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Revision of the Restrictiveness of Living Environment Scale (ROLES)

J. C. Huefner1, Ph.D., A. Doucette2, Ph.D., K. O Brien3, Ph.D., R. W. Thompson1, Ph.D., M. E. Rauktis4, Ph.D. & P. J. Pecora, Ph.D.3

casey family programs

~ Abstract ~

This poster presents the background, methodology, and results for the revision of the ROLES. Restrictiveness of the setting was measured using the REM-Y which was found to be a reliable and valid measure of restrictiveness. Analysis of the REM-Y data using a Rasch measurement model found that the scale segmented into three statistically significant restrictiveness subgroups.

~ The Restrictiveness Evaluation Measure (REM-Y) ~

· The revision of the ROLES changes the way we look at restrictiveness. Rather than focus on rankings of program types this work is based on actual practice · The REM-Y was created based the restrictiveness dimensions in published research, and refined through systematic reviews by content experts and cognitive interviewing with stake-holder groups · A pilot study was conducted that allowed further refinement of the REM-Y · Ultimately, the REM-Y was programmed into an online survey program.

Differential Item Function - Age

Minimum Restrictiveness

-3 -2 -1 0

Person-Item Map: REM-Y

PLACEMENTS MAP OF ITEMSS <MORE RESTRICTIVE>|<rare> 2 + | | | | | . | REMOVED CONTACT W/OTHERS |T 1 . + PRN MEDICATION . | MECHANICAL RESTRAINT .# T| FAMILY INTERACTION PHYSICAL RESTRAINT # |S MUSIC .# | # # | FRIEND SELECTION ## | .### | 0 ## S+M MOVEMENT W/SETTING EDUC. SETTING INTERACTION W/FRIEND TELEVISION RECREATION EXTRA CURRICULAR ##### | PRIVACY TREATMENT INTENSITY COMMUNICATION .#### | MOVEMENT IN COMMUNITY FINANCES PERSONAL ENTERTAINMENT DEVICES ######### | DECOR ########## | CLOTHING .############ |S EMPLOYMENT DRIVER LICENSE TREATMENT DECISIONS ####### M| .########## | CHOICE OF LIVING SETTING -1 .##### + INTERNET .######## |T .####### | .## | ## S| ## | # | . | -2 .# + | T| .# | | | . | . | -3 + # | | | . | | | . | -4 . + <LESS RESTRICTIVE>|<frequ ent> EACH '#' IS 3.

Maximum Restrictiveness

1 2 3

Television Music Communication Internet Recreation Extra curricular Clothing Decor Entertainment devices Employment Movement in community Movement w/setting Driver's license Educational setting Removed contact w/others Mechanical restraint Friend selection Interaction with friends Privacy Family interaction Treatment decisions Treatment intensity PRN medication Physical restraint Choice of living setting Finances

~ Purpose ~

· The current ROLES is limited in that the list of placements is neither exhaustive nor mutually exclusive

·Many placement settings are not included (e.g., therapeutic foster care, community based detention, juvenile detention, etc.) · There is a tremendous amount of variation in restrictiveness for individual programs within each treatment settings, resulting in overlapping distributions of restrictiveness

~ Participants ~

· E-mail invitations were sent to 974 service providers around the country inviting them to complete the REM-Y as it applied to a specific youth currently in their program · Forms were completed on 394 youth · Mean age was 16.6 years old · 61% of responses came from Residential Job Corps, Residential Treatment, or Group Home settings · 41% of evaluations were for African American youth, and 39% for Caucasian youth · 58% were receiving psychological, educational, substance abuse, welfare related, or court ordered services

Less than 6 years 6-10 years 11-14 years 15-18 years old 19 -21 years

· Item spread - more than two standard deviations - covers a broad range on the measured construct · Some item content likely confounded with the resources available to the treatment setting (e.g., clothing, employment opportunities, etc.)

Less Restrictive

Ind ep en de n Pa t ren ts

More Restrictive

Ad op tio n

F Tx oste Fo r ste r

Gr ou p

Inp atie nt

RT C

Jai l

Differential Item Function - Race

Minimum Restrictiveness

-1.5 -1 -0.5 0 0.5

~ Conclusions ~

· All but three of the REM-Y items show good fit to the Rasch model · The Rasch separation index supports the use of the REM-Y in differentiating between groups of youth restrictiveness of the living environment · There are contextual factors, such as age (i.e., developmental stage) that have be taken into account.

Maximum Restrictiveness

1 1.5 2

· Disregard for individual variation within the various treatment settings can obscure outcomes in practice and restrictiveness research

~ Analysis ~

· Psychometric analyses were conducted using the Rasch measurement model (WINSTEPS® software)

·The Rasch model tests how well empirical data fit in terms of the measurement model constraints ·Items were calibrated in terms of difficulty, and how they contribute differentially to the measured construct

~ Research Goals ~

· To test and refine the REM-Y thus providing a flexible, psychometrically sound approach for measuring restrictiveness · To lay the groundwork for developing a robust set of General Environment Types that will ultimately simplify how restrictiveness is typically measured and replace the current ROLES

~ Results ~

· Results are preliminary, data is still being collected.

·Some placement types are underrepresented (e.g., jail, substance abuse treatment, inpatient psychiatric, independent living)

Caucasian African American Hispanic

~ Conceptual Definition ~

Restrictiveness is the ways in which adults in a child's life have anticipated that limits need to be made for the child's safety, developmental and therapeutic needs.

· Rasch separation index = 2.87, reliability = .87 · The separation index indicates that the REM-Y can reliably differentiate approximately three groups from minimal to substantial restrictiveness · Differential Item Function

·There were, as expected, significant differences for age ·No significant difference were noted for gender

Television Music Communication Internet Recreation Extra curricular Clothing Decor Entertainment devices Employment Movement in community Movement w/setting Driver's license Educational setting Removed contact w/others Mechanical restraint Friend selection Interaction with friends Privacy Family interaction Treatment decisions Treatment intensity PRN medication Physical restraint Choice of living setting Finances

~ Future Research ~

· Future analyses needs to examine the impact of the interaction between age, race, and placement setting on restrictiveness · Are the differences seen for race reflective of over- or under-representation in certain residential settings, or are they reflective of practice? · Analysis and development of the General Environment Types (GETs) · Analyze the how the acceptability, availability, and appropriateness of the placement setting interact with restrictiveness to impact outcome

Presented at the 20th Annual Louis de la Parte Florida Mental Health Institute Research Conference, Tampa, FL

1Girls

and Boys Town National Research Institute, 2The George Washington University, 3Casey Family Programs, 4Pressley Ridge

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