Changes in Congregate Care Utilization and Placement Outcomes throughout the Implementation of California's Continuum of Care Reform

Background: Passed in 2015, California’s Continuum of Care Reform (CCR; AB 403) aimed to reduce the state’s reliance on congregate care by transitioning group homes into short-term residential treatment programs (STRTPs), facilities offering trauma-informed services for youth with acute behavioral health needs. While nearly a decade has passed since the CCR was signed into law, no research has leveraged population-level data to examine associated changes. The current study uses administrative records from California to provide a preliminary overview of the relationship between the implementation of CCR and foster care placements.

Method: Data were derived from administrative child protective case records. The sample included youth ages 12-17 who began a child welfare-supervised foster care placement during an eight-year observation period encompassing CCR implementation (2012-2020; N = 44,001). Youth were followed through their first adolescent placement episode (PE) or two years following their first adolescent entry (whichever came first). The independent variable was a three-level variable categorizing youth as entering before (pre-CCR; 2012-2014), during (2015-2017), or after (post-CCR; 2018-2020) CCR implementation. Regressions estimated whether the period of entry was associated with congregate care and placement outcomes. Congregate care outcomes included the risk, number, length, and county of congregate care placements. Placement outcomes included placement instability (3+ during PE), predominant placement, and the number of non-foster care (i.e., hospitals, juvenile halls) and shelter placements. Regression analyses controlled for sociodemographic and case characteristics.

Results: One-third of the sample was placed in congregate care. Congregate care placements decreased by nearly 10% over the observation period (χ² = 540.9, p < .001, V = .11), while the median number of days spent in congregate care increased by 39 days (p < .001). Controlling for covariates, post-CCR youth had a 26% lower risk of congregate care placement compared to pre-CCR youth (RR = 0.74, p < .001). Post-CCR youth placed in congregate care had slightly fewer congregate care placements (IRR = 0.93, p < .001), but a greater risk of out-of-county congregate care placements (RR= 1.45, p < .001). The likelihood of having a foster family home as a predominant placement increased (RR = 2.19, p < .001). Although overall placement instability decreased slightly (RR = 0.95, p < .001), post-CCR youth placed in congregate care had a somewhat higher risk of placement instability (RR = 1.05, p < .001). The number of non-foster care and shelter placements among youth never placed in congregate care increased over CCR implementation (IRRs = 1.43 and 1.76, respectively, p’s < .001).

Conclusion and Implications: Results suggest the CCR has yielded mixed effects. Youth are less likely to experience group care and more likely to be placed in foster homes, highlighting progress toward the CCR’s initial goals of promoting family-like placements. However, stays in congregate care are longer and further from youths’ counties of origin, and youth never placed in congregate care have significantly more non-foster care and shelter placements. Findings can inform the development of policies and practices that can promote agencies’ capacity to place youth in family-like settings.