AT A CROSSROAD: RESIDENTIAL TREATMENT — NOT WHETHER, BUT WHO, WHAT, AND FOR WHAT PURPOSE

Introduction

Child welfare services in general and out-of-home placement including residential treatment in particular are at a crossroad (AACRC, 2009). Changes in policy, practice, and program development, and the availability of data and research to inform these changes, are having an impact on the future direction of placement services to children, youth, and families. The use of data and analytics to improve outcomes for children/youth/families can apply at all levels of the child welfare system from intake through to permanency. This article focuses on the use of data and research in developing and improving targeted and effective trauma-focused services across the child welfare continuum, with specific emphasis on children/youth removed from parental care and placed in higher levels of out-of-home care such as congregate care (CC).

The term congregate care can have various meanings, but generally refers to non-family, group-based services to children whether in a smaller family group home, larger secure residential facilities, or more restrictive secure residential treatment facilities.

The utilisation of data and research can identify the most appropriate and effective types and levels of service, based on the level and type of need. An example from one U.S. state jurisdiction will illustrate how data can inform the development of child welfare policies and practices.

The current context of child welfare services in the United States, including principles and processes that impact program and policy development, is delineated by the recently passed 2018 Family First Prevention Services Act (FFPSA)—known as the Family First legislation. Consistent with child welfare policy of ‘least-restrictive alternative’, the goal of Family First is to keep families together and allow child welfare agencies to repurpose funds previously restricted to the purchase of out-of-home services. This repurposing of funds supports the need for promotion of family-based placements. The assumption is that improving access to lesser-restrictive alternatives to placement will increase the likelihood of family-based care and reductions in lengths of stay for children who for safety reasons have been removed from the care and custody of their caregivers. Specific provisions in Family First incentivise states to reduce CC.

The FFPSA fits with the overall values of child welfare practice, which include the least restrictive/family/community-based focus taking child safety and child well-being into consideration; a focus on family, as well as the child; services based on the level of need, provision of effective elements of practice and interventions, and a match between child/family needs and services. It is my experience that there is a continuum of need from community-based, non-intrusive, voluntary services through intensive in-home and out-of-home services, up to and including involuntary psychiatric hospitalisation.

Data available from the 2014 Child Maltreatment Report suggest that

out-of-home placement services apply to a small overall percentage of the children involved in U.S. child welfare services (USDHHS, 2016). The data show that in the U.S. there has been an overall increase of reports to child welfare services since 2010, with 2014 rates at 3.6 million referrals for 6.6 million children. The data also show that, based on screening procedures and interventions provided at earlier stages of system involvement, one in five reported children are actually substantiated for maltreatment and a little more than half (58%) of those confirmed receive post-investigation services. Even fewer children are placed in out-of-home care (2% of all referrals), with one in three (36%) receiving post-response referrals. As of 2016, children placed in CC composed 12% (53,328) of those children in out-of-home care in the U.S. (Pecora & Davis, 2018). While those in CC total over 50,000 children, these numbers already reflect a 34% decrease in CC placements since 2004. These data suggest a winnowing from millions of children screened and investigated to a small number of children who are actually removed from parental custody. One would assume the highest level of need in those children who are placed in one of the highest levels of service, especially for children placed in the most expensive and most restrictive levels of care, often far from their homes.

While these assumptions might appear reasonable, a 2015 Federal Cohort Study of CC (U.S. Children’s Bureau, 2015) revealed several findings:

use of CC varied widely by community;
nearly one-half (41%) of children had no clinical indicators documented in official records;
one-third (32%) had a child behaviour indicator (which means 68% did not);
one in five (20%) had a DSM diagnostic indicator;
fewer than 10% (7%) had a disability indicator; and
one in four entered CC as their first placement.

These data raise serious questions about the role of CC in the United States. Why is there variation in use? Why are so many children placed in CC who do not have behaviour problems or clinical indicators for this highest level of care? Why are so many children entering CC as their first placement?

This article is based on a keynote address presented by Diana J. English at the National Australian Child Abuse and Neglect Conference, August 2018. Correspondence concerning this article should be addressed to Diana J. English, Child Welfare Consultation Services (CWCS) Seattle, Washington 98146.

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