Delores A Taylor and Stuart W Alpert (1973) Continuity and Support Following Residential Treatment New York: Child Welfare League of America ISBN 0 87868 098 5
This study into the outcomes of residential treatment at a children’s village in Connecticut, USA, is notable for two reasons:
– It confirms a belief which some child care workers had had for several decades (Heywood, 1978) that successful extra-familial care is associated with family involvement.
– This was not the sort of answer the researchers were looking for or expecting.
Though they were not to know it, an almost contemporaneous study of fostering in New York (Fanshel and Shinn, 1978) was to come to similar conclusions. Both studies make uncomfortable reading for professionals who like to believe in their professional efficacy and raise serious questions about the ways in which many countries manage their extra-familial care.
Key Ideas
- Positive post-discharge adaptation is primarily associated with parental support and continuity through visits to the child and the child visiting home and the involvement of the parents in decisions about the child’s treatment.
- This may be enhanced through clarity about the family situation even where the family is broken.
- Neither the child’s circumstances on admission nor their degree of change during residence are relevant to a child’s post-discharge adaptation.
- Follow-up treatment has a negative impact on post-discharge adaptation.
Contents
In Chapter 1 ‘Background to the study’, the authors set out the aim of studying the post-discharge experience and post-discharge environment of children discharged from residential treatment. Though there had been a lot of investment in residential treatment, some children appeared not to benefit from it.
Starting from the assumption that parental, mental health and social welfare support would be available to children on discharge, they intended to focus on discharge plans and the post-discharge environment to find out:
- how children were adapting,
- how specific and effective discharge plans had been,
- how supportive post discharge environments were,
- how far there had been continuity of relationships with the residential placement,
- why some children failed post discharge.
Their focus on support in the post-discharge environment had arisen out of previous studies which had stressed the need for support for families and suggested that prior involvement with the community, parental involvement in planning and positive relationships with parents while in placement appeared to be associated with success.
They hypothesised that continuity between pre- and post-discharge environments and post-discharge support would be beneficial but that how well a child responded to discharge would relate to the problems they had had on admission and that those who had responded well to treatment would also adapt best on discharge.
Previous research had suggested that children responded best to treatment if there was
- an external cause for the admission,
- clarity about the reason for the admission.
However Taylor and Alpert also noted that there were inconsistencies between the results of previous research in this area.
In Chapter 2 ‘Methodology of the study’, the authors describe how the Child and Family Services of Connecticut which, among other things, operated a specialised foster care service and a group home for adolescents, had introduced a therapeutic programme at its children’s village in 1955.
The sample for the research was the 186 children admitted after 1 January 1955 and discharged before 31 August 1967 who had been in the village for at least six months and were at least 13 years old on 1 January 1968. Of these, two had died, 36 were not located, 20 refused to participate and 38 did not respond. Of the 90 who indicated some willingness to participate 75 (or 50.7% of the 148 located) returned usable questionnaires.
A comparison between respondents and non-respondents showed that the respondents:
- had been in care more recently,
- were more likely to have lost parents through death,
- were more likely to have experienced two or more prior placements,
- were less likely to have experienced prior treatment intervention,
- were more likely to have been referred by other departments of the Child and Family Services,
- were less likely to have attended the on-site school.
However, comparison of the respondent sample showed they were representative of the total population discharged over the same period.
At the time of the study the average age of the sample was 18.5; the average age at admission was 10.2; the overwhelming majority were white males, one in seven had had a previous referral to the organisation and one in sixteen had had two periods in the children village; most were there over two years. In about half the cases, their problems had been identified within the year before admission and just over half had received some other treatment before admission; a third had had two or more other placements prior to admission.
In nearly half the sample, mother was absent from the family; in 70% father was absent and in about a third they were separated from siblings, mostly because of sibling placements; however one in nine were placed with siblings.
12% had been born into broken families and only 33% were living in intact families on admission; divorce had taken place in 40% of the broken families. 10% were adopted.
Three quarters of the sample were of average or above average intelligence; a third had attended the on-site school. While around a half were working at their expected school grade on admission, on discharge nearly three quarters were, while the remainder who had been behind on admission amounted to less than a quarter on discharge.
A third were in voluntary care throughout and nearly half were in voluntary care on discharge while a small number moved between voluntary and compulsory care.
Only 21% had no contact with their parents; of the remainder around two fifths visited home and a similar number were visited by their parents.
Only about 25% were considered to have completed their treatment on discharge and most were recommended for community-based treatment post-discharge.
Over half were discharged to the care of family or relatives and the others mostly to foster care; over half remained in contact with the agency post-discharge.
