ORIGINAL PAPER

Parental Involvement in Residential Care: Distance, Frequencyof Contact, and Youth Outcomes

Jonathan C. Huefner • Robert M. Pick •

Gail L. Smith • Amy L. Stevens • W. Alex Mason

� Springer Science+Business Media New York 2014

Abstract The relationship between physical distance to

program, different types of family contact, and youth

behavioral outcomes, discharge assessment, and 6-month

follow-up was examined. Data came from clinical record

information for 350 youth who had been admitted to a

group home program between July 2009 and October 2011.

Path analysis was used to examine the hypothesized pattern

of interrelationships among the variables. Study results

found that home visits of youth with their families were

related to better outcomes, while program visits by family

were unrelated to outcomes. Phone contacts during the

week were also unrelated to youth outcomes, whereas

weekend phone contacts were significantly related to less

successful outcomes. Findings suggest that family contact

is important for the health and wellbeing of youth in resi-

dential care, but that not all family/friend contacts are

equally beneficial and that some can even undermine a

youth’s progress. Specific recommendations are made for

future research to inform practice on how to make the most

of these opportunities. Ultimately, all family and friend

contact should be a positive factor in the youth’s treatment

and outcomes.

Keywords Family engagement � Residential care � Home

visits � Telephone contact � Outcomes

Introduction

The importance of family involvement for children in

residential care has long been recognized (Whittaker 1979;

Williamson and Gray 2011). Federal law, funded initia-

tives, and accreditation guidelines have all incorporated

principles of family involvement as a basic right for chil-

dren in care (Adoption Assistance and Child Welfare Act

1980; Administration for Children and Families 2010;

Stroul and Friedman 1986; Walter and Petr 2008). One of

the fundamental rationales for community-based programs

is the felt imperative of facilitating and maintaining contact

between youth and their families (Brown et al. 2010; Pu-

mariega 2007).

The physical distance between a residential program and

the child’s family is a strong predictor of the frequency of

family contact, with greater distances associated with less

contact (Baker et al. 1993; Kruzich et al. 2003; Robst et al.

2013a). It has to be recognized, however, that children

typically are not placed in residential settings until after

several failed episodes of care in other settings (typically

foster care; Baker et al. 2007; Connor et al. 2004), and the

distance from home tends to increase with each additional

placement (McGill et al. 2006). Thus, a history of place-

ment disruption plays a role in family and friend involve-

ment with children in residential programs. From a

consumer perspective, parental involvement is important to

children in residential care (Degner et al. 2007), and 84 %

of parents wish their children were placed closer to home

(McGill et al. 2006).

Family involvement has been shown to be related to

greater youth satisfaction with the residential stay (Bar-Nir

and Schmid 1998; Palareti and Berti 2010; Smith et al.

2004). While consumer satisfaction is certainly good, the

relative independence of satisfaction from clinical change

J. C. Huefner (&) � G. L. Smith � A. L. Stevens � W. A. Mason

Boys Town National Research Institute for Child and Family

Studies, Boys Town, NE 68010, USA

e-mail: jonathan.huefner@boystown.org

R. M. Pick

Boys Town Nebraska/Iowa, Boys Town, NE 68010, USA

123

J Child Fam Stud

DOI 10.1007/s10826-014-9953-0

(Avery et al. 2006; Lambert et al. 1998) makes it a weak

outcome measure. Greater family involvement has also

been associated with shorter lengths of stay (Landsman

et al. 2001; Little et al. 2005), however, other research has

found that greater family involvement was associated with

longer lengths of stay (Robst et al. 2013a). Family

involvement has been shown to be related to higher per-

centage of treatment goals met (Stage 1998), and home

visits specifically have been shown to be strongly associ-

ated with not dropping out of treatment before program

completion (Sunseri 2001). These measures of program

performance are good but are, at best, indirect measures of

clinical outcome.

Family involvement has been related to measures of in-

program improvement. Greater family involvement is

associated with behavioral and academic improvement

(Prentice-Dunn et al. 1981). The measure used in this

study, however, relied on a one-item retrospective five-

point rating of behavioral improvement and another for

academic improvement. Direct observation of problem

behavior and grade-level measures of academic perfor-

mance would have provided much stronger evidence of

clinical improvement, and one study taking this approach

did not find that frequency of parental contact was asso-

ciated with these outcomes (Vorria et al. 1998). Greater

family involvement has been associated with better post-

discharge permanency (Landsman et al. 2001; Lee 2011;

Little et al. 2005), and lower readmission rates (Lakin et al.

2004). These findings, while limited in scope, are the

strongest evidence of family contact producing lasting

positive outcomes.

