Key experts were asked to identify other elements of treatment associated with positive treatment outcomes not discussed in the broad areas described above. A range of best practices was described, many replicating previous themes (e.g. harm reduction, client/treatment matching). A significant new theme that emerged was the importance of specific staff charcteristics as a factor related to treatment outcome and success. Staff qualities were described in relation to attitude, background and skills. In terms of attitude, key experts described the most effective therapists as being able to:
The most important aspect of staff background defined by respondents was the ability to speak with familiarity (and experience) to issues of importance to youth. Direct familiarity with different cultures and issues related to sexual orientation were emphasized. In terms of specific staff skills, respondents stressed the need for staff to:
Key experts highlighted two aspects of treatment:
Key experts favoured group therapy over one-to-one therapy. Supporting positive peer connections through group work was considered to be a very valuable component of clinical practice. However, it was also stressed that not all youth do well in groups.
Key experts also noted that there was a lack of certain types of treatment resources and options for youth, making success difficult to achieve. Specific gaps were noted in the following areas:
|Areas of Best Practice||Key Expert Themes|
The quality of the staff/client relationship has been identified in the literature as an important determinant of treatment success. In a review of several studies, Russell (1990) described specific staff characteristics which are likely to be related to successful youth treatment programs, and concluded that effective staff are:
Alexander et al. (in a study cited by Russell, 1990) indicated that it is the global quality of the staff relationship with clients that accounts for most outcome variance. Alexander et al. (as cited in Russell, 1990) concluded that relationship skills combined with a well-structured agenda and operational program framework are both essential to treatment success. Spooner et al. (1996) also attempted to define staff characteristics associated with optimal outcomes. Characteristics summarized from several studies include:
Luborsky (as cited in Spooner et al. 1996) found that the ability of a therapist to form a warm, supportive, therapist/client relationship, and a "helping-alliance" early in treatment was significantly correlated with the outcome. He also found that consistency in applying established treatment procedures was also correlated with treatment success.
A comparative study (McLellan et al. as cited in Spooner, 1996) of four different "types" of treatment providers found that the most effective were better organized, saw clients frequently, kept better case notes, were more consistent in their application of program policies and referred to specialists frequently. The most effective counsellors anticipated problems in each client's life and developed strategies in collaboration with clients to help resolve these problems.
In a study by Friedman and Glickman (as cited in Catalano et al. 1990 - 1991), 65 program variables were correlated with treatment outcomes. Staff-related variables showing significant correlation with treatment success were: