Current Projects

Program Implementation

The goal of this National Institute of Mental Health-funded study on quality of services is to examine how service provision and the engagement of youth in residential care correspond to youth outcomes. This study will help us learn about strategies for assessing the quality of staff service delivery and monitoring other key facets of care, such as the working relationships among staff and youth, youth motivations for and expectations of care, and youth satisfaction with care. It is anticipated that these factors will be related to youth outcomes at discharge. Current findings:

• There is a high quality of service delivery at Boys Town Family Homes.
• The quality of service delivery remains fairly constant over time.
• As would be expected, the tools for assessing quality of service indicated that experienced staff have a higher level of program implementation quality.
• Youth are generally satisfied with the quality of services they receive.

Common Sense Parenting^®

Boys Town's Common Sense Parenting^® program is a behavioral parent-training intervention that is designed to improve parenting and family interactions, as well as prevent child behavior problems. Findings from preliminary evaluations suggest that the program has a positive impact on its targeted outcomes. Boys Town is currently partnering with the University of Washington's Social Development Research Group to evaluate the program in a randomized, controlled trial.

This National Institute on Drug Abuse-funded study will test Common Sense Parenting^® in its standard six-session form and in an expanded form that adds two sessions from a program called Stepping Up to High School. The goal is to evaluate whether or not these interventions will prevent youth from dropping out of school and engaging in risky behaviors.

In-Home Family Services^SM

Boys Town's In-Home Family ServicesSM provide family-centered, skill-based interventions for families that are at risk for child maltreatment, have children who are experiencing significant behavioral-emotional problems and/or are at risk for having a child removed from their home. Boys Town recently began a three-year outcome study to support ongoing program improvement and build the evidence-base for the program.

This study includes a comprehensive evaluation of the implementation and outcomes of Boys Town In-Home Family ServicesSM as they are delivered as part of the Family Risk, Safety and Permanency Program in southwest Iowa. A particular focus of the study will be learning more about substance-abusing families, given the magnitude of this problem in southwest Iowa.

Psychotropic Medication Utilization
in Residential Care

Despite the lack of research about its effectiveness in youth, and evidence of potential adverse effects, psychotropic medication utilization rates have drastically increased in behaviorally disordered children since the early 1990s. Boys Town recently hosted a National Institute of Mental Health-funded conference on the use of psychotropic medications with youth in residential care settings. A diverse group of researchers, physicians and other experts identified areas where research is necessary and formed preliminary research teams for future study. Boys Town has conducted a series of studies focused on medication use and behavioral treatment for youth. These studies have examined the forces that drive the current high medication rates, processes for taking youth off psychotropic medications and the effective management of medication use within the context of other treatments. Current findings:

• There is a high rate of psychotropic medication utilization with youth entering residential care, though utilization rates drop significantly over the course of care in Boys Town programs.
• By making medication management decisions systematically, and basing them on behavioral data, it is possible to make changes to psychotropic medication that have a positive effect on youth behavior and psychological well-being.

In 2011, Boys Town hosted on a conference on psychotropic medication usage in residential care.
Psychotropic Medication Conference

Family Reunification

The Boys Town Family Reunification Process was developed and is being evaluated as part of an Office of Juvenile Justice and Delinquency Prevention grant. The goal is to link Boys Town's Family Homes and In-Home Family ServicesSM programs to support youth transitions from out-of-home care back to their homes. Family Consultants provide services to the family while a child is in the Family Homes program, as well as when he or she returns home. Initial results:

• Youth who experienced linked services had significantly reduced their behavior problems at the end of services.
• Parents who received linked services reported improved parenting skills (e.g., more consistent discipline).
• At six-month post-departure, youth who experienced linked services had more positive outcomes that those who did not, including:
  - Lower rates of arrests and less alcohol and drug usage.
  - Increase school attendance and an increased likelihood to be at home or in a home-like setting.

On the Way Home Aftercare Services

The On the Way Home Aftercare Model was developed to provide aftercare for adolescents who are re-integrating into home and school settings after departing from residential care. This Institute of Educational Sciences-funded study is designed to evaluate the impact of this intervention on parenting and academic issues such as improved home/school communication, dropout prevention, placement stability and homework completion. Compared to a services-as-usual control group:

• Youth were more likely to stay at home or in a home-like setting.
• Youth were less likely to drop out of school.

Patterns of Movement through an Integrated Continuum of Care

Boys Town provides services to youth through an Integrated Continuum of Care that encompasses a wide array of services and restrictiveness levels, all using the core intervention Boys Town ModelSM. In the Boys Town Nebraska/Iowa Region, youth can enter our residential continuum at any point, with the Intensive Residential Treatment Center being the most restrictive and Family Homes being the least restrictive. Boys Town is currently conducting research on the patterns of youth movement through our Integrated Continuum of Care, as well as their post-departure functioning. Results indicate that:

• Most youth systematically move from more-restrictive to less-restrictive placements as a function of their behavioral improvements.
• Eighty percent of youth who either enter and depart or step down and depart from the Family Homes program go home or to a home-like setting.
• At 12 months post-discharge, youth who stepped down and departed from the Family Homes program have maintained better outcomes than those departing from more-restrictive Continuum settings.

Health Risks of Youth in Out-of-Home Care

Studies have shown that at-risk youth have general health problems in addition to psychological risks. Therefore, intervention programs need to address both sets of needs in an integrated fashion. To begin this line of research, Boys Town has partnered with researchers at the University of Nebraska-Lincoln. Initial studies examined the prevalence of chronic general health problems for youth enrolled in family-style residential care at Boys Town, the utilization of health care services in this at-risk population and the association between physical and mental health problems. More than 1,700 youth files were analyzed in these studies. For at-risk youth in residential care:

• Approximately one-third of these youth had chronic general health problems (e.g., asthma) requiring ongoing treatment.
• This prevalence rate is much higher than the general population and similar to that of previous research with youth who have significant behavioral-emotional problems.
• Youth in residential care with internalizing (e.g., anxiety, withdrawal) behavior problems had the highest rate of health care services utilization.