Congregate Care, Residential Treatment and Group Home State Legislative Enactments 2014-2019

10/30/2020

Just over 400,000 American children live in foster care, and some 55,000 reside in group homes, residential treatment facilities, psychiatric institutions and emergency shelters. This type of placement—called “congregate care”—may be beneficial for children who require short-term supervision and structure because their behavior may be dangerous.

However, many officials believe that children who don’t need that type of intense supervision are still in these group placements—depending on the state, between 5% and 32%—making it harder to find them permanent homes and costing state governments three to five times more than family foster care.

A recent federal analysis of Adoption and Foster Care Analysis (AFCARS) data revealed important information about children and youth placed in congregate care settings in the U.S.  The analysis defined congregate care as “A licensed or approved setting that provides 24 hour care for children in a group home (7-12 children) or an institution (12 or more children).  These settings may include a child care institution, a residential treatment facility or a maternity home.”

Why are children placed in congregate care?

Children and youth are placed in congregate care settings for a variety of reasons. As of September 30, 2013, 36% of children in congregate care had a DSM (Diagnostic and Statistical Manual of Mental Disorders – the standard classification of mental health disorders) diagnosis; 45% had a child behavior problem; 10% had a disability; and, 28% had no clinical indicators.

How long do children stay in congregate care?

Children placed in congregate care were in care for an average of 8 months, compared to 11 months for children in other types of care.  However, children who spent time in congregate care spent an average of 28 months in foster care compared with 21 months total time in care for children in other types of care.

  • 36% spent less than 60 days in congregate care
  • 5% spent 61 to 90 days in care
  • 35% spent 91 days to 1 year
  • 24% spent more than 1 year in congregate care

Who are the children in congregate care?

Age – Average age to enter congregate care was 14.
 

Race – 30% of children in congregate care were African-American, 40% are White; nearly 20% were Hispanic; less than 1% were Native Hawaiian or Other Pacific Islander; less than 1% were Asian; 1.6% were American Indian/Alaska Native.

Sex – 62% were male; 37% were female

What does the research say about congregate care?

Research indicates that children, especially those ages 12 and under, should be placed in the least restrictive, most family-like settings possible. It is critical that infants and young children should be allowed to develop healthy, secure attachments with adults who are consistently available. Youth who live in institutional settings are at greater risk of developing physical, emotional and behavioral problems that can lead to school failure, teen pregnancy, homelessness, unemployment and incarceration and are less likely to find a permanent home than those who live in family foster care.

Several proven effective interventions, such as Multisystemic Therapy (effective in reducing sexual behavior problems, substance use, and delinquency) and Multidimensional Treatment Foster Care (a community-based treatment program proven to reduce juvenile offender recidivism) are programs delivered in family and community-based settings.

How can states further reduce reliance on congregate care?

According to a recent federal analysis of states’ use of congregate care, states have used several broad strategies to reduce the placement of young children into congregate care:

  • Unified statewide strategic plans
  • Leadership and workforce development
  • Prevention and early intervention
  • Strengthening of community-based services
  • Address barriers to services
  • Statewide treatment-focused foster care model
  • Flexibility in service provision

Other approaches have included:

  • Alternative placement programs
  • Early trauma screening assessments and treatment
  • More specialized data collection systems
  • Development of multidisciplinary committees to review assessment and placement recommendations

Family First Prevention Services Act

The federal legislation, Family First, was passed in 2018 and contains provisions related to the use of residential treatment programs and facilities. These include:

  • Limiting the number of youth permitted in a child care institution to 25
  • Places a limit of two weeks on federal payments for placements that are not foster homes or qualified residential treatment programs (QRTP).
  • Defines a QRTP as the following:
    • Licensed by at least one of the following:
      • The Commission on Accreditation of Rehabilitation Facilities.
      • Joint Commission on Accreditation of Healthcare Organizations.
      • Council on Accreditation.
    • Utilizes a trauma-informed treatment model that includes service of clinical needs.
    • Must be staffed by a registered or licensed nursing staff.
      • Provide care within the scope of their practice as defined by state law.
      • Are on-site according to the treatment model.
      • Are available 24 hours a day and seven days a week.
    • Be inclusive of family members in the treatment process if possible, and documents the extent of their involvement.
    • Offer at least six months of support after discharge.
  • Places limits on how long a child may stay in a QRTP

More information on these regulations can be found on NCSL’s summary of the bill here. NCSL also tracks all introduced state legislation related to the bill on its Family First Legislation page.

