Residential Group Care Research Articles

The Impact of Trauma-Informed Training for a Youth Residential Center on Staff Attitudes and Behavior

ABSTRACT Purpose Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice. The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. Materials and methods A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. Results There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. Discussion The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. Conclusion This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.

Does Group Size of Provision Matter for Children Who Experience Residential Group Care in Scotland?

It is widely recognised that trauma-informed care is fundamental to meeting the needs of children who experience residential care. Service design is central to this, and the aim of this article is to illustrate the experiences of 13 young people who have lived within group care settings, to highlight how a service’s capacity can impact on children’s needs being met. Using findings from a PhD thesis engaging 18–29-year-olds in Scotland, the research used a mixed methodological approach of questionnaires and semi-structured interviews to elicit young people’s retrospective care experiences. The findings show that the number of children within a setting can adversely affect the feeling of being emotionally and practically supported, resulting in some children feeling that their needs were not fully met. This will offer insight to practitioners, managers and decision makers who are engaged in the delivery and development of children’s services. Background: The United Nations Convention on the Rights of the Child (UNCRC) articles 3, 9 and 20 and Scotland’s Independent Care Review state what children should expect from authorities and services responsible for providing alternative care. The ambition for Scotland’s children is that they “grow up loved, safe, and respected so that (they) realise their full potential”. For those who spend a period of their childhood growing up in residential care, they should experience a relational, trauma-informed and caring approach from staff.

Experiences of gender-responsive trauma-informed care among female youth in deep-end residential group care facilities

Over the past two decades, research on trauma and adversity and the implementation of trauma-informed care (TIC) has become established in social work, psychiatry, and other helping professions. Girls assigned to restricted out-of-home placements by legal order who use social services frequently have a history of childhood trauma. Whereas the extant literature has examined gender-responsive TIC among victimized women, it has barely addressed educational-rehabilitative work with girls placed in deep-end juvenile facilities. The present study aims to fill this gap by responsive gender-responsive practices of a unique gender-responsive and trauma-informed placement for adolescent girls.The research method was based on threefold database including observations, semi-structured interviews with girls and staff, and drawing data from ongoing documentation of the work in the placement as was documented by the staff.Findings refine eight principles of gender-responsive TIC: relationships, safety, empowerment and voice, trustworthiness, and transparency, perceiving maladaptive behaviors as useful survival skills, peer support, removing social barriers, and reducing re-traumatization.The article proposes a framework set of principles for gender-responsive trauma-informed care and discusses theoretical and practical implementations that are essential for future policies regarding professional work with adolescent girls in deep-end placements. Discussion rises the need for a new refining of guidelines coherent and holistic model for creating gender-sensitive trauma-informed care when working with adolescent girls who experienced adverse childhood events. Studies using controlled designs might examine the effects of such a framework by developing guidelines and action principles as a basis for fostering standardized training for professionals who work with adolescent girls in extreme social exclusion.

The Effect of Family Foster Care vs. Residential Group Care on Educational Attainment

This study investigates the effect of foster care relative to residential group care on enrollment in upper secondary education among Danish children in out-of-home care who were placed out of home at the age six to 14 years (n = 4530). We address the proposition that children placed in family foster care generally have less severe emotional and/or behavioral problems than children placed in residential group care by utilizing a variation in the municipalities’ relative use of foster care among all children placed in out-of-home care. We find evidence that children living in municipalities with a high inclination to use foster care will be more likely to enroll in upper secondary education (p = 0.004). When splitting the sample by gender, we see that the effects are significant only among girls. When looking at potential mechanisms, we find that children in foster care are more likely to attend the school-leaving exams after lower secondary school, while we find no effect on the average standardized test score in the school-leaving exams. As with the main results, these findings apply to the girls only.

