Understanding Subgroups of Child Welfare Placement Histories over Time in the Context of Youth Behavior and Development: A Latent Transition Analysis of Risk of Entry to Residential Treatment

Background and Purpose: Residential treatment settings, or facilities that provide 24-hour care to children with significant behavioral concerns, are a necessary part of the care continuum. The potential benefits of RTS include access to treatment for youth, while drawbacks include concerns about cost and effectiveness that have led to recent policy shifts aimed at reducing the use of these settings. Limited resources for community mental health mean it is important to target preventative services and identify the potential for this risk early. Therefore, this study aimed to identify latent classes of child welfare placement histories, with a focus on entry to RTS, and how youth behavior and development are associated with the probability that youth will move through these classes over time.

Methods: This study utilized secondary child welfare administrative data from a mid-Atlantic state. The study sampled youth placement experiences from the first three years of a single spell in care and consisted of 2,528 youth. The study utilized latent transition analysis. Variables used as latent class indicators included placement setting type, including history of experiencing a placement type and dominant placement type during the study period, and number of placement moves per month. Latent statuses were estimated at one, two, and three years following the start of placement spell. The study also estimated differences in latent status membership and item response probabilities based on whether the youth had identified behavioral concerns at entry to care. Finally, the study explored developmental stage at first entry to out-of-home care as a predictor of initial latent status membership and transition probabilities.

Results: The study identified two latent statuses: High Movement through Congregate Care and Stable in Family Care and that youth did transition through these statuses over time. The High Movement class was the most prevalent class after one year in care but became less prevalent at each time point. Membership to the High Movement class was associated with higher risk of RTS entry. Youth with behavioral concerns at entry to care had a significantly higher likelihood of membership to the High Movement class were less likely to move out of this class at each time point and were more likely to return to this class if they transitioned out. Developmental stage at first entry to care was associated with latent status membership, with older youth more likely to belong to the High Movement class associated with entry to RTS. The association between developmental stage at first entry to out-of-home care and latent status membership did not differ based on youth behavior.

Conclusions and Implications: Results indicate that although youth may experience instability and time in congregate care settings, this is temporary and most youth achieve stability in family settings. Older youth with behavioral concerns who enter out-of-home care are particularly vulnerable to experiencing placement instability and RTS entry. Those hoping to reduce the use of RTS should target stabilizing adolescents in family settings by providing resources to caregivers and access to community mental health services.