Article Figures & Data
Figures
- Figure 1.
Distributions of standardized mean ratings of treatment milieu for community and secure facilities by rater type. Means are standardized (converted to a scale in which the mean of the responses is zero, z score) to make direct comparisons among the youth and expert ratings. The box plots represent the minimum, maximum, and interquartile (25–75th percentile) range of the scale distributions.
Tables
- Table 1
Matching Dimensions of Organizational Functioning6 with Environmental Adherence (EA) Items
Dimensiona Definition Subscales Example Items EA Youth Items EA Staff Items Institutional orderb Set schedules, clear lines of responsibility, and cohesion among staff about shared mission. Clear rules and routines; consistency of messages provided by staff about normative values; positive modeling and connection between staff members and residents Overall organization We follow a regular schedule every day. Item 6. Did staff explain to you how to earn privileges?
Item 7. Do you know what structure/activities to expect on a daily basis? Item 8. Do staff lead activities in the program?Item 5. Program is structured in a way that ensures treatment is occurring
Item 6. Youth have structured programming on the floor (behavior permitting)
Item 7. Important treatment specific information is communicated among staff dailyStaff connectedness Staff worked with kids who were failing. Item 1. Does the staff’s voice remain firm and supportive when a youth is not following directions? Item 1. Staff are respectful in their communication with youth
Item 9. Staff structures milieu to actively engage youth in generalizing skills
Item 10. There is a clear programmatic structure that pairs privilege to treatment performanceStaff negative behavior How much do you see staff using disrespectful language? None None Caring adults Concerned connection between staff members and residents; Positive relationships with caring adults; Social support provided by key staff members Social support: Domains Is there an adult here with whom you can talk about important decisions in your life? Item 2. Would you describe staff as “excited to work with youth” during interactions?
Item 3. Are staff working with you to accomplish your treatment goals?
Item 4. Do staff assist you in resolving treatment concerns you may have?Item 2. Staff convey genuine regard and liking toward youth
Item 3. Staff demonstrate that they listen to youth
Item 4. Behavior is described in an empathetic, objective and nonjudgmental way
Item 11. Staff help youth accomplish treatment goals that are important to the youthSocial support:Diversity How many different adults can you talk to about important decisions? None None Reentry planningb Gains made during institutional stays may deteriorate unless reinforced or built on in the community; Institutions provide focused resources to assist in the community transition Future orientation of the program Staff help individuals here get jobs. Item 10. Do staff work with you on how to apply your skills to your community/home setting? None Release counselor Did you have a person assigned to you to help you out with making arrangements for you to return to the community? None None Treatment milieuc Staff members coach youth on emotional and behavioral skills and reinforces use of these skills in the milieu Not applicable Not applicable Item 5. Are you practicing new skills to earn reinforcements (token incentives) from staff?
Item 9. Do staff help coach you on how to use your skills?Item 8. Program effectively reinforces behaviors
Item 12. Staff apply DBT strategies in the milieu
Item 13. Staff support each other in delivering the treatment with fidelity↵a Mulvey6 included eight selected dimensions of organization functioning, including safety; institutional order; harshness; caring adults; fairness; antisocial peers; services; and reentry planning. Dimensions included here are based on availability of EA items that are conceptually similar and align with Mulvey’s definitions and example items.
↵b Institutional order, harshness, level of service provision, and release planning distinguished the most among different institutions in Mulvey et al.6 Intraclass correlations are examined for the subscales.
c Extends Mulvey’s findings with the addition of a new “treatment milieu” dimension.
- Table 2
Descriptive Statistics and Scale Reliability for Staff and Youth Environmental Adherence Measures
Subscale Environmental Adherence Measurement Tool Descriptive Statistics Scale Reliability Range M (SD) scale mean (sd) alpha ICC Youth ratings (n = 2,570) Overall organization Item 6. Did staff explain to you how to earn privileges? 0–4 2.78 (1.30) 2.65 (0.91) 0.63 0.37 Item 7. Do you know what structure/activities to expect on a daily basis? 0–4 2.52 (1.15) Item 8. Do staff lead activities in the program? 0–4 2.60 (1.11) Staff connectedness Item 1. Does the staff’s voice remain firm and supportive when a youth is not following directions? 0–4 2.37 (1.01) – – 0.29a Social support Item 2. Would you describe staff as “excited to work with youth” during interactions? 0–4 2.21 (1.07) 2.57 (0.89) 0.78 0.39 Item 3. Are staff working with you to accomplish your treatment goals? 0–4 2.79 (1.07) Item 4. Do staff assist you in resolving treatment concerns you may have? 0–4 2.67 (1.07) Future orientation of the program Item 10. Do staff work with you on how to apply your skills to your community/home setting?b 0–4 2.39 (1.24) – – 0.50a Treatment milieu Item 5. Are you practicing new skills to earn reinforcements (token incentives) from staff? 0–4 2.53 (1.24) 2.57 (1.01) 0.61c 0.34 Item 9. Do staff help coach you on how to use your skills? 0–4 2.59 (1.11) Expert ratings (n = 677) Overall organization Item 5. Program is structured in a way that ensures treatment is occurring 0–3 1.96 (0.91) 1.77 (0.79) 0.80 – Item 6. Youth have structured programming on the floor (behavior permitting) 0–3 1.63 (0.95) Item 7. Important treatment specific information is communicated among staff daily 0–3 1.72 (0.95) Staff connectedness Item 1. Staff are respectful in their communication with youth 0–3 2.40 (0.74) 1.83 (0.60) 0.69 – Item 9. Staff structures milieu to actively engage youth in generalizing skills 0–3 1.66 (0.80) Item 10. There is a clear programmatic structure that pairs privilege to treatment performance 0–3 1.44 (0.76) Social support Item 2. Staff convey genuine regard and liking toward youth 0–3 2.06 (0.76) 2.03 (0.56) 0.83 – Item 3. Staff demonstrate that they listen to youth 0–3 2.23 (0.64) Item 4. Behavior is described in an empathetic, objective and nonjudgmental way 0–3 2.15 (0.67) Item 11. Staff help youth accomplish treatment goals that are important to the youth 0–3 1.69 (0.67) Future orientation of the program – – – – – – Treatment milieu Item 8. Program effectively reinforces behaviors 0–3 1.41 (0.71) 1.66 (0.55) 0.78 – Item 12. Staff apply treatment strategies in the milieu 0–3 1.68 (0.67) Item 13. Staff support each other in delivering the treatment with fidelity 0–3 1.89 (0.59) Ratings 1 2 3 4 5 6 7 8 Youth ratings 1. Overall organization – 2. Staff connectedness 0.67** – 3. Social support 0.66** 0.78** – 4. Future orientation of program 0.77** 0.70** 0.84** – 5. Treatment milieu 0.76** 0.65** 0.77** 0.78** – Expert ratingsb 6. Overall organization 0.41** 0.34** 0.36** 0.33** 0.46** – 7. Staff connectedness 0.40** 0.43** 0.40** 0.43** 0.49** 0.82** – 8. Social support 0.36** 0.43** 0.40** 0.29* 0.49** 0.75** 0.84** – 9. Treatment milieu 0.42** 0.39** 0.36** 0.30* 0.49** 0.75** 0.85** 0.82**
