Mental Health and Behavioral Problems of Youth in the Child Welfare System: Residential Treatment Centers Compared to Therapeutic Foster Care in the Odyssey Project Population

Article excerpt

This is the first multisite, prospective study of behavioral and mental health disorders of youth in residential treatment centers (RTC) and therapeutic foster care (TFC), and the first study to compare the two. This study addressed two ques- tions in a sample of 22 agencies in 13 states: (1) how preva- lent were emotional and behavioral disorders in the youth admitted to RTCs and TFC?, and (2) were the youth in RTCs significantly more likely to be disturbed than youth served in TFCs? Data were drawn from the Time 1 phase of the lon- gitudinal national "Odyssey Project" developed by the Child Welfare League of America (1995). Measures included an extensive child and family characteristics form (CFC) and the Child Behavior Checklist (CBCL). The results revealed extremely high levels of behavioral and mental health disor- ders in the sample as a whole, well above the norms for a non-child welfare population. The prevalence of disorder in the RTC population was substantially greater than in the TFC population.

The purpose of the study was to document and compare the degree of emotional and behavioral disorders exhibited by youth in two levels of care in the child welfare system: residential treatment centers (RTC) and therapeutic foster care (TFC). Although a small body of work has documented the degree of disorder within each of these populations separately, no multisite study has compared youth across these two program settings. Although both program types serve children in the child welfare system with serious emotional disturbances, the ways in which these mental health disturbances are similar or different has not yet been determined (Curtis, Alexander, & Lunghofer, 2001; Meadowcroft, Tomlinson, & Chamberlain, 1994). Such data can be useful for identifying the types of youth that tend to be served by these two different treatment settings and should assist in program planning and advocacy efforts.

Available studies of the prevalence of behavioral and mental disorder in the RTC population are limited to two chart studies and several single-site studies. Dale, Baker, Anastasio, and Purcell (2007) conducted a chart review of youth who entered 13 New York State residential treatment centers in fiscal year 2001. The authors found high levels of problem behaviors, significantly more than ten years earlier. Specifically, youth entering RTCs in FY 2001 were more likely to have histories of substance abuse problems, juvenile delinquency behaviors, and prior psychiatric hospitalizations.

Lyons, Libman-Mintzer, Kisiel, and Shallcross (1998) also found high rates of mental health problems in youth in 15 Illinois residential treatment centers (although group homes and supervised independent living apartments were included in defining residential treatment). Trained psychologists conducted chart reviews and results revealed that more than 80% of the sample met the criteria for a diagnosis in at least one of the five categories on the Children's Severity of Psychiatric Illness. More than half the children in the sample met the criteria for emotional disturbance.

A few single-site studies have also appeared in the literature. Whittaker, Fine, and Grasso (1989) examined administrative data to describe a sample of boys entering one RTC in 1985. The authors found that the youth entering the agency tended to come from single-parent families or had no parents at all. Three-fourths of the youth had a prior placement and many had been adjudicated for either a status or criminal offense. Behavioral and emotional problems among the youth included substance abuse, suicidal threats, running away, and sexual acting-out.

A recent Child Welfare League of America report presents brief synopses of several single-site studies using the Child Behavior Checklist to assess mental health problems of youth served by the child welfare system (LeProhn, Wetherbee, Lamont, Achenbach, & Pecora, 2002). A few of these studies provide data on youth in residential treatment. …