Community Treatment of Extremely Troublesome Youth with Dual Mental Health/mental Retardation Diagnoses: A Data Based Case Study
Fabry, Bernard D., Reitz, Andrew L., Luster, W. Clark, Education & Treatment of Children
This report describes a data-based case study of a linked array of community based treatment services that appears to have been effective for extremely troublesome dual diagnosed children and adolescents. Hallmarks believed to be relevant to the successes achieved are described, followed by long-term data supporting treatment effectiveness. This report provides apparent support at the data-based case study level for applied research, and presents a simple evaluation strategy that can be used in clinical settings.
As human services continue to evolve from institutional models of care to community based and managed care models, there is an increasing need for documentation of effective community based services for children and adolescents with both developmental disabilities and mental health diagnoses, and the most challenging problems (Mason, Galvin, & Basford, 1998; Small, Kennedy, & Bender, 1991). There is a growing body of literature confirming that children and adolescents entering out-of-home care now are more disturbed than in the past (Dore, 1999; Hochstadt, Joudes, Zimo, & Schachater, 1987; Knitzer, 1989; McIntyre & Keesler, 1986; Urquiza, Wirtz, Peterson, & Singer, 1994). These youth place great demands on community based services, and evidence based models of effective service delivery are needed.
It has been suggested that research is extremely difficult to accomplish in community-based clinical programs (Mason et al., 1998; Scotti, Ujcich, Weigle, Holland, & Kirk, 1996; Stein, 1995). The clients present widely differing needs and the demands on staff are intense and variable, making it difficult to hold critical variables constant while systematically varying others. However, applied research in more controlled settings does suggest what ought to constitute best practice in community based clinical settings. It has been suggested that the most effective interventions for youths can be provided by the adults who live and interact with the youths in the context of their everyday lives (Durrant, 1993; Hobbs, 1982). A number of researchers also have suggested that functional analysis, or functional assessment, provides a model for identifying effective interventions (Carr et al., 1999; Gable, 1996; Horner, 1994; Horner & Carr, 1997; Kemp & Carr, 1995). Data-based case studies from clinical settings can p rovide a bridge between rigorous applied research and everyday clinical settings by providing some validation of the more formal research as well as suggesting promising directions for future research.
The purpose of the present report is to present a data-based case study using a simple program evaluation strategy that suggests the effectiveness of a community based clinical program serving very challenging children and adolescents with a wide variety of problems. The clinical components of the program outlined below were adopted and adapted from promising practices reported in the applied research literature.
The participants included 15 boys and 3 girls with dual mental retardation and mental health diagnoses, referred for out-of-home placements due to the severity of their behavior. Table 1 lists their ages, IQ scores when reported, diagnoses given in admission documents, and primary presenting problems. At the time of admission the youths ranged in age from 4 to 17 years with a median age of 12 years. Since IQ scores were not a requirement for admission, only diagnoses of mental retardation were available for some youths. For the remaining youths IQ scores fell in the profound range (low of 16) to the mild range (high of 71) of mental retardation with the median in the moderate range. Diagnoses at admission included attention deficit/hyperactivity disorder, autism/pervasive developmental disorder, bipolar disorder, oppositional defiance disorder, post-traumatic shock disorder, schizo-affective disorder, and trichotillomania. …