Residential Care for Youth in the Child Welfare System: Stop-Gap Option or Not?

Abstract

This study provides national estimates for length of stay in residential care and examines within-group variability along salient predictors. Using data from the National Study on Child and Adolescent Well-Being, the sample included 254 youth with episodes in residential care. Descriptive analyses provided estimates for length of stay over the three-year study period. Negative binomial regression was used to examine the effect of predictor variables on length of stay. Results indicate that a minority of youth experienced short stays in residential care. Chronic health problems and a greater number of placements were associated with longer stays. Implications for practice and research are discussed.

Relationship Between Time in Residential Treatment and Youth Outcomes: Results from a Cross-Site 5-Year Analysis

“…As trends in the mental health field shift toward providing treatment to youth in their homes and communities, residential treatment centers (RTCs) are under scrutiny as they are one of the highest levels of care in child welfare's continuum of services (James et al 2012). The majority of youth in out-of-home placements are served in foster care or other family-based settings; however RTCs still serve approximately 14 % of youth (US Department of Health and Human Services 2014).…”

“…Furthermore, increasing pressure to use evidence-based and empirically-supported interventions also contributes to the need for RTCs to demonstrate successful outcomes for youth (James et al 2012), especially when alternative treatments such as treatment foster care effectively serve youth with emotional and behavioral issues while maintaining them in a family environment at a reduced cost to funders (Chamberlain 1994;2002;Turner and Macdonald 2011). Due to effectiveness of lower cost services, RTCs not only need to demonstrate effectiveness in serving youth with behavioral problems, but also demonstrate cost effectiveness and overall cost savings to stakeholders.…”

“…One way this can be accomplished is by identifying an ideal time in treatment for youth in RTCs that allows youth to successfully graduate from residential programs and enables them to avoid future costly placements such as juvenile detention or psychiatric hospitalizations. There is growing need to identify an ideal amount of time spent in residential treatment, especially as policy makers shift toward viewing residential treatment as a temporary intervention and experts asserting RTCs should be used as a stop-gap solution for youth who need stabilization and cannot immediately be returned home or to a lower level of care such as foster care (James et al 2012). Although there is a lack of research using rigorous research designs, there is advancement in the field to either adopt or learn from other treatment models that already have an evidence-base, especially in response to scrutiny around time in treatment in RTCs (James 2011).…”

Reunifying Families After an Out-of-Home Residential Stay: Evaluation of a Blended Intervention

“…Over the past few decades, there has been a trend in child welfare to move away from longer lengths of stay in outof-home residential care towards shorter lengths of stay or community-based services (James et al 2012). There are several reasons for this trend, including the Adoption Assistance and Child Welfare Act (P.L.…”

“…96272), which states that any child removed from their home must be placed in the least restrictive placement possible. Further, some have argued that extended stays in residential stay are indicative of poor quality or ineffective care (Lyons and McCulloch 2006;McCurdy and McIntyre 2004), while others point to the fact that out-of-home residential care is one of the most costly of all child welfare interventions (Child Welfare Information Gateway 2012; Gies 2003;James et al 2012). For example, it has been estimated that as much as 19 % of Medicaid spending for children's mental health goes towards only about four percent of children that are being served in residential facilities (Center for Health Care Strategies 2013).…”