Dale, N., Baker, A. J. L., Anastasio, E., & Purcell, J. (2007). Characteristics of children in residential treatment in New York State. Child Welfare, 86(1), 5-27.
This was a study of children and families served by residential treatment centres (RTCs) in the New York State child welfare system to determine: (1) the prevalence of behavioural and emotional problems in youth entering the system, (2) whether this proportion had increased in the past 10 years, and (3) whether there were identifiable subgroups of these youth. Sixteen RTCs (of a total of 44 in NY) agreed to participate in the study; all provided data for 2001, but only 13 of these had comparative data for 1991. For both time periods, information was collected for a randomly selected 25% of admissions. Data, collected using a modified version of the form completed on all new admissions, included 15 variables dealing with: child maltreatment (3 variables), behavior problems (5 variables), mental health problems (3 variables) and parental behaviors (4 variables). Overall, the data revealed "a highly troubled population of youth and families," with a significant increase over 10 years in the proportion of youth with mental health problems or juvenile justice backgrounds. However, due to the design of the study, it is unclear whether children in out-of-home care are experiencing more mental health problems or whether admission criteria for RTC's have changed and now tend to serve youth with more severe problems.
The methodology for this study was straightforward and clearly described. Though the sample was not large (N = 249), selection procedures seem to have been chosen to make it as representative as possible. The 16 RTCs in the sample were compared to the other 28 RTCs in New York State on all client and agency variables for which information was available, and no significant differences were found. The same 13 agencies were used in 1991 and 2001, and no significant changes in gender distribution or mean age were found. The statistical procedures used to test the significance of 1991/2001 changes were not elaborate - variables were coded as yes =1, no = 0, and values of chi-square calculated - but yielded some highly significant findings. Increases in percentages of cases reporting substance abuse, delinquent behaviour, histories of psychiatric hospitalization or use of psychotropic medication were al significant at p < .01 - .001 levels. Findings were presented in clear tables.
The authors discussed and compared the child welfare, mental health, and juvenile justice systems at some length, and argued that the child welfare system now gets cases that used to be dealt with by the other two systems, but without appropriate structure or funding. Their findings were specific to the situation in New York State; however they seem important enough to make it worthwhile to try to replicate them with studies in other jurisdictions.
Among specific recommendations to deal with this situation were a call for more rigorous accreditation of RTCs, better funding to allow for employment of appropriately qualified staff, and substance abuse screening and treatment for all youth entering RTCs. Finally, acknowledging that this changing situation calls for a new way of working, the authors argued that there is "a tremendous need for rigorous evaluating and disseminating research to ensure that new program initiatives are sustained only if they are proven to work and are cost-effective," with a "need to focus on both short- and long-term outcomes."