Providing Continuity of Care in Residential Care: A Test of Two Care Giving Models

Purpose: Research is reported that examined differences in two residential care giving models (CGM), houseparent (HP) vs. child care worker (CCW), in providing continuity of care for youth in residential care. The HP model assumes that a “family like” environment is needed in residential care, and can be best maintained by a couple who live on-site. The CCW model uses rotating shift workers who live off-site to staff residential units.

Continuity is defined as caretaker's interactions with youth that are predictable, appropriate, and occur over an extended period time that establishes a pattern of care on which youth can depend and anticipate (Wahler, 1994). Continuity is essential for youth who have a history of disrupted relationships with families, experience multiple placements, and who have many transitory relationships while in-care.

Methodology: Data were collected in a facility that used a cottage system with each cottage being staffed by either HP's or CCW's. Two different means of data collection were employed. First, a record review was completed to track staffing and census patterns for each cottage over a 24 month period. This review was used to construct continuity variables. These variables were:

1. The ratio of time in residence each youth had a particular CGM,

2. the longest period of time in residence the youth had the same caretaker (stated as a ratio of time in residence),

3. and the number of caretakers a youth experienced while in residence.

Second, youth and caretakers were interviewed at multiple data collection points using standardized measures over the 2-year period. Ninety-eight percent of residents agreed to participate. (n=290). The continuity variables were combined with interview data and examined in multi-variate analysis to test study hypotheses. It was hypothesized that:

1.HP's would provide more continuity than CCW's.

2.Higher levels of continuity with caregivers would be associated with the following:

a. fewer behavioral problems as measured by the Child Behavioral Check list (Achenbach, 1991),

b. more independent living skills as assessed by the Ansel Casey Life Skills Assessment (Casey Family Program, 1998),

c. higher levels of satisfaction with the quality of life, as measured by Annual Client Evaluation (Wilson & Conroy, 1999).

Findings: (1) HP's were associated with more continuity than CCW's. (2) Continuity of care was significantly associated with a reduction in behavioral problems. (3) HP's were associated with a reduction in behavioral problems, but only at a near significant level when controlled for by gender. (4) A change of caretakers was associated with an increase in behavioral problems. (5) The acquisition of independent living skills was not affected by CGM or continuity. (6) Youth with CCW's reported more satisfaction with their quality of life than their counterparts with HP's, but only at a level that approached significance.

Implications: This study provides data to suggest that continuity of care is an important variable to consider in residential care staffing, and it may be more important than the type of CGM. Means of increasing continuity among staff are discussed.