There's No Place Like Home

The American Journal of Orthopsychiatry features in its May issue a special section titled "Residential Care and Treatment of Children and Adolescents: Current Issues in the United States and Abroad."

As noted in the lead article by Mary Dozier, Joan Kaufman, Roger Kobak, Thomas G. O'Connor, Abraham Sagi-Schwartz, Stephen Scott, Carole Shauffer, Judith Smetana, Marinus H. van IJzendoorn, and Charles H. Zeanah, "Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association" (PDF, 95KB)opens in new window, ideally, children will be raised in private homes with one or more stable, loving, and dedicated parents.

This ideal cannot always be met. This is the case for an estimated 2 million children worldwide who are living in group care institutions or group homes. Dozier et al. supplemented the United Nations General Assembly's Guidelines for the Alternative Care of Children by providing 10 research-backed statements of their own, outlining the issues, concerns, and potential outcomes that should be taken into account when considering placing children in group care residential settings.

In "Health-Related Quality of Life Among Adolescents in Residential Care: Description and Correlates" (PDF, 89KB)opens in new window, Timothy D. Nelson, Katherine M. Kidwell, Steven Hoffman, Alexandra L. Trout, Michael H. Epstein, and Ronald W. Thompson reported the results of their study of the health-related quality of life (HRQoL) of 229 adolescents living in residential care.

They found that the mean HRQoL score for the residential-living sample was lower than for the general adolescent population; scores tended to be lower for younger adolescents, girls, those who had been in residential care for a shorter time, and those on psychotropic medications. The results indicate that interventions targeting quality of life of adolescents in residential care may be needed, with special attention being paid to those identified as being at risk.

In "Profile of Children Placed in Residential Psychiatric Program: Association With Delinquency, Involuntary Mental Health Commitment, and Reentry Into Care" (PDF, 306KB)opens in new window, Svetlana Yampolskaya, Debra Mowery, and Norin Dollard reported the results of their study of youths receiving services in Florida's State Inpatient Psychiatric Program (SIPP).

Three classes of children were identified:

• children with multiple needs
• children with no caregivers
• abused children with substantial maltreatment history

Children with multiple needs were found to be at greatest risk for adverse outcomes, such as being readmitted to SIPP, entering the juvenile justice system, and experiencing involuntary mental health assessment. Interagency coordination to improve service delivery and interventions that support parents when children are transitioning out of SIPP are a few of the suggested strategies to mitigate these problems and improve the outcomes for children in the system.

As mentioned earlier, ideally, youths with behavioral and emotional needs would stay in their homes and communities when receiving treatment rather than being sent to institutions. In "Program and Practice Elements for Placement Prevention: A Review of Interventions and Their Effectiveness in Promoting Home-Based Care" (PDF, 126KB)opens in new window, by Bethany R. Lee, Chad Ebesutani, Karen M. Kolivoski, Kimberly D. Becker, Michael A. Lindsey, Nicole Evangelista Brandt, Nicole Cammack, Frederick H. Strieder, Bruce F. Chorpita, and Richard P. Barth, the authors conducted a meta-analysis of 37 studies described in 51 articles to discover whether common elements across interventions helped to reduce out-of-home placement.

Nine program elements, 11 youth-directed elements, 11 caregiver-directed elements, and five family-directed elements were identified, including case management, crisis care, marital therapy, goal setting, and support networks. Additional study is needed to further specify which elements work best in what situations, but the current findings mark a helpful beginning of the path to successful outcomes.

In "Feature Article Coverage of Australian Out-of-Home Care: Portrayals and Policy Reform" (PDF, 68KB)opens in new window, by Laura McCosker, Bob Lonne, Kerri Gillespie, and Greg Marston, the authors analyzed the effects that print media stories of child abuse and neglect in 10 widely read Australian newspapers have had on the development of policies regarding child protection, particularly in relation to out-of-home care.

Although the papers did bring abuses to light and galvanized public and political pressure for interventions and policy fixes, they also were found to sensationalize some of the system problems and misrepresent the actual incidence of various types of maltreatment in Australia (e.g., emphasizing criminal matters and physical and sexual abuse while understating neglect, the dominant form of maltreatment), thereby ignoring the social structural factors that helped create the underlying circumstances leading to maltreatment.

Overall, feature articles were found to be helpful in informing the community about system issues, outcomes, and reform agendas, and they can be helpful in showing cases of abuse in a wider context rather than attributing such tragedies simply to individual criminal behavior.

In "Children With Disabilities in Russian Institutions: Can the West Help Protect the Most Vulnerable?" (PDF, 57KB)opens in new window, Liepa V. Boberiene and Ekaterina Yazykova discussed the stigma in Russia that leads to children born with physical or mental disabilities being seen as defective and their parents being pressured to place them in institutions, where the children receive, at best, perfunctory care.

Any child without developmental delays going into the system will, in the unstimulating and overcrowded environment characterized by minimal medical care and virtually no educational opportunities, develop developmental delays in time. Federal Russian agencies tasked with improving the system for children with disabilities have been ineffectual at implementing change.

Given worsening relations with the Western world, most precipitously with the United States, Russia has limited foreign adoptions as well as the ability of non-governmental organizations to help improve institutional conditions or influence policy-making. Despite this difficult atmosphere and recent setbacks, activist efforts must continue if there is to be any improvement in the lot of Russia's most vulnerable children.

Citations:

• Barbarin, O. A., & Melton, G. B. (Eds.). (2014). Residential care and treatment of children and adolescents: Current issues in the United States and abroad [Special section]. American Journal of Orthopsychiatry, 84, 219–272.
• Dozier, M., Kaufman, J., Kobak, R., O'Connor, T. G., Sagi-Schwartz, A., Scott, S., …Zeanah, C. H. (2014). Consensus statement on group care for children and adolescents: A statement of policy of the American Orthopsychiatric Association. American Journal of Orthopsychiatry, 84, 219–225. doi: 10.1037/ort0000005
• Nelson, T. D., Kidwell, K. M., Hoffman, S., Trout, A. L., Epstein, M. H., & Thompson, R. W. (2014). Health-related quality of life among adolescents in residential care: Description and correlates. American Journal of Orthopsychiatry, 84, 226–233. doi: 10.1037/h0099812
• Yampolskaya, S., Mowery, D., & Dollard, N. (2014). Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care. American Journal of Orthopsychiatry, 84, 234–243. doi: 10.1037/h0099808
• Lee, B. R., Ebesutani, C., Kolivoski, K. M., Becker, K. D., Lindsey, M. A., Brandt, N. E.,…Barth, R. P. (2014). Program and practice elements for placement prevention: A review of interventions and their effectiveness in promoting home-based care. American Journal of Orthopsychiatry, 84, 244–256. doi: 10.1037/h0099811
• McCosker, L., Lonne, B., Gillespie, K., & Marston, G. (2014). Feature article coverage of Australian out-of-home care: Portrayals and policy reform. American Journal of Orthopsychiatry, 84, 257–265. doi: 10.1037/h0099828
• Boberiene, L. V., & Yazykova, E. (2014). Children with disabilities in Russian institutions: Can the West help protect the most vulnerable? American Journal of Orthopsychiatry, 84, 266–272. doi: 10.1037/h0099813

Note: This article is in the Social Psychology & Social Processes topic area. View more articles in the Social Psychology & Social Processes topic area.