The re-invention of residential treatment: an agenda for research and practice¹

Foster care is a federally funded child welfare program that includes family-based and residential group care for children who for a variety of reasons cannot remain with their primary caregiver. Foster care placements are intended as temporary homes while efforts are made toward reunification with the birth family or other permanency options can be arranged. The vast majority of children in foster care have been abused or neglected, or have experienced other types of trauma that make them vulnerable to adverse developmental outcomes.

This article presents the findings of a qualitative study in a Flemish centre for children and adolescents with emotional and behavioural disorders. The change in demand for care for this highly troubled population has created a need for intervention models that address students' socio-emotional needs. When preparing an organisation to implement such intervention models, it is critical to obtain a thorough needs assessment or pre-implementation evaluation of staff in the organisation. Fifty interviews with different staff members were performed, guided by three research questions: (1) How do staff perceive the children and youth cared for, including behaviour, needs and demands of these youths?; (2) How do staff attempt to translate this demand for care into treatment, and what obstacles could possibly stand in the way?; and (3) What are, according to staff, critical issues to take into account when implementing EBP, both on the individual and the organisational level? Using a grounded theory approach, the analysis resulted in a pre-implementation model. In the following article, this model will be discussed and illustrated with quotes from staff members.

This paper presents findings from a structured review of treatment models that are relevant to group care and residential treatment settings for children involved with the child welfare system. Initiated and guided by The California Evidence-Based Clearinghouse for Child Welfare, five treatment models — Positive Peer Culture, Teaching Family Model, Sanctuary Model, Stop-Gap Model, and Re-ED — were reviewed for effectiveness. In this paper, each model's treatment features are described and relevant outcome studies reviewed in terms of their effectiveness as well as relevance for child welfare practice. Findings indicate that four of the models are either supported or promising in terms of evidence for effectiveness. Implications for group care practice and research are discussed.

There is a widespread concern for children in public care who experience repeated moves and a lack of opportunity to settle down. The aim of the present analysis was to examine the placement histories of children in long-term out-of-home care and to gain knowledge of important factors that affect stability as reported by children, parents, and social workers. Within a prospective research design, the placement histories of 70 Norwegian children were followed through eight years, at several time points. Both counting and qualitative analyses were conducted. The findings emphasize the significance of carrying out a thorough investigation of the specific circumstances of each placement and placement change when the question of breakdown and stability is raised. The informants' accounts of placement breakdowns reflect the considerable responsibility assigned to foster carers for ensuring stability for children in care. The paper discusses premises and implications of this assumption, and points out that more realistic expectations and increased attention to the children's views and attitudes of the placement may contribute to greater stability in care.

This study examined patterns of movement for youth receiving services within a continuum of intensive and restrictive residentially-based programs. Data were collected for 701 completed episodes of care within a three-program residential continuum of care over a 5 year period, and examined time within program, movement between programs, in-program disruptive behavior, and discharge status. Results showed that most youth either remained in a stable placement in the least restrictive of the programs, or followed a pattern of placements that systematically moved them from more restrictive to less restrictive settings. Of note, transitions from more restrictive to less restrictive programs correspond to deescalating levels of problem behavior; and over 80% of the youth were stepped down to either family-based or independent living situations at the time of departure. Findings support the notion that a continuum of intensive residential services can serve the needs of youth with significant emotional and behavioral needs.