• By Laura Whybra
  • Posted on Thursday 01st August, 2013

Care homes for children: from last resort to second best?

strong>Caring for children and young people in group homes and other institutions tends to be treated as a last resort. But a new review of studies from the past 30 years partly challenges this view by showing that residential care can achieve positive outcomes by providing evidence-based treatments.Carried out by a team from the Netherlands, it concludes that institutional care can be as effective as non-institutional care, and that it is at its most promising when children receive therapeutic help that is evidence-based.The analysis of 27 controlled studies involving 17,000 children and young people found that effectiveness did not vary according to age, gender, or the type of outcome being considered. However, the use of cognitive behaviour therapy exerted a positive effect, while social skills training did not.The lack of support for social skills interventions with young people may cause some surprise, but the authors point to previous research suggesting that the positive effects of programs are generally small and do not persist for long afterwards. They also note how their results complement a previous analysis of care outcomes for non-institutional settings by showing that young people react more positively to evidence-based treatments than to regular group care. Evidence-based treatment “seems imperative”So while accepting that first consideration should be given to foster care and other non–institutional interventions – especially for young children – they argue that evidence-based treatments should be made imperative where institutional care is the only option that is realistically available.The statistical meta-analysis include only experimental or “quasi-experimental” studies from the last three decades where outcomes were compared for otherwise similar groups of children placed in different settings. Critically, the research team undertook a series of analyses for different types of comparison – including whether institutions did or did not use evidence-based treatments.The institutional care assessed in this study consisted of 24-hour group living facilities providing care or mental health treatment for children and young people aged between 8 and 20. It included secure as well as open facilities and many of the young people in residence exhibited serious behavior problems, including law violations. Evidence-based treatment (EBT) for the purpose of the analysis was defined as structured and manual-guided treatment based on empirical evidence.Evaluations of treatments involving coercion, notably “boot camps”, were not included in the study because of their known ineffectiveness. Most of the studies that were included came from North America, with a few from Western Europe. The analysis was restricted to studies that appeared in peer-reviewed journals. However, the authors applied a test for possible “publication bias” towards studies showing positive and statistically significant results, which proved negative.“Better insights” into effectivenessThe results of the meta-analysis are timely and important because of growing pressure on institutional care settings to demonstrate positive outcomes because they provide an expensive as well as drastic response to the needs of vulnerable and troubled children. Alongside high costs, equivocal results have led to a general view that it should be used as a last resort. However, it has also been argued that for some children institutional care can be more effective – especially those who need highly supervised environment. And for some children there is simply no alternative.The meta-analysis is comprehensive and the first of its kind for almost two decades. Quite reasonably, it claims to offer “new and better insights” into the effectiveness of institutional youth care.It is, even so, a pity that it proved impossible investigate a number of relevant factors, including the way that young people’s cognitive abilities might have influenced the results, length of stay in institutions, the size of living groups and the characteristics of staff who provided therapies. Although they were the best available, the studies included in the analysis did not provide enough information to take account of these potentially important variables. Only future research can repair that omission.**********References:De Swart, J. J. W., Van den Broek, H., Stams, G. J. J. M., Asscher, J. J., Van der Laan, P. H., Holsbrink-Engels, G. A. and Van der Helm, G. H. P. (2012). The effectiveness of institutional youth care over the past three decades. Children and Youth Services Review 34, 1818-1824.

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