Effectiveness and implementation of evidence-based practices in residential care settings

Abstract

Purpose Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS? Methods Evidence-based psychosocial interventions and respective outcome studies, published from 1990–2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool. Results Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers. Conclusion The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results.

Therapeutic residential care in Spain. Population treated and therapeutic coverage

“…It seems to be a sufficiently broad definition to include any event that causes problems in the regular network of residential care, which goes against the specific and specialized character that these centres should have (Chor et al, ). Moreover, the lack of a clearer definition of the profile to treat hinders both the design of intervention programmes and the assessment of their efficacy (James, ; James et al, ; Pecora & English, ). It seems clear that further research is needed to define the profile of cases that should be referred to TRC.…”

“…Moreover, from a technical standpoint, there is growing interest in developing evidence‐based intervention programmes (James, ; James, Alemi, & Zepeda, ; Pecora & English, ). Although it is very difficult to carry out efficacy studies—because they tend to be performed with very small samples, amongst other reasons—results indicate some factors associated with the efficacy of the intervention, such as being based on a defined theoretical model, with defined phases that include the family, and relatively short placements, among other aspects (Whittaker et al, , ).…”

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

“…Institutional EBT contains group as well as individual treatment, which is mostly based on behavioural, cognitive and solution focused treatment models (Rose, 2014;Van der Helm & Hanrath, 2011;Whittaker, Del Valle, & Holmes, 2015). For a recent overview of evidence-based treatment methods applied in institutional settings, see James, Alemi, and Zepeda (2013). Examples of group based programs are EQUIP (Van Stam et al, 2014) and Re-Art (Hoogsteder et al, 2014).…”

Attitudes, Perceptions, and Utilization of Evidence-Based Practices in Residential Care

“…Although this may seem like an encouraging finding at first glance, it needs to be viewed critically since very little to date is known about client outcomes in residential care settings where EBPs are implemented. Only a few outcome studies of a limited number of EBPs in residential care have been published to date, and a review of these studies paint a mixed picture (James, 2011; James et al, 2013). While studies have mostly determined positive effects with regard to many target outcomes, findings of existing studies are confounded by significant methodological weaknesses.…”

“…Several recent reviews (James, 2011; James, Alemi & Zepeda, 2013; James, 2014) point to a small body of research suggesting the implementation of several promising program-wide residential care models (e.g., Teaching Family Model, Positive Peer Culture, Sanctuary Model). Limited efforts are also evident to implement evidence-based client- or diagnostic-specific interventions in residential care settings.…”