Shining a torch behind the shutters of residential care

“To know that something works is good, to know how it works is better,” concludes Erik J. Knorth at the end of a trawl through the increasingly dusty-looking literature on residential care for children with serious behavior or emotional problems.

It’s a modest conclusion since he and his team admit that their work only offers answers to the question of whether residential care works; even with such an extensive archive to go at, it stops well short of how.

Knorth, of the University of Groningen in the Netherlands and his research team (including colleagues at his own university and Universities of Strathclyde and Glasgow) begin by noting the great swings of the residential care pendulum.

In the early 1990s, the generally accepted view was that placements in institutions could be quite helpful for some. However, less than a decade later, policymakers were declaring that the evidence that residential care was harmful to children was indisputable.

Knorth and his team decided to take a fresh look at the findings. They searched for studies on residential care published between 1990 and 2005 and found 27 fairly rigorous ones which, together, included data on 2,345 children and young people. They then conducted a meta-analysis of these studies.

They found that, on average, after a period of residential care, the psychosocial functioning of children and young people improved. Indeed, they concluded that residential care achieved better results than treatment at home with the same very problematic group. And young people who acted out and behaved poorly seemed to make more progress in residential care than did those who tended to internalize their problems.

Behavior-therapeutic methods and focusing on family involvement showed the most promising short-term outcomes. However, most of the studies reviewed did not track children for more than three or four months after their residential stay ended, so the long-term impact was not clear.

But to complete the circle: what also remains unclear is why kids improved during their stays. What specific types of positive experiences – or absence of negative experiences – helped them the most? Knorth and company admit that this is a more difficult question to answer (disconcertingly so, remembering how heavy the investment once was in efforts to find out); they also make the case for reviving research interest if we are to improve the lives of troubled children.

• Summary of “Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care” by Knorth E J, Harder A T, Zandberg T and Kendrick A J in Children and Youth Services Review, Volume 30, Issue 2, February 2008, pp 123-140.