Reflections on Care Experiences Among Early, Middle, and Late Adolescents in Residential Care

Although most youth served in residential group care are adolescents, empirical theories indicate that youth needs vary at different stages of adolescent development. These differences likely impact adolescents’ experiences and, ultimately, responses to treatment; a neglected research topic that may have implications for residential placement and services. This study explored youth experiences in residential care at different stages of adolescence. A descriptive qualitative content analysis from a sample of 103 youths was used to classify open-ended text into categories among early, middle, and late adolescents. Comments showed similarities and differences across developmental stages in six categories—general views on placement, relationships, needs and supports, safety, autonomy and control, and growth and development. Youth in late adolescents were more contemplative about their time in residential care, with comments reflecting a need for more autonomy, while expressing how residential care has helped with future endeavors and goal planning. Middle and early adolescents’ experiences were more varied. Early adolescents focused on relationships outside of care and discussed support needs differently, compared to middle and late adolescents. Our findings suggest that experiences in residential placements differ in important ways across stages of adolescent development.

“I hope my voice is heard.”: A mixed-methods study of youths’ perceptions of residential care

There are a lack of studies examining youth’s perspective on their experiences in residential care. Such studies may yield important contributions to quality improvement and, hence, outcomes of youth in residential care. In this mixed-methods study, we aimed to evaluate youths’ perspectives of the quality of care and experiences in residential group care. The sample (N = 450) was comprised of 50.9% females and 48.6% males with a mean age of 14.77 (±2.27). The majority were white (36.3%) and black (36.0%). The sample was drawn from 127 residential care programs in Florida. This study was approved by an Institutional Review Board. Data were collected as part of a larger statewide pilot of the Quality Standards Assessment (QSA). We used univariate analyses to describe quality ratings and a multilevel model to examine associations between QSA scores and youth and program characteristics. Youths’ care experiences were categorized using a content-analysis of their open-ended responses. Overall, youth rated the quality of their placements highly. The multilevel model revealed that quality ratings were higher among youth with family reunification as their discharge plan versus non-relative care. Youths’ open-ended responses supported positive views on their placements and connections with staff. Negative comments focused on environmental restrictions and staff/peer relations. The inclusion of youth perspectives can contribute to improved service experiences and outcomes.

Co-producing to understand what matters to young people living in youth residential rehabilitation services.

Residential group care is an important service for vulnerable young people experiencing mental health, substance abuse and/or behavioural challenges. Yet little is written about specific models and their outcomes, especially from the perspectives of the young people who use these services. This project aimed to explore what matters to young people living in a 12-month voluntary residential program for young people aged 16-25. This participatory action research study was co-produced with Youth Residential Rehabilitation Service residents and staff as co-researchers. A steering group comprising residents, staff and researchers oversaw all research stages. 18 young people and 17 staff members participated in either individual or group interviews to discuss what was important in Youth Residential Rehabilitation Services. Data analysis drew on grounded theory techniques; subsequent codes and themes were refined in the steering group. We identified the 'change work' that young people were expected to do, and the milieu factors that created a supportive environment. As young people were figuring out their directions and learning new skills, they needed to be understood as the developing expert of their own lives. Real relationships with staff and other young people created a culture of belonging, safety and feeling known. These findings are metaphorically captured in the image of an egg. Our study highlights that real relationships between all Youth Residential Rehabilitation Service community members are central to creating the atmosphere of safety and belonging that enables healing and self-development to occur.

The Florida Institute for Child Welfare at Florida State University

ABSTRACTThis article discusses the role of The Florida Institute for Child Welfare (Institute) in the overall goals of child welfare in the state of Florida. The complexity of child welfare requires thoughtful and innovative methods of training and practice. The Institute was created as a result of a series of child fatalities and negative child and family outcomes. The Institute has been tasked with maintaining a program of research that informs child welfare legislation. By creating the Institute, an objective voice, to focus on building an infrastructure of research, it is clear that state leaders have prioritized the effectiveness of our child welfare system. Prominent research has included an analysis of the frontline workforce, residential group care, and the behavioral health of child welfare-involved parents. With the passing of the new law, the Family First Prevention Services Act, research-based services are being promoted and prioritized among federal child welfare leaders. The Institute offers advisement and consultation to Florida’s state child welfare system relating to workforce development, training, and the provision of research-based services. This paper will include the description of the Institute and ongoing research.

