History of Congregate Care Part 2

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 Part 1 Recap:

• Residential treatment facilities began to appear in the 1940s
• The creation and implementation of the therapeutic model still used in residential treatment facilities to this day, occurred in the 1950s
• Residential treatment facilities began to receive criticism from family therapists and family advocates in the 1970s-1980s

History of Congregate Care:

1990s: Alternative Options²

• Community-based alternatives to residential treatment begin to appear
  • Such as: Day hospitals (now outpatient services); family preservation programs; wraparound services; multisystemic treatment
• Medication for disruptive behaviors, anxiety, depression, thought disorders, and affective instability begin being utilized in outpatient settings to manage symptoms

2000s: Youth in Foster Care and Congregate Care

• In 2004, 18% of youth in foster care were in congregate care placements³

2010s: A Change Takes Place

• In 2013, 14% of youth in foster care were in congregate care placements⁴
• In the 2010s, lived experience leaders began sharing about the importance of congregate care reform
• In 2018, the Family First Prevention Services Act (FFPSA) was signed into law. FFPSA⁵:
  • Established requirements for placement in residential treatment programs
  • Improved the quality and oversight of services
  • Allows federal reimbursement for care in certain residential treatment programs for children with emotional and behavioral disturbance requiring special treatment

Summary:

Due to criticism of residential treatment facilities beginning in the 1970s-1980s, alternative, community-based options began to appear in the 1990s. In the 2010s, lived experience leaders began sharing about the overreliance on congregate care and the need to reform congregate care policy. This helped lead to the passing and implementation of the Family First Act in February of 2018.

---

Related Resources:

• Safely Reducing the Use of Congregate Care: Considerations in the Age of Family First (archived webinar)
• Family First Implementation: A One Year Review of State Progress in Reforming Congregate Care

Resources from the National Foster Care and Alumni Policy Council:

• Reducing Reliance on Congregate Care: Our Priorities
• Historic Opportunity to Reform Child Welfare: Youth & Alumni Priorities on Quality Residential Services
• Webinar Recording & Recap: Historic Opportunity to Reform Child Welfare: Youth & Alumni Priorities on Quality Residential Services

---

Sources:

¹ Congregate Care in the Age of Family First

² Baldessarini, R.J. (2000). American biological psychiatry and psycho-pharmacology, 1944-1994. In R.W. Menninger & J.C. Nemiah (Eds.), American psychiatry after World War II: 1944-1994 (p. 371-14120. Washington, D.C.: American Psychiatric Press.

^3-4A National Look at the Use of Congregate Care in Child Welfare by U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau

⁵Family First Prevention Services Act