Placement Experiences of Youth with Behavioral Concerns at Entry to out-of-Home Care: Exploring the Association between Child Development and Entry to Residential Treatment

Background and Purpose: Youth behavioral difficulties have been well established as a predictor of child welfare placement instability, which can be detrimental to wellbeing. For some youth, placement instability may result in escalating behavioral health needs that prevent stability in family settings, contributing to a cycle of further placement instability. Some youth whose behavior prevent them from remaining in family placement settings are placed in residential treatment settings (RTS). Few studies have applied a developmental lens to our understanding of RTS entry. This study aimed to understand the placement experiences of child welfare involved youth over time by using secondary administrative data to explore how developmental period at first entry to care is associated with placement setting outcomes, including entry to RTS for youth with behavioral challenges.

Methods: This study utilized child welfare administrative data from a mid-Atlantic state. The dependent variable of interest was placement type, specifically RTS entry. The independent variable was developmental period at first entry to out-of-home care. Initial analysis included univariate and bivariate analysis to explore trends in placement transitions over time and the associations between placement experiences and developmental stage. Additional univariate and bivariate analyses were conducted to describe characteristics of youth who entered RTS and the association between timing of entry to RTS and developmental stage. Finally, a competing risks survival model was utilized to estimate the effect of developmental period at first entry to care and other covariates on the risk of entry to RTS.

Results: Transitions into RTS were less common than transitions into non-therapeutic group care settings. Transitions were unlikely to be into kinship care settings. Initial placement disruption, initial placement type, timing of first RTS entry, and prior placement setting were significantly associated with developmental period. Multivariate results found that developmental stage was a significant predictor of risk of RTS entry. Covariates identified as significant predictors of entry to RTS included race, parental inability to cope with role, placement type prior to placement change, and county type.

Conclusions and Implications: Findings suggest that youth who first enter out-of-home care with behavioral difficulties in childhood and pre-adolescent are at greater risk of RTS entry but take longer to access this care. These youth may require earlier access to mental health services to address behavioral concerns. Findings regarding the low rate of transition into kinship care suggest that these caregivers may require additional resources to support accepting youth with existing behavioral challenges. Finding further indicate that youth with behavioral concerns when entering out-of-home care who experience placement disruptions may not be accessing treatment. This may indicate that while policy targeting a reduction in RTS does reduce entries to this setting, it does not mean that youth are having their behavioral health needs met. This suggests that current policy efforts should be complemented by increased access to supportive services that help youth remain stable in family settings.