1. science
2. medicine
3. medical research

THERAPEUTIC RESIDENTIAL CARE IN THE U.S.
CHALLENGES AND OPPORTUNITIES IN
BUILDING EVIDENCE-BASED PRACTICES
A Symposium for EUSARF 2014, Copenhagen,
Denmark
5 September, 2014
The Value of Cross-National Discourse
• In their closing essay to a recent insightful and cogent
volume on residential care in international perspective,
three of the contributors - Mark Courtney (U.S.), Talal
Dolev (Israel) and Robbie Gilligan (Ireland) remind us
that:
….. the dilemmas we confront and the solutions we
imagine are shared across cultural and geographic
boundaries, and across time. It highlights the importance of
developing a body of evidence to support our care
choices… ( In Courtney & Iwaniec, 2009 p.208).
Defining ‘Therapeutic Residential Care’
• Therapeutic Residential Care involves the planful use of a
purposefully constructed, multi-dimensional living
environment designed to enhance or provide treatment,
education, socialization, support and protection to children
and youth with identified mental health or behavioral
needs in partnership with their families and in
collaboration with a full spectrum of community-based
formal and informal helping resources (Whittaker, del
Valle & Holmes, 2014).
Presenters
• Ronald W. Thompson , Ph.D.
• Daniel L. Daly, Ph.D.
• Sigrid James, PhD, MSW
• Christopher Bellonci, M.D
• Susan Ramsey, MPA
• Richard W. Small, Ed.M., Ph.D., LCSW
• James K. Whittaker, Ph.D. - Symposium Chair
Identifying Research Priorities for
Therapeutic Residential Care
• James K. Whittaker, Ph.D.
• Charles O. Cressey Endowed Professor Emeritus at
the University of Washington School of Social Work,
Seattle, WA 98105, USA: [email protected]
A Challenging Landscape for TRC
• Absence of clear-cut diagnostic indicators for therapeutic
•
•
•
•
•
•
•
•
residential placement.
Concerns about attachment in particular for young children
placed in residential care.
Fear of abuse and neglect within residential settings.
Concerns about ‘deviancy training’
Questionable effectiveness of TRC.
Lack of consensus on critical intervention components.
Atrophy of TRC theory, model development and empirical
research.
Rising costs of TRC.
A growing preference for family-based treatment alternatives.
Older Reviews: A Direction & A Caution
• Research Priorities for Residential Group Child Care
• JAMES K. WHITTAKER and STEVEN I. PFEIFFER
• This paper provides (1) a selective review of relevant
research on developmental psychopathology and its
relevance for group care programming, (2) a summary
overview of major themes in residential care outcome
research, and (3) suggestions for future research on
group care with implications for direct practice, service
organization, and policy.
• Child Welfare (1994): 73,5:583-601.
Our 1994 Research Priorities
• Testing New Strategies for Dissemination of Relevant
•
•
•
•
•
Research
Research on Improved Training Strategies
Identifying Sub-Groups of Youth Appropriate Who Might
be Better Served in Therapeutic Residential Care
Research in Improving Coordination of Therapeutic
Residential Care and Other Community Programs
Research on Successful Transitions and Maintenance of
Treatment Gains
Policy Level Research Specific to Therapeutic Residential
Care
1994 Priorities continued….
• Research on Innovative Model Development
• Research on Development of Client Information Systems
•
•
•
•
•
for Effective Practice
Research on Family Involvement
Empirical Research on Components of ‘Success’
Research on the Service Continuum and the Place of
Therapeutic Residential Services Within It
Research on Methods for Preventing Child Maltreatment
in Therapeutic Residential Settings
Longitudinal Research on Children and Youth Who
Experienced Therapeutic Residential Placement
2014 Review: 6 Domains for Research
•
Some Promising Domains for Future
Research in TRC: 2014
• Pathways to Therapeutic Residential Care
• Promising Program Models and Innovative Practices
• Preparing Youth for Successful Transitions from
Therapeutic Residential Care
• Improving the Research Base for Therapeutic Residential
Care: Logistic and Analytic Challenges/Methodological
Innovations
• Calculating Costs for Therapeutic Residential Care:
Regional and National Perspectives
• Linking Focused Training and Critical Evaluation in
Therapeutic Residential Care: A Foundation for Staff
Support
But: Remember that Cautionary Note
from Our Earlier Review!
• Perhaps as no other sector of child welfare service, group child
care is more often than not seen as the problem and not the
solution.
• Underlying these specifics is a deep and enduring skepticism
about the "reformability" of institutions generally and, in
particular, group care settings for children and youths.
Underlying Jerome Miller's reforms in juvenile institutions in
Massachusetts in the early 1970s and on through some of the
current family preservation initiatives, is the belief that true
system reform will not occur as long as a "placement"
philosophy dominates service thinking. Hence any attempts to
examine group child care seriously (other than perhaps
documenting the abuses within it) are resisted for fear of
promoting the service over other more family-centered and
placement-preventive alternatives (Whittaker & Pfeiffer, 1994).
The Bottom Line?
• Identifying Research Priorities for Therapeutic Residential
Care is Not Sufficient to Insure Their Implementation
• At least in the U.S., we need an added something to ‘kickstart’ a program of research and development
• Part of this might involve the creation of a consensus
statement of international researchers to do two things:
• Underscore the critical importance of therapeutic residential
provision as one of a suite of intensive services designed to meet
the needs of high-resource using children and youth
• Identify and prioritize a cross-national research agenda that seeks
to illuminate the highest and best uses of therapeutic residential
care
Therapeutic Residential Care
Summit Conference*
• …an invitational working conference of approximately 30-40
international experts devoted exclusively to critical reflection on the
current status and future directions for intensive therapeutic
residential care services for high-resource using children and youth
and their families. Participant discussion will center on three major
foci:
• (1) What the research says about intensive therapeutic
residential care provision as a sub-set of out-of-home placement
services: child/youth/family characteristics and characteristics
of the agency treatment setting.
•
• (2) The current state of model program development in intensive
therapeutic residential care services
•
• (3) What is the place of intensive therapeutic residential care in
various service systems, including mental health, child welfare
and juvenile justice and how should it be designed and funded?
•
*J.K. Whittaker & R.W. Small –Co-Convenors
Conference Products
• A consensus document on:
• Utilization Options for Therapeutic Residential Care
within Different Service Systems
• Identification of promising pathways for development
of innovative program models and protocols for their
rigorous evaluation
• Identification of a prioritized set of questions for
future research