Original Title: Efficacité des modèles et des approches de réadaptation pour les jeunes en difficulté d’adaptation

Authors' objectives: The rehabilitation services offer must meet the unique and varied needs of young people with adjustment problems. According to several key players, this offer must also be diversified in order to keep young people interested, create a sense of belonging, promote the development of a support network and allow for the outward transfer of acquired knowledge, in particular by encouraging the involvement of community organizations, as well as address emerging issues. However, Special Commission on the Rights of the Child and Youth Protection (CSDEPJ) (Commission spéciale sur les droits des enfants et la protection de la jeunesse), established in 2019, identifies several issues in the field that interfere with the quality of service offerings, such as, obsolete living environments, limited accommodations in certain regions, clients who should be placed in specialized accommodations or lack of diversified accommodation resources. In light of these findings, the Ministry of Health and Social Services (Ministère de la Santé et des Services sociaux) sought the support of the Institut national d’excellence en santé et en services sociaux (INESSS) to determine the guiding principles, targets and goals of rehabilitation, in order to propose an updated definition of rehabilitation for young people with adjustment problems aged 10 and over. This report answers the following evaluation question: Which rehabilitation models and approaches should be used? Three key questions were addressed: 1. Which rehabilitation models and approaches are considered effective for young people with adjustment problems? 2. What are the barriers and facilitators to implementing these models and approaches? 3. How are these practices experienced and perceived by the main stakeholders, namely, young people, their families and staff workers?

Authors' results and conclusions: RESULTS: Nine models and approaches, whose effectiveness had been evaluated, were identified in 19 publications. They were grouped together on the common basis of their objectives and intervention targets. The grouping of trauma-focused models and approaches included: • Attachment, Regulation and Competency (ARC); • Children and Residential Experiences (CARE); • Fairy Tale Model; • Sanctuary Model; • Trauma-Informed Care (TIC); • Trauma Systems Therapy (TST); • Trauma Systems Therapy – Foster Care (TST-FC). The grouping of models and approaches that focus on antisocial behaviours and prosocial skills included: • Approche de communauté d’entraide et de justice (ACEJ) [community of care and justice approach]; • Multidimensional Treatment Foster Care (MTFC). (#1 RESULTS FROM THE TRAUMA-CENTRED MODELS AND APPROACHES): A total of 12 publications (from 10 studies) documented the effects of grouping trauma-centered models and approaches for young people in rehabilitation, as well as the barriers and facilitators to implementing them as reported by various stakeholders (e.g., managers, staff workers, trainers, foster parents). Despite a low level of trust in the evidence, the results indicated that this grouping may improve externalized behaviours, mental health, placements and global youth functioning. However, certain variables, such as time and the intensity of treatment, seem to influence the effectiveness of the grouped models and approaches. Insufficient data made it impossible to grade the level of evidence of the trauma-centered models and approaches on the dimension « quality of the relationship between youth and adults ». A few facilitators and barriers to the implementation of these models and approaches were reported in 5 studies. The main facilitators are related to training, support and organizational conditions, while the main barriers are more related to the very nature of the model or approach, the tools that need to be put in place, the time required to appropriate them and certain practice conditions. No results regarding experience and perceptions were identified for this grouping of trauma-centered models and approaches. (#2 RESULTS FROM THE GROUPING OF MODELS AND APPROACHES FOCUSED ON ANTISOCIAL BEHAVIOURS AND PROSOCIAL SKILLS): A total of 7 publications (from 4 studies) documented the grouping of models and approaches focused on antisocial behaviours and prosocial skills. All of them included efficacy data, and of these, two also presented data related to young people’s experiences and perceptions. With a moderate level of trust in the evidence, the results suggested that this grouping may improve externalized or delinquent behaviours, mental health and global functioning, specifically among youth with a conduct disorder, antisocial behaviours or a strong antisocial profile. It should be noted that the results of one study highlighted the importance of applying the models and approaches of this grouping to the target youth, since young people who do not fit the target profile would not benefit from such model. Insufficient data from this grouping made it impossible to grade the level of evidence on these dimensions: education, quality of the relationship between youth and adults, quality of the relationship with peers, homelessness and placements. The results regarding the experiences of young people came from a single study (2 publications) and concerned both positive and negative aspects related to the social climate found in shelters. No results regarding facilitators and barriers to the implementation of the grouped models and approaches were identified. CONCLUSION: It is now possible to rule on the effectiveness of certain models and approaches used in the context of rehabilitation, as well as on some of the elements related to the implementation of the models and approach, and to perceptions and experiences. It appears, among other things, that the models and approaches assessed show some degree of effectiveness in improving a number of dimensions in the lives of young people in rehabilitation. In that regard, the principles, targets and goals that emerge from the groupings of models and approaches can be used to propose an updated definition of rehabilitation for young people with adjustment problems. That being said, these results will be enhanced by the results of complementary reports, namely a report on the characteristics and needs of young people in rehabilitation and another report on the guiding principles, targets and goals of rehabilitation. The process leading up to the publication of this last report (expected in 2023) will entail stakeholder consultations, which will complete the portrait of barriers and facilitators and of experiences and perceptions. Considerations related to the applicability and acceptability of the results will also be discussed, and other information drawn from the Québec context will be taken into account. Moreover, models not identified in this review – but used in rehabilitation services in Québec – will be considered. All the results from this series of reports will contribute to the reflection surrounding the update of the definition of rehabilitation for young people with adjustment difficulties aged 10 and over.

Authors' methods: To answer these those key questions, a systematic review was conducted using publications identified in several targeted bibliographic databases and in the grey literature. These publications were selected using predefined inclusion criteria, and the relevant information was extracted. In the case of publications which report on efficacy data, an analytical narrative synthesis was preferred, particularly because of the heterogeneity of these publications. Specifically, a grading evidence process was applied according to the Public Health Agency of Canada (PHAC) criteria. Data concerning implementation barriers and facilitators as well as on experiences and perceptions (questions 2 and 3) were the subject of a thematic analysis and an analytical narrative synthesis.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/definition-actualisee-de-la-readaptation-parmi-des-jeunes-en-difficulte-dadaptation-ages-de-10-ans-et-plus.html

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/definition-actualisee-de-la-readaptation-parmi-des-jeunes-en-difficulte-dadaptation-ages-de-10-ans-et-plus.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)