NUMBER 714 • 1 APRIL • TRANSITIONING FROM RESIDENTIAL TREATMENT
In a break with then-prevailing attitudes, Finkelstein (1980) proposed, based upon the experience of Parsons Child and Family Center in Albany, NY, that residential treatment programs be structured from inception upon the plan for discharge with priority given to a return to the family. Focusing treatment on the needs of the family, not just on needs of the child, altered the approaches traditionally utilized in residential treatment. This past research may have led to a change in staff attitudes towards family and parental involvement in treatment and in discharge planning: a more recent study showed that residential staff members were very supportive of greater family involvement, although they showed more support for families in the role of service recipients than as decision makers (Baker, Heller, Blacher & Pfeiffer, 1995).
Involvement of family members as service recipients was further supported in research employing a records review of 130 adolescents served in residential treatment. Researchers looked for predictors of discharge status, examining variables related to demographics, victimization, family dysfunction, prior antisocial behaviors, and therapies (Stage, 1999). "The results showed that the odds were 8:1 that residents who received family therapy were discharged to less restrictive settings" (Stage, 1999). Findings such as these support early and continued involvement of family members in their child's services.
It remains important that the family and service community work together during planning for discharge and transitioning back into family care. "Aftercare is a distinct and necessary intervention for children leaving residential treatment...[a time] when child and family face critical tasks" (VanHagen, 1982). Family involvement and contact, and/or resolution of issues surrounding biological families' parenting, represent crucial issues demanding attention when returning children to less restrictive environments while supporting treatment gains post discharge. Parents "were unable to rear the children themselves because of a host of problems, and...these problems ...[need to be] confronted to enable the parents to resume care" (Tam & Ho 1996). Family therapy appears to be an important component in attaining this goal (Stage, 1999).
Since the majority of children eventually return to family-centered community living, service values have shifted toward supporting the child and family. In fact, "the degree of environmental support following discharge tended to be a stronger predictor of success and improvement than [the] clinical treatments received during placement (Durkin & Durkin, 1975)" as cited in Hoagwood & Cunningham, 1992.
Environmental supports include family, school, community, peer group, and professional helpers. These same supports make it more likely that positive treatment gains achieved will be maintained: "The gains of the treatment experience were not maintained if supports were not in place when the child returned home (Whitaker & Pecora, 1984) as cited in Hoagwood & Cunningham, 1992. In addition, Hoagwood & Cunningham cite a study that found:
[O]ver two thirds of the respondents stated that the availability of community-based services for the student and family would have prevented residential placement. The availability of community-based services with which to transition a student from residential placement back into the community was the single most likely reason...for positive discharge. Specifically mentioned were services that included day treatment, respite care, intensive in-home family support, and crisis stabilization.
Ogilvie, M. (2001) Transitioning from residential treatment: Family involvement and helpful supports. Focal Point, Vol.15 No.1
Baker B., Heller T., Blacher J., & Pfeiffer S. (1995). Staff attitudes toward family involvement in residential treatment centers for children. Psychiatric Services 46(1), 60-55.
Finkelstein, N. E. (1980). Family-centered group care. Child Welfare, 59(1), 33-41.
Hoagwood, K., & Cunningham, M. (1992). Outcomes of children with emotional disturbance in residential treatment for educational purposes. Journal of Child and Family Studies, 1(2), 129-140.
Stage, S. A. (1999). Predicting adolescents' discharge status following residential treatment. Residential Treatment for Children & Youth, 16(3), 37-56.
Tam, T. S. K., & Ho, M. K. W. (1996). Factors influencing the prospect of children returning to their parents from out-of-home care. Child Welfare, 75(3), 253-268.
VanHagen, J. (1982). Aftercare as a distinct and necessary treatment phase: Results of the St. Vincent's aftercare study. Residential Group Care & Treatment, 1(2), 19-29.