In the United States, an estimated 33,000 youth ages eight and older live in residential care facilities. And across the globe, researchers estimate that some 2.7 million young people live in residential care.
In the U.S. and many developed countries, adolescents typically enter residential care after experiencing abuse, neglect, or other adverse childhood experiences. In addition, many young people admitted to residential care have experienced multiple, unsuccessful foster placements. These youth often have significant emotional and behavioral needs that require special support in an environment designed for education, treatment and protection.
Across the globe, opponents of youth residential care – including UNICEF, an agency of the United Nations responsible for aiding children worldwide – are calling for an end to all residential care for children and youth. They cite the problems of maltreatment and substandard care some children have experienced in large institutional care facilities.
But proponents maintain that residential care facilities provide the structured, intensive care required for young people who cannot remain safely in a home environment. A recent review notes that much of the research cited to prove the harmful effects of residential care relies on studies of infants cared for in group settings, and isn’t a suitable comparison for older children. Research also documents “… a solid body of research that indicates that good residential care is not harmful and is as effective or more effective than other forms of care.”
For more than 50 years, Cornell’s Residential Child Care Project (RCCP) has led the way in developing evidence-based programs to support high-quality residential care by training staff members in the best ways to help young people heal and grow and helping organizations provide the support and structure that staff need. To date, RCCP leaders have worked with more than 7,000 agencies in 17 countries to provide training and to implement and evaluate programming. They believe that high-quality residential care is essential for a small number of children and youth who have multiple needs that cannot be effectively met in their family homes, communities, or even specialized foster care.
“We believe that the world needs a continuum of resources for children and families, and that group care is part of that continuum,” said Martha Holden, director of RCCP and a senior extension associate at Cornell.
“Bad things can and have happened in institutions, but these tragic events also occur in foster care and in families,” she said. “We should be focused on how to provide quality care regardless of the setting.”
Residential care is especially important for some youth who have experienced extensive trauma, Holden said. That’s because living in a structured environment with adults specially trained on how to respond to behaviors and build relationships may be the best path forward for some young people.
“Without that available, they end up sleeping in hotels and often can become homeless,” she said. “We want to have some quality residential programs available for kids and families who need them.”
A primary goal of the RCCP is to provide ongoing training and support to help residential care staff understand the impact of trauma on children’s development. In high-quality residential care settings, adults learn how to respond to “pain-based behaviors” that are caused or triggered by trauma. And they develop the skills to build relationships that help children feel safe. With support from their organizations, trained adults help children learn to regulate emotions and develop their interpersonal skills.
RCCP offers two main programs. Therapeutic Crisis Intervention (TCI) helps entire organizations learn how to prevent and manage crises effectively. This program teaches staff how to deescalate difficult situations. Studies demonstrate that the TCI system leads to a reduction in the use of physical restraints for residents. And at facilities using TCI, staff report greater confidence in their own and their colleagues’ ability to manage crises, as well as greater confidence in their ability to help children learn how to cope with crises.
The second program, CARE: Creating Conditions for Change (CARE), provides organizations with a framework of routines, structures, and processes to support children while minimizing interpersonal conflict on a daily basis. The CARE program, identified as one of “two strong models of high-quality residential care,” focuses on six main principles: child development, family involvement, relationship building, understanding trauma, cultivating skills among children and adults, and focusing on the whole environment. Studies have found that the implementation of CARE improves children’s relationships with staff, reduces serious behavioral incidents such as aggression toward staff and property destruction, and reduces the use of both physical restraints and psychotropic medications.
“Where children grow up is important,” Holden said. “Even more critical is the quality of experiences they have growing up, wherever they are.”
The take-home message: Residential care programs are essential in supporting and rehabilitating a small population of youth who have experienced trauma and cannot remain safely in home environments.
