Quality care in residential childcare institutions: a systematic scoping review
Mapping review
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We examined research from 2010-2019 on interventions, methods and strategies focusing on quality care for children and youth living in residential care institutions.
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Key message
We examined research from 2010-2019 on interventions, methods and strategies focusing on quality care for children and youth living in residential care institutions.
Our systematic scoping review identified 16 primary studies with approximately 3400 children and youth living in residential youth care institutions. We identified four qualitative studies concerning experiences and 12 quantitative studies describing different strategies residential care institutions may consider using to create a safe and affirmative environment for youth. There were seven interventions for youth and two for staff. All in all, the results of the studies suggest that interventions for youth and staff can facilitate quality care in residential youth care institutions.
Essential elements of quality care in residential youth care institutions appear to be youth user involvement, contact with family and friends, placement stability, sense of domestic safety and clear rules. It also appears essential to have an adequate number of staff who have expertise in creating trusting relations and who care about the youth, listen to- and acknowledge their emotions and experiences.
We found that research on strategies to facilitate quality care for children and youth in residential youth care institutions is somewhat limited and mixed. There appears to be no studies on this topic from Norway or other Nordic countries. We identified few qualitative studies and few studies that examined different organisational structures, staffing arrangements or staffing compositions. It is possible that such aspects are important in facilitating quality care for children and youth in residential youth care institutions.
Summary
Background
Children and youth can be placed in out-of-home care in cases where efforts to meet their needs, concerning both safety and/or care, are not being met. Out-of-home placements involve either foster care, a group care home or a residential care institution. In Norway, there are four types of state-run residential care institutions: youth institutions, institutions for youth with serious behavioral problems, emergency placement- and assessment institutions, and substance abuse placements. The state-run residential care institutions, such as residential youth care institutions, are almost exclusively for youth age 13-18 years. A successful child welfare system is important for youth and society in general. Providing quality care is essential for youth to develop positively and have all of their needs met.
The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) commissioned the Norwegian Institute of Public Health to conduct a systematic scoping review of both quantitative and qualitative evidence on interventions, methods or strategies that facilitate quality care for children and youth in residential care institutions.
Objective
The aim of this systematic scoping review was to examine different interventions, methods or strategies for children and youth in residential care institutions.
Method
To identify relevant studies, a search specialist searched seven international databases in October 2019, including MEDLINE, EMBASE and PsycINFO. We also searched Google and manually screened the reference lists of relevant studies. We included studies published 2010-2019. We included both quantitative studies on effects and correlations of interventions, and qualitative studies on youth’s experiences of interventions, methods or strategies for quality care in residential youth care institutions. We excluded residential treatment institutions for substance abuse, emergency placement, and institutions for serious behavioral problems. Two researchers independently screened all titles and abstracts from the literature search, and thereafter the full texts, for eligibility according to the inclusion criteria. One researcher extracted data from the studies and a second researcher checked the correctness and completeness. We sorted and combined the data from the included studies narratively and created tables when relevant.
Results
We included 16 studies: four qualitative studies about experiences, and 12 studies examining different strategies residential care institutions may consider to facilitate a safe and positive environment for young residents. The studies were conducted in Australia, Canada, England, Portugal, Scotland and the USA. In total, around 3400 children and youth between 6 and 21 years of age (mean age 15) were included in the studies.
Studies investigating effect reported seven different interventions for children and youth and two interventions for staff. All outcomes were measured on the children/youth. The results from the four experimental, controlled studies suggested:
- The intervention “Teaching Family Model” (TFM) may reduce externalising behaviour and using point card token economy in TFM homes may reduce externalising behaviour and improve emotional and behavioural functioning.
- Sexuality education program (“Power Through Choices”) may improve youth’s knowledge, intentions and communication regarding safe sex.
- A cognitive behavioural program may improve anger management and aggressive behaviour in youth.
- The HEAL program («Healthy eating, active living») for overweight children and youth does not seem to improve their intentions regarding increased physical activity and healthier diet.
The results of the interventions in the remaining studies are more uncertain, as these studies have designs that in general are less suited to measure effect. However, the results indicate that the comprehensive CARE program («Children and Residential Experiences») may lead to less property destruction, less aggression towards staff and fewer incidences of youth running away. Focusing on the working alliance between staff and youth may lead to less behavioural problems. Family contact for youth in residential care may lead to less disruptive behaviour, better success after leaving care, and follow-up success. Finally, the results from the two interventions for staff indicate that milieu therapy may lead to less use of restraints and training staff in positive psychology may lead to less aggressive behaviour and fewer youth running away.
The four qualitative studies all focused on different environmental aspects for youth in residential care institutions. While there were few commonalities among the studies, it appeared to be important for children and youth to have autonomy, contact with family and friends, placement stability and a good relationship with staff. It appeared to be important to have staff who were caring, supportive and motivational.
Discussion
There is a limited amount of research (published 2010-2019) on care for children and youth in residential youth care institutions, yet, the 16 studies that we identified offer some insights. Quality care for children and youth in residential youth care institutions appear to be characterised by elements such as: youth user involvement, contact with family and friends, placement stability, sense of domestic safety, clear rules and an adequate number of staff, staff who have expertise in creating trusting relationships and who care about the youth, listen to- and acknowledge their emotions and experiences.
The amount of research on quality care for youth in residential youth care institutions is increasing. To date, most studies are from North America. The results of the studies suggest that there are interventions for youth and staff that can reduce behavioural problems in children and youth. However, we identified few studies that examined different organisational structures, staffing arrangements or staffing compositions. It is possible that such aspects are important in facilitating quality care for children and youth in residential care. There are also few published studies on children and youth’s experiences with strategies facilitating quality care. Lastly, there appears to be no studies from Norway or other Nordic countries (published 2010-2019) examining aspects of quality care for children and youth in residential youth care institutions.
Conclusion
The aim of this systematic scoping review was to gain an overview of the research evidence (published 2010-2019) on quality care for children and youth in residential youth care institutions. We found that research on this topic is somewhat limited and mixed. Overall, the study results suggest that interventions involving youth or staff facilitate quality care. However, it is important to keep in mind that we have not conducted a full systematic review: we have not assessed methodological quality, quantitatively synthesized the results or assessed the certainty of the evidence. Cautious interpretations of study results are therefore advised.
