Abstract
ObjectiveThis multilevel meta-analysis compared the outcomes of Treatment Foster Care Oregon for Adolescents (TFCO-A) and home-based treatment programs (HBT) with residential youth care for children and youth aged 0 to 23 years. MethodsA total of 145 effect sizes for different types of behavioral problems were derived from 24 controlled studies (n = 16,943 participants). A three-level random-effects meta-analysis was conducted. ResultsWe found a small statistically significant overall effect (d = 0.21), 95% CI [0.090-0.338], which indicated that non-residential youth care was slightly more effective than residential youth care. However, moderator analysis revealed that TFCO-A yielded a larger effect size (d = 0.36) than HBT (d = 0.08). ConclusionsOur findings suggest that youth treated in treatment foster care have better outcomes than youth in residential care, which is not true for children who are treated at home. Therefore, in case of out-of-home placement treatment foster care should be the first option. Given that residential care has no additional value for youth who are treated at home, and often sets limits to juveniles’ needs for self-determination, residential care seems an option if TFCO-A is not available and living at home is no longer possible because the child’s (immediate) safety is at stake.
Highlights
There is an ongoing debate on how to effectively treat youth with complex needs who are at risk for out-of-home placement, especially round-the-clock care in residential settings (Whittaker et al, 2016)
Residential youth care, is the most intensive and most expensive type of youth care, which substantially restricts autonomy of children and adolescents and deprives them of family life, which is undesirable for youth who are placed in residential care because home-based treatment or foster care is not available (Busschers & Konijn, 2019) or due to long-term undertreatment of severe behavior problems (Broeders, Van der Helm, & Stams, 2015)
6.04 effect sizes were extracted from each included study (SD = 5.06; range = 1–20)
Summary
There is an ongoing debate on how to effectively treat youth with complex needs who are at risk for out-of-home placement, especially (therapeutic) round-the-clock care in residential settings (Whittaker et al, 2016). These youths experience severe problems in behavioral functioning at home, in school and during leisure activities (AttarSchwartz, 2009; Eltink et al, 2017; Frensch, & Cameron, 2002; LelouxOpmeer, Kuiper, Swaab, & Scholte, 2017; Martín, González-Garciá, Del Valle, & Bravo, 2018). Residential youth care is mostly seen as a ‘placement of last resort’
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