THERAPEUTIC RESIDENTIAL CARE IN THE U.S.CHALLENGES AND OPPORTUNITIES IN BUILDING EVIDENCE-BASED PRACTICES

A Symposium for EUSARF 2014, Copenhagen, Denmark

5 September, 2014

The Value of Cross-National Discourse

• In their closing essay to a recent insightful and cogent volume on residential care in international perspective, three of the contributors - Mark Courtney (U.S.), Talal Dolev (Israel) and Robbie Gilligan (Ireland) remind us that:

….. the dilemmas we confront and the solutions we imagine are shared across cultural and geographic boundaries, and across time. It highlights the importance of developing a body of evidence to support our care choices… ( In Courtney & Iwaniec, 2009 p.208).

Defining ‘Therapeutic Residential Care’

• Therapeutic Residential Care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support and protection to children and youth with identified mental health or behavioral needs in partnership with their families and in collaboration with a full spectrum of community-based formal and informal helping resources (Whittaker, del Valle & Holmes, 2014).

Presenters• Ronald W. Thompson , Ph.D. • Daniel L. Daly, Ph.D. • Sigrid James, PhD, MSW • Christopher Bellonci, M.D• Susan Ramsey, MPA• Richard W. Small, Ed.M., Ph.D., LCSW• James K. Whittaker, Ph.D. - Symposium Chair

Identifying Research Priorities for Therapeutic Residential Care

• James K. Whittaker, Ph.D. • Charles O. Cressey Endowed Professor Emeritus at

the University of Washington School of Social Work, Seattle, WA 98105, USA: jimw@uw.edu

A Challenging Landscape for TRC• Absence of clear-cut diagnostic indicators for therapeutic

residential placement. • Concerns about attachment in particular for young children

placed in residential care. • Fear of abuse and neglect within residential settings.• Concerns about ‘deviancy training’ • Questionable effectiveness of TRC. • Lack of consensus on critical intervention components. • Atrophy of TRC theory, model development and empirical

research. • Rising costs of TRC. • A growing preference for family-based treatment alternatives.

Older Reviews: A Direction & A Caution

• Research Priorities for Residential Group Child Care • JAMES K. WHITTAKER and STEVEN I. PFEIFFER

• This paper provides (1) a selective review of relevant research on developmental psychopathology and its relevance for group care programming, (2) a summary overview of major themes in residential care outcome research, and (3) suggestions for future research on group care with implications for direct practice, service organization, and policy.

• Child Welfare (1994): 73,5:583-601.

Our 1994 Research Priorities• Testing New Strategies for Dissemination of Relevant

Research• Research on Improved Training Strategies• Identifying Sub-Groups of Youth Appropriate Who Might

be Better Served in Therapeutic Residential Care• Research in Improving Coordination of Therapeutic

Residential Care and Other Community Programs• Research on Successful Transitions and Maintenance of

Treatment Gains• Policy Level Research Specific to Therapeutic Residential

Care

1994 Priorities continued….• Research on Innovative Model Development• Research on Development of Client Information Systems

for Effective Practice• Research on Family Involvement• Empirical Research on Components of ‘Success’• Research on the Service Continuum and the Place of

Therapeutic Residential Services Within It• Research on Methods for Preventing Child Maltreatment

in Therapeutic Residential Settings• Longitudinal Research on Children and Youth Who

Experienced Therapeutic Residential Placement

2014 Review: 6 Domains for Research

•

Some Promising Domains for Future Research in TRC: 2014• Pathways to Therapeutic Residential Care • Promising Program Models and Innovative Practices • Preparing Youth for Successful Transitions from

Therapeutic Residential Care • Improving the Research Base for Therapeutic Residential

Care: Logistic and Analytic Challenges/Methodological Innovations

• Calculating Costs for Therapeutic Residential Care: Regional and National Perspectives

• Linking Focused Training and Critical Evaluation in Therapeutic Residential Care: A Foundation for Staff Support

But: Remember that Cautionary Note from Our Earlier Review!

• Perhaps as no other sector of child welfare service, group child care is more often than not seen as the problem and not the solution.

• Underlying these specifics is a deep and enduring skepticism about the "reformability" of institutions generally and, in particular, group care settings for children and youths. Underlying Jerome Miller's reforms in juvenile institutions in Massachusetts in the early 1970s and on through some of the current family preservation initiatives, is the belief that true system reform will not occur as long as a "placement" philosophy dominates service thinking. Hence any attempts to examine group child care seriously (other than perhaps documenting the abuses within it) are resisted for fear of promoting the service over other more family-centered and placement-preventive alternatives (Whittaker & Pfeiffer, 1994).

The Bottom Line?• Identifying Research Priorities for Therapeutic Residential

Care is Not Sufficient to Insure Their Implementation• At least in the U.S., we need an added something to ‘kick-

start’ a program of research and development• Part of this might involve the creation of a consensus

statement of international researchers to do two things:

• Underscore the critical importance of therapeutic residential provision as one of a suite of intensive services designed to meet the needs of high-resource using children and youth

• Identify and prioritize a cross-national research agenda that seeks to illuminate the highest and best uses of therapeutic residential care

Therapeutic Residential Care Summit Conference*

• …an invitational working conference of approximately 30-40 international experts devoted exclusively to critical reflection on the current status and future directions for intensive therapeutic residential care services for high-resource using children and youth and their families. Participant discussion will center on three major foci:

• (1) What the research says about intensive therapeutic residential care provision as a sub-set of out-of-home placement services: child/youth/family characteristics and characteristics of the agency treatment setting.

•  • (2) The current state of model program development in intensive

therapeutic residential care services•  • (3) What is the place of intensive therapeutic residential care in

various service systems, including mental health, child welfare and juvenile justice and how should it be designed and funded?

• *J.K. Whittaker & R.W. Small –Co-Convenors

Conference Products• A consensus document on:

• Utilization Options for Therapeutic Residential Care within Different Service Systems

• Identification of promising pathways for development of innovative program models and protocols for their rigorous evaluation

• Identification of a prioritized set of questions for future research