Quality of life among adolescents living in residential youth care

Objectives: Quality of Life (QoL) should be an important outcome measure in Residential Youth Care (RYC) institutions, as Child welfare services are aimed at providing care and protection, fostering well-being and prosocial... [ view full abstract ]

Objectives: Quality of Life (QoL) should be an important outcome measure in Residential Youth Care (RYC) institutions, as Child welfare services are aimed at providing care and protection, fostering well-being and prosocial behavior. QoL is defined as subjectively perceived well-being and satisfaction that can be best evaluated by the child itself, according to his/hers own experiences across several life domains. The dearth of research in this area gives rise to serious concern. The present study is to our knowledge the first large scale, nationwide study assessing QoL among adolescents living in RYC. For a comparison, adolescent self- and primary contact proxy reports were compared to the general population and to adolescent outpatients in Child and Adolescent Mental Health Service (CAMHS). Also, we investigated the association between self-report of QoL in adolescents living in RYC and proxy reports of their primary contacts at the institution.
Methods: All residents between the ages of 12-20 years living in RYC in Norway were invited to participate. Eighty-six RYC institutions (with 601 eligible youths) were included, 201 youths/ parents did not give their consent. Finally, 400 youths aged 12-20 years participated, yielding a response rate of 67 %. As a reference frame for comparison, a general population (N=1444) and an outpatient sample of adolescents in CAMHS (N=68) were available. We used the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). General Linear Model analyses (ANCOVA) were conducted with five KINDL life domains as dependent variables and group as independent variable.
Results: Results showed that self- and proxy reports of QoL in adolescents living in RYC were significantly (p<0.001) poorer QoL compared to the general population on the life domains physical- and emotional well-being, self-esteem, and relationship with friends. Adolescents evaluated their physical well-being as worse compared to adolescents in CAHMS. Self- and proxy reports in RYC differed significantly on two of five life domains, but correlated low to moderate with each other.
Conclusions: The results in this study raise major concerns about the poor QoL of the adolescents living in RYC, thereby challenging the child welfare system and decision makers to take action to improve the QoL of this group. The use of QoL as outcome measures is highly recommended.