Developing Quality Standards and Performance Measures for Residential Group Care: Translating Theory to Practice

ABSTRACTWith the increased emphasis on accountability at the federal and state levels, efforts to identify and address issues impacting the quality and effectiveness of residential care programs are needed. Establishing quality practice standards with measurable performance indicators is a useful means for promoting and evaluating the quality of care in residential programs and informing a process of continuous quality improvement. In this article, we describe a state-wide initiative to enhance the quality of residential group care in Florida. Specifically, we describe efforts to establish a set of quality standards for residential programs and to operationalize the standards by developing and piloting an assessment designed to measure the extent to which group home practices align with the standards. In addition to describing steps taken, we highlight important conceptual and practical considerations for translating standards generated from extant research, best practices, and field experts into clearly defined domains and measurable standards that can be meaningfully transported into a complex practice setting. Finally, we discuss lessons learned and recommendations that may guide similar efforts beyond the state of Florida.

Increasing Youth Engagement in Residential Group Care: A Mixed Methods Pilot Study of a Youth-Guided Incentive Program

Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement. In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n = 16). A semi-structured focus group with service providers (n = 7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two). Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program. This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.

Educating children and youth in care in Alberta: a scoping review

Alberta Education and Alberta Children Services have reported consistent low achievement in school by children and youth in care, especially those in residential group care. This article provides the current picture of research and practice (policy) regarding the learning experience of children and youth in care. Utilizing a scoping review of local and international research studies, the paper argues that the education of children in care in Alberta is not considered an important issue. The dominance of the social work paradigm in children and family services is exposed as inadequate, and hence the call for social pedagogy to be adopted. Determinants of educational achievement for children and youth in care are examined and using these attainment factors, the article identifies and recommends areas that Alberta Education and Alberta Children Services need to consider with urgency if children and youth in care are to benefit from schooling like all other children.

Residential Group Care as a Last Resort: Challenging the Rhetoric

ABSTRACTThere is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care.

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n=903) or foster care (n=179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD=2.43) and 13.65 (SD=2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n=526; 53.1%), the borderline group (n=232; 23.4%), or the high functioning group (n=232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.

Latent subtypes of youth in psychiatric residential care

In current practice, residential care programs in the United States are often more general than specialized with little demonstrated results of effectiveness for different types of youth. Subgroup analyses focused on developing a thorough understanding of the subpopulation of youth served in residential group care have potential to inform targeted program development. Using assessment records of a sample of 447 youth in psychiatric residential treatment, a latent class analysis was performed to identify youth subtypes. The results revealed four classes of youth characterized by severe levels of functional impairment and externalizing behavioral problems. Class distinctions were observed in the areas of psychiatric diagnoses, child behavioral problems and strengths, family characteristics, and maltreatment histories. An examination of class profiles lends support for the applicability of some general approaches across therapeutic residential programs, including the use of trauma-informed care and family-centered practice frameworks. The findings further demonstrate the need to also include program elements that are specified to the types of youth the program is designed to treat. Implications for policy and developing specified treatment protocol matched to the types of youth served in psychiatric residential programs are discussed.

The Role of Therapeutic Alliance and Fidelity in Predicting Youth Outcomes During Therapeutic Residential Care

There is a gap in understanding how the treatment fidelity aspects of adherence and quality, along with common process factors such as therapeutic alliance, impact outcomes for youth. Few studies have examined both constructs of implementation and process factors simultaneously in regard to their relationship to client outcomes. This study examined the role of (a) youth ratings of implementation quality for a provider of therapeutic residential care, (b) the records of staff ratios of positive to negative statements to youth as reported for a token economy system, and (c) youth ratings of therapeutic alliance in relation to youth emotional and behavioral functioning at 6 months into therapeutic residential services. The study included data collection activities with 112 youth and staff at intake into residential group care through 6 months into residential services. Both youth ratings of therapeutic alliance and the ratio of positive to negative staff interactions with youth were related to improved youth emotional and behavioral functioning, as reported by staff using the Child Behavior Checklist. These findings suggest that it is important to consider both implementation and common process factors when looking to improve the quality of care for youth in therapeutic residential care.

