A Systematic Review of Quality Indicators in Therapeutic Residential Care Drawn from Young People<acute accent>s Beliefs and Experiences

Young people<acute accent>s perspectives on service quality in Therapeutic Residential Care (TRC) are commonly excluded or overshadowed by those of adults which has led to calls for better youth self-report indicators of quality healthcare. In response, we performed a systematic review of peer-reviewed literature to identify the most important quality indicators for young people by reviewing the literature on their beliefs and experiences regarding TRC and building on the four-pronged parsimonious framework (setting, staffing, treatment approach, and safety) proposed by Farmer et al., (2017). Following PRISMA guidelines, a systematic literature search was conducted in March 2022. Of the 17, 815 records screened, 15 articles, composed of 15 samples were included. A total of five domains and 13 quality indicators were identified: 1) Setting; 2) Staffing (professional skills and access to specialist support [doctor/therapist]); 3) Treatment approach (effective transition and aftercare support, rest and time to think, life skills, behavioural improvement, access to education and farm animals as therapeutic aides); 4) Safety (staff actions and structure and stability), and 5) Milieu factor (trusting relationships, family involvement, and relationship continuity). These four domains provide a practical framework for better-oriented treatment. The additional domain identified as the milieu factor places the critical quality indicators of TRC (e.g., trusting relationships) from the perception of the youth themselves, at the centre of attention, and encourages services to assess the extent to which they have the milieu factor, so they can strategically adapt and be responsive to the needs of young people. Policy and service delivery implications are discussed.