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Is there a future for residential youth care and treatment? Messages from research


Introduction. Residential child and youth care is not only the oldest but nowadays also one of the least 'sexy' forms of assistance to children and young people in need. In the USA 'it has fallen out of favor with influential segments of the mental health community' (Leichtman, 2006, p. 285); in Europe it 'was criticised for providing out of date education and repressive regimes that failed to meet the individual needs of children and young people' (Colton, Roberts, & Williams, 2002, p. 66). Hellinckx (in Colton et al., 2002) observes that during the last two to three decennia the number of residential centres has been reduced considerably in most of the (Western) European countries.

He explains this evolution by pointing out the fact that the target population has changed (children usually do have parents and, as a consequence, a more family-oriented service may be preferred); alternative, less drastic forms of professional support have been developed (for instance, home-based interventions); the social position of children and parents has been strengthened ('empowerment'); financial considerations are at stake (placements generate high costs); and - last but not least - research seems to show less positive outcomes.

Research outcomes. Concerning this research issue questions were raised as to the effectiveness of residential placements, especially in comparison with well-conceptualised non-residential alternatives. It is remarkable, however, that the empirical proof for this ascribed lack of effectiveness is small.

Taking the period 1990-2005 as an example we were not been able to detect even one (experimental) study that allows us to formulate causal inferences related to the effects of a residential treatment programme (Knorth, Harder, Zandberg, & Kendrick, 2008).

Generally it strikes that there are few reviews and meta-analyses of outcomes concerning residential child and youth care services. Nevertheless, the available research does show that residential placements can probably contribute to the positive development of some youth with serious behavioural and/or emotional disturbances.

A review by Frensch and Cameron (2002) focused on 15 effectiveness studies about child and youth care in residential group homes and treatment centres. The study highlights the importance of aftercare and working with the child and his or her family in terms of improving the effectiveness of residential care. Another review by Hair (2005), reading up of 18 outcome studies, concluded that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach.

We ourselves recently reported on research into outcome studies published in the period 1990-2005 (Knorth et al., 2008). The application of strict inclusion and selection criteria yielded 27 pre- and quasi-experimental studies (PE and QE) covering the development and outcomes for a bit less than 2.500 children and young persons. For seven studies with a PE-design it was possible to calculate an overall effect size (ES).

The weighted mean ES ranged from .45 (internalising problem behaviour) to .60 (externalising problem behaviour; behaviour problems in general), indicating a moderate-high level of change, i.e. reduction of problem behaviour. QE-studies indicate that residential programmes applying behaviour-therapeutic methods and focusing on family involvement show the most promising short term outcomes.

There is little evidence on long term outcomes of residential care. Many studies lack a specific description of the residential intervention programme.

Aim and lay-out. The question arises what the role and function of residential care and treatment might be within the broad continuum of child and family services: What kind of future can be anticipated for residential child care? Who are the children and young persons who might profit from this kind of service? And what professional and organisational conditions are needed to promote a good quality of care and a good quality of life for young inhabitants during their stay in residence and afterwards? A selection of research outcomes will be offered as a contribution to answering these complicated questions.

In the paper further attention will be paid to what is seen as the most central characteristic of the residential intervention (Leichtman, 2006): the social climate and therapeutic milieu, including the staff that is responsible for modelling it.

Besides we will reflect on the inclusiveness of residential child care, i.e. the extent to which the environment of the child or young people (family, peers, social network) is being involved and takes part in the care and treatment process (Hill, 2000).

Key references

Colton, M. J., Roberts, S., & Williams, M. (Eds.) (2002). Residential care: Last resort or positive choice? Lessons from around Europe. Special Issue. International Journal of Child and Family Welfare, 5(3), 65-140.

Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of residential mental health placements for children and youth. Child and Youth Care Forum, 31(5), 307-339.

Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: A review of research from 1993 to 2003. Journal of Child and Family Studies, 14(4), 551-575.

Hill, M. (2000). Inclusiveness in residential child care. In M. Chakrabarti, & M. Hill (Eds.), Residential child care: International perspectives on links with families and peers (pp. 31-66). London/Philadelphia: Jessica Kingsley Publishers.

Knorth, E. J., Harder, A. T., Zandberg, T., & Kendrick, A. J. (2008). Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review, 30 (in press) [doi:10.1016/j. childyouth.2007.09.001].

Leichtman, M. (2006). Residential treatment of children and adolescents: Past, present, and future. American Journal of Orthopsychiatry, 76 (3), 285-294.

Contacts: Erik J. Knorth, Professor of Child and Youth Care, University of Groningen, Faculty of Behavioural and Social Sciences, Dept of Special Needs Education and Child Care, Groote Rozenstraat 38, NL-9712 TJ Groningen, The Netherlands, E-mail: E.J.Knorth@rug.nl



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