Some research examining family involvement has

accounted for different types of contact. Most typically,

this has involved recognizing the difference between face-

to-face visits and telephone contacts (Lakin et al. 2004;

Nickerson et al. 2006; Robinson et al. 2005). Generally,

face-to-face visits have been better predictors of outcomes

than telephone calls (Barber and Delfabbro 2009; Robst

et al. 2013b), but some studies have found no such dif-

ference (Oyserman and Benbenishty 1992). This raises the

question as to the relative impact of telephone and face-to-

face contact on outcomes. Each type of contact might have

unique effects on youth in residential care.

Additionally, there is the recognition that there are dif-

ferent types of face-to-face contact, i.e., family visits to the

program versus youth home visits (Nickerson et al. 2007).

Several studies focus on the impact of home visits (Attar-

Schwartz 2009; Landsman et al. 2001), while others focus

on family visits to the program (Frensch and Cameron

2002; Ryan and Yang 2005), but no study has made a direct

comparison of home visits versus family visits on out-

comes. These findings also beg the question of whether

there are different types of phone contact. There is no

literature that has examined this, however, clinical expe-

rience (Pick) has noted that while weekday calls were often

used for updates and making plans, calls Friday through

Sunday are often instances where plans for visits were

cancelled or the ‘‘wish you were here’’ message high-

lighted the fact that the youth was not there with the family.

Research has shown that when planned contacts with

families do not occur, children can become distressed and

aggressive (Hayden et al. 1999; Ogilvy 2012).

In summary, there is some promising evidence that

family involvement is related to positive outcomes for

youth in residential care, but many questions remain about

this relationship. Specifically, researchers have argued that

greater focus needs to be placed on clinical outcomes of

family involvement in residential care research (Johnson

1999; Nickerson et al. 2006). This study will use structural

equation modeling to examine the relationship between

physical distance to program, different types of family

contact, and a broad range of clinical outcomes for youth.

We expect that greater physical distance will be associated

with lower frequency of family contacts, that higher levels

of family contact will be associated with better outcomes,

and that physical distance will have no impact on outcomes

after accounting for the effect of family contact. Addi-

tionally, we hypothesize that while overall family contact

will be beneficial, (1) home visits will have a more positive

impact on outcomes than do program visits, and (2)

weekday phone calls will have a more positive impact on

outcomes than do weekend calls (which may even have a

negative impact on outcomes).

Method

Participants

We examined clinical record data for 350 youth who had

been admitted to a family-style group home program

between July 2009 and October 2011, who had been dis-

charged prior to January 1, 2012, and for whom the orga-

nization had collected a 6 month follow-up questionnaire.

All data came from a single, nation-wide youth care

organization, which consists of one large care facility in the

Midwest, and nine smaller, locally administered programs

in various sites across the USA. The central program serves

approximately 706 youth a year, who come from every

state in the USA. The local programs are located in eight

states and collectively serve approximately 268 youth a

year. Extensive file review data collection was required for

this study, so Monte Carlo simulations conducted in Mplus

(Muthen and Muthen 2002) were used to determine the

number of subjects required for acceptable statistical

power. Power computations derived from Monte Carlo

J Child Fam Stud

123

simulation using the same statistical model proposed for

this study showed that a sample of 350 would have power

in excess of .80 to detect effect sizes of at least r = .09 for

estimates of the direct effects of distance and types of

family contact on outcome. Half of the sample (n = 175)

was randomly drawn from the pool of 208 qualifying youth

who were in the large, centrally located program, while the

other half (n = 175) was randomly drawn from the pool of

307 qualifying youth were from one of nine local sites. The

treatment model employed by all the sites is based on a

modified version of the teaching family model (Daly and

Davis 2003). See Table 1 for the demographic information

for the youth in this study.

On average, participants averaged 2.7 prior placements

prior to admission to the current program (40.8 % having

one or two and 39.1 % having three or more prior place-

ments). Additionally, most of these youth came to this

program from either treatment (41.4 %) or juvenile justice

(29.9 %) settings, with the balance coming from home

settings (28.7 %). Forty-three percent of participants were

wards of the state. Slightly more than half (53.1 %) of the

youth had a DSM diagnosis at the time of admission. The

most frequent admission diagnoses were conduct/opposi-

tional defiant (29.6 %), attention-deficit/hyperactivity

(25.8 %), and substance abuse (23.1 %) disorders. Sev-

enty-two youth (20.6 %) entered the program on one or

more psychotropic medication, with a 2.0 average number

of medications (range 1–5). Forty-four youth entered the

program on an anti-psychotic, 37 were on an anti-depres-

sant, 32 on a stimulant/NRI, 14 on a mood stabilizer, and

eight on other, less common psychotropics (anxiolytics,

alpha agonists, etc.).

