While it is commonly argued that evidence shows foster care to have better outcomes than group care, this conclusion is based on a few studies comparing group homes with a specialized model of foster care called Multidimensional Treatment Foster Care (MTFC). In the foster homes studied, parents were expected to implement an individualized behavior management system and were supervised during weekly group meetings and daily telephone calls. School performance was monitored daily by contact with teachers. Clients participated in therapy weekly with therapists who were employed by the program.
National numbers are not available, but it is likely that few foster children are in intense treatment programs like MTFC.
Even the conclusion that MTFC is more effective than group care is open to question. Dr. Bethany Lee is one of the nation's leading experts on group care. She points out that there are several methodological problems with the existing comparative studies between group care and foster care.
In her own study, she and her co-author, Dr. Ronald Thompson, tried to minimize these limitations. Comparing youth who received foster care through Boys Town with youth who participated in Boys Town family-style group homes, they found that the youth in group care were more likely to be favorably discharged, more likely to return home and less likely to experience a subsequent formal placement than the foster care youth. No differences were found in subsequent legal involvement or the likelihood of living in a homelike setting six months after discharge.
It is important to note that Boys Town group homes differ from the traditional group home, which is staffed by shift workers. In the Boys Town family home program, six to eight boys or girls live with a married couple in a single-family home. The home functions like a family, where every child attends school, participates in extracurricular activities and take part in daily chores and family activities. This type of family-style group home looks more like a foster home than like a shift-style group home, as I learned when I visited a Boys Town group home in Washington, D.C.
The “teaching parents” who run the home have a wall full of pictures of young men who have graduated from the home and who often come back for visits. All their children have grown up in the home, which is bright, sparkling and immaculate — especially compared to some of the dark, dingy foster homes where some children are placed. Based on extensive research documenting positive impacts, the family home model was found to be a promising practice in an exhaustive review of the research by the California Evidence-based Clearinghouse for Child Welfare.
As Boys Town researchers point out, “Many organizations like Boys Town acknowledge and agree that at-risk youth should be served in their own homes or in foster care whenever possible, and have already made a shift to that approach. … But even with that shift, we still know that these less-restrictive approaches cannot meet the needs of all youth, particularly those with serious behavioral and emotional problems.”
Anyone who has worked with these youth, as I have, and seen them expelled from home after home, knows how true that statement is. It is not without cost to let children bounce from home to home. Placement disruptions cause trauma, may require a change of school and lead to further emotional and behavioral problems. Eventually these youth may end up in a residential treatment center or in the criminal justice system — or even homeless.
Unfortunately, jurisdictions around the country have been turning against group care with the result that there are no appropriate placements for many youths. Of course every child should be in the least restrictive setting capable of meeting his/her needs, but agencies around the country are hurting children by denying them the higher level of care that they need. And I can't help feeling that saving money is part of the motivation behind this misguided policy.
Yes, quality residential care costs money. But not providing the level of services needed by our most troubled youth costs even more.
Marie Cohen (MSW, MPA) gave up a career as a policy analyst and researcher to become a child welfare social worker in the District of Columbia for five years. She is now blogging at fosteringreform.blogspot.com and on Twitter @fosteringreform.