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12 MAY 2010

NO 1576

Group care

What do the following services have in common?

Despite their differences, all of these services fall under the general heading of group child care. This segment of the service continuum is comprised of a number of types of service, each sharing the common element of caring for groups, however small, of special-needs children on a 24-hour-a-day basis. This 24-hour care is the most obvious commonality with TFC. National standard-setting associations recognize several different types of group care settings for children who are dependent and/or have behavioral/emotional difficulties. These include residential treatment centers; group homes; crisis and shelter care facilities; children’s psychiatric facilities and respite care facilities (Child Welfare League of America 1984). Depending upon the state and jurisdictions, group care services for children might be provided under mental health, juvenile correction, child welfare, developmental disabilities auspices, or a combination of two or more of these. Accordingly, there is considerable overlap beween group care services provided by these different authorities, as well as a lack of precision in various definitions of group care. Notice, for example, the similarities in the following definitions offered by the Child Welfare League of America for residential treatment and group home service:

Institutional Care for Children — Residential Treatment (RT)
To provide treatment in a group care therapeutic environment that integrates daily group living, remedial education and treatment services on the basis of an individualized plan for each child, exclusively for children with severe emotional disturbances, whose parents cannot cope with them and who cannot be effectively treated in their own homes, in another family, or in other less intensive treatment-oriented child care facilities. Service elements include: (1) study and diagnosis to determine appropriate service and to develop a treatment plan for each child; (2) work in behalf of or directly with children and youth in a therapeutic milieu during placement (including provision of group living facilities and the essentials of daily living such as dental care, and child care supervision; (3) provision of treatment services as needed by each child (social work, psychiatry, psychology, remedial education); (4) work with parents while child is in placement; (5) post-placement activities during readjustment period.

Group Home Service (GH)
To provide care and treatment in an agency-owned or operated facility that assures continuity of care and opportunity for community experiences, in combination with a planned group living program and specialized services, for small groups of children and youth who are unable to live in their own homes for any reason and who, because of their age, problems, or stage of treatment, can benefit by such a program. Service elements include: (1) assessment to determine the need for and the appropriateness of placement, development of a plan for services, and preparation for place ment; (2) if placement is the plan, discharge plans should be included in case planning; (3) work in behalf of or directly with children and youth during placement (including provision of facilities and the essentials of daily living, arrangements for education and recreation; activities congruent with their own religious, cultural, and ethnic traditions; medical-dental care; child car supervision; social work, psychiatry, psychology, vocational and employment guidance and use of other health and welfare services; (4) work with parents while child is in placement; (5) work with parents to strengthen and enhance parental functioning while their children are in placement; (6) post-placement activities during the adjustment period; (7) aftercare services to children, youths, and their families to help them to adjust to the home and community and, when appropriate, to independent living arrangements. (pp. xxiii—xxiv)

Precisely what is meant by such constructs as "therapeutic milieu" is not specified, nor is the implied progression of serving the most "severely disturbed" child in more sophisticated and restricted residential treatment centers empirically borne out in existing programs where severely disturbed children are being treated in less restrictive, more family-oriented settings (Cherry 1976; Dimock 1977; Rubenstein et al. 1978). Moreover, Maluccio and Marlow’s (1972) observation over a decade ago regarding the placement process in institutional care is still largely correct:

The decision to place a child in residential treatment is presently a highly individualized matter based on a complex set of idiosyncratic factors defying categorization. The literature does not indicate agreement on consistent criteria or universal guidelines and it is not certain whether institutions diverse in origin, philosophy, policy, and clientele can agree on a basic set of premises. (p. 239)

In sum, we must be chary of references to "group and institutional care" as though it were a single entity. It is not. Rather, this segment of the service continuum contains a range of different kinds of residential placements that overlap considerably in terms of dehnition, purpose, population served, and bureaucratic responsibility. Where a child is placed in this array of group services may depend upon factors external to the child’s diagnostic status.

JAMES K. WHITTAKER AND ANTHONY N. MALUCCIO

Whittaker, J.K. and Maluccio, A.N. ((1989). Changing paradigms in residential services for disturbed/diturbing children: Retrospect and prospect. In Robert P. Hawkins and James Breiling (Eds.) Therapeutic Foster Care: Critical Issues. Washington D.C. Child Welfare League of America. pp. 82-84.

REFERENCES

Cherry, T. (1976). The Oregon child study and treatment centers. Child Care Quarterly, 5. pp. 146-155.

Child Welfare League of America. (1984). Directory of member agencies. New York. Child Wlfare League of America.

Dimock, E.T. (1977). Youth crisis services: Short-term community-based residential treatment. Child Welfare, 56. pp. 187-196.

Maluccio, A.N. and Marlow, W.D. (1972). Residential treatment of emotionally disturbed children: A review of the literarture. Social Service Review, 46. pp. 230-251.

Rubenstein, S.J. et al. (1978). The parent therapist program: Alternative care for emotionally disturbed children. American Journal of Orthopsychiatry, 48. pp. 654-662.

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