Procedure

The data used in the study came from the organization’s

administrative database. Family and friend contacts were

recorded in the system as a family contact code, but details

about the contact were recorded in a text field. Overall, it

was necessary to glean information from 14,323 contact

records. The distance and type of contact data used in this

study came from the file review process. All outcome data

used in this study is routinely collected by the organization

as part of the clinical management process. The research

protocols were reviewed and approved by the organiza-

tion’s internal review board according to federal

guidelines.

Measures

Distance

The distance value for each youth was based on the specific

family member, relative, or friend who made contact with

the youth during their stay. Most contact was made by

immediate family members (79.0 %), followed by other

relatives (13.5 %), and friends (7.5 %). The Mapquest.com

driving directions function was used to calculate distance

based on the home address of the person contacting the

youth and the address of the residential program. The

distance value for a youth was the average distance for all

persons making contact.

Family/Friend Contact

Face-to-face contacts included family or friend visits to the

residential program and home visits by the youth. Tele-

phone contact was any telephone call between the youth

and their family or friends, regardless of the duration of the

call or who initiated the contact. For certain analyses, the

two types of general contact were further divided into two

subtypes. Face-to-face contacts were split into (1) all visits

family or friends made to the treatment program, or (2)

home visits. Program visits included any family or friend

visit to the program, court appearances, treatment team

meetings, family therapy, etc. Home visits were instances

where a youth stayed with a family member or relative and

which involved sleeping over at least one night. Phone

contacts were divided into two types: (1) phone calls with

family/relative that occurred on Monday through Thursday,

or (2) calls that occurred on Friday through Sunday. A total

count of the occurrence of each contact type was computed

and then divided by the youth’s length of stay to control for

time in treatment.

Table 1 Demographic information

National

program

Local

programs

Total

sample

N 175 175 350

Daily census 354 20 374

Average length of stay (days)* 317.2 197.9 257.6

Admission age 15.8 15.5 15.7

Race*

Caucasian 42 % 26 % 34 %

Not Caucasian 58 % 74 % 66 %

Sex

Female 37 % 36 % 36.5 %

Male 63 % 64 % 63.5 %

Average miles between

home and program*

267.7 62.3 165.0

* Significantly different p \ .05

J Child Fam Stud

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Outcomes

This study used three measures of outcome: disruptive

behavior, departure success, and follow-up success.

Disruptive Behavior Forty in-program disruptive and

problem behaviors were aggregated to create a disruptive

behavior index. The total sum of all problem behaviors that

occurred in the last 2 weeks in the program was used to

create an index of departing problem behavior. Items for

the disruptive behavior index fall within seven domains

with 4–8 items each: aggression (e.g. physical aggression

towards others, property damage), avoidance (e.g. run-

away, medication refusal), lethality (e.g. self-destructive

behavior, suicidal ideation), school (e.g. office referral, in-

school suspension), sexual issues (e.g. sexual exploitation,

sexual assault), substance abuse (e.g. alcohol use, mari-

juana use), and delinquency (e.g. gang behavior, fire

setting).

Departure Success Four measures were used for this

index. The measures were departure reason (favorable/

unfavorable), percent of youth goals met, percent of family

goals met, and departure Restrictive of Living Environment

Scale (ROLES; Hawkins et al. 1992). These items were

entered into the administrative database by the program’s

Clinical Specialists. Because of the wide mix of ranges for

these measures, they were z-score transformed and the

averaged to make the index used in the analyses.

Follow-Up Success Trained interviewers call the youth

(or someone who knows the youth) after they have been

discharged for 6 months. The follow-up survey has a series

of questions regarding how the youth is currently doing.

Fourteen of these items were used as an index of aftercare

success. Items included current ROLES, number of sub-

sequent out-of-home placements, whether the youth is in

school and/or working, involvement in illegal activities,

and quality of relationships with family and friends. A

minimum of 11 responses to the 14 items were required,

and responses were averaged to create a measure of

aftercare success.

Analysis

The data were analyzed with path analysis using Mplus 6.0

(Muthen and Muthen 2010). Associations between dis-

tance, family/friend contact, and outcome were estimated

and full information maximum likelihood estimation was

used to handle incomplete data. Two hypothesized path

models were tested: a basic model (see Fig. 1) and a full

model (see Fig. 2). Both of the hypothesized path models

were just-identified (i.e., saturated), with no degrees of

freedom available to estimate fit indices (i.e., df = 0;

v2 = 0).

