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Paper

Outcomes for youth in residential care

abstract

Background. Over the past 20 years in the state of Illinois in the United States, the use of institutional or residential care has risen and fallen. With questions about both the appropriateness of the care for certain children and the value of this very expensive care, evaluative data is needed to determine the outcomes for these children in order to determine how they may be better served and how the overall budget for this type of care can be reduced. Currently, new administrative procedures are being put into place in order to improve the outcomes, both in terms of time in care and discharge outcome. In part, the results of the research for this paper has informed the details of those administrative procedures.

 Purpose. The purpose of the study is to provide policymakers and service providers with research that can inform management and practice decisions about how to better serve the most troubled children and youth in substitute care in Illinois. Questions:

-  What are the experiences of children prior to entering residential treatment?

-  What are discharge outcomes (i.e., where youth go at the point of discharge)?

-  What are the post-discharge outcomes (i.e., what happens to youth after discharge)? And how are all of these events related to the characteristics of the child? For example, how does a child's age or mental health affect the timing and type of discharge outcome?

-  What methods were used?

Both multivariate and descriptive methods were used to understand the outcomes that children experience. Administrative data on individual's children experiences was the data sources. Data from the child welfare agency was combined with data on health care (for mental health care data). We have conducted these analyses for 2003 and 2006. For each of these years, we analyze over 3,000 children who have experienced residential care in Illinois.

 Key findings and recommendations. Among first-time entrants in 2003 (fiscal year), more than a third (over 500 youth) had 11 or more prior placements and nearly 40 percent (over 650) came from high-end placements. In both 1995 and 2003 Illinois had about 150 youth who first entered residential care after having experienced 16 or more placements (including some runaway events). In other words, a substantial subset of youth entering residential care previously experienced the trauma of repeated placement failures in nonresidential settings.

Not surprisingly, given the increasing concentration of highly troubled and traumatized youth entering residential care, overall residential care discharge outcomes worsened over time. Among all youth who entered residential care in 2002 and were discharged prior to the end of 2003, 59 percent ran away or were discharged to hospitals, detentions, or other residential care placements, up from 45 percent for 1995 entrants. These findings illustrate that a majority of youth entering residential care in recent years experienced some type of negative or unplanned discharge outcome.

- Number of prior placements. Repeated placement failures before entering residential care increased the likelihood of subsequent negative discharges from residential care (detention or juvenile incarceration) hospitalization, or running away) and, for youth stepped down to foster care at discharge, increasing the likelihood of stepping back up into residential care.

- Gender. Boys were more likely than girls to experience residential care as a first or subsequent placement, less likely to step down to foster care (a less-restrictive and usually less-intensive form of substitute care), and if stepped down to foster care, more likely than girls to be stepped back up to residential care.

- Race. Hispanic youth in foster care were less likely than other youth to enter residential care. Among youth in residential care, African American youth were significantly more likely than other youth to be discharged to foster care, but significantly less likely to be discharged to a permanency setting (reunification with parents, adoption, subsidized guardianship).

- Maltreatment: Youth who experienced inadequate supervision (a type of child neglect) prior to entering substitute care were at greater risk of entering residential care from foster care, experiencing a lateral discharge from one residential care placement to another, and being stepped back up to residential care following discharge to foster care or permanency.

- Running away: Running away from foster care more than doubled the likelihood of entering residential treatment, and, for youth in residential care, running away 2 or more times prior to entering residential care doubled the likelihood of negative discharges.

- Length of stay in residential care: Among youth stepped down to foster care, having been in residential care for less than 90 days significantly increased the likelihood of stepping back up to residential placement.

Key references

Budde, S., Mayer, S., Zinn, A., Lippold, M., Avrushin, A., Bromberg, A., Goerge, R., & Courtney, M. (2004). Residential Care in Illinois: Trends and Alternatives. Chicago, IL: Chapin Hall Center for Children CS-103.

 Contacts: Robert M. Goerge, Chapin Hall Center for Children at the University of Chicago, 1313 E. 60th St. Chicago, IL 60202, USA, E-mail: rgoerge@chapinhall.org, Phone 773-256-5137.

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