Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Therapeutic Group Homes
For adolescents with serious emotional disturbances the therapeutic group home
provides an environment conducive to learning social and psychological skills.
This intervention is provided by specially trained staff in homes located in the
community, where local schools can be attended. Each home typically serves 5 to
10 clients and provides an array of therapeutic interventions. Although the
types and combinations of treatment vary, individual psychotherapy, group
therapy, and behavior modification are usually included.
There are two major models of therapeutic group homes. The first is the teaching
family model, developed at the University of Kansas, then moved to Boys Town in
Omaha, Nebraska (Phillips et al., 1974). The second is the Charley model,
developed at the Menninger Clinic. Both models use their staff as the key agents
for change in the disturbed youth; selection and training of the staff are
emphasized. Both models employ couples who live at the homes 24 hours a day. The
teaching family model emphasizes structured behavioral interventions through
teaching new skills and positively reinforcing improved behavior. Other group
homes use individual psychotherapy and group interaction.
There is a dearth of research on the effectiveness of therapeutic group home
programs targeted toward emotionally disturbed adolescents. These homes have
been developed primarily for children under the care of juvenile justice or
social welfare. A dissertation (Roose, 1987) studied the outcomes of 20
adolescents treated in a group home. Adolescents with severe character pathology
or major psychiatric disorders were not admitted. Twenty group home adolescents
were compared with 20 untreated adolescents. At an 18-month followup, 90 percent
of the treated group had fair or good functioning, defined by improved
relationships with parents, peers, and fellow workers. Only 45 percent of the
untreated group achieved similar functioning. The treated group experienced a
significant decrease in psychopathology, while the untreated group did not.
Therapeutic group homes were compared with therapeutic foster care in two
studies. The first study found equivalent gains for youth in the two
interventions, but group home placement was twice as costly as therapeutic
foster care (Rubenstein et al., 1978). A second study, a randomized clinical
trial, compared the outcomes for 79 males with histories of juvenile delinquency
placed in either group homes or therapeutic foster homes (Chamberlain & Reid,
1998). The boys treated in therapeutic foster homes had significantly fewer
criminal referrals and returned more often to live with relatives, suggesting
this to be a more effective intervention. The implication of these studies is
that if therapeutic foster care is available, and if the foster parents are
willing to take youth with serious behavioral problems, therapeutic foster care
may be a better treatment choice for youth who previously would have been placed
in group homes.
Existing research suggests that therapeutic group home programs produce positive
gains in adolescents while they are in the home, but the limited research
available reveals that these changes are seldom maintained after discharge (Kirigin
et al., 1982). The conclusion may be similar to that for residential treatment
center placement: long-term outcomes appear to be related to the extent of
services and support after discharge. Adolescents who have been placed in
therapeutic group homes because of mental disorders frequently have histories of
multiple prior placements (particularly in foster homes), a situation that is
associated with a poor prognosis. Thus, future programs would benefit from
assessing alternative strategies for treatment after discharge from group homes.
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