Results

Descriptive statistics and bivariate correlations for vari-

ables included in the basic model are shown in Table 2.

Overall, youth averaged 21.3 contacts per 100 days in

program (i.e., one contact of one type or another every

4.7 days). As seen in the univariate correlations, greater

physical distance between the program and family and

friends was related to less face-to-face contact, but unre-

lated to the number of phone contacts. Face-to-face contact

was not related to outcomes, phone contact was related to

greater disruptive behavior and less departure success, and

greater physical distance was related to better departure

success.

The path analysis for the basic model is shown in Fig. 1,

where ten out of eleven paths were statistically significant.

Greater distance between home and program was signifi-

cantly related to fewer face-to-face contacts, but was not

Fig. 1 Path analysis—basic model. Note: Significant correlations are

in bold typeface

Fig. 2 Path analysis—full model. Note: Significant correlations are

in bold typeface

J Child Fam Stud

123

related to the frequency of phone contacts. Frequent face-

to-face contacts were significantly related to better results

for all three outcome measures. Conversely, frequent

phone contact was significantly related to worse outcomes

on all three measures. Unexpectedly, there was a direct

significant relationship between greater distance between

home and program and better results on all outcomes

measures.

Residual correlations for the basic model showed that face-

to-face contacts remained significantly correlated (r = .51),

and that all three outcome measures remained significantly

correlated (behavior/departure, r = -.52; behavior/follow-

up, r = -.25; departure/follow-up r = .50). The estimated

R2 for the outcome variables was .03 for bad behavior, .08 for

departure success, and .04 for follow-up.

Descriptive statistics and bivariate correlations for

variables included in the full model are shown in Table 3.

The most common type of contact was weekday phone

calls (7.5 per 100 days), followed by program visits (5.4

per 100 days), weekend calls (4.7 per 100 days), and then

home visits (3.6 per 100 days). As seen in the univariate

correlations, greater physical distance between the program

and family and friends was significantly related to less

frequent home visits and program visits, but was not related

to the frequency of weekday or weekend phone calls.

Home visits were related to better outcomes for all out-

comes, while phone contact was not related to outcome.

Conversely, weekday phone calls were not related to

outcomes, while weekend phone calls were related to

greater disruptive behavior and less departure success.

Again, greater physical distance was related to better

departure success.

The path analysis for the full model is shown in Fig. 2,

where in a manner similar to the basic model, greater

distance between home and program was significantly

related to fewer program visits or home visits, but was not

related to the frequency of either weekday or weekend

phone contacts. Of note, more frequent home visits were

related to better results for all outcome measures, but the

frequency of program visits was not. As expected, weekend

calls (i.e., Friday through Sunday) were related to worse

outcomes, but only significantly so for departure success.

Conversely, we expected that weekday calls (i.e., Monday

through Thursday) would be related to better outcomes, but

this was not the case. As with the basic model, there was a

direct significant relationship between greater distance

between home and program and better results on all out-

comes measures.

Residual correlations for the full model showed that

weekday and weekend calls were significantly related

(r = .86); as were program visits and home visits

(r = .22). Similarly, program visits were significantly

related to weekday and weekend calls (r = .56 and r = .49

respectively). Home visits were also significantly related to

weekday and weekend calls (r = .21 and r = .12 respec-

tively). Again, all three outcome measures were

Table 2 Raw score means,

standard deviations, and

univariate correlations for the

basic model

* Significantly p \ .05

M SD 2 3 4 5 6

1. Distance 172.7 344.5 -.36* -.03 -.06 .12* .10

2. Face to face (per 100 days) 9.1 8.6 .49* -.04 .06 .03

3. Phone (per 100 days) 12.2 16.4 .11* -.13* -.10

4. Bad behavior 3.3 6.2 -.55* -.27*

5. Discharge status 34.1 13.4 .53*

6. Follow-up 2.7 .81

Table 3 Means, standard

deviations, and univariate

correlations for the full model

* Significantly p \ .05

M SD 2 3 4 5 6 7 8

1. Distance 172.7 344.5 -.32* -.28* -.05 .01 -.05 .13* .10

2. Home visit (per 100 days) 3.6 4.1 .29* .22* .11* -.20* .25* .13*

3. Program visit (per

100 days)

5.4 6.5 .55* .47* .03 -.08 -.05

4. Weekday phone (per

100 days)

7.5 10.4 .86* .08 -.10 -.09

5. Weekend phone (per

100 days)

4.7 6.5 .14* -.18* -.11

6. Bad behavior 3.3 6.2 -.60* -.35*

7. Discharge status 34.1 13.4 .54*

8. Follow-up 2.7 .81

J Child Fam Stud

123

significantly correlated (behavior/departure, r = -.56;

behavior/follow-up, r = -.30; departure/follow-up

r = .50). The estimated R2 for the outcome variables was

.08 for bad behavior, .16 for departure success, and .06 for

follow-up.

