New Policy Brief: “Safe and Effective Reduction of Congregate Care”

In January, the Chadwick Center for Children at Rady’s Children Hospital and Chapin Hall at the University of Chicago released a collaborative policy brief entitled “Using evidence to accelerate the safe and effective reduction of congregate care for youth involved with child welfare.”

Drawing on data from the Multistate Foster Care Data Archive, the National Survey of Child & Adolescent Well-Being, and the California Evidence-Based Clearinghouse for Child Welfare, the brief presented key findings on the variation in use of congregate care between states and outlined recommendations for customizing safe and effective strategies to decrease reliance on congregate care at the state level in response to legislative and administrative pressure to do so, such as the proposed Family First Act.

Notably, the brief cites the Ainsworth & Hansen (2005) cautionary report of results from Australia’s elimination of congregate care in its summary, arguing for capacity to be built rapidly and effectively in various areas to account for a planned reduction in congregate care:

In principle, any effort to reduce the use of and support for congregate care must be paired with steps to establish the infrastructure to meet the needs of children now in group placements who will be served in more home-like settings. Failure to do so may result in a host of unintended consequences including the increased disruption of foster and kin placements, higher demands on hospital emergency rooms and psychiatric hospitals, and increased use of far more restrictive juvenile justice settings.

ALTERNATIVES TO CONGREGATE CARE

According to the brief’s findings on populations in congregate care, the necessary capacity to be built includes (1) less restrictive, home-like, or home-based disruptive behavior treatments to reduce long-term use of congregate care and  (2) placement stabilization programs to reduce short-term reliance on congregate care as emergency shelters.

The brief cites evidence-based programs rated “well supported” in these two areas by the California Evidence-Based Clearinghouse (CEBC). Treatment Foster Care Oregon – Adolescents appears in both lists. Though not mentioned by the brief, Utah Youth Village’s adaptation of the Teaching-Family Model in an in-home context, Families First, is rated a “promising” Disruptive Behavior Treatment by the CEBC.

The brief’s first recommended action is for state policy makers and agencies to work collaboratively with treatment providers to create customized strategies for reducing congregate care. As we have previously discussed in advocacy updates, this kind of collaborative planning could facilitate conversations surrounding the redefinition of Teaching-Family Model group care with live-in teaching parents as treatment foster care, as it would likely become expedient for states to revisit definitions when looking to quickly build capacity in alternatives.

FOR TEACHING-FAMILY MODEL AGENCIES

Teaching-Family Model agencies could/should become influential voices at the state level, representing a deep knowledge base of Teaching-Family Model systems that can (1) build capacity with proven implementation science and (2) offer evidence-based services across the continuum.

In terms of the brief’s language and argument, there are a number of things to respond to in further depth. We will provide evidence-supported responses and other updates on the latest research and advocacy developments here, in our members-only blogs section of the website.

KEY FINDINGS

  • The overall use of congregate care has decreased by 20% since 2009, but there is substantial variation among states even in this trend (suggesting detailed analysis is needed to understand local trends).

  • Some states rely heavily on congregate care as a first placement (suggesting capacity building for foster homes is needed).

  • Youth placed in congregate care and therapeutic foster homes have significantly higher levels of internalizing and externalizing behaviors than those placed in traditional foster care (suggesting that increased access to services that effectively address internalizing and externalizing behaviors are essential to safely reducing the use of congregate care).

  • Compared to youth whose clinical needs are met through therapeutic foster care, youth placed in congregate care are more likely have externalizing problems (suggesting that strategies for serving these youth in home-based setting should focus on preparing those homes to respond by de-escalating difficult behaviors).

  • The California Evidence Based Clearinghouse for Child Welfare (CEBC) contains tested strategies for disruptive behavior problems, however, many of them have not been tested for use with the child welfare population (suggesting that support is needed for implementation and evaluation of interventions that may stabilize foster care placements).

Chimera Collective