Pathways to Residential Care: Repeated-Measures Latent Class and Confirmatory Analyses of Adolescents' Placement Histories Prior to Residential Placement

Background: Within the context of the public child welfare system, children's prior placement histories play an important role in decisions about placement in residential care. Disrupted, or otherwise unsuccessful, placements are often the primary precipitant of placement in a residential care facility, and the character of children's prior placement histories serves to inform a number of clinical decisions both before and during children's residential care episodes. Yet, the nature of children's prior placement histories, and how they relate to residential care outcomes, are not well understood. In general, studies have examined these relationships by considering specific events (e.g., placement moves) in isolation, or by developing ad hoc summaries of children's placement histories that do not take into consideration differences in the sequencing or duration of different events. However, from a clinical perspective, children's placement histories are informative partly because of what they reveal about the development of children's pathology through time, and across settings, which can be difficult to measure directly. With this in mind, the current study uses information about the interrelationship between the sequence and timing of different placement events to identify a typology of pre-residential-care placement pathways among a sample of adolescents. The clinical significance of these pathways is assessed by comparing the characteristics and discharge outcomes for adolescents experiencing each pathway.

Methods: The study sample includes youth, age 13 to 16, who entered residential care for the first time under the auspices of a Midwestern state public child welfare agency (N=7,187). Based on administrative data records of placement moves, runaway episodes, placements in detention, and psychiatric hospitalizations during the year preceding placement into residential care, repeated-measures latent class analysis (RMLCA) is used to develop a typology of pre-residential care placement pathways. Based on the posterior probabilities generated by the RMLCA, the characteristics of adolescents experiencing each pathway are compared. Also, using agency-level fixed-effects hazard models, the relationship between pathway type and the timing and disposition of adolescents' residential care discharge is examined. To account for uncertainty in the RMLCA-based classification of pathways, all comparisons are based on samples generated via parametric bootstrap methods.

Results: Results of the RMLCA model suggest the existence of between 4 and 6 modal placement pathways, including those characterized by habitual placement moves and runaways, periods of initial stability followed by psychiatric hospitalization, and long stays in detention. Youth experiencing different pathways are found to differ with respect to a number of characteristics, including age, gender, and type of maltreatment allegation. Also, the disposition and timing of youth's discharge outcomes are found to differ significantly across placement pathways.

Conclusions and Implications: The results of this study suggest the existence of distinct, clinically significant pathways leading to placement in residential care. The findings also support the use of prior placement histories to inform placement and treatment decisions, and as a predictor of placement outcomes, which may be particularly useful within the context of performance-based contracting (McMillen et al, 2008).