Predicting residential care placement among youth in state custody who experienced psychiatric crisis

Understanding predictors of residential placement is essential for the development of interventions to divert youth to less restrictive and costly alternatives or develop residential treatment models that more effectively address the needs of the youth who require this intensive level of care. This study examines the extent and predictors of entry into residential care among youth in state custody who have experienced a psychiatric crisis.

A total of 672 children and youth in Illinois who received their first crisis screening between 2001 and 2003 and had no history of residential care at the time of first crisis episode were followed until 2005 using child welfare records and data from the Screening, Assessment, and Supportive Services program.

Overall, 36% of the sample were placed in residential care at some point after their first crisis screening. Among the youth placed in residential care, 54% did so within 6 months of their first crisis screening, with an additional 18% between 6 and 12 months. Psychiatric hospitalization, older age, and type of child welfare placement, independent of psychiatric status, were associated with an increased risk for residential care placement.

Having an inpatient psychiatric episode places children and youth at greater risk for residential care placement, suggesting that it would be efficient to develop diversion programs from residential placements within and immediately following psychiatric hospital episodes of care. Youth in psychiatric crisis may also benefit from efforts to include their biological, adoptive, or foster families as part of the treatment process.