What difference does treatment make? Developing a qualitative measure of young people's progress in residential rehabilitation
This research aimed to produce a robust qualitative outcome measure of young people’s progress in treatment, which would have the potential to be used more widely than existing tools, and contribute to evidence-based residential treatment options for particular groups of young people in Australia. It took place over three years, and was conducted in four residential rehabilitation services for young people – three in New South Wales and one in Perth, Western Australia. Ninety-five young people took part in the study.
The research followed from preliminary research (Wilson, Saggers & Wildy, 2008), which identified a framework of five stages - removed from 'being normal'; resisting treatment; reflecting on the journey; returning to self; and 'being normal' - within which young people move, often back and forth, during treatment. These stages provided the foundation for the design of the qualitative assessment instrument, called My Journey Map (MJM), using a narrative structure based on young people’s own stories of their experiences and progress across the five stages. Nested within each stage are five dimensions, with each dimension in turn containing narratives based around various aspects of importance in the lives of the young people.
Quantitative outcomes of the results from the MJM show the instrument as valid and internally consistent. Inter-rater reliability was significant between the two clinicians, and somewhat less so between client and clinician. At entry (T1) there was also significant correlation across sub-scales. Assessments completed at T1 and at exit (T2) show change over time for the majority of clients, as reported both by clients and clinicians.
Qualitatively, results showed that the MJM was a relevant and useful tool for practitioners working within residential rehabilitation services. Practitioners commented that it addressed key individual areas, provided opportunities to challenge clients who felt they were not making progress, and that it was engaging for the young people. The MJM was also found to be a practical, easy-to-use tool, with one practitioner commenting that it gives the young people "an opportunity to reflect on their progress and to also think about what they need to do in order to make a change in their lives".
The MJM was not without some practical and ethical challenges to its use. These included difficulties around young people leaving the service outside hours of work; clients being unwilling to complete assessments; and issues around contacting young people who have left the service for follow-up assessments. Using offensive language themselves, and ensuring that the young people understood the context-specific nature of its use in the MJM, was also a challenge for some practitioners.
The MJM addresses key individual areas that are important to the rehabilitation of young people and delivers significant insights that enable provision of more tailored and effective treatment options to the young people in the services. Data collected using the MJM approach has been shown to supplement quantitative data collected routinely by treatment services, to inform, illustrate, confirm or even challenge the interpretation of those data. In sum, the MJM contributes to the ability of residential rehabilitation services for young people with problematic drug and alcohol issues to record and celebrate incremental change and provides significant insights for use by service providers in treatment, and in public health strategies.
Wilson, M., Saggers, S. & Wildy, H. (2008). Outcome measures for young people attending substance misuse services for detoxification and residential rehabilitation in Perth, Western Australia. Perth: Centre for Social Research, Edith Cowan University.