What have state legislatures done regarding congregate care?

Child welfare agencies are working to reduce the use of congregate care by reinvesting funds into family-based and prevention services and changing policies to favor family placements and discourage congregate care. For example, some states have lowered the number of beds in group facilities and increased the number of family foster homes. Other states are including children and families in the decisions made on where children should be placed and what resources families might need to keep their children home safely.

Below are state legislative enactments from 2014-2019 related to congregate care and residential treatment or group homes.

NCSL reviewed state congregate care legislative enactments from 2014 through 2019. The topics identified in the scan include: Assessments to Determine Level of Care; Commissions/Task Forces/Annual Reports; Courts; Educational Outcomes; Funding; Interstate Compact on the Placement of Children/Out-of-State Placement of Children; Oversight and Administration of Psychotropic Medications; Protection from Abuse; Reduce Reliance on Congregate Care/Promotion of Community-Based Care; Rights of Children in Foster Care; State Oversight of Residential Facilities/Licensing; Statewide Plans for Behavioral Health and Health; Training; Tribes; and Other.

Enacted State Legislation 2014-2019

State

Year

Relevant Sections

Legislation

Alabama

2017

Establishes registration and regulatory requirements for religious, faith-based, church nonprofit, other nonprofit, or for profit alternative boarding schools, outdoor programs, or residential institutions that house children for counseling, therapeutic, behavioral, or educational purposes when on-site residency of children is required for periods over 24 hours. Establishes accountability for children enrolled at or housed by religious or faith-based facilities, institutions, and programs that house children for periods of over 24 hours. Requires an employee, volunteer, or applicant for employment or a volunteer position to undergo a criminal background investigation prior to having unsupervised contact with children. Establishes a provision for fees and charges associated with the registration and regulation of these facilities. Prohibits the operation of any youth residential facility, institution, or program in the state under this act unless the entity holds a current registration approval from the Department of Human Resources.

AL H 440

Arizona

2019

Relates to residential care institutions, relates to children, relates to Central Registry background check system that provides information to licensees regarding persons who are employed or seeking employment to provide direct services to children in a licensed behavioral health residential facility, requires licensees that do not contract with this state, that contract with the federal government, and that employ persons providing direct services to children to submit information for background checks.

AZ S 1247

Arizona

2016

Relates to human services budget reconciliation for 2016-2017, requires a legislative report on the Arizona training program and associated group homes, requires a timeline for facility closure, a timeline for transition of residents to new residential settings, a costs estimate, monitoring, placement oversight, protection and advocacy services and medical and behavioral health care support for transitioning persons, requires a notice to affected residents and legal guardians, makes other appropriations.

AZ H 2705

Arizona

2016

Relates to foster care, relates to foster home certification, certification as a child developmental certified home, the number of foster children who may be placed in a child developmental certified home, training, life safety and monitoring requirements, incident reports, life safety inspections, payment of certain costs, excluding children eligible for the Long Term Care Program, the definitions of child development foster home, community residential setting and group home, and other matters.

AZ H 2099

Arkansas

2017

 Allows a community provider that is licensed as a family style residential home or that provides a family home setting and is approved by the Division of Children and Family Services, in addition to foster family homes, to receive foster care maintenance payments.

AR H 1849

California

2017

Makes changes to the resource family approval process by authorizing a county or foster family agency to approve a resource family to care for a specific child and prohibiting a resource family from being licensed to operate certain other residential facilities on the same premises as the residence. Makes changes to resource family approval hearings.

CA A 404

California

2017

Amends the Community Care Facilities Act which provides for the licensing and regulation of community care facilities. Authorizes the licensing of a short term residential therapeutic program operating as a children's crisis residential center and requires regulation of such programs. Details guidance to counties for the provision of children's crisis residential services, including funding.

