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Paper

Secure residential treatment for juveniles with severe behavioural problems: what about its outcomes?

• issue: Issue 3 / 2008
• authors: Annemiek T. Harder, Erik J. Knorth, Margrite E. Kalverboer, Tjalling Zandberg
• keywords: The Netherlands, outcomes, secure treatment, residential care

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abstract

Background. In many countries, youth with the most serious behaviour problems are placed in residential institutions. In particular, secure residential treatment settings seem to have become a kind of 'last resort' for these youth. Secure residential treatment refers to a type of service in which care and treatment are offered in a secured environment. The problems of young people in these facilities are complex and often have started at an early age. Research suggests that their problems are quite stable over time.

There is not much known about the outcomes of secure care and the factors that influence outcomes in particular. A central theme that will be discussed in this paper is the effectiveness of secure residential treatment for troublesome and troubled youth and their families. We will present a selection of findings derived from an international literature study.

Purpose and method. Aim of the literature study is to map current scientific knowledge about residential child and youth care. We will direct the attention to one specific form of residential care - secure treatment - and ask what can be said, based on recent scientific literature, about the outcomes of secure treatment facilities.

The literature was collected by searching a number of national (Dutch) and international journals and databases. A total of 798 studies about residential child and youth care were found published in the past 15 years (1990 through to mid 2005). The search provided a set of 138 effect studies that reported about empirical research (Harder et al., 2006; Knorth et al., 2008). Only a small part of these effect studies (n=23) focused on secure treatment.

Key findings and implications. A total of 67 outcome measures have been used in the 23 studies. This indicates that almost three outcome measures are used in each study on average. Table 1 shows the used outcome measures.

Tab. 1 - Used outcome measures in studies (N=23)

Results of secure residential treatment are often viewed in terms of behavioural functioning of youths. Specifically, delinquent behaviour (recidivism) is often used as an outcome measure. In a majority of studies (70%) recidivism is used as an indicator of outcome. Measures related to the well-being and behaviour of parents or family, satisfaction concerning treatment, goal realization and dropout are rarely applied as indicators of effectiveness for secure care. The outcome studies show that youths still regularly show problems after leaving secure treatment.

From many studies (43%) it is not clear whether children show improvement or deterioration in problems during their stay, because these studies are focused on the period after the young person has left the residential setting.

Results from a limited number of studies that looked at the functioning of youths during their stay indicate that some youths do show improvement. Different studies indicate that youth who have left the setting prematurely show less improvement in comparison with youth who have completed the secure care programme.

Studies that looked at the rate of recidivism in terms of police or justice contacts show percentages from 30 to 64 for youth from secure residential treatment settings one year after departure. In most studies, recidivism is defined in terms of police or justice contacts. A few studies that looked at self-reported delinquency one year after departure show rates from 62% to 75%. It must be noted that the recidivism rate is dependent on the period of time that is taken into account after leaving care: the longer this period, the higher the recidivism rate. A review of five meta-analyses on the effectiveness of residential treatment methods for youngsters with severe behavioural problems shows an average reduction of recidivism by about 9% (Grietens, 2002).

Different factors can influence the outcomes of secure residential treatment. Positive results may be hard to achieve due to the fact that youth in secure care often show grave and long-standing problems.

Moreover, limitations in the care programme such as the absence of an intervention theory or the use of obsolete methods can restrict positive results. Those programme characteristics are also defined as 'what works' aspects. Research on outcome and what works in child and youth care receives a lot of attention over the last years. For example, various studies on residential child and youth care suggest that the long-term outcome of residential treatment can be improved by offering aftercare services.

For an increase in the effectiveness of secure treatment it is important to gain a clear insight into the way in which results are realized and not merely into the results itself. This implicates that research should be more focused on the care process rather than just the outcome of care. A second implication of the findings is that there should be more attention for aftercare and the reintegration of youth in society in the long run. If there are good aftercare services after residential care, the long-term outcome will probably be increased. Third, outcome studies for secure residential treatment should focus on outcome measures that are more different, such as the well-being and behaviour of parents, satisfaction about treatment and goal realization. That will give a clearer view on the results achieved for this type of treatment. Furthermore, we recommend that studies focus more on the development of youth and/or their families during the stay in secure treatment.

Key references

Grietens, H. (2002). Evaluating the effects of residential treatment for juvenile offenders: A review of meta-analytic studies. International Journal of Child and Family Welfare, 5(3), 129-140.

Harder, A. T., Knorth, E. J., & Zandberg, Tj. (2006). Residential child and youth care in the picture: A review study on its target group, methods and outcomes. Amsterdam: SWP Publishers (in Dutch).

Knorth, E. J., Harder, A. T., Zandberg, Tj., & Kendrick, A. J. (2008). Under one Roof: A Review and Selective Meta-Analysis on the Outcomes of Residential Child and Youth Care. Children and Youth Services Review, 30(2), 123-140.

Contacts: Annemiek T. Harder, University of Groningen, Dept of Special Education and Child Care, Groote Rozenstraat 38, 9712 TJ Groningen, The Netherlands, E-mail: a.t.harder@rug.nl,  Phone +31 503636552.