What are the outcomes for youth placed in congregate care settings?

Congregate care is costly on many levels: it is more expensive and produces poorer outcomes than family-based settings, and it poses roadblocks to the timely achievement of permanency.1 Over the past ten years, the field has seen a 37 percent reduction in the number of children living in congregate care nationwide.2 Data indicate that children and youth who live in congregate settings spend an average of eight months there.2 This information packet provides an overview of the use of congregate care in child welfare, highlights of research about outcomes for youth placed in congregate care, and selected resources on congregate care.

Use of congregate care in child welfare

While the child welfare field has been moving toward a more circumscribed use of congregate care, the scale and pace of these reductions have been inconsistent across jurisdictions.

Continued investments are needed to ensure the safe and appropriate reduction of congregate care and the development of a robust continuum of care that includes “adequate infrastructure to meet the needs of youth in family-based placements, including youth who require more intensive services or supports to heal and thrive.”4

Outcomes for youth placed in congregate care: research highlights

All children need consistent, nurturing adults in their lives in order to form healthy attachments and to develop positive socio-emotional skills.5 While some youth may benefit from the specialized treatment services available in certain congregate care placements, most of these services can also be provided through therapeutic foster care or wraparound and mobile treatment provided to youth in family-based settings. If therapeutic residential care is deemed necessary, jurisdictions should have a structured decision-making process to ensure that only specific youth who can most benefit are placed in this setting; that it offers the most appropriate, evidence-based interventions; and that it is used for the shortest amount of time necessary to achieve key safety, therapeutic, and permanency goals.6

In general, research indicates:

  • Young adults who have left group care are less successful than their peers in foster care.7
  • Youth with at least one group-home placement were almost 2.5 times more likely to become delinquent than their peers in foster care.8
  • Youth placed in group homes, rather than in family care, have poorer educational outcomes, including lower test scores in basic English and math.9
  • Youth in congregate care are also more likely to drop out of school and less likely to graduate high school.9
  • Youth who have experienced trauma are at greater risk for further physical abuse when they are placed in group homes, compared with their peers placed in families.8

Alternatively, children and youth placed in family foster care:

  • Had fewer placements;
  • Spent less time in out-of-home care;
  • Were less likely to be re-abused;
  • Were more likely to be placed near their community of origin; and
  • Were more likely to be placed with their siblings.10

Outcomes for youth placed in congregate care: selected resources

American Orthopsychiatric Association, Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association (2014)
This consensus statement by a group of internationally recognized researchers provides 10 reasons why group-care settings can be detrimental to the well-being of youth and includes the research base for each.

Chapin Hall & Chadwick Center, Using Evidence to Accelerate the Safe and Effective Reduction of Congregate Care for Youth Involved with Child Welfare (2016)
This brief analyzes data from the second National Survey of Child and Adolescent Well-Being (NSCAW II) to compare youth placed in congregate care with youth who were placed in kinship or traditional foster care or youth who remained in their birth homes. The brief includes evidence-based strategies for better meeting the needs of youth in congregate care.

Child Welfare Capacity Building Collaborative, Working With Children and Youth With Complex Clinical Needs: Strategies in the Safe Reduction of Congregate Care (2016)
This guide is intended to highlight the array of evidence-based practices, promising practices, and strategies that exist nationwide to safely reduce congregate care and to help child welfare administrators, supervisors, workers, and private agencies enhance their capacity to use congregate care appropriately.

Barth, Institutions vs Foster Homes: The Empirical Base for a Century of Action (2002)
This formative report looks at four outcome areas for youth in congregate care: safety and well-being, permanency/re-entry, long-term successes of children, and costs of out-of-home care. The report includes a chart comparing the perceptions of children by placement type (p. 4).

State Policy Advocacy and Reform Center, Therapeutic Foster Care: Exceptional Care for Complex, Trauma-Impacted Youth in Foster Care (2013)
This report provides a description of treatment foster care and includes a chart comparing traditional foster care, treatment foster care, and residential treatment (p. 2).


1 Annie E. Casey Foundation. (2012). Reducing congregate care: Worth the fight. Retrieved from http://www.aecf.org/blog/reducing-congregate-care-worth-the-fight
2 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2015). A national look at the use of congregate care in child welfare. p. 2. Retrieved from https://www.acf.hhs.gov/cb/report/national-look-use-congregate-care-child-welfare
3 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2015). A national look at the use of congregate care in child welfare. p. 3. Retrieved from https://www.acf.hhs.gov/cb/report/national-look-use-congregate-care-child-welfare
4 California Child Advocates for Change. (2016). Child welfare policy brief: Developing a robust continuum of care to support foster youth in family-based settings. Retrieved from http://kids-alliance.org/wp-content/uploads/2016/10/Policy-Brief-Developing-a-Robust-Continuum-of-Care.pdf
5 Dozier, M., Kaufman, J., Kobak, R., O’Connor, T., Sagi-Schwartz, A., Scott, S., . . . Zeanah, C. (2014). Consensus statement on group care for children and adolescents: A statement of policy of the American Orthopsychiatric Association. American Journal of Orthopsychiatry, 84(3), 219–225. Retrieved from https://www.apa.org/pubs/journals/features/ort-0000005.pdf
6 Pecora, P. J., & English, D. J. (2016). Elements of effective practice for children and youth served by therapeutic residential care. p. 2. Retrieved from https://www.casey.org/media/Group-Care-complete.pdf
7 Barth, R. P. (2002). Institutions vs. foster homes: The empirical base for the second century of debate. Retrieved from http://bettercarenetwork.org/sites/default/files/Institutions%20vs%20Foster%20Homes.pdf
8 Ryan, J. P., Marshall, J. M., Herz, D., & Hernandez, P. M. (2008). Juvenile delinquency in child welfare: Investigating group home effects. Children and Youth Services Review, 30, 1088-1099. https://doi.org/10.1016/j.childyouth.2008.02.004
9 Annie E. Casey Foundation. (2015). Every kid needs a family: Giving children in the child welfare system the best chance for success. Retrieved from http://www.aecf.org/m/resourcedoc/aecf-EveryKidNeedsAFamily-2015.pdf
10 Lee, B. R., Bright, C. L., Svoboda, D. V., Fakunmoju, S., & Barth, R. P. (2011). Outcomes of group care for youth: A review of comparative studies. Research on Social Work Practice, 21(2), 177-189. https://doi.org/10.1177/1049731510386243