For the study, the young people were asked to complete a self report form and the remaining information was obtained from case records and other records available to agency.
In Chapter 3 ‘Post discharge adaptation’, the authors report that, of the whole sample for whom information was available, over two thirds were living in a family or their own home and one in seven in some form of care.
A fifth of the respondents had dropped out of school but, apart from two in institutions, all those not at school were married or in employment.
The responses to the self report form revealed a generally positive adaptation except to relatives, foster families and professionals not associated with the children’s village.
In Chapter 4 ‘Continuity and support following residential treatment’, the authors report that continuity on its own was not associated with positive outcomes; support was associated with positive outcomes and the most positive outcomes were associated with the combination of continuity and support from family or foster family.
However, continuity and support from the children’s village and support from relatives were both associated with negative outcomes.
Friends also contributed to positive outcomes alongside parental support but not otherwise; support on its own from neighbours, the children’s village or other professional staff was irrelevant.
The most positive post-discharge adaptation was associated with high parental contact including visits and with parental involvement with professional staff.
In Chapter 5 ‘Pre-admission characteristics and post-discharge adaptation’, the authors report that pre-admission characteristics were not associated with post-discharge adaptation except that younger children, those who had stability even within a broken family, those who had not had to wait for treatment and those who had had prior family contact with a family agency appeared to do better. However, those who had had prior contact with other types of agency did not.
There was no association with the seriousness of the child’s problem, the number of prior placements, the child’s legal status, family intactness at admission, school attainments, IQ or other demographics.
In Chapter 6 ‘The treatment experience’, the authors report that the degree of change in the institution was not related to post-discharge adaptation. Though the children and their social workers often disagreed about the benefits of treatment, children with long-term problems were more likely to say they had changed in the institution.
Interestingly, those who had attended the on-site school for any period appeared to have a better post-discharge adaptation and the same associations held for those placed in foster care post-discharge even though there were significant demographic differences between them and those that went home.
In Chapter 7 ‘Summary‘, the authors summarise their findings that positive post-discharge adaptation is related to family support with continuity AND
- early detection,
- contact with a family agency,
- parental visiting,
- parental involvement in treatment,
- family continuity post-discharge.
Positive adaptation may also be enhanced by a clear resolution of the family situation, whether through death or divorce.
It has no relationship with pre-admission adaptation or the degree of change of the child during treatment.
However, follow-up treatment has a negative impact on post-discharge adaptation.
Discussion
At the time this was published, there were heated debates about treatment methods in child care and social work. Behaviourism was on the rise and challenging the half-century dominance of Freudian approaches while cognitive developmental theory was waiting in the wings. In practice, Wolins (1969) had already pointed out in his cross-cultural studies that different theoretical approaches appeared to have little relationship to the outcomes of group care but Taylor and Alpert (1973) had the advantage of being able to ask a consistent set of questions of a whole sample for which they had much more detailed records than were available to Wolins.
Their confirmation of Trotzkey’s finding (1930) that the attainments of children in institutional care tend to improve when Fanshel and Shinn (1978) were about to find less significant improvement in the attainments of children in foster care foreshadows Wiener and Wiener (1990) who found that children in residential care tend to do better than those in foster care.
This research brings extra-familial care full circle. While Mary Carpenter (1853) had argued for offering children in distress an alternative family within residential care, an idea that had gradually been displaced by the idea that such children should be offered family placements (Trotzkey, 1930; Rowe and Lambert, 1973), it was now clear that, alongside quality of care regardless of who provided it, the other key to successful residential care and, with the publication of Fanshel and Shinn (1978), foster care was family involvement at all stages.
References
Carpenter, M (1853) Juvenile delinquents, their condition and treatment London: W & F G Cash See also Children Webmag November 2008
Fanshel, D and Shinn, E B (1978) Children in foster care: a longitudinal investigation Guildford: Columbia University Press
Heywood, J S (1978) Children in care: the development of the service for the deprived child Third edition London: Routledge & Kegan Paul
Rowe, J and Lambert, L (1973) Children who wait: a study of children needing substitute families London: Association of British Adoption Agencies
Taylor, D and Alpert, S W (1973) Continuity and support: following residential treatment New York: Child Welfare League of America
Trotzkey, E L (1930) Institutional care and placing-out; the place of each in the care of dependent children Chicago: The Marks Nathan Jewish Orphan Home See also Children Webmag November 2008
Wiener, A and Wiener, E (1990) Expanding the options in child placement Lanham MD: University Press of America
Wolins, M (1969) Group care: friend or foe? Social work, 14(1):35-53 Reprinted in Wolins M (Ed.) (1974) Successful group care Chicago: Aldine