CA A 501

California

2016

Provides that the resource family approval process replaces certification of foster homes by foster family agencies and the approval of guardians. Makes changes concerning certain rates, inspections, criminal records exemptions, false statements, short-term residential therapeutic programs, certain licensing and operation requirements, and permanent placement options. Relates to short-term residential therapeutic programs as licensed facilities providing an integrated program.

CA A 1997

California

2015

Provides for the reclassification of treatment facilities and the transition from the use of group homes for children in foster care to the use of short-term residential treatment centers. Revises certain foster care parent training. Provides for development of child and family teams to inform the process of placement and services to foster children and to children at risk for foster care placement. Relates to funding children's placement. Relates to recovering overpayments. Requires progress updates.

CA A 403

California

2014

Includes foster family home inspections, residential care facility inspections and license suspension and revocation and resident health and safety, home care services and home care aid registration background clearance, reporting dependent adult or elder or child abuse, CalWORKs ineligibility, welfare-to-work assistance, CalWORKs aid increase, the Low-Income Home Energy Assistance Program, the CalFresh program, commercially sexually exploited children, group foster care providers, caregivers and AFDC.

CA S 855

Florida

2017

Requires DCF to develop, in collaboration with the Florida Institute for Child Welfare, service providers, and other community stakeholders, a statewide quality accountability system for providers of residential group care that promotes high quality in services and accommodations. Requires DCF to convene a workgroup on increasing the number of high-quality foster homes and report to the Governor and Legislature by November 15, 2017. Establishes a shared family care residential services pilot program to facilitate the temporary placement of substance-exposed newborns and their families in the home of trained volunteer families for the purpose of mentoring and receiving treatment and services and appropriates funds for this purpose.

FL H 1121

Hawaii

2016

 Relates to the age of consent for adolescent mental health services, states that a minor who is fourteen years of age may consent to mental health treatment or counseling services provided by a licensed mental health professional, includes involvement of the minor's parents or legal guardians unless the professional determines it would be inappropriate, requires parental or guardian consent to prescribe medication to the minor or to place the minor into an out-of-home or residential treatment program.

HI S 2886

Idaho

2016

It is the finding of the Legislature that the Department of Health and Welfare is responsible for the educational needs of school-age children placed in its custody by the courts for either child protective or mental health issues. If the Department of Health and Welfare places a child in a licensed residential treatment facility that includes a nonpublic accredited school, and it is determined by the Department of Health and Welfare that it is in the best interest of the child to be educated at the residential treatment facility, then it is the responsibility of the Department of Health and Welfare to pay for such education at the rate of $71.05 per student per educational day. This intent language does not preclude other Idaho state agencies from exercising their responsibility to ensure a free and appropriate education for these students within the requirements of federal disability law. The fiscal impact of this language is approximately $690,000 from existing appropriations.

ID S 1403

Illinois

2019

Amends the Child Care Act, decreases the number of children that a foster family home may provide care for, provides that an application to operate a foster family home shall include the name and address of at least one relative who can attest to the applicant's capability to care for the child or children, establishes reporting requirements for the Department of Children and Family Services after placing a child in a qualified residential treatment program.

IL H 2571

Illinois

2018

Amends the Probate Act, provides that the court shall not appoint an employee of an agency that is directly providing residential services to a ward as a guardian.

IL H 4686

Illinois

2017

Allows the court to approve the placement of a minor in an out of state residential treatment center, upon application by the Department of Children and Family Services, when the court determines that the placement of the minor in an out-of-state residential treatment center is in the best interest and is the least restrictive, most family-like setting for the minor. Requires the department to include a written explanation.

IL H 2910

Illinois

2015

Provides that certain child care facilities providing temporary residential shelter services to children in guardianship, temporary custody, or protective custody shall provide certain interventions and activities, maintain certain staffing levels, require screening and assessment upon admission to evaluate certain behaviors, and establish certain rules and procedures, provides for a hold on admissions, licensing sanctions, and monitoring of facilities.

