Graduate Thesis Or Dissertation
 

Change Trajectories of Adolescents in Long-Term Residential Treatment

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https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/p55480039

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  • The change process for clients in long-term adolescent residential treatment has received heightened research attention for the past 15-year (Gass, 2006). The research indicates that individuals enrolled in long-term adolescent residential treatment centers, on average, experience improved psycho-social functioning to degrees that are statistically and clinically significant (Behrens & Satterfield, 2011; Tucker et al., 2014). However, there is a lack of knowledge about how change occurs for these clients, despite knowing common factors that typically make counseling successful (Duncan et al., 2010). Examining the factors that foster this change process in long-term adolescent residential treatment seems vital to guide future research, improve quality of care, and further share information (Earl & Wanlass, 2016). In this dissertation, grounded in Duncan and associates' (2010) research on the Theory of Common Factors, we conducted two studies. Study 1 examined multiple factors related to the change phenomenon and Study 2 examined factors that contribute to the therapeutic outcome in long-term adolescent residential treatment. The first study examined the functional form (shape) of change in 182 individuals in long-term adolescent residential treatment in terms of differences in treatment gains between sites as well as differences between those who completed their programs (completers) and those who discharged prematurely (non-completers) across all sites. The guiding research questions were: 1. What is the functional form of the average change in global functioning for adolescents who are discharged from long-term adolescent residential treatment according to the YOQ-2-SR? 2. Does change in global functioning vary by for adolescents according to the YOQ-2-SR? 3. How does change in global functioning differ by site for adolescents who complete long-term residential treatment compared to those who do not complete treatment? We used an abductive/exploratory design to answer these questions, conducted through a hierarchal linear modeling (HLM) analysis. The HLM analysis results showed that the functional form of change in long-term adolescent residential treatment was quadratic in nature, with more treatment gains happening early in treatment and then leveling off. However, the results also demonstrated significant variability in outcomes between individuals. The findings also demonstrated differences between sites, both in the functional form of change and global functioning gains. However, on average, all programs helped their clients show clinically significant gains over the course of treatment. There were significant differences between completers and non-completers, with completers making more increases in global functioning gains, and non-completers having reduced gains in outcome early in the treatment process. Lastly, a unique finding we discovered was that treatment duration did not impact treatment outcome, meaning no statistical differences were found in global functioning improvements based on length of stay. The second study examined the program completion status and the therapeutic relationship between client and counselor as potential contributing factors to change in psychosocial functioning in 176 individuals enrolled in long-term adolescent residential treatment. The research questions were informed by the first study’s exploratory analysis and were as follows: 1. Are adolescents in long-term residential treatment more likely to complete treatment if they report a high degree of satisfaction with their therapist, as measured by a Session Rating Scale-3 (SRS-3) total score of 36 or above reported by clients at more than half the measurement points (i.e., a median score at or above 36)? 2. Do adolescents in residential treatment who report a high degree of satisfaction with their therapist, as measured by a SRS-3 total score of 36 or above more than half the time (i.e., a median score at or above 36), have larger gains in global functioning as measured by the YOQ-2-SR when controlling for initial YOQ-2-SR score, site, site variability, and number of SRS-3 measurements? We used a hypothesis-based analyses to learn more about the research questions, conducted through a chi-square and ANCOVA. However, to have true conclusive research, further experimental analyses will need to be conducted. The results of this study demonstrated that there was a statistically significant relationship between therapeutic alliance and completion status, χ2(1) = 11.62, p < .001, V = .26, which means that those who had an overall positive relationship with their therapist were more likely to complete their treatment program. Also, we found that those who had an overall positive relationship with their therapist had better gains in global function during their treatment process than those who did not have an overall clinically beneficial relationship with their therapist, p = .039 d = .72. The results of both studies illustrate the change phenomenon and its contributing factors in long-term adolescent residential treatment programs and were consistent with Duncan and associates' (2010) research on the Theory of Common Factors. These results demonstrated: a) that change is not a linear process, b) the importance of considering site when examining long-term adolescent residential treatment programs, c) differences between completers and non-completes treatment outcome, and d) that therapeutic alliance is related to completing a program and better treatment outcomes and Overall, both studies' findings contributed to understanding how change occurs and factors that positively impact treatment outcomes in long-term adolescent residential treatment.
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