Centering Youth Voice in Psychiatric Residential Treatment Research: Lessons from the Families in Transition Study

Abstract Psychiatric residential treatment (RT) is one of the most restrictive levels of care for youth with severe emotional and behavioral challenges. Despite the complex needs of youth involved in RT, their perspectives remain underrepresented in research, limiting knowledge regarding approaches for engaging this population in research. This paper describes findings from the Families in Transition (FIT) Study, a randomized controlled trial that evaluated a group-based behavioral parent training program for parents of youth in RT. The current study was conceptually framed as a feasibility study of engaging youth in RT research. Data were collected from parents and youth at baseline, 6 weeks, and 6 months using measures of emotional and behavioral functioning, placement restrictiveness, and mental health symptoms. Feasibility was assessed through recruitment, enrollment, and retention, as well as barriers encountered during youth engagement. Although 64 parents enrolled in the parent study, only five youth enrolled in the youth component. Review of recruitment records and study notes identified multiple barriers to youth participation, including challenges associated with recruiting youth while residing in RT, parent apprehension regarding participation burden and emotional distress, and difficulties related to remote data collection. Procedural adaptations included prioritizing post-discharge recruitment, flexible scheduling, enhanced communication with parents, and implementation of extensive safety protocols. As a secondary exploratory objective, parent and youth responses on shared measures were compared descriptively. Although based on a small sample, parent and youth reports differed in their perceptions of emotional and behavioral concerns and placement restrictiveness. Findings highlight the challenges of engaging youth in RT in research and underscore the importance of collaboration, flexible procedures, and innovative approaches to incorporating youth voice in mental health research.