Discussion

There is a strong sense that family contact is important for

the health and wellbeing of youth in residential care (Ge-

urts et al. 2012). While the results of this study support this

position, we also found that not all family/friend contacts

are equally beneficial and that some can even undermine a

youth’s progress. Results confirmed that distance between

residential program and family home was inversely related

to frequency of face-to-face contact, but found that it was

unrelated to frequency of phone contact. The full path

analysis model showed that frequency of home visits with

an overnight stay was the strongest predictor of positive

outcomes, and unexpectedly that frequency of family/

friend visits to the residential program was not related to

outcome. The full model also showed that frequency of

weekday phone calls was not related to outcome, and that

greater frequency of weekend phone calls was associated

with negative outcomes.

Home visits of youth with their families were found to

be especially beneficial for all three outcome measures.

The value of home visits may come from simply spending

time with family, being in a familiar home and community

environment, and being rewarded for treatment progress. It

may also be that some combination of time with family

along with factors such as a youth’s improved behavior,

new social skills, and a greater appreciation for home borne

of time spent in restrictive care produces the positive

effect. While visits are rarely supervised, they were struc-

tured via a home visit note. The home visit note outlines

goals for the visit, and the success of youth in meeting

those goals were reported back to the organization. Home

visits are seen not only as a time for engagement and

bonding, but also as an opportunity to generalize skills

learned in the program. It is felt that this occurs when

parents see the progress the child is making and use

parental approval to reinforce improved behavior. It is

hoped that home visits provide a motivation for the youth

to continue working and improving in order to make

reunification happen.

It is likely that home visits had at least some increase in

frequency as youth got closer to family reunification dates.

Whether this produces greater or lesser compliance to

program rules has been a matter of some debate within the

program. An important follow-up study to the results

reported here is whether improved behavior impacts the

frequency of home visits or vice versa. An autoregressive

cross-lagged path analysis would be ideal for answering

this question in future research.

It was surprising that program visits were unrelated to

the outcome measures. Program staff work to facilitate

family engagement by visiting with the family before and

after the visit in order to help develop better rapport

building and positive communication patterns. Visiting

family members are also invited to participate in home

activities, such as meals, outings, birthdays, and holidays,

whenever this is possible. The treatment program, how-

ever, is not a natural home environment, and visiting

family members may feel uncomfortable, intimidated, and

disempowered. Additionally, program visits are shorter in

duration than home visits, generally lasting from several

minutes (e.g. when dropping something off) to a couple of

hours at most. Perhaps these lesser ‘‘doses’’ of family

engagement are insufficient to produce a positive impact.

The lack of impact of family and friend visits on outcomes,

however, clearly indicates that further work is needed to

determine how to better leverage these opportunities for the

benefit of youth and their families.

Surely there are some program visits and phone calls

that are positive and benefit the youth, but overall, the

balance of these types of contact produced no effect in the

multivariate models. Future research should focus on dis-

covering those aspects of family visits and phone contact

that are especially helpful in order to allow out-of-home

programs to fully take advantage of these opportunities.

Similarly, an effort also needs to be made to identify those

aspects of family/friend contact that are negative. Ideally,

contact from family and friends, whenever and however it

occurs, should be a positive factor in the youth’s treatment

and outcomes.

A greater frequency of weekend calls from family and

friends were associated with less successful outcomes,

although only significantly so for the Departure Success

index in the full model path analysis. Clinical observation

and experience suggests that weekend calls have a longer

duration than weekday calls, and are more likely to be

situations where family plans are cancelled and youth take

the opportunity to complain (Pick). A detailed analysis of

the nature and content of phone contacts is not an area that

has been studied and will need to be examined in future

research. For instance, what are the factors that undermine

the beneficial influence of family and friend telephone

contact for youth in residential care? Is it possible to teach

families how to make the most of these opportunities, or

maybe a post-call process to help youth derive the greatest

benefit from family/friend telephone contacts?

