Comparing the outcomes of residential care with other types of placement, such as foster care
This rating shows how effective the intervention is at achieving the evaluated outcome.
This rating shows how confident we can be about a finding, based on how the research was designed and carried out.
|Children's behaviour and skills||Overall effectiveness: 0 (maximum 2)||
Strength of evidence
: 2 (maximum 3)
- Children in non-residential placements had better outcomes than children in residential care
- When all placements were evidence-based there was no difference in most outcomes between residential and non-residential placements
- Children in residential care were more likely to be involved in offending
- The evidence reviewed was of moderate strength
What is this?
Residential care is a form of group care for children who are looked after, where care is provided by teams of paid staff. This may be arranged under a care order or a voluntary accommodation arrangement, including short breaks for disabled children. Residential care is an alternative to foster care or kinship care, which are more common placements for children who cannot live with their birth family. In England in 2018,11 per cent of looked after children were living in residential care placements, the majority of which were in children’s homes. The profile of looked after children living in children’s homes in England tends to be older, with three-quarters aged between 14 and 17 and over half are male.
How is it meant to work?
Children may have a residential care placement for a variety of reasons; it may be a planned short-term therapeutic placement with the aim that the child will subsequently return home or move to a foster care placement. It may be a more suitable placement than foster care if a child has complex needs, including emotional and behavioural difficulties, which require support from a larger staff team or more specialist skills. In some cases residential care may be a preferred placement choice for a young person who does not want to live in a family environment.
Children are often placed in residential care once other placement options, such as foster care, have been unsuccessful (only around a quarter have a children’s home as their first placement). Therefore, children living in children’s homes have often experienced multiple previous placements and carers. Children living in residential care are more likely than other looked after children to have poor mental health (nearly three quarters according to one study). This indicates that the majority of children living in residential care in England are likely to have some therapeutic needs.
What are the evaluated outcomes?
- Children's behaviour and skills
How effective is it?
The review compared different types of interventions, to identify how they influenced children’s behavioural outcomes. The types of interventions compared included residential care ‘as usual’, non-residential ‘care as usual’ (e.g. foster and kinship care), evidence-based residential care and evidence-based non-residential care (e.g. Functional Family Therapy, Multi-Systemic Therapy or Multidimensional Treatment Foster Care). In this review, ‘evidence-based’ treatment interventions were defined as those that are structured, often manualised, and based on evidence-informed theories about the causes of behavioural problems.
The review considered how residential care affects children’s behaviour problems (externalizing, internalizing and total problems), their skills (social and cognitive) and offending behaviour.
Overall, residential care had no effect on children’s behaviour and skills, compared with non-residential placements. This is based on moderate strength evidence.
Children in non-residential placements (e.g. foster care) had better outcomes than children in residential care when both were providing ‘care as usual’. However, when evidence-based residential care was compared with evidence-based non-residential placements, there were no significant differences in outcomes. The exception to this was that children in residential care were significantly more likely to be involved in offending behaviour.
Where has it been studied?
This review analysed findings from 19 research studies. Of these, 14 were carried out in the USA, three in Canada, one in the Netherlands and on in Germany. None of the studies included were from the UK.
Who does it work for?
The review considered the outcomes of residential care for children aged between 4 and 17 years old. Out of the 19 studies included, 11 of these included children living in children’s homes, five studies included children living in psychiatric inpatient units, one study included children living in a young offenders’ institution and two studies included mixed groups of children.
Child characteristics that were included in the analysis were the children’s sex, the percentage of girls in the study and their ethnicity. The analysis found that studies with a higher percentage of girls showed less positive outcomes. The authors suggest that this may be because girls in residential care are more likely to have internalizing problems, whereas boys are more likely to have externalizing problems. There is some evidence to suggest that children with externalizing problems are more likely to make positive progress in residential care.
When, where and how does it work?
Children living in residential care may have more severe behavioural problems than children living in other types of placement for a variety of reasons. Some of the potential influences identified in the review include:
- Effects of previous neglect and trauma on children’s brain development
- The impacts on children of disrupted relationships, including separation from their parents
- Negative peer influences
Also, some children may have started in foster care and then moved to a residential placement due to the complexity of their needs. Therefore, there may be differences between the groups of children who were studied.
Some of the mechanisms that are suggested for how children’s outcomes can be improved in a residential setting include:
- A safe and structured group living environment
- Residential workers who are warm and responsive
- Opportunities for children’s development
- Therapeutic relationships
- Trauma-informed treatment.
However the review did not analyse what mechanisms led to the interventions that were studied being more or less effective.
What are the costs and benefits?
There is no information on the cost benefit of residential care in this review.
How is it implemented?
The review does not identify key features of implementation for the models of residential care studied. Of the 19 studies included in the review, seven looked at the effectiveness of models of residential care that were considered ‘evidence based’. This means they were structured, in some cases manualised, and were informed by empirically tested theories about the causes of behavioural problems.
The review suggests that these evidence based models might include group as well as individual treatment and are often based on behavioural, cognitive and solution-focused treatments.
- Children in non-residential placements (e.g. foster care) had better outcomes than children in residential care when both were providing ‘care as usual’
- When evidence-based residential care was compared with evidence-based non-residential placements, there were no significant differences in most outcomes
- Children in residential care were significantly more likely to be involved in offending behaviour
- Studies that included a higher proportion of girls in residential care showed less positive outcomes
- The evidence included in the review was of moderate strength.
This summary comes from an original systematic review called: The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis. (Strijbosch, E. L. L., Huijs, J. A. M., Stams, G. J. J. M., Wissink, I. B., Van der Helm, G. H. P., De Swart, J. J. W., & Van der Veen, Z.). Published 2015.