Reunifying families: Can blending family services with out-of-home residential stays help youth at risk of offending?

Returning from residential care to home is often a bumpy ride for both families and young people. A Boys Town program that aims to smooth the transition shows early promise as a way to keep youth in school and out of trouble.

Young people who end up in residential care face a tough time when they go back home. They usually return to the environment they left – an environment that may include high levels of family stress and isolation, poor community resources, and friends who are in trouble at school or with the police.

This transition is made harder by a lack of continuity between residential care and at-home aftercare. Historically, these follow-up activities have been provided by different agencies, forcing the youth and family to adjust to new services and new approaches. This can lead to additional anxiety or confusion for young people and their families.

How could transitions from residential care to home be better organized to support young people, and to help them maintain improvements in behavior and academic achievement they made during their time away from home?

This was the question that researchers from the US non-profit Boys Town set out to answer. They tested a “blended” service: a combination of residential and aftercare services. A family consultant worked with the family before and after discharge to provide continuity.

It didn’t work for everybody. While in residential care, 30% of the teenagers re-offended, were moved to a more restrictive placement, or ran away. But of those who completed a survey a year after discharge, the majority had remained arrest-free, were living in a home-like setting and had either graduated or were attending school – a promising result for a high-risk group of teens.

Supporting young people at risk of offending
For many young people who enter the juvenile justice system, arrest is part of a downward spiral. Such a spiral is bad for them, hard on their families and communities, and expensive for society. As a result, prevention and early intervention initiatives to divert young people from offending or re-offending are extremely valuable.

Over recent decades, out-of home residential care has come to be seen as a “last resort” to be used only after other options have been exhausted. Lengths of stay have become shorter, creating a greater need for community-based aftercare services.

These in-home services aim to improve the teen’s family environment and help them access other sources of support. However, strong continuity between residential care and aftercare is rare.

Given the limited delivery of integrated residential and aftercare services, there have been few studies examining the impact of such support. The latest Boys Town research builds on the authors’ previous pilot study of a combined residential and aftercare program. The new study includes a larger sample (89 youths), and includes children at risk of entering the criminal justice system as well as those already involved in the system.

Blending residential placements and community aftercare
The intervention is an adaptation of the Teaching-Family Model – a behavioral treatment program where groups of six to eight youths are placed in a family home with a married couple to allow them to experience positive interactions with peers and adults and teach them interpersonal and living skills such as self-control, managing positive and negative consequences, and building relationships.

The program combined the out-of-home residential group program with a family-based, in-home aftercare service. The aftercare worker, called a “family consultant,” engaged with the family as the teen entered the placement and provided intensive in-home family services once planning had begun for the transition home (approximately two months prior to discharge from the residential component). The family worker continued to provide support for several months after the child returned home.

During the residential program, the young people and their families developed a reunification plan and the family worker provided personalized services to both the young person and family members with the goal of reintegrating the child into the home and community.

The study involved 89 teenagers (mostly boys) already involved with, or at risk of entering, the juvenile justice system in the US. Of these, 27 (30%) re-offended, were moved to a more restrictive placement, or ran away. Older boys (16- and 17-year-olds) seemed the most difficult to reunify with their families.

After the intervention, the young people who participated displayed fewer behavior problems, interacted more positively with their peers, and their families showed improved parenting skills. Almost 70% of the original sample were available for a 12-month follow-up. In this survey, 76% of the young people had remained arrest-free, 76% were living in a homelike setting, and 72% had either graduated or were attending school.

This represents a positive result for at least half of the original sample, although outcomes for the 30% who could not be contacted for the 12-month follow-up are not known.

This study compared the same group of youths prior to and after the intervention. Without a comparison group who did not receive the intervention, it is not possible to draw firm conclusions about the intervention’s effectiveness. More robust studies are needed to show if this blended approach produces better outcomes than treatment as usual. However, this study provides evidence that better integration of residential and aftercare services is a promising practice.

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Reference:
Ringle, J.L., Thompson, R.W. and Way, M. (2014). Reunifying Families After an Out-of-Home Residential Stay: Evaluation of a Blended Intervention. Journal of Child and Family Studies, DOI 10.1007/s10826-014-0009-2.