Children do better in the least restrictive and most family-like placement. The use of non-family based placements originated from a need to provide children whose history, mental health conditions, and behavior made returning to birth parents, or placement with kin or foster home placement, a challenge. However, while it is recognized that for some children, a short-term residential intervention might be in their best interest, it should only be used when it is the least detrimental alternative. An overwhelming body of research shows us that children simply do better in in families. Children and youth who stay long-term in non-family group homes are more likely to test below or far below in basic English and math , drop out of high school, be arrested , and experience physical and sexual abuse while in group care.
Why do children do better in families? Healthy attachments with a parent figure are necessary for children of all ages and help reduce problem behaviors and interpersonal difficulties. Furthermore, group care prevents children from having access to peers who are coping well with everyday life, who do not have behavioral or emotional problems, and who can provide positive peer support. Finally, while quality residential programs do exist, a lack of consistent and rigorous regulation of group care facilities results in many substandard programs that fail to provide quality interventions and fail to achieve positive outcomes for the children they serve.
Close to half of children placed in non-family based placements do not have a documented clinical or behavioral need that would warrant such a placement. Of the 55,916 children in non-family placement, more that 40% had no documented clinical or behavioral need that might warrant such a placement. Also unsettling is that 31% of children in non-family placement settings were children 12 and younger. Experts agree that the risk of clinical attachment disorders in young children who are placed in these types of settings is high. Too often, children 12-17 years old are placed in non-family placement as a last resort because of their age and lack of viable foster home options. And the use of non-family placement for children who are under the age of 12 is at 31%, at a time when young children need healthy and secure attachments. The use of non-family placement should be strictly limited to young children whose mental health and therapeutic needs warrant a short-term intervention. An in-depth assessment with a standardized tool should be used to determine if the child’s behavioral and/or mental health issues are indeed so severe that they prohibit that child from safely living with a family in the community and that there are no alternative community-based treatment options.
There is tremendous variation in placement rates of children in non-family placements across and within states. States vary significantly in their use of non-family placement, and tremendous variation even exists within some states. For example, for federal fiscal year 2014, the percentage of children placed in non-family based placement ranged from low of five percent in Oregon and Washington State to a high of 32 percent in Colorado. The national average was 14 percent. The average stay in non-family placement for a child is eight months with 34% of children spending more than nine months in non-family placement. State policies, practices, and funding mechanisms are unique in each state, making the case for the need for juvenile courts and child welfare systems across the country to establish a consistent set of definitions, assessment processes, and best practices for placing children in non-family placement.
Non-family based placement is very costly. The personal costs to children who are abused and neglected is immeasurable and the economic burden is significant. The cost of placing children in a non-family placement is 7-10 times the cost of placing children in a family setting. The disproportionate numbers of children living in non-family placement continues to drive up the costs for child welfare systems. Communities that have embarked on the reduction or elimination of non-family placements have succeeded in using their funding streams to provide a wide array of community-based services to keep children with families whenever possible.
Best Practices for Residential Interventions for Youth and their Families: A Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System
Experts have identified critical components of safe, quality, and effective residential treatment programs. After a thorough assessment process, if it is determined that a short-term residential intervention is in the best interests of the child and is the least detrimental treatment option, experts have identified the critical components of safe, quality, and effective residential treatment programs. The Best Practices for Residential Interventions for Youth and their Families: A Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System identifies the following critical components:
- Focus on permanency;
- Engage, support, and partner with families;
- Engage, support, and empower youth;
- Provide culturally and linguistically competent services;
- Provide trauma informed care;
- Link residential programming with the home communities of the youth and families;
- Prevent seclusion and restraints;
- Work with youth in transition to adulthood;
- Engage in the informed use of psychotropic medications;
- Create organizational cultures supportive of best practices; and
- Focus on outcomes.
 Wiegmann, W., Putnam-Hornstein, E., Barrat, V.X., Magruder, J. & Needell, B. The Invisible Achievement Gap Part 2: How the Foster Care Experiences of California Public School Students are associated with Their Education Outcomes (2014).
 Ruan, J.P., Marshall, J.M., Herz, D. & Hernandez, P.M. Juvenile Delinquency in Child Welfare: Investigating Group Home Effects, Children and Youth Services Review, 30(9), 1088-1099 (2008).
 Dozier, et al. Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association. American Journal of Orthopsychiatry © 2014 American Orthopsychiatric Association, Vol. 84, No. 3, 219–225 (2014).
 Id., at 220.
 Id., at 221.
 See Appendix A, Children in Out-of-Home Placement.
 See “Best Practices for Residential Interventions for Youth and their Families: A Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System.” Building Bridges Initiative and the Association of Children’s Residential Centers (2016). This resource guide includes numerous action steps that residential centers should take to achieve each critical component, along with related key questions that courts should ask.