Examining Longitudinal Service Trajectories of Children Entering Residential Care through Different Pathways
Residential care settings have long been a critical component of child welfare and mental health services, and, broadly defined, encompasses group homes, residential treatment centers, statewide inpatient facilities, and emergency shelters. These settings provide 24-hour care and treatment for children with complex needs.
Children in residential care often present with high acuity or specialized needs, requiring a greater level of services due to severe behavioral, emotional, or mental health problems, developmental disabilities, and chronic medical conditions.
As research continues to examine the costs and effectiveness of residential care, understanding and validating best practices and policies is critical to ensure optimal outcomes for involved children and families.
The Landscape of Residential Care
Nationally, about 10% of children in the foster care system are placed in residential care, with over 600,000 children receiving services in residential-based mental health settings. Medicaid remains the largest funder of children’s behavioral health services, with residential care accounting for nearly 20% of Medicaid spending on children’s mental health, despite serving less than 4% of eligible children.
For many families, accessing residential care is an overwhelming challenge, primarily due to financial barriers. In extreme cases, having exhausted other options to get their child into residential care, parents will relinquish their rights to the state so their child’s treatment, once in state custody, will be covered by Medicaid. This is an emotionally and legally complex decision that underscores serious gaps in the child welfare system.
Residential Care Pathways
Children enter residential care through varying pathways that may influence service experiences in critical ways. Dr. Shamra Boel-Studt and her team at the Institute for Quality Children’s Services, received a grant from the Institute for Research on Poverty to examine service trajectories of children entering residential care via Child Protective Services (CPS) pathways and non-CPS pathways using the CCOULD dataset. The data includes Medicaid and child welfare data from Florida and Kentucky from 2016-2021.
Prior research suggests that children entering residential care through the CPS often have greater mental health needs than those who enter through non-CPS pathways. However, more research is needed to understand the long-term service trajectories of children in residential care. The IQCS’s research project aims to analyze the distinct pathways through which children enter residential care and their subsequent service experiences over time. By identifying trends in placement stability, service utilization, and long-term outcomes, policymakers and social workers can make informed decisions about interventions that best support children with high acuity and specialized needs and their families.
“Social work researchers are at the forefront of this evolving landscape, advocating for policy and practice that prevent custody relinquishment, increase access to essential services and improve service coordination for children with complex needs,” shared Dr. Boel-Studt.
As the research unfolds, Dr. Boel-Studt and her team at the IQCS emphasize the importance of strong research support for developing policy and practice standards to ensure every child receives the care they need. “The future of residential care depends not only on funding and policies but on a commitment to reimagining a system that truly serves the best interests of children and families,” Dr. Boel-Studt concluded.
Dr. Shamra Boel-Studt is an association professor at the FSU College of Social Work and director of the FSU Institute for Quality Children’s Services. Contact her at sboel-studt@fsu.edu.