Young Children in Psychiatric Residential Care: An Analysis of Latent Classes and Treatment Outcomes

Background: National child welfare statistics show that 31% of children served in group care are under the age of 12 (AFCARS, 2014). Traditionally, group care has been reserved for children with specialized needs requiring placement in structured settings. Debate over the appropriate use of group care has resurfaced with different stakeholders weighing in with varying perspectives. Research demonstrating harmful effects of group care placement has been used to support policy positions opposing its use for young children (Dozier et al., 2014). Yet, the majority of this research stems from international studies focusing on congregate settings that scarcely resemble the majority of group homes in the United States. To ensure the well-being of all children involved in the child welfare system, it is crucial that policy decisions not be made based on gross generalizations and a lack of sufficient evidence. Given the percentage of young children served in group care and the momentum toward reducing and/or eliminating its use, research is needed that contributes to a better understanding of this subset of young children and that adequately represents different types of group care facilities in outcomes analyses. The purpose of this study was to identify and describe subgroups of young children receiving psychiatric residential treatment (PRT) and to examine treatment outcomes. Methods:  Data were extracted from case records of 224 children ages 5-10 with severe behavioral and/or mental health conditions who were treated in PRT facilities in the Midwest. The sample was 69.2% white, 12.9% black, and 10.3% multiracial and 70% were boys. Continuous measures included inventories of child problems, child strengths, family problems, family strengths, and child maltreatment history, and the Child and Adolescent Functional Assessment Scale (Hodges, 1997). Cronbach's alphas ranged from .60-.83 across measures. Categorical measures included psychiatric diagnoses, primary family types, and discharge placement types. Analysis: A latent class analysis was performed to identify child subgroups and an ANCOVA was used to examine change in functional impairment (CAFAS scores) from admission to discharge between groups. Results: The best fitting model supported three classes. Children in class one were more likely to have experienced poly-victimization and to have families reporting a greater complexity of problems. Children in class two had a high prevalence of co-occurring psychiatric diagnoses. A high proportion of children in class three (52%) were diagnosed with reactive attachment disorder and came from two-parent adoptive/pre-adoptive, low problem families. All three groups experienced statistically significant improvements in mean CAFAS scores from admission to discharge. Additionally, 95% of children across all groups were discharged to family-based placements; spending fewer than six months in care on average. Conclusion: The results shed light on the subgroups of children who are likely to be referred to PRT and lend evidence supporting that, for these children, brief placement in intensive group care can result in significant improvements. The results underscore the need for research that adequately represents the service population and type of group care program to inform evidence-supported practice and policy. Specific practice, policy, and research recommendations will be discussed.