We were surprised by greater distance being directly

associated with better outcomes, since some prior research

has reported the opposite pattern of association (Robst

J Child Fam Stud

123

et al. 2013b). This unexpected finding suggests that this is

an area that merits specific research examination. One

possible explanation for this finding is that greater dis-

tances result in removal from the negative environmental

influences that led to the youth being placed in residential

care. Another factor may be that those who were placed

from a longer distance might perceive a greater need to

commitment themselves to being successful in the program

in order to get back home. Thus, with program completion

and returning home there could be a greater sense of

accomplishment and a relatively stronger desire to stay at

home for good. For their part, families that were further

away may be relatively happier to have their youth back

and may have worked harder to create a home environment

that positively supports youth outcomes (e.g. permanency).

This appears to be an especially interesting area for future

research.

As was pointed out, residential placement typically only

occurs after a history of failed out-of-home placements

(Baker et al. 2007; Connor et al. 2004), and the distance

between family home and treatment program tends to

increase with each additional placement (McGill et al.

2006). A history of failed out-of-home placement, for its

part, is associated with trauma histories and more severe

emotional and behavior problems (Chamberlain et al. 2006;

Hyde and Kammerer 2009). Placement disruption, trauma,

and pathology all have the potential to impact family

involvement as well, and all of these factors will likely

need to be accounted for as research in this area moves

forward.

Limitations and future directions. While this study built

upon earlier research (and even expanded upon it in the

case of the phone call split), research in this area is clearly

in the early stages of development. Because the focus of

this study was youth in a single residential service provider,

results might be idiosyncratic to the agency. The use of

data from the smaller, locally-administered programs

across the USA, however, would argue against the results

being limited due to geography. The unexpected results

(e.g. greater distance tended to be associated with better

outcomes, telephone contact tended to have a negligible to

negative impact on outcomes) might have been a function

of this particular organization, and the unique combination

of variables examined. It would be very interesting to see if

replication in other residential programs would produce

similar results. A second shortcoming was that the calcu-

lation of physical distance was based on an average of all

contacts, and thus was not focused necessarily on the

family/home targeted for reunification. The approach we

adopted, however, did examine the impact of distance on

all family/friend contacts and how contact in that broadest

sense impacted outcomes. Given the importance of suc-

cessful reunification, however, research examining the

impact of contact with the reunification family on out-

comes is another area which needs research attention,

especially given that some family/friend contact was

associated with poorer results. A third limitation of this

study is that it does not account for the possibility that

youth outcomes impact the frequency of family contact.

For example, because phone contacts place less demand on

limited time and money resources than do home visits,

perhaps more frequent phone contact is stimulated by

youth who struggle in the program. While this possibility

does not explain the weekend call effect, this limitation

could be answered in future research with a longitudinal

study linking youths ongoing clinical status with frequency

of parental contact (both face-to-face and telephone). A

fourth limitation is that home visits might have been

dependent on good behavior for the youth, and youth who

struggled within the program may have been less likely to

have home visits. While it is true that regular home visits

were contractually mandated for some youth, additional

research is needed to account the impact of youth behavior

on home visit. Finally, information on the purpose for,

content of, and response to each visit or telephone call was

not available to us. It is likely that an understanding of the

impact of family and friend contact on youth in residential

care will be incomplete without this information.

References

Adoption Assistance and Child Welfare Act, 42 U.S.C. § 1305 et seq.

(1980).

Administration for Children and Families. (2010). Family involve-

ment in the Improving child welfare outcomes through systems of

care initiative. Washington, DC: US Department of Health and

Human Services.

Attar-Schwartz, S. (2009). School functioning of children in residen-

tial care: The contributions of multilevel correlates. Child Abuse

and Neglect, 33, 429–440. doi:10.1016/j.chiabu.2008.12.010.

Avery, K. N. L., Metcalfe, C., Nicklin, J., Barham, C. P., Alderson,

D., Donovan, J. L., et al. (2006). Satisfaction with care: An

independent outcome measure in surgical oncology. Annals of

Surgical Oncology, 13, 817–822. doi:10.1245/ASO.2006.08.019.

Baker, B. L., Blacher, J., & Pfeiffer, S. (1993). Family involvement in

residential treatment of children with psychiatric disorder and

mental retardation. Hospital & Community Psychiatry, 44,

561–566.

Baker, A. J. L., Kurland, D., Curtis, P., Alexander, G., & Papa-

Lentini, C. (2007). Mental health and behavioral problems of

youth in the child welfare system: Residential treatment centers

compared to therapeutic foster care in the Odyssey Project

population. Child Welfare, 86, 97–123.

Barber, J. G., & Delfabbro, P. H. (2009). The profile and progress of

neglected and abused children in long-term foster care. Child Abuse

and Neglect, 33, 421–428. doi:10.1016/j.chiabu.2006.03.013.

