Barriers to Moving Youth Out of Residential Programs

Background and Purpose:

There are several reasons to facilitate moving youth from residential treatment programs into treatment foster homes when possible. Treatment foster care is cheaper, less invasive, less stigmatizing and offers more opportunities for learning practical skills for daily living and building lasting connections. A systematic understanding of the practical barriers involved in making these moves a reality can help programs better plan these efforts and move youth into the community more quickly. This study examines barriers that were encountered while attempting to move eight older youth (ages 16-18) out of residential programs into treatment foster care homes in a small clinical trial.

Methods:

Data sources include semi-structured interviews with youth who were eligible to be moved out of residential programs, semi-structured interviews with program staff involved in moving youth into treatment foster homes, and reviews of clinical meeting notes. Interviews were audio-recorded, transcribed, cleaned and read by both authors. Analysis followed a systematic iterative process of text review, interpretation and data categorization whereby the analysts identified statements that were relevant to our questions, made inferences and organized them into codes (Miller & Crabtree, 1999). The authors read transcripts as they became available, developed codes, applied codes in NVIvo 7 and produced coding reports for further analyses. Multiple readers were used, and agreement between readers assessed and differences reconciled.

Results:

Several barriers were identified. (1) Educational issues were paramount. They included lapsed individualized educational plans that made it difficult to place youth in appropriate educational settings, and school timing issues. There was never a good time to change schools. (2) Youth were sometimes reticent about moving. Some feared their new foster parents would not be able to handle their emotional and behavioral problems and would ask them to be removed, which they saw as further damaging fragile self-confidence. Some thought that staying in residential care would be a quicker path to where they wanted to go, such as apartment living. (3) There was also some case worker reticence, including doubts about whether youth could be served in the community and doubts about the capabilities of potential foster parents. (4) There was a lack of psychiatrists with caseload space, especially those willing to take Medicaid reimbursement. (5) There were fit issues between foster youth and foster parents. The program had foster parents willing to serve older foster youth with severe problems, but not always foster parents willing to serve the specific youth eligible for placement.

Conclusions and Implications:

Programs designed to move youth into treatment foster care from residential programs can develop capacities to address these barriers. These include developing expertise in educational issues, an ability to market these programs to youth and case managers in ways that highlight opportunities and means to other desired outcomes such as living more independently or with relatives. Findings also highlight the need for flexible funding to overcome temporary obstacles to placement. Youth fears about placements need to be verbalized and processed with prospective foster parents.