Predicting Length of Stay in Residential Care and the Impact on Youth Outcomes

Background: Length of stay (LOS) for youth residential group care (RGC) has decreased, yet research on the impacts of shorter stays on youth outcomes is unclear. Traditionally, RGC is reserved for youth with more challenging needs attributed to severe trauma and behavioral health conditions. Recently, the Family First Prevention Services Act (FFPSA, 2018) placed restrictions on the availability of federal funding for residential placements. Considering youth served in RGC are at heightened risk for poor outcomes and repeated re-entry into care, determining proper placement duration is crucial.

This study examined predictors of LOS in RGC and how LOS in RGC impacts youth outcomes. The research questions included: 1) What factors predict LOS among youth in RGC? 2) How does LOS effect youth outcomes on measures of functional impairment and discharge placement?

Methods: Data were extracted from case files of 447 youth in Midwestern RGC facilities over a five-year period. The majority were white (71.6%) males (59.5%) with a mean age of 10.60 years (SD=2.60). Average LOS was 43.18 weeks (SD=20.25). Analyses included three hierarchical regressions. First, youth demographics, maltreatment, youth behaviors, and treatment experiences were entered in four steps to predict LOS. Second, Child and Adolescent Functional Assessment Scale (CAFAS) intake scores, LOS, and statistically significant predictors of LOS from analysis 1, were entered in two steps to predict discharge CAFAS scores. Third, the same predictors were entered in the model as analysis 2 to predict discharge placement.

Results: Analysis 1 found gender (b=5.47, CI_95% .45, 10.49), prior neglect (b=5.72, CI_95% .91, 10.52), poor relationship skills (b=.40, CI_95% 1.48, 14.0), physical restraints (b=.40, CI_95% .12, .68) and family contacts (b=.02, CI_95% .01, .05) predicted longer LOS (Model R²=.10). Analysis 2 found severe impairment at admission (b=.65; CI_95% .52, .76), physical restraints (b=1.59; CI_95% 1.04, 2.15) and family contacts (b=.08; CI_95% .04, .12) predicted greater impairment at discharge while longer LOS (b=-.42, CI_95% -.62, -.23) predicted less impairment (Model R²=.25). Analysis 3 showed longer LOS (OR=1.04, CI_95% 1.02, 1.06) predicted increased odds of discharging to a lower-level care setting (e.g. family-based care) while neglect (OR=.33, CI_95% .16, .70), and restraints (OR=.95, CI_95% .91, .99) predicted decreased odds of discharging to lower-level care (Negelkerke R²=.17). Interactions between LOS and factors predicting outcomes were examined and found to be nonsignificant.

Conclusions: Results identified factors predictive of longer LOS in RGC and longer LOS predicted less impairment at discharge and increased odds of discharging to lower-level care; a finding that is inconsistent with policies restricting time in RGC. The findings showed that several of the same factors predicting longer LOS also predicted functional and placement outcomes. However, the relations between these factors and outcomes is not conditional upon LOS. Presently, the understanding of how LOS impacts youth outcomes in RGC is deeply limited. This study highlights the importance of in-depth examinations into LOS in RGC to inform research-based policies and mitigate negative consequences.