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September/October 2016Vol. 17, No. 7Effective Practice in Therapeutic Residential Care

Casey Family Programs published a research brief that calls for more targeted services for children and youth in therapeutic residential care (TRC), better data to inform appropriate interventions, and more focused consideration of alternative treatment options. The brief summarizes research data on the use of TRC facilities for children and youth and suggests how various interventions and overall systems reform can help ensure more appropriate and targeted services and work toward improved permanency outcomes for children and youth.

The authors note that 14 percent of all youth placed in out-of-home care are placed in TRC settings—group homes, residential treatment centers, or psychiatric residential treatment facilities—serving seven or more children. The brief explains that there has been an evolution in the child welfare field over the last few decades regarding the use of congregate care, and that many States are reconsidering how they use this form of care. TRC facilities have been encouraged to assess their intervention models and the target populations they are designed to serve.

The authors note that children and youth may often be placed in congregate care for reasons that might not be consistent with their actual needs and that there are substantial data gaps regarding the clinical diagnoses of these individuals, the demographic characteristics of their families of origin, and interventions this population may have received prior to entering this more involved level of care. The authors contend that most children and youth can be more appropriately served with less restrictive and less costly treatment.

The brief cites the following TRC interventions as "well-supported" based on current data: Attachment Biobehavioral Catch-Up, Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy, Coping Cat, Ecologically-Based Family Therapy, Eye Movement Desensitization and Reprocessing, Multisystemic Therapy for Youth With Problem Sexual Behavior, PAX Good Behavior Game, and Trauma-Focused CBT. However, the brief concludes that better research data would help the field discern which interventions are most useful for children and youth with specialized needs and encourages the routine evaluation of such measures to better inform child welfare practice.

Elements of Effective Practice for Children and Youth Served by Therapeutic Residential Care, by Peter J. Pecora and Diana J. English, 2016, can be accessed at

A summary of key elements of effective TRC and related infographics are also available at (862 KB).