Bar-Nir, D., & Schmid, H. (1998). Psychosocial treatment and

relations between children in residential boarding schools and

their parents. Child and Family Social Work, 3, 247–257. doi:10.

1046/j.1365-2206.1998.00077.x.

J Child Fam Stud

123

Brown, J. D., Barrett, K., Ireys, H. T., Allen, K., Pires, S. A., & Blau,

G. (2010). Family-driven youth-guided practices in residential

treatment: Findings from a national survey of residential

treatment facilities. Residential Treatment for Children and

Youth, 27, 149–159. doi:10.1080/0886571X.2010.500137.

Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A.,

& Stoolmiller, M. (2006). Who disrupts from placement in foster

and kinship care? Child Abuse and Neglect, 30, 409–424.

Connor, D. F., Doerfler, L. A., Toscano, P. F., Volungis, A. M., &

Steingard, R. J. (2004). Characteristics of children and adoles-

cents admitted to a residential treatment center. Journal of Child

and Family Studies, 13, 497–510. doi:10.1023/B:JCFS.

0000044730.66750.57.

Daly, D. L., & Davis, J. L. (2003). Long-term residential program

training manual. Boys Town, NE: Boys Town Press.

Degner, J., Henriksen, A., & Oscarsson, L. (2007). Youths in coercive

residential care: Perception of parents and social network

involvement in treatment programs. Therapeutic Communities,

28, 416–432.

Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last

resort? A Review of residential mental health placements for

children and youth. Child & Youth Care Forum, 31, 313–345.

doi:10.1023/A:1016826627406.

Geurts, E. M. W., Boddy, J., Noom, M. J., & Knorth, E. J. (2012).

Family-centred residential care: The new reality? Child and

Family Social Work, 17, 170–179. doi:10.1111/j.1365-2206.

2012.00838.x.

Hawkins, R. P., Almeida, M. C., Fabry, B., & Reitz, A. L. (1992). A

scale to measure restrictiveness of living environments for

troubled children and youths. Hospital & Community Psychiatry,

43, 54–58.

Hayden, C., Goddard, J., Gorin, S., & van der Spek, N. (1999). State

child care: Looking after children?. London: Jessica Kingsley.

Hyde, J., & Kammerer, N. (2009). Adolescents’ perspectives on

placement moves and congregate settings: Complex and cumu-

lative instabilities in out-of-home care. Children and Youth

Services Review, 31, 265–273. doi:10.1016/j.childyouth.2008.07.

019.

Johnson, M. M. (1999). Multiple dimensions of family-centered

practice in residential group care: Implications regarding the

roles of stakeholders. Child & Youth Care Forum, 28, 123–141.

doi:10.1023/A:1021993222772.

Kruzich, J. M., Jivanjee, P., Robinson, A., & Friesen, B. J. (2003).

Family caregivers’ perceptions of barriers to and supports of

participation in their children’s out-of-home treatment. Psychi-

atric Services, 54, 1513–1518. doi:10.1176/appi.ps.54.11.1513.

Lakin, B. L., Brambila, A. D., & Sigda, K. B. (2004). Parental

involvement as a factor in the readmission to a residential

treatment center. Residential Treatment for Children and Youth,

22, 37–52. doi:10.1300/J007v22n02_03.

Lambert, W., Salzer, M. S., & Bickman, L. (1998). Clinical outcome,

consumer satisfaction, and ad hoc ratings of improvement in

children’s mental health. Journal of Consulting and Clinical

Psychology, 66, 270–279.

Landsman, M. J., Groza, V., Tyler, M., & Malone, K. (2001).

Outcomes of family-centered residential treatment. Child Wel-

fare, 80, 351–379.

Lee, L. J. (2011). Adult visitation and permanency for children

following residential treatment. Children and Youth Services

Review, 33, 1288–1297. doi:10.1016/j.childyouth.2011.03.002.Little, M., Kohm, A., & Thompson, R. W. (2005). The impact of

residential placement on child development: Research and policy

implications. International Journal of Social Welfare, 14,

200–209. doi:10.1111/j.1468-2397.2005.00360.x.

McGill, P., Tennyson, A., & Cooper, V. (2006). Parents whose

children with learning disabilities and challenging behaviour

attend 52-week residential schools: Their perceptions of services

received and expectations of the future. British Journal of Social

Work, 36, 597–616. doi:10.1093/bjsw/bch297.

Muthen, L. K., & Muthen, B. O. (2002). How to use a Monte Carlo

study to decide on sample size and determine power. Structural

Equation Modeling: A Multidisciplinary Journal, 9, 599–620.

doi:10.1207/S15328007SEM0904_8.