IL H 1530

Illinois

2015

Requires any child or person in the care of the Department of Children and Family Services who is placed in a residential facility to be reported as missing if there is no contact between a facility employee and the child or person within a certain period and the child or person is absent from the facility without approval, provides for notification of caseworkers, reports to the National Center for Missing and Exploited Children and to a sheriff, certain care plans, and missing persons alerts.

IL S 1775

Illinois

2015

Creates the Foster Children's Bill of Rights Act, provides that foster children and adults have the right to adequate and healthy food and adequate clothing, and for youth in group homes, residential treatment facilities, and foster homes, an allowance, to not be locked in a room, building, or facility, and to have caregivers and child welfare personnel with sensitivity training on matters concerning race, ethnicity, national origin, color, ancestry, religion, mental and physical disability, and HIV status.

IL H 3684

Indiana

2017

Requires the secretary of family and social services to require residential care and supported housing for chronic addiction that receive reimbursement when used as a recovery residence to be certified and meet standards determined by the division through administrative rules.

IN H 1006

Iowa

2016

Provides for the development, adoption, and enforcement of certain rules and standards relating to certification of children's residential facilities, requires a certificate of approval prior to the operation thereof, and provides further for certain application and approval or denial requirements, provides for restricted use of the facility, reports and inspections, certain eligibility for injunctive relief or civil action on the part of parents or guardians, and the provision of educational programming.

IA S 2304

Kansas

2019

Concerns children and minors, relates to placement of a child in a qualified Residential Treatment Program, requires the ongoing assessment of the strengths and needs of the child continues to support the determination that the needs of the child cannot be met through placement in a foster family home, that the placement in a qualified Residential Treatment Program provides the most effective and appropriate level of care for the child in the least restrictive environment, requires placement to meet goals.

KS H 2103

Kentucky

2017

Allocates funds from the estimated amount of savings that would otherwise remain in the general fund to KY-ASAP to address neonatal abstinence syndrome by providing supplemental grant funding to community substance abuse treatment providers to offer residential treatment services to pregnant women through programs that employ evidence-based behavioral health treatment or medically assisted treatment and to provide supplemental funding for traditional KY-ASAP substance abuse programming under current law.

KY H 282

Louisiana

2016

Relates to residential facilities, provides for residents of residential homes, provides for completion of educational courses by such residents, provides for the jurisdiction, powers, duties, and regulations of the Department of Children and Family Services regarding youth under care by specialized providers, provides an exemption for a child housed at a home residential home that does not receive Title IV-E funding to remain in the home until his twenty-first birthday to complete any educational course.

LA S 397

Maine

2019

Requires the Department of Health and Human Services to adopt rules for children's residential care facilities that include procedures for fingerprint based background checks and child abuse and neglect registry checks for all staff working in the facility, to ensure compliance with the requirements governing fingerprint based background checks contained in federal Family First Prevention Services legislation.

ME H 1274

Maryland

2019

Requires the juvenile court to conduct a hearing to review the status of a child placed in a qualified residential treatment program and make a determination within a certain period of time after the child enters the placement, requires the juvenile court to review an assessment and consider certain factors at a hearing.

MD S 1043

Missouri

2015

Modifies provisions related to the Division of Youth Services, relates to youth in custody, community work programs, supervision, vocational training and specified trust funds, relates to mental health treatment programs, residential facilities designated as a maximum security facility, moderate care facilities, day treatment programs, community work programs, wages for work at a state park, restrictions on access to DYS trust funds, deposits of payments from Social Security and representative payees.

MO H 1149

Nebraska

2019

Amends the Children's Residential Facilities and Placing Licensure Act, changes provisions relating to investigations and reporting.

NE L 59

New Hampshire

2016

Directs the department of health and human services and the department of education to develop a comprehensive system of care for children's behavioral health services, provides for cost-effectiveness, decreased use of inpatient and residential services, increased cross-system collaboration, decreased duplication, and improved use of Medicaid, establishes reporting requirements, authorizes the departments to enter into an interagency agreement regarding program implementation.

