Residential Care and Cure: Achieving Enduring Behavior Change with Youth by Using a Self-determination, Common Factors and Motivational Interviewing Approach

Abstract

Residential treatment for youth includes both care, such as basic care-taking tasks and pedagogical child-rearing tasks, and cure elements, such as the therapeutic milieu and individual treatment plans. With these elements, residential treatment aims to achieve a healthy development and a decrease of the present problems with youth. However, achieving enduring change with youth after they have left residential treatment is a great challenge. This challenge can be explained by care workers' difficulties to establish good, genuine therapeutic relationships with individual youth. Furthermore, it can be explained by the commonly used treatment approach to achieve behavior change with youth during residential care. In this paper, I suggest that higher long-term effectiveness of residential treatment can be achieved by applying a combination of three treatment approaches. First, by focusing on youth's individual needs and intrinsic motivations using the Self-Determination Theory (SDT) perspective. Second, by using the Common Factors model as residential care element to promote professionals' interpersonal skills and good, genuine therapeutic relationships with youth. Third, by applying the Motivational Interviewing (MI) approach as a residential cure element. By integrating these approaches as intervention components, it is very likely that residential treatment will contribute to more enduring behavior changes with youth.

Professionalizing Care Workers: Outcomes of a ‘Motivational Interviewing’ Training in Residential Youth Care

“…This token economic model is based on the assumption that the cause of adolescents' problems is a lack of skills. As a result, care workers aim to improve the circumstances of the adolescents by teaching them skills or competences (Harder, 2018). The social competence model is regularly used in residential youth care facilities to achieve behavioral change with adolescents.…”

“…There are also questions about the effectiveness of residential youth care (Whittaker, Del Valle, & Holmes, 2015). It seems difficult to achieve long-term behavioral change among this target group (Harder, 2018;Knorth, Harder, Zandberg, & Kendrick, 2008): Should positive changes occur in young people during treatment, for instance, they tend to then disappear over time (Frensch & Cameron, 2002). The training of residential care workers in MI might contribute to an increase in the quality and effectiveness of residential youth care (cf.…”

“…The training of residential care workers in MI might contribute to an increase in the quality and effectiveness of residential youth care (cf. Harder, 2018).…”

Mind-mindedness in out-of-home Care for Children: Implications for caregivers and child

“…Residential group facilities typically host 8 to 10 children under the supervision of a team of an equivalent number of residential care workers, mostly working in a schedule of eight hours at a time. Their work includes basic care-taking and child-rearing, and, if needed, provision of individual or group treatment and creation of a therapeutic milieu (Harder, 2018). Residential treatment is considered a 'last resort' for youth whose problems could not be addressed by non-residential interventions (Dozier et al, 2014;Harder, 2018;Hellinckx, 2002;Whittaker, Del Valle, & Holmes, 2015), and shows worse outcomes compared to youth with similar problems who are placed in therapeutic foster care (Gutterswijk et al, 2020).…”

“…Their work includes basic care-taking and child-rearing, and, if needed, provision of individual or group treatment and creation of a therapeutic milieu (Harder, 2018). Residential treatment is considered a 'last resort' for youth whose problems could not be addressed by non-residential interventions (Dozier et al, 2014;Harder, 2018;Hellinckx, 2002;Whittaker, Del Valle, & Holmes, 2015), and shows worse outcomes compared to youth with similar problems who are placed in therapeutic foster care (Gutterswijk et al, 2020). Young persons in residential group care have been shown to have the most severe psychosocial problems compared to children in foster care and family homes (Leloux-Opmeer, Kuiper, Swaab, & Scholte, 2016).…”