Institutional Care for CWS-Supervised Youth: Spells and Re-Entry Dynamics in the USA

Background:

Institutional Care in the USA once dominated out-of-home care but now serves only 5% of all CWS-supervised youth. The Family First Prevention Services Act (FFPSA) of 2018 significantly limited the duration of federal funding for institutional placements, based on the view that such care is costly and less effective than family-based alternatives. No national analysis using nationwide data has examined the policy impact. This study examines admissions, demographics at entry, length of stay, and reentry rates.

Method:

This study uses the Report and Placement Integrated Data System (RAPIDS), which links the National Child Abuse and Neglect Data System (NCANDS) and the Adoption and Foster Care Analysis and Reporting System (AFCARS) to create a longitudinal dataset. The sample includes children who (1) spent at least 7 days in an institution during their first placement, (2) were not removed solely for housing issues, (3) were aged 0–18 at removal, and (4) entered care between FY 2013 and 2020. Children in group care were not included in these analyses. Reentries were observed within a one-year window following permanency. Analyses included child maltreatment reports (CMRs) by age, race, and gender, as well as permanency outcomes, reentry rates, subsequent maltreatment, removal reasons, and placement types.

Results:

After an initial 5% increase from FY2013-2014, annual admissions to institutions declined by 15% yearly. Considering all institutional placements from FY2013-2020, the gender ratio (1.48, M:F) was higher than in the general foster care population (1.05, M:F). Racial and ethnic composition was 45.3% White (non-Hispanic), 27.7% Black (non-Hispanic), 19.4% Hispanic/Latino, 5.3% Multiracial (non-Hispanic), and 2.3% American Indian, Alaska Native, Asian, or Pacific Islander (non-Hispanic). The median age at entry was 15, with younger children more likely to exit the care from family settings and older youth to more restrictive ones. Prior CMRs were common for first placement (83%), primarily for neglect (60%) and physical abuse (22.3%). Removal reasons included child risk alone (36.1%), maltreatment alone (16.5%), parental inability to care alone (7.6%), and multiple factors (35.8%). While 41.1% experienced a subsequent CMR, only 7.8% reentered care. Of those, 56.6% had a CMR. Reentry patterns varied by placement, CMR type, and removal reason.

Conclusions and Implications:

As Congress considers the revisions of FFPSA, these findings underscore the importance of national, longitudinal data in evaluating the effects of federal policy on institutions. The sector has experienced significant strain under funding restrictions, contributing to unintended consequences such as youth temporarily housed in hotels. While reentry rates from institutions are relatively low, especially within the first year, the reasons for reentry are complex and often unrelated to new incidents of maltreatment. Instead, factors such as youth behavioral challenges and family instability are more prevalent. More nuanced use of institutional placements—aligned with the needs and risks of each child—could improve outcomes and reduce system inefficiencies. Continued analysis of uses of institutional placements for what reasons and for how long is critical for strengthening the out-of-home care service array.