A quasi-experimental study of a health and wellness group intervention for adolescents in residential treatment facilities (RTFs) and examination of risk factors as treatment success predictors
Maggiulli, Laura Rae Greyber
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Background : Prevalence rates of overweight and obesity in children and adolescents are alarming, and even more so in populations with serious emotional disturbances (SEDs) living within residential settings. Integrated health and wellness interventions are necessary to address comorbid physical and mental health disorders that are commonplace for youth living in RTFs with SEDs and high rates of a history of trauma, clinical risk factors, and environmental and psychosocial stressors. Expanding services to include health and wellness interventions may in fact produce overall change in areas of wellness beyond just mental health, and thus impact treatment success at discharge. Specific Aims : Specific aim one of the present study was to test that effectiveness of a health and wellness intervention on body mass index (BMI) and treatment outcomes including success at discharge and discharge level of improvement. The second specific aim was to examine the impact of demographic and risk factors on BMI and treatment success at discharge. Methods : The present study was a quasi-experimental design with an intervention and a treatment-as-usual comparison RTF. Secondary data was collected from closed records for youth who were admitted and discharged from one of the two RTFs within a three year time frame. Sample : The full sample consisted of 144 youth across both RTFs and the matched sample resulted in 62 youth across both RTFs. Intervention : The intervention was a health and wellness intervention that consisted of psychoeducation, family engagement, behavioral skills training, meal and snack protocol, and a fitness and activity protocol. Additionally, the intervention youth participated in community projects and were provided with resources to participate in physical activity. The TAU group received normal services including individual, group, family, recreational, educational, and clinical therapy. Data Analyses : Data was analyzed using descriptive statistics including cross-tabulations, standard deviations, means, and frequencies. Inferential statistical methods included logistic, ordinal, and linear regression as well as repeated measure ANOVA. A propensity score-matched analysis was used to match youth across the two RTFs. Results : For specific aim one, results show that the intervention did not have a significant impact on BMI (range, category, raw score, and percent). Additionally, the intervention did not impact level of improvement at discharge, but did however impact success at discharge. Youth in the intervention RTF were significantly more likely to be successfully discharged relative to the TAU RTF youth (p=.001). For predictor variables, there were no significant predictors of BMI. Conversely, the diagnoses of mental retardation or borderline intellectual functioning and gender significantly predicted success at discharge. Specifically, youth without this diagnosis and youth who were male were more likely to be successful at discharge relative to youth with the diagnoses and females. Conclusions : Though results from this study are mixed, it has important implications not only for clinical practice, but also future research. Results for specific aim one indicated that the intervention was not particularly effective in improving BMI. However, results indicate that the intervention had a significant impact on treatment success at discharge, which suggests that the intervention improved skills, goal attainment, well-being, and mental and behavioral health.