The Outcome of Institutional Youth Care Compared to Non-Institutional Youth Care for Children of Primary School Age and Early Adolescence: a Multi-Level Meta-Analysis

• Title: The Outcome of Institutional Youth Care Compared to Non-Institutional Youth Care for Children of Primary School Age and Early Adolescence: a Multi-Level Meta-Analysis
• Authors: E Strijbosch, J Huijs, G Stams, I Wissink, G Van der Helm, J De Swart, Z Van der Veen (2015)

This is the only document relating to residential child care currently on the What Works in Children’s Social Care (WWCSC) website evidence pages.

The research abstract advises it was “undertaken to ‘gain knowledge … (to) help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care”.

The WWCSC says “busy professionals need help to identify the most promising ways of working” and so their ambition is (to) “generate, collate and make accessible the best evidence for practitioners, policymakers and practice leaders to improve children’s social care and the outcomes…”.

Residential practitioners reading this research review from Denmark will be comforted that the centre is taking a cautious approach to its publications acknowledging “there will be gaps…where reliable evidence doesn’t exist for certain interventions”. High prominence of this being one of those areas – there being little research into residential child care – is essential. Policy and decisions on commissioning and service delivery need firmer ground than is presented here. It needs a community of knowledge with researchers contributing from a variety of perspectives, as can be seen in the review of Love in Professional Practice that follows in this issue.

The attraction of the review to the WWCSC is that it could be seen to “collate, synthesise and review existing evidence” according to its website. Residential practitioners will advise that there are gaps in the evidence presented.

Thinking of the WWCSC desire to “focus on impact” it is important that it is understood that in this review, “evidence-based” treatment interventions were defined as those that are structured, often manualised, and based on evidence-informed theories about the causes of behavioural problems. This would exclude models of care based on attachment or resilience, as, though they have well founded research basis, they are not manualised. The focus on manualisation receives critique by Harbo and Kemp, from a Danish perspective too, in this issue.

The WWCSC bear in mind the nuance of social care. Here there are distinctions made of residential “care as usual”, non-residential “care as usual” (e.g. foster and kinship care), evidence-based residential care and evidence-based non-residential care. It is imperative that further nuance is applied in future documents especially looking at international examples e.g. the differences between how fostering and residential care is defined or used in the differing countries.

The review analysed findings from 19 research studies from the USA, Canada, the Netherlands and Germany. None of the studies included were from the UK. This is crucial as the context in which residential child care are different in other countries.

The research frame included externalising, internalising and total problems, and skills, social and cognitive, however it does not appear to account for differences of the needs of the young people, their intensity and frequency, in differing placement types. This is crucial in determining the outcomes. It may be that other readers of this research also conclude it does not appear to be possible to be as definitive as presented that “children in non-residential placements had better outcomes than children in residential care” if there is inclusion that there are differing needs, role and task to be found in fostering and residential sectors.

There are discernible factors that must have had a strong effect on the evaluation yet are absent in England. The residential sector now defines a children’s home as a setting registered as such with Ofsted or equivalent. UK children’s homes are much smaller than internationally; in England on average four young people. Psychiatric inpatient units or young offenders’ institutions are not seen as residential child care in England. They are included in the study. The review considered the outcomes of residential care for children aged between four and 17 years old. This is unrepresentative of UK residential child care where we have few children under 11 and most are mid-teens.

The WWCSC summary seems to be aware of the need to grow their evidence base when observing “Children living in residential care may have more severe behavioural problems than children living in other types of placement for a variety of reasons”, these being the “effects of previous neglect and trauma on children’s brain development (and emotional wellbeing?)”, “impacts on children of disrupted relationships, including separation from their parents”, “negative peer influences”. There is further qualification and equivocation: “Some children may have started in foster care and then moved to a residential placement due to the complexity of their needs.” The complexity of their needs being a factor in placement choice but does not enter into the study conclusions. “Therefore, there may be differences between the groups of children who were studied”.

The WWCSC advises how children’s outcomes can be improved in a residential setting; a safe and structured group living environment, residential workers who are warm and responsive, opportunities for children’s development, therapeutic relationships, and trauma-informed treatment.