I'm preparing a presentation on treatment of
youth with Conduct Disorder. I'm of the opinion that a reasonable treatment
outcome for residential facilities should exceed 80%. Is that reasonable?
I would appreciate any information that folks can provide on outcome rates and how they define successful treatment outcomes.
In Oregon, the generally agreed success rate with delinquent youth in residential treatment is around 60%, defining success as avoiding further penetration into the juvenile justice system and institutionalization. (Success is not defined as no further delinquent activity.)
Residential treatment program stays can run from four months to two years, depending on the program approaches. These youth typically have numerous delinquent referrals or a major infraction prior to becoming eligible for residential treatment – these are not light-weight first time offenders. However, to say this is a success rate with conduct disordered youth is probably misleading. Many of these youth have a mental health diagnosis other than conduct disorder. (It is estimated that more than 60% of the youth in the state juvenile corrections institutions – many of whom failed in residential treatment – have a mental health diagnosis other than conduct disorder.)
Treatment outcome? How are we defining that?
Here we have an age old question of how do we justify the existence of treatment for delinquent youth. Outcomes are not necessarily the way to do this. As Steve Cable states, about 60% is an acceptable outcome. The facts are, some youth who never complete treatment and may have even failed multiple placements go on to a life free of major court involvement while some that graduate from programs end up in correctional facilities. The reoffend rate for juvenile sex offenders who successfully complete treatment is about 20% so that there is around an 80% success rate for these youth. Then there are issues such as the age of the child when he/she entered treatment. Was it gender and cultural specific treatment or the standard approach used with white adolescent males? There is a lot of research taking place that is examining many of these factors. The outcomes are also getting better because of the research-based treatment approaches being used by a well-trained and competent staff who understand relational and experiential treatment. Steve Cable has been in this business a few years and speaks to many of the questions that I may have raised.
The programs I manage have about 35 youth from both Child Welfare and the Juvenile Justice Divisions. Over the past 3 years I have looked at our outcomes using the criteria outlined by Mr. Cable and we are right at the 60% as an average.
Now for the rest of the story. We do not claim to be
able to work effectively with every child, nor is every child open and ready
for treatment. Does this mean that we failed? According to outcome
approaches? Yes! Our take on it is very different. We ask the questions such
as, "Did the child increase in his/her ability to function and manage life
situations? Did the child make any connections to an individual or the
program or reflect the ability to live it's values? Did the child improve in
any of the environments in which they lived, e.g. school, home, treatment
groups, medication acceptance, etc." Just because a child acts in a manner
that requires them to move to a different environment does not make them a
failure. We often times have a youth who needs a more secure treatment
environment who has made significant growth in one of the other domains of
life. I find outcomes interesting but not the criteria by which to judge
programs or youth.
John: One more thing, never accept the Conduct Disorder Diagnosis. Look for RAD, PTSD, Depression, Anxiety Disorder, combined with ADHD, Bi-polar, etc. Conduct Disorder is an easy out for psychologists and psychiatrists. Get a good mental health assessment. I have never found a pure CD youth. A good psych is not one that just gives justification for sending the youth to a corrections program.