Comparing outcomes for youth in treatment foster care and family-style group care

Abstract

Group care programs are often criticized for producing poor outcomes, especially in light of community-based alternatives like treatment foster care that have a stronger evidence base. In this study, data from Girls and Boys Town were used to compare outcomes of youth in treatment foster care (n=112) and group care (n=716) using propensity score matching, a method that can minimize selection bias in nonrandomized designs. Eighteen background covariates were used to develop propensity scores for the likelihood of receiving treatment foster care rather than group care. Several matching methods generated balanced samples on which the outcomes were compared. Results found that group care youth were more likely to be favorably discharged, more likely to return home, and less likely to experience subsequent placement in the first six months after discharge. Legal involvement and residing in a home-like environment at follow-up did not differ. Positive outcomes for group care youth suggest that family-style group care programs may promote effectiveness. Keywordstreatment foster care; family-style group care; propensity score matching Prevailing wisdom in systems of care for youth promotes a philosophy of least restrictive and community-based care (Stroul & Friedman, 1986). A growing body of evidence suggests that specialized foster care settings like treatment foster care (Chamberlain & Reid, 1991;Fisher & Chamberlain, 2000) are more effective and cost-efficient than group care (Chamberlain & Reid, 1998;Eddy & Chamberlain, 2000; U.S. Department of Health and Human Services [USDHHS], 1999). In a continuum of care, group care often serves youth whose needs surpass the capacity of traditional family foster care, but are not acute enough to warrant inpatient hospitalization (CWLA, 2004). With the emergence of treatment foster care as a possible alternative to group placements, questions about the continued broad use of group care are increasing (Barth, 2005).Despite widespread questions about youth safety during care (Barth, 2002) and equivocal outcomes following care (Hair, 2005;Wells, 1991), group care programs are prevalent. In this article, the term group care will be used interchangeably with residential care to label programs Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptChild Youth Serv Rev. Author manuscript; available in PMC 2009 January 1. Published in final edited form as:Child Youth Serv Rev. 2008 ; 30(7): 746-757. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript that provide services 24-hours a day to...

Navigating Family Roles Within An Institutional Framework: An Exploratory Study In One Private Chinese Orphanage

“…Similar outcomes are evident for juvenile offenders (Larzerene et al 2004;Kirigin 2001). Lee and Thompson (2008) report an increase in educational attainment, positive adult-youth relationships, and decreases in re-arrest rates for youth served in teaching-family homes over those served in residential programs.…”

Defining Group Care Programs: An Index of Reporting Standards

“…The review included only two-group outcomes studies so the effects of a group care placement could be compared to an alternative service, which is a stronger research design than the more commonly published single group studies. Overall results suggested the most positive effects for family-centered group care models (Landsman et al 2001), Teaching-Family group care (Lee and Thompson 2008;Thompson et al 1996) and multi-dimensional treatment foster care (MTFC; Chamberlain et al 2007;Chamberlain and Reid 1998). The practice components that are emphasized in these more effective group care models include family involvement, family-style living, adult supervision and behavior monitoring, positive reinforcement, limit setting, and social skills training.…”

“…Just as ''in-home'' services like wrap around and multi-systemic therapy have some overlapping elements but are not identical-and may have quite different results (Stambaugh et al 2007)-the same is likely to be true for group care. Research that indicates, in general terms, that ''group care'' appears to offer no additional overall benefit for the average youth (see, e.g., Barth et al 2007;Chamberlain and Reid 1998;Ryan et al 2008) has to be tempered by evidence that some group care has better results on some dimensions than treatment foster care (Lee and Thompson 2008). Tools to minimize over generalizing across programs with different intervention components and goals offer the field more precision in determining which studies of group care provide information relevant to which program models or elements work what youth.…”

The Transition Status of Youth Departing Residential Care

“…While studies evaluating the direct benefits of residential care are mixed (Curry 1991;Lee and Thompson 2008), the literature evaluating long-term outcomes post-discharge reveals a discouraging picture of academic failure and economic and social emotional struggles (CWLA 2005b;Lyons et al 2001). For example, a recent study reported findings of youth from residential group care and therapeutic foster care at 6, 12, and 24 months postdischarge.…”