NH S 534

North Dakota

2019

Revises provisions relating to licensing exemptions for the delegation of the administration of routine medications to a qualified service provider, agency foster homes for adults, criminal history record investigations, and the implementation of residential habilitation and community support services in a residential setting or private residence.

ND H 1099

North Dakota

2019

Expands the powers and duties of the Director of Juvenile Court to include receiving and examining requests for review of a child's placement at a qualified residential treatment program.

ND S 2069

Oklahoma

2019

Relates to the Oklahoma Children's Code, relates to definitions, adds definition of qualified residential treatment program, provides an effective date.

OK S 318

Oklahoma

2019

Relates to children, relate to the Childrens Code, adds definitions, modifies term, requires individual service plan to provide least restrictive placement information, authorizes judicial discretion to place child in least restrictive placement, permits placement of child in a family style residential program, mandates report to include least restrictive placement information, provides an effective date.

OK H 1993

Oklahoma

2015

Relates to the Children's Code, lists relatives for Departmental notification after removal, relates to lowered age for transition planning, age restrictions on planned alternative placement, input from child for certain permanency plans, training, foster care, duties for persons receiving custody, rules for residential care facilities, requires list of document for child to receive and reduced age for adulthood services, provides for sex trafficking victims and reports of runaways.

OK H 1078

Oregon

2019

Prohibits long term care facilities, residential facilities, adult foster homes, child care facilities, child caring agencies, foster homes, youth care centers, youth offender foster homes, or other entities that are licensed, certified, or registered to provide care to children, youth, individuals with disabilities, or older adults, from interfering with disclosure of information by prospective employees, employees, or volunteers about treatment of individuals cared for to regulatory agencies.

OR S 917

Oregon

2017

Expands the definition of child in care to include children receiving care and services from certified foster homes and developmental disabilities residential facilities. Excludes child from the definition of child in care when care is provided in child's home by child's parent. Expands abuse reporting requirements and responsibilities to certified foster homes and developmental disabilities residential facilities. Exempts certain entities from having procedures and protocols to report abuse.

OR S 243

South Dakota

2014

Revises provisions regarding the education of children placed in residential treatment centers or intensive residential treatment centers, requires such education to be the responsibility of the school district where the center is located, provides for the calculation method for special education services.

SD H 1032

Texas

2019

Requires the department to develop trauma-informed protocols to reduce runaways. The department shall monitor and coordinate with general residential operations providing treatment services to children or young adults with emotional disorders to maintain and improve the quality of residential child-care services purchased by the department.

TX S 781

Texas

2017

Details DFPS functions relating to investigations of alleged abuse or neglect occurring at a child-care facility, including a residential child-care facility, among those not subject to transfer to the Health and Human Services Commission as part of the consolidation of the health and human services system.

TX H 5

Texas

2017

Requires the Department of Family and Protective Services (DFPS), in selecting a foster care placement for a child, to consider whether the placement is in the child's best interests. Requires DFPS, in determining whether a placement is in a child's best interests, to consider whether the placement is the least restrictive setting for the child, is the closest in geographic proximity to the child's home, is the most able to meet the identified needs of the child, and satisfies any expressed interests of the child relating to placement, when developmentally appropriate. Specifies that, if a suitable relative or other designated caregiver is not available, placing the child in a foster home or a general residential operation operating as a cottage home is considered the least restrictive setting and defines "least restrictive setting" as a placement for a child that, in comparison to all other available placements, is the most family-like setting. Clarifies that, with respect to a child who is six years of age or younger and who is removed from the child's home, if a suitable relative or other designated caregiver is not available as a placement for the child, the least restrictive setting for the child is placement in a foster home or a general residential operation operating as a cottage home, only if DFPS determines it is in the best interest of the child.

TX H 1542

Texas

2015

Relates to caregiver screening and training by substitute care providers for children in the conservatorship of the Department of Family and Protective Services, sets forth requirements for contracts for residential child-care services provided by a general residential operation or by a child-placing agency.

TX H 781

Texas

2015

Relates to the notification of certain persons concerning certain events related to a child in foster care or in the managing conservatorship of the Department of Family and Protective Services to include a change in the child's medical condition, enrollment or participation of the child in a drug research program, an initial prescription of a psychotropic medication, and a change of a residential child-care facility, requires notification of State legislative representatives about the death of such child.

