Exploring Quality of Care in Group Homes for Youth: What is It and Does It Exist?

Background and Purpose:

Group homes are one of the most commonly used out-of-home placements for youth with mental health/behavioral problems. Despite widespread use, there are concerns (e.g., quality, iatrogenic effects, safety and cost) and very little research to inform this discussion. Therefore, the current presentation focuses on quality of care and variations among group homes.

Methods:

Data come from a quasi-experimental NIMH-funded study of group homes. The sample includes homes that were implementing a “promising” model of treatment (i.e., the Teaching Family Model based on social and cognitive learning theory) as well as homes that were not [50 homes from a total of 14 agencies (7 Teaching Family, 7 non-Teaching Family), 233 youth currently enrolled in the study]. Data come from multiple sources: interviews with staff, interviews with youth, record reviews, and structured observations in the home. Data are collected every four months at each participating home, and all youth who live in the home during the 2-year data collection period are eligible. Data come from initial interviews and structured in-home observations.

Results:

Primary findings show tremendous variation in the treatment and practice in group homes. Youth in the participating homes range from 6-20 years old (at study entry); 42% are female; and 58% are racial/ethnic minorities.

Data from interviews with the youth show that youth in non-Teaching Family Homes (TFHs) report an average of nearly 2 hours per day of unsupervised time with group home peers, while youth in TFHs report 1 hour of such unsupervised time (p<.01). Youth in non-TFHs also report spending over an hour each day (prior to bedtime) in their bedroom (compared to 45 minutes in Teaching Family homes) (p<.01). Youth in non-TFHs also report consistently lower levels of agreement with statements about quality of staff behaviors (e.g., staff care about me; staff are fair; staff are pleasant to be around). Youth in both types of homes report that the program varies considerably, depending on which staff members are on duty.

Structured observations by study interviewers rated (TFHs) significantly higher on nearly all measured domains (p<.05). These included constructs that derive explicitly from the TFH model (e.g., youths' greetings skills, house meetings, effective use of pre-teaching) as well as more generic quality constructs (e.g., staff models appropriate interpersonal behavior; if motivation system exists, it includes a positive focus; enough structure is in place to promote healthy routines; youth have access to age-appropriate items; home is clean and well-maintained).

Conclusions and Implications:

In current policy debates, group homes are often portrayed negatively. However, little is known about what actually occurs in “usual practice” group homes, so there is little empirical evidence to contribute to this ongoing discussion. Preliminary results from initial interviews and observations suggest that there is tremendous variation in group home practices. They also suggest that while variation between TFH and non-TFHs is strong, variation within each of these subgroups is also substantial. This presentation will discuss quality of care and implications for future policy and practice decisions