Leading Edge Residential Treatment

Residential treatment for children and youth is a service that has historically generated concerns. Some youth and families credit residential with having “saved their lives,” and the service is seen as needed to provide safety for youth when community services are insufficient or ineffective. Yet, practices in residential programs have often focused on coercion and control. In the worst-case scenarios, abuses, and even deaths, have occurred. Outcomes have often not been great, with young people having to return to out of home placement following discharge.

In recent years the field has responded by developing innovative practice [1]approaches, building on the most recent science and evidence. The service is being reconceptualized as a “residential intervention”[1] provided to young people and their families, for a specific purpose and period of time. A growing body of evidence is showing the beneficial impact of implementing leading edge practices in residential interventions.[2] In general, these practices align with key principles of the brain science, center relationships as the prime mediator of outcome, honor voice and choice, and reduce the imposition of power and control.

Because most of these practice innovations require significant change initiatives in residential programs, they are challenging to integrate and sustain, often requiring focus on one or two practice changes at a time. Organizations that embrace and implement them during start-up are in a better position to build cultures of safety and care.

Idaho Youth Ranch will embrace and implement innovative care practices during start-up are in a better position to build cultures of safety and care_

This is the aim of Idaho Youth Ranch . This long-standing mental health provider has responded to the vacuum of residential services in Idaho, whose young people were being sent out of state when community services weren’t effective in meeting their needs, by developing its Residential Center for Healing & Resilience (RCH&R). The organization’s values and culture—centered around relationships, hope, healing, resilience, growth mindset, compassion and transparency—afford an aligned foundation for implementing leading-edge practices. The RCH&R is being designed with a commitment to bringing together, learning, and integrating these transformational therapeutic practices to provide the best opportunity for youth and families to succeed.

What follows are leading edge practices that have been shown over the past 20 years to positively impact outcomes of residential interventions, and which Idaho Youth Ranch will be implementing when this state-of-the-art center launches. Future articles will examine each of these practices in more detail, in the hopes of stimulating a robust dialogue to inform the startup and program development process.

  • Trauma-Informed Care Trauma informed care involves more than providing trauma treatment. It is an organization-wide endeavor. A grounding in brain science is key to becoming trauma informed, both clinically and organizationally. Staff are trained and supported to:
    • realize the pervasive and widespread impact of overwhelming stress and trauma, not only on the individuals they serve, but also on staff, community partners, and stakeholders;
    • recognize the signs and symptoms of overwhelming stress and trauma;
    • respond in their interventions and practices, as well as in policy and procedures; and
    • resist retraumatization, i.e. become and remain attuned to policies, procedures, practices, and interventions that may have the unintended consequence of creating stressful or traumatic experiences.[3]
  • Family Driven Care Family Driven Care involves regarding families as equal partners in all decision making, including treatment planning, program policies/procedures, and improvement initiatives.[4] Many strategies have been developed and successfully implemented in residential programs to engage, involve, and partner with families, with transformational impacts on program culture and outcomes.[5]
  • Youth Guided Care Youth Guided Care involves and empowers youth to have decision making roles in the care of their own lives, as well as the policies and practices of the program, and even in their home community.[6] There are practices and strategies for engaging and empowering youth that have yielded outstanding results for residential programs.
Youth Guided Care at Idaho Youth Ranch involves and empowers youth to have decision making roles in the care of their own lives-1
  • Cultural Competence Cultural competence refers to the ability to effectively respond to the challenges and opportunities posed by the presence of cultural diversity.[7] Cultural competence provides the foundation for developing knowledge, skills, and awareness necessary for achieving equity, diversity, and inclusion.[8] It is critical in residential interventions, since evidence shows that when the culture of an individual is not attended to, the person is at risk of receiving services that may be more harmful than helpful.[9]
  • Peer Support Peer support is the practice of hiring people who have had the same sorts of life experiences as the individuals receiving help— i.e. peers. It is not new, having been first introduced in addictions treatment, and then migrating to mental health services. While peer support has come slowly to residential programs, agencies have been experiencing transformational impacts on their culture and practice from hiring family members with lived experience of having children in the service system as well as those who were recipients of services in their youth. A body of practice knowledge is emerging as increasing numbers of programs utilize peers as a quality improvement and workforce development strategy.
  • Permanency Practices Permanency practices focus on strengthening, building, and maintaining lifelong, supportive family relationships while also building the skills youth and families need for life in the community. Residential programs focusing on permanency practices are more likely to experience improved short- and long-term outcomes for youth and their families.[10]
  • Aftercare: Linking Residential and Community Providing continuity of relationship and experience during the transition and aftercare period is a key determinant of long-term outcome.[11] Linking residential and community services throughout the intervention, starting at intake, facilitates development of skills and resources necessary for a successful aftercare transition.
  • Collaborative Problem Solving Collaborative Problem Solving (CPS) is a trauma-informed, evidence-based, skills focused approach for working with children who are having challenges meeting everyday expectations in their actions and behavior. It teaches a philosophy/mindset grounded in neuroscience and evidence, paired with a practice model that promotes socio-emotional learning and a growth mindset. CPS is unique in that it can be used across all community settings—home, schools, foster care, residential, outpatient, juvenile justice, child welfare, and wraparound-- thus creating a common language and continuity of experience for the youth and family. It can be learned and used by individuals at all levels, including family members/caregivers, therapists, front line counselors, teachers, classroom aides, medical and psychiatric staff, and administrators.
  • Integrated Education Education is often seen as separate and different from the treatment efforts in residential programs. Integrating education and treatment provides a coherent and predictable experience for youth that optimizes their ability to learn and grow.
  • Outcomes Management Residential programs are developing new systems for identifying and measuring outcomes. These can enable programs to make immediate changes in treatment plans as well as longer term quality improvements.
  • Therapeutic Crisis Intervention This is a framework for responding to highly dysregulated behavior that presents an immediate safety risk. It has been developed and refined to align with the latest research and knowledge about neurodevelopmental processes and trauma-informed care.

Stay tuned for more detailed looks at each of these practices, and please weigh in with thoughts and questions.

[1] Blau, et. al, 2014

[2] Caldwell, et. al. 2020

[3] SAMHSA, 2014

[4] SAMHSA, 2013

[5] Craig, 2022

[6] SAMHSA, 2013

[7] National Health Care for the Homeless Council, 2016

[8] Goodman, 2014

[9] Cabral-Johnson and Pumphrey, 2015

[10] Lister, Frey, and Estrella, 2018

[11] Walter and Petr, 2008

Leading Edge Communtiy Home Page