Muthen, L. K., & Muthen, B. O. (2010). Mplus user’s guide (6th ed.).

Los Angeles, CA: Muthen & Muthen.

Nickerson, A. B., Brooks, J. L., Colby, S. A., Rickert, J. M., &

Salamone, F. J. (2006). Family involvement in residential

treatment: Staff, parent, and adolescent perspectives. Journal

of Child and Family Studies, 15, 681. doi:10.1007/s10826-006-

9041-1.

Nickerson, A. B., Colby, S. A., Brooks, J. L., Rickert, J. M., &

Salamone, F. J. (2007). Transitioning youth from residential

treatment to the community: A preliminary investigation. Child

& Youth Care Forum, 36, 73–86. doi:10.1007/s10566-007-9032-

4.

Ogilvy, R. S. (2012). An examination of individual packages of care

for young people under ministerial guardianship in South

Australia. Unpublished doctoral dissertation, Flinders University

of South Australia.

Oyserman, D., & Benbenishty, R. (1992). Keeping in touch:

Ecological factors related to foster care visitation. Child and

Adolescent Social Work Journal, 9, 541–554. doi:10.1007/

BF00845413;10.1007/BF00845413.

Palareti, L., & Berti, C. (2010). Relational climate and effectiveness

of residential care: Adolescent perspectives. Journal of Preven-

tion and Intervention in the Community, 38, 26–40. doi:10.1080/

10852350903393426.

Prentice-Dunn, S., Wilson, D. R., & Lyman, R. D. (1981). Client

factors related to outcome in a residential and day treatment

program for children. Journal of Clinical Child Psychology, 10,

188–191. doi:10.1080/15374418109533047.

Pumariega, A. J. (2007). Residential treatment for children and youth:

Time for reconsideration and reform. American Journal of

Orthopsychiatry, 77, 343–345.

Robinson, A. D., Kruzich, J. M., Friesen, B. J., Jivanjee, P., &

Pullmann, M. D. (2005). Preserving family bonds: Examining

parent perspectives in the light of practice standards for out-of-

home treatment. American Journal of Orthopsychiatry, 75,

632–643. doi:10.1037/0002-9432.75.4.632.

Robst, J., Armstrong, M., Dollard, N., Rohrer, L., Sharrock, P.,

Batsche, C., et al. (2013a). Characteristics related to family

involvement in youth residential mental health treatment.

Children and Youth Services Review, 35, 40–46. doi:10.1016/j.

childyouth.2012.10.004.

Robst, J., Rohrer, L., Armstrong, M., Dollard, N., Sharrock, P., Batsche,

C., et al. (2013b). Family involvement and changes in child behavior

during residential mental health treatment. Child & Youth Care

Forum, 42, 225–238. doi:10.1007/s10566-013-9201-6.

Ryan, J. P., & Yang, H. (2005). Family contact and recidivism: A

longitudinal study of adjudicated delinquents in residential care.

Social Work Research, 29, 31–39.

Smith, M., McKay, E., & Chakrabarti, M. (2004). What works for

us—boys’ views of their experiences in a former List D school.

British Journal of Special Education, 31, 89–94.

Stage, S. A. (1998). Predicting adolescents’ discharge status follow-

ing residential treatment. Residential Treatment for Children and

Youth, 16, 37–56. doi:10.1300/J007v16n03_03.

Stroul, B. A., & Friedman, R. M. (1986). A system of care for children

and youth with severe emotional disturbances. Washington,

D.C.: Georgetown University Child Development Center.

Sunseri, P. A. (2001). The prediction of unplanned discharge from

residential treatment. Child & Youth Care Forum, 30, 283–303.

J Child Fam Stud

123

Vorria, P., Rutter, M., Pickles, A., Wolkind, S., & Hobsbaum, A. (1998). A

comparative study of Greek children in long-term residential group

care and in two-parent families: II. Possible mediating mechanisms.

Journal of Child Psychology and Psychiatry, 39, 237–246.

Walter, U. M., & Petr, C. G. (2008). Family-centered residential

treatment: Knowledge, research, and values converge. Residen-

tial Treatment for Children and Youth, 25, 1–16. doi:10.1080/

08865710802209594.

Whittaker, J. K. (1979). Caring for troubled children. San Fransisco,

CA: Josey-Bass.

Williamson, E., & Gray, A. (2011). New roles for families in child

welfare: Strategies for expanding family involvement beyond the

case level. Children and Youth Services Review, 33, 1212–1216.

doi:10.1016/j.childyouth.2011.02.013.

J Child Fam Stud

123