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns. MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained. ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation. ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.

A Review of Trends, Research, and Recommendations for Strengthening the Evidence-Base and Quality of Residential Group Care

ABSTRACTAlthough the appropriate use of residential group care remains a subject of longstanding debate, most child welfare stakeholders, including practitioners, researchers, and advocacy groups, acknowledge that for some youth high quality group care is an essential intervention. In this article we review trends and issues related to the use of residential group care. We further review findings from outcomes research and recommendations put forth by scholars and national groups with expertise in residential care focused on building the empirical evidence-base and improving the quality of residential care for children and adolescents involved with the child welfare system.

Preliminary Results of the Louisiana Sex Offender Treatment Program

The purpose of this study was to offer preliminary support for the Louisiana Sex Offender Treatment Program (LSOTP) in addressing the needs of juvenile sex offenders. Research objectives were (1) to offer statistical evidence for reductions in anxiety, depression, cognitive distortion and negative attitudes towards women comparing a group of 21 adolescents, 12 of whom received services as usual and nine of whom participated in the LSOTP. A controlled experimental evaluation design was utilized. The juvenile sex offenders were randomly assigned to the experimental group for 12 weeks receiving treatment services and a control group receiving care “as usual” in a residential group care program. Participants in the experimental group experienced statistically significant decreases in cognitive distortions related specifically to rape and molestation.The results of this study offer preliminary support of the LSOTP as a best practices alternative to other treatment modalities.

Attachment relationships of adolescents who spent their infancy in residential group care: The Greek Metera study

A prospective longitudinal study beginning whilst the infants were living in the Metera Babies Centre showed that the great majority showed a disorganized attachment during the period of residential care, even though neither abuse/neglect nor subnutrition were involved. There was an initial follow-up post-adoption age at four years. This paper concerns a further follow-up of the 52 adopted adolescents aged 13 years who had spent their first two years of life in Metera Babies Centre. They were compared to 36 adolescents reared in their biological families who, during their infancy, attended full-time public day care. The key aim was to examine continuities and discontinuities between early and contemporary relationships. The Child Attachment Interview was employed in adolescence. The main findings were a significant decrease in the rate of disorganization and a lack of a significant difference between the previously institutionalized group and the family care comparison group on attachment qualities in adolescence. There was not sufficient statistical power, however, to detect a small difference.

Kinship Services Network Program: Five year evaluation of family support and case management for informal kinship families

The purpose of the present study is to seek to better understand if a community-based family support program, Kinship Services Network (KSN), can improve the social support and family resource needs for kinship families and promote safety and permanence for children in informal kinship placements at a low cost. During the five year evaluation period, KSN served 2956 participants in one urban southeastern county. A stratified random sample of participants completed pre- and post-assessments of their perceived social support and adequacy of family resource needs. Administrative data was used to determine whether children of all participants remained in the care of a relative twelve months after program completion. Cost estimates were used to compare the costs for several placement options for children. Additionally, a case example is used to illustrate program implementation. Participants in the program improved their adequacy of social support and improved family resource needs (p<.001). Ninety-nine percent of participants' children did not enter the child welfare system at twelve month follow-up, showing placement stability and child safety. KSN cost of service is less than half the costs associated with adjudicating a child dependent. Non-relative foster care is 6× (six times) and residential group care is more than 21× (twenty-one times) as expensive as the KSN Program. Recommendations are provided to help community based organizations promote case management and family support services in their own communities.