Improving Outcomes While Reducing Time In Residential Treatment

We have a project looking for a home. We want to create a brief intensive trauma therapy diversion program for teens on their way into residential placement. The goal is to dramatically reduce time in residential placement, reduce costs accordingly, and improve outcomes. If it works – which it should – this can become a preferred alternative to typical longer-term residential care. Here are the details.

For example, let’s say we have a catchment area in which an average of 12 youth per week are placed in residential care for an average of three months duration. We reserve five beds in a residential facility, for the diversion program. We hire five therapists and train them in our intensive trauma-focused therapy approach.

On the way into placement, each young person in this catchment area is asked, “Are you interested in doing a week of intensive therapy instead of your longer [anticipated 3 month] placement?” Presumably many or most will be interested, if only for the chance to shorten their time in placement. They will be told, “There are two conditions. The first is that if you want to have a chance at this, you will have to agree to participate in post-treatment and follow-up evaluations, whether or not you get into the program. The second is that if you do get into the program, you have to actually do the therapy. If you don’t, you’ll be switched to the regular residential placement.”

Those who choose to go forward are given a bed in the diversion program if a bed is available. If a bed is not available, they go to the normal/longer placement. Thus the intensive therapy is provided to as many people as possible, while allowing for randomization and a comparison group.

Those in the diversion program receive intensive therapy for full consecutive days until treatment is completed. Then the youth is discharged as per the facility’s normal procedures, and the bed is open for someone new. Outcomes to be tracked include psychological symptoms (anger, anxiety, depression, posttraumatic stress), problem behaviors, and level of functioning/care, at the end of the placement (whether the intensive 1-week placement, or the longer one) and again three months later.

Why am I so confident that this will work? Because:

• Trauma has been implicated as a primary source of emotional distress and problem behaviors.
• Trauma healing is more stabilizing than so-called stabilization interventions.
• Our trauma-informed therapy has been successful in engaging distressed youth, reducing treatment time, and improving outcomes, in community as well as residential settings.
• Intensive trauma-focused therapy is just as effective as the same type of therapy delivered in hourly sessions.
• The intensive trauma therapy format cuts total treatment hours by about 50% while also reducing the risk of treatment disruption due to crises or other life events.

The problem with most residential treatment programs – even the better ones – is that there is little opportunity for actually healing from trauma and loss memories. The focus tends to be on stabilization and self-management skills. This may be useful, but limited in impact as well as durability. Intensive trauma therapy, on the other hand, leads to healing, which has profound and lasting benefit.

For this project to happen, there must be a residential facility willing and able to house the diversion program beds. And the party paying for the residential care (government agency; insurer) must be willing to fund the project, in anticipation of the ultimate savings and improved outcomes. If you think your agency or facility might be a good home for this project, I hope you’ll contact me. We could do a lot of good.