SOCIAL WORK RECOMMENDATION

Social Work Recommendation

Social Work Recommendation

Issue

The original use of “continuum of care” used least restrictive and most appropriate as the accepted standard. The continuum included services such as prevention/diversion, family preservation, counseling, in-home services, day care, day treatment, foster care, adoption, residential treatment, family reunification, transitional care, and aftercare. In the last 20 years, however, child welfare practice has created a linear notion of “continuum of care” as a case management blueprint governing most decisions. Currently, the child welfare field widely accepts that the most humane and efficient approach to allocating services to children and families is to provide those services from least to most restrictive, as this stepwise intervention is presumed to cost less and keep families together. This practice has resulted in residential services being used as the intervention of last resort, often after multiple failures in other services, rather than as the most appropriate intervention based on a thorough assessment of the individual child and family's current needs.

Support for Residential Services in the Continuum

Residential services are an important and integral component within the multiple systems of care and the continuum of services. Residential services include supervised/staffed apartments, group homes, residential treatment, intensive residential treatment, emergency shelter, short-term diagnostic care, detention, and secure treatment. Residential care's primary purpose is to address the unique needs of children and youth who require more intensive services than a family setting can provide. Either on site or through links with community programs, residential services provide educational, medical, psychiatric, and clinical/mental health services, as well as case management and recreation (CWLA, 2004). Within residential settings, children and their families are offered a variety of services, such as therapy, counseling, education, recreation, health, nutrition, daily living skills, pre-independent living skills, reunification services, aftercare, and advocacy (Braziel, 1996). A number of studies have identified positive outcomes associated with residential care.

A Canadian study of 40 children in residential care found that for the majority of children, functioning was severely impaired at admission, moderately impaired at discharge, and normal at one and three years post-discharge (Blackman, Eustace, & Chowdhury, 1991). A study of children diagnosed with conduct disorder in residential care found that the number of concerns expressed by caregivers decreased between admission, discharge, six-month, one-year, and two years post-discharge (Day, Pal, & Goldberg, 1994). Finally, a retrospective study of 200 children served at group homes in the Midwest found that, as adults, 70% had completed high school, 27% had some college or vocational training, and only 14% were receiving public assistance (Alexander & Huberty, 1993). Family-centered residential care has shown considerable success. Landsman, Groza, Tyler, and Malone (2001) found that youth in family-centered care had shorter lengths of stay, were more likely to return home at discharge, and had better long-term stability than youth in traditional residential care. Similarly, at 6-, 12-, 18-, and 24-month follow-up, 58% of youth discharged from family-focused, community-oriented residential programs had been involved in no new illegal activity, had continued to participate in educational endeavors, and had not been ...