What is Congregate Care?

‘Congregate care’ refers to a wide range of out-of-home placement settings including: Group homes, residential treatment facilities, emergency shelters, and in-patient hospitals1. Under the Family First Act (FFA), congregate care settings must be licensed as Qualified Residential Treatment Programs, to receive funding through FFA.

History of Congregate Care:

1920s: Inpatient care

  • Inpatient care facilities for adolescents are created2

1940s: The First Congregate Care Placement3

  • The first congregate care placement is created to serve youth with mental illnesses
  • “Residential treatment” begins to be utilized to describe these placements
  • Psychiatry and social work become more respected, creating a path for utilizing treatment modalities in congregate care placements

1950s: The Therapeutic Model is Created4

  • The therapeutic model, still used today, for congregate care placements is created and implemented
  • The model includes: milieu therapy, specialized mental health treatment, and residential school services
  • In 1956, the American Association of Children’s Residential Centers (AACRC) is created

1970s-80s: Residential Treatment vs Hospitalization5

  • A distinction is made between ‘residential treatment’ and ‘hospitalizations’
    • Residential treatment are: A type of institutionalization; run by psychologists and social worker; fewer types of therapy and less sophisticated therapies
    • Hospitals are: Run by doctors and nurses; designed to treat more ‘disturbed’ patients; more types of therapy and more sophisticated therapies
  • Residential treatment begins to receive criticism by family therapists and family advocates due to the separation of children from their families, minimal family involvement, and the behavior of children who had been placed in residential treatment

Summary:

While inpatient care facilities began being utilized in the 1920s, it wasn’t until the 1940s when residential treatment facilities began to appear. After the creation of residential treatment facilities, the 1950s saw the creation and implementation of the therapeutic model still utilized in residential treatment facilities to this day. As residential treatment facilities became more common, the 1970s-1980s saw distinctions arise between ‘residential treatment’ and ‘hospitalizations.’ During this time, residential treatment facilities began to receive criticism from family therapists and family advocates.

Read part 2 here!

Related Resources:

Sources:

1 Congregate Care in the Age of Family First

2  Francis, G. & Hart, K.J. (1992). Depression and suicide. In V.B. Van Hasselt & D.J. Kolko (Eds.), Inpatient Behavior Therapy for Children and Adolescents (pp. 93-111). New York: Plenum Press.

3-5Perspectives on Residential and Community-Based Treatment for Youth and Families by Magellan Health Services Children’s Services Task Force