Staff Experiences of Stress and Coping in a Residential Treatment Facility for Youth

Working in social services tends to be very stressful for workers. Caregivers are asked to work long hours, complete paperwork and administrative tasks and are responsible for the care and wellbeing of others. Eleven female Childcare Workers were interviewed to determine what causes them stress at work and how they cope. Stress was caused by: long hours, no breaks, low wages, unpaid work, poor communication, consistency and training, high expectations of staff, temper tantrums, abuse, and anxiety about meeting resident’s needs. Workers would like more support from their managersand reported a lack of effective teamwork. Many reported not coping well with the stressors of this job and most reported that they take their work stress home with them.

Effectiveness of Intensive Alternative Family Treatment on Reducing Re-Admissions to Psychiatric Residential Treatment Facilities

Children and youth with high behavioral health needs can receive care in a psychiatric residential treatment facility (PRTF). Overutilization of PRTFs is concerning because they are highly restrictive and costly residential care settings. Intensive Alternative Family Treatment (IAFT®) is an intensive therapeutic foster care program combined with service implementation strategies that is designed to reduce risk for entry to PRTF among youth with high behavioral health needs. This article presents findings from a quasi-experimental study examining the effectiveness of IAFT services in such a population of youth. In this study, we balanced treatment and comparison groups by first sampling youth with intensive care needs as indicated by having a prior PRTF spell. We then used propensity score weighting and covariate adjustment to estimate the effectiveness of IAFT in preventing PRTF re-entry. We found that receipt of IAFT was associated with a 24% lower risk of PRTF re-entry compared with youth who exited from a PRTF in the same state but did not receive IAFT. Sensitivity tests yielded mixed results regarding the effect of IAFT. Overall, results suggest that IAFT is an effective treatment approach for reducing risk for PRTF entry among youth with high behavioral health needs.

Gamma oscillations predict pro-cognitive and clinical response to auditory-based cognitive training in schizophrenia

Cognitive impairments are pervasive and disabling features of schizophrenia. Targeted cognitive training (TCT) is a “bottom-up” cognitive remediation intervention with efficacy for neurocognitive outcomes in schizophrenia, yet individual responses are variable. Gamma oscillatory measures are leading candidate biomarkers in the development of biologically informed pro-cognitive therapeutics. Forty-two schizophrenia patients were recruited from a long-term residential treatment facility. Participants were randomized to receive either 1 h of cognitive training (TCT, n = 21) or computer games (TAU, n = 21). All participants received standard-of-care treatment; the TCT group additionally completed 30 h of cognitive training. The auditory steady-state response paradigm was used to elicit gamma oscillatory power and synchrony during electroencephalogram recordings. Detailed clinical and cognitive assessments were collected at baseline and after completion of the study. Baseline gamma power predicted cognitive gains after a full course of TCT (MCCB, R2 = 0.31). A change in gamma power after 1-h TCT exposure predicted improvement in both positive (SAPS, R2 = 0.40) and negative (SANS, R2 = 0.30) symptoms. These relationships were not observed in the TAU group (MCCB, SAPS, and SANS, all R2 < 0.06). The results indicate that the capacity to support gamma oscillations, as well as the plasticity of the underlying ASSR circuitry after acute exposure to 1 h of TCT, reflect neural mechanisms underlying the efficacy of TCT, and may be used to predict individualized treatment outcomes. These findings suggest that gamma oscillatory biomarkers applied within the context of experimental medicine designs can be used to personalize individual treatment options for pro-cognitive interventions in patients with schizophrenia.

Effects of Rules and Feedback on Classroom Behavior of Adolescents in a Residential Treatment Setting

Over the past 30 years, researchers have shown that various types of group contingency procedures can decrease problem behavior displayed by young children in academic settings. Recently, researchers have demonstrated that presession rules, within-session feedback, and interdependent group contingencies (i.e., contingently delivered tangible and edible items) increased appropriate behavior displayed by detained adolescents in a residential treatment facility. Nevertheless, it is possible that rules with feedback about rule violations could produce comparable outcomes. To address this question, we used a nonconcurrent multiple baseline design across classrooms to evaluate the extent to which rules, visual feedback (i.e., marks on a board denoting rule violations), and postsession feedback decreased problem behaviors in three classrooms within a residential detention facility. Results indicate that problem behavior decreased to less than 10% of observation intervals in each classroom. Results from a social validity measure indicate that the procedures and outcomes were acceptable to the respective classroom teachers.