TX H 1309

Texas

2015

Relates to certain requirements for certain facilities licensed by the Department of Family and Protective Services and the department's enforcement authority, makes changes relating to notice and hearing requirements and residential operations providing services to children who are victims of trafficking, removes certain fees for child-care facility and child-placing agency licensure, makes changes concerning enforcement policies and administrative penalties, provides for certain cease and desist orders.

TX H 2070

Utah

2019

Makes amendments to child welfare provisions, clarifies that the Division may support a finding of child abuse or neglect and that a judge may substantiate a finding, clarifies language regarding policies and rules, clarifies procedures for the Department of Human Services regarding child pornography, requires certain employee background checks, outlines requirements for a juvenile court to follow when a child is placed in a residential treatment program.

UT S 128

Vermont

2017

Requires the commissioner for children and families, with assistance of the departments of mental health and of disabilities, aging, and independent living and the agency of education to report on the use of out-of-state and in-state residential child placement. Details what the report must include.

VT H 542

Virginia

2015

Out of this appropriation, $100,000 the first year and $100,000 the second year from the general fund shall be provided to contract with Youth for Tomorrow (YFT) to provide comprehensive residential, education and counseling services to at-risk youth of the Commonwealth of Virginia who have been sexually exploited, including victims of sex trafficking. The contract shall require YFT to provide individual assessments/individual service planning, individual and group counseling, room and board, coordination of medical and mental health services and referrals, independent living services for youth transitioning out of foster care, active supervision, education, and family and family reunification services. Youth for Tomorrow shall submit monthly progress reports on activities conducted and progress achieved on outputs, outcomes and other functions/activities during the reporting period. On October 1 of each year, YFT shall provide an annual report to the Governor and the Chairmen of the Senate Finance and House Appropriations Committees that details program services, outputs and outcomes.

VA H 5002

Washington

2019

Eliminates the use of the valid court order exception to place youth in detention for noncriminal behavior, expands procedures for sanctions imposed upon juveniles for contempt of court, revises provisions relating to at risk youth petition proceedings, prohibits a child involved in a child in need of services proceeding from being placed in confinement, provides for secure residential programs with intensive wraparound services.

WA S 5290

Washington

2017

Authorizes the Department of Social and Health Services, for the purposes of ensuring the safety and welfare of youth who are in foster care, to disclose to the Department of Commerce and certain contracted providers, only those confidential child welfare records that pertain to or may assist with meeting the services needs of foster youth who are admitted to crisis residential centers or HOPE centers under contract with the office of homeless youth prevention and protection. Changes certain duties of the Department of Commerce and the Department of Social and Health Services with regard to the homeless youth prevention and protection act.

WA H 1816

Washington

2016

Modifies the Juvenile Justice Act with regard to court orders for residential treatment and expanding the chemical dependency disposition alternative to include mental health and co-occurring disorder treatment, requires the costs incurred by juvenile courts for the mental health, chemical dependency, and/or co-occurring disorder evaluations, treatment, and costs of supervision required under these provisions to be paid by the Department of Social and Health Services.

WA H 2746

West Virginia

2016

Relates to state responsibilities for children, eliminates a sunset provision for a commission to study residential placement of children, provides for a juvenile referee, clarifies that prosecuting attorneys are only required to represent the Department of Health and Human Resources in child abuse and neglect cases, clarifies that Department of Health and Human Resources is required to attempt to terminate parental rights when parent has committed sexual assault or sexual abuse, makes technical changes.

WV S 329

Contact Us

The Denver-based child welfare project staff focuses on state policy, tracking legislation and providing research and policy analysis, consultation, and technical assistance specifically geared to the legislative audience. Denver staff can be reached at (303) 364-7700 or childwelfare@ncsl.org.

NCSL staff in Washington, D.C. track and analyze federal legislation and policy and represent state legislatures on child welfare issues before Congress and the Administration. Staff in D.C. can be reached at (202) 624-5400 or cyf-info@ncsl.org.