A key concept in the continuum-of-care model is matching the restrictiveness of treatment to the level of youth behavior problems. Restrictiveness refers to the degree that treatment and setting constrains choices and limits freedoms of patients. Only a few investigators have examined this relationship, and the findings have been equivocal. Extending our initial study of the relationship between youth behavior problems and program restrictiveness, we examined the relationship across seven programs spanning the continuum of care: parent training program, outpatient clinic, family preservation program, treatment foster care, residential group home, acute-care shelter, and inpatient psychiatric hospital. Results indicated a high level of correspondence between restrictiveness and youth behavior problems, with the least restrictive programs serving children with fewer behavior problems and highly restrictive programs serving children with more behavior problems.
Get full access to this article
View all access options for this article.
References
1.
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.
2.
Armstrong, M. I., & Evans, M. E. (1992). Three intensive community-based programs for children and youth with serious emotional disturbance and their families. Journal of Child and Family Studies, 1, 61–74.
3.
Bachrach, L. L. (1980). Is the least restrictive environment always the best? Sociological and semantic implications. Hospital and Community Psychiatry, 31, 97–103.
4.
Bickman, L., Foster, E. M., & Lambert, E. W. (1996). Who gets hospitalized in a continuum of care?Journal of the American Academy of Child and Adolescent Psychiatry, 35, 74–80.
5.
Bickman, L., Guthrie, P. R., Foster, E. M., Lambert, E. W., Summerfelt, W. T., Breda, C. S., & Heflinger, C. A. (1995). Evaluating managed mental health services: The Fort Bragg experiment. New York: Plenum Press.
6.
Boys Town. (1994). Boys Town treatment foster family services. Boys Town, NE: Author.
7.
Bullock, L. M., Zagar, E. L., Donahue, C. A., & Pelton, G. B. (1985). Teacher's perceptions of behaviorally disordered students in a variety of settings. Exceptional Children, 52, 123–130.
8.
Burns, B. J. (1991). Mental health service use by adolescents in the 1970s and 1980s. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 144–150.
9.
Dore, M. M., Wilkinson, A. N., & Sonis, W. A. (1992). Exploring the relationship between a continuum of care and restrictiveness of children's mental health services. Hospital and Community Psychiatry, 43, 44–48.
10.
England, M. J., & Cole, R. F. (1992). Building systems of care for youth with serious mental illness. Hospital and Community Psychiatry, 43, 630–633.
11.
Friedman, R. M., & Street, S. (1985). Admission and discharge criteria of children's mental health services: A review of the issues and options. Journal of Clinical Child Psychology, 14, 229–235.
12.
Friman, P. C., Evans, J., Larzelere, R., Williams, G., & Daly, D. L. (1993). Correspondence between child dysfunction and program intrusion: Evidence of a continuum of care across five child mental health programs. Journal of Community Psychology, 21, 227–233.
13.
Friman, P. C., Soper, S. H., Thompson, R., & Daly, D. (1993). Do children from community-based parent training programs have clinically significant behavior problems?Journal of Community Psychology, 21, 56–63.
14.
Garritson, S. H. (1987). Characteristics of restrictiveness. Journal of Psychosocial Nursing, 25, 10–19.
15.
Gottlieb, S. J., Reid, S., Fortune, A. E., & Walters, D.C. (1990). Child/adolescent psychiatric inpatient admissions—Is the “least restrictive treatment” philosophy a reality?Residential Treatment for Children and Youth, 7, 29–39.
16.
Handwerk, M. L., Larzelere, R. E., Soper, S. H., & Friman, P. C. (1997). Parent and child discrepancies in reporting severity of problem behaviors in three out-of-home settings. Manuscript submitted for publication.
17.
Hargreaves, W. A., Gaynor, J., Ransohoff, P., & Attkisson, C. C. (1984). Restrictiveness of care among the severely mentally disabled. Hospital and Community Psychiatry, 35, 706–709.
18.
Hawkins, R. P., Almeida, M. C., Fabry, B., & Reitz, A. L. (1992). A scale to measure Restrictiveness of Living Environments for troubled children and youths. Hospital and Community Psychiatry, 43, 54–58.
19.
Hundert, J., Cassie, J. R. B., & Johnston, N. (1988). Characteristics of emotionally disturbed children referred to day-treatment, special-class, outpatient, and assessment services. Journal of Clinical Child Psychology, 17, 121–130.
20.
Killebrew, J. A., Harris, C., & Kruckeberg, K. (1982). A conceptual model for determining the least restrictive treatment-training modality. Hospital and Community Psychiatry, 33, 367–370.
21.
Kinney, J. M., Madsen, B., Fleming, T., & Haapala, D. A. (1977). Homebuilders: Keeping families together. Journal of Consulting and Clinical Psychology, 45, 667–673.
22.
Kloss, J. D. (1980). Restrictiveness: Denning its multiple dimensions. Hospital and Community Psychiatry, 31, 422.
23.
McKelvey, R. S. (1988). A continuum of mental health care for children and adolescents. Hospital and Community Psychiatry, 39, 870–873.
24.
Munetz, M. R., & Geller, J. L. (1993). The least restrictive alternative in the postinstitutional era. Hospital and Community Psychiatry, 44, 967–973.
25.
Peterson, R. L., Zabel, R. H., Smith, C. R., & White, M. A. (1983). Cascade of service model and emotionally disabled students. Exceptional Children, 49, 404–408.
26.
Ransohoff, P., Zachary, R. A., Gaynor, G., & Hargreaves, W. A. (1982). Measuring restrictiveness of psychiatric care. Hospital and Community Psychiatry, 33, 361–366.
27.
Rothstein, L. F. (1990). Special education law. New York: Longman.
28.
Saxe, L., Cross, T., & Silverman, N. (1988). Children's mental health: The gap between what we know and what we do. American Psychologist, 43, 800–807.
29.
Stroul, B. A., & Goldman, S. K. (1990). Study of community-based services for children and adolescents who are severely emotionally disturbed. Journal of Mental Health Administration, 17, 61–77.
30.
Teare, J. F., Smith, G. L., Osgood, D. W., Peterson, R. W., Authier, K., & Daly, D. L. (1995). Ecological influences in youth crisis shelters: Effects of social density and length of stay on youth behavior problems. Journal of Child and Family Studies, 4, 89–101.
31.
Tuma, J. M. (1989). Mental health services for children. American Psychologist, 44, 188–199.
32.
Wolf, M. M., Phillips, E. L., Fixsen, D. L., Braukman, C. J., Kirigin, K. A., Willner, A. G., Schumaker, J. B. (1976). Achievement place: The Teaching Family Model. Child Care Quarterly, 5, 92–103.
33.
Zimet, S. G., Farley, G. K., & Zimet, G. D. (1994). Home behaviors of children in three treatment settings: An outpatient clinic, a day hospital, and an inpatient hospital. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 56–59.
