Wright School Research Findings Overview
For the past 3 years, Wright School, a mental health residential program for children located in Durham, has been collaborating with researchers at Duke University to assess the program's effectiveness. In this time of increasing concern about effective ways to treat the state's most difficult-to-treat youth with mental health problems, this research was undertaken to examine the extent to which Wright School's approach was 'working.'
Data were collected on children as they entered Wright School, as they were discharged from Wright School, and at 3- and 6-months after discharge. Analyses examined the extent to which children improved during the course of treatment, whether treatment gains were sustained after discharge, what types of youth seemed to benefit most from the program, and whether variations in service provision were related to child-level outcomes.Children Served
Wright School is designed to serve youth from ages 6 to 12 whose needs are unable to be adequately met in their home communities. Hence, they represent some of the most troubled and difficult-to-serve youth in the state.
During the study period, 119 youth entered Wright School. Of these, 98 (82%) participated in the full study. At the time of admission, youth ranged in age from 7-13 (mean=10.7), 13% were female, and 35% were African American. Nearly all youth had multiple psychiatric diagnoses (96%), including ADHD (92%), externalizing disorders (Conduct Disorder, Oppositional Defiant Disorder) (69%), and mood disorders (Depression, Dysthymia, Bipolar) (76%).
Treatment at Wright School
Wright School is a state supported mental health program with treatment philosophy guided by the principles of Re-Education. Key facts: residential with weekend visits home, average length of stay = 6 months.
Results
During the course of treatment, youth showed tremendous improvement. From entry to discharge, youth showed significant decreases in problem behaviors (as measured by the Child Behavior Checklist) and significant increases in personal strengths (as measured by the Behavioral and Emotional Rating Scale).Because both the CBCL and BERS have been used in a variety of populations, it is also possible to use one of the most stringent criteria in treatment research to examine improvement how many of the youth moved into the 'normal' range during the course of treatment. As they entered Wright School, few youth (20%) scored in the normal range on the CBCL or BERS. By the end of treatment the majority (75%) scored in this range. This indicates that not only had the youth made substantial progress, but that by the end of treatment they were behaving and functioning within the normal range for children of their age.
After intensive treatment, it is common to see some loss of gains and a return to the pre-treatment levels of problems. These data on Wright School suggest substantial sustainability of effects after discharge. By 6-months after discharge, CBCL and BERS scores showed considerable stability. The majority of youth were regarded as 'stable' (a CBCL or BERS score within 1 standard deviation of discharge score).
Table 1. BERS and CBCL Scores Across Time
BERS
CBCL
Mean (standard deviation)
Percent in the 'normal' range
Mean (standard deviation)
Percent in the normal range
69.7 (20.0)
21.4
27.6 (9.1)
9.6
96.7 (22.7)
73.2
16.1 (9.8)
55.6
88.9 (29.6)
58.6
19.3 (10.8)
45.1
88.2 (28.1)
58.6
19.0 (11.2)
49.3
Total N enrolled in study = 98
Factors Associated with Effectiveness
Overall, improvements during treatment and maintenance of gains after discharge were similar across youth. Wright School appeared to be equally effective for youth regardless of sex, race, diagnoses, home community, or family factors.
However, two factors were related to more substantial gains. Younger children appeared to improve more than older children. Children who were 10 or younger were 4 times more likely to be in the normal range by discharge than children who were 11 or older.
Length of stay was associated with more positive gains by 6-months post-discharge. By 6 months after discharge, 70% of children in the 'long stay' group (longer than 192 days) scored in the normal range (compared to 47% of 'short stay' children).Conclusions
Wright School is an effective program for serving the state's most difficult-to-treat 6 to 12 year olds. Youth show enormous gains during treatment and maintain much of this gain for at least 6 months after discharge. The program appears to benefit a wide range of youth and to be effective with youth regardless of race, sex, or psychiatric diagnosis. The program appears to have its greatest impact on youth who are younger (7-10) and who stay in the program longer (more than the 6 month average).
Recent literature in children's mental health interventions suggest that few interventions show this magnitude of change or sustainability of change for a broad range of such difficult-to-treat youth. Exact processes that drive these gains are not clear from the current work. However, qualitative data suggest that Wright School's extensive liaison work with the home community and family, effectiveness in getting post-discharge services into place, and structured Re-Ed program provide a crucial and effective treatment approach for youth who are at serious risk for a host of problematic behaviors and outcomes as they approach adolescence.
