She added that she wanted to emphasize that this study is the first systematic exploration of outcomes of private parent-choice residential treatment.
Ellen also pointed out one interesting observation that the degree of change between youth with and without mood problems such as depressive or bi-polar is slightly different. She believes this difference is related to the nature of mood disorders. "I think there was one pattern in diagnosis that did show up and that was regarding mood problems because it appears that youth with mood problems don't improve as much as those without mood problems. However, they did improve significantly and moved from the clinical to the normal range, so the changes we saw were still dramatic and meaningful. The slight difference in the degree of change between youth with mood disorders and those without was around eight or nine points. It was not a huge difference, but it was enough to say that children without mood disorders did a little better in residential treatment, yet both groups did very well. Although we can only hypothesize the reasons for this difference, my hypothesis was that mood disorders are a diagnosis of a recurring nature, so even if we can treat it effectively there are still residual problems."
In conclusion, Ellen pointed out this study found that based on the answers of 993 families, "the youth did change after the course of treatment," and their ability to function by the time of discharge improved to well within the normal range of most teenagers. Youth who entered the programs with extreme and sometimes disabling psychological and social problems ranked in the 97th percentile, meaning they were functioning worse than 97% percent of teenagers. "Typically, in outcome research, you'll see a change but not like what we found in this study, which showed a dramatic change of 30-40 percentile points. Not only did the youth change significantly for the better while they were in treatment, but that change was not dependent on their demographic background, treatment history or types of problems. Again, you do not normally find that in outcome research. For instance in the public residential literature, you find males tend to do better then females, younger children tend to do better then teenagers, and students with substance abuse problems don't do as well as students with other problems. In this study, we found that regardless of the problems the student presented with originally, they did have a significant clinical change, which surprised me as a researcher because I was not expecting to see that."
I read your interview with Dr. Behrens with interest. It would be helpful to know more about Dr. Behren’s research design and methodology. I presume she drew a random sample for the study; otherwise, the results cannot be generalized to the school/residential population at large. Parents and the residential treatment community should applaud Dr. Behren’s original efforts to provide new knowledge. As with any research, the validity and reliability of the results rests with replication of the study by other researchers.
Jerry W. Clark, M.S.W., Ph.D.
Dba Behavioral Services Ltd.
P. O. Box 14223 University Sta.
Reno NV 89507
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