Implementing Evidence-Based Practice in Residential Care: How Far Have We Come?

ABSTRACT

Residential care agencies have been making efforts to provide better quality care through the implementation of evidence-based program models and evidence-based treatments. This article retraces the developments that led to such efforts. It further aims to answer two questions based on the available conceptual and empirical literature: (a) What is the current status on milieu-based program models that were developed for residential care settings with a therapeutic focus? (b) What is known about the implementation of client- or disorder-specific evidence-based treatments into residential care settings? Findings from this review will be integrated to provide recommendations to residential care providers about the integration of evidence-based program models and treatments into their agencies and to point to the challenges that remain for the field.

KEYWORDS:

• residential care
• evidence-based practice
• implementation

Acknowledgment

This paper was invited by the Association of Children’s Residential Centers (ACRC). It was independently written. Helpful feedback was provided by Dr. James Whittaker, Dr. Elizabeth Farmer, and Kari Sisson, Executive Director of the ACRC. This paper does not constitute an official position of the ACRC but is an attempt to summarize the current knowledge on evidence-based practice and residential care. The paper is published in this journal since it was written with its target audience (practitioners, providers, policymakers, and researchers engaged with the field of residential care) in mind.

A version of the paper was presented as a Keynote Speech on 27 April 2017 under the title Best Practice Promising Models, Evidence Based Treatments: The Intricacies of Implementation at the 61st Annual Conference of the Association of Children’s Residential Centers in Portland, Oregon, USA.

Notes

1. While this review will primarily address policy and practice developments in the United States, a number of countries have experienced similar developments. However, it is important to note that considerable variability exists cross-nationally in the conceptualization, role and utilization of residential care (Ainsworth & Thoburn, 2014).

2. In this paper, I will use the generic term ‘residential care’ (primarily for the sake of ease), realizing the need for definitional and conceptual clarity of the role and function of residential care in the continuum of services for children and families as well as differing opinions on the best and most precise terminology to be used (e.g., Ainsworth & Thoburn, 2014; Butler & McPherson, 2007; Lee, 2008; Whittaker et al., 2014).

3. It deserves noting that evidence-based practice in this context was understood as treatments, interventions or services whose effectiveness was supported by carefully implemented scientific methods (Rosen & Proctor, 2002). This definition, which is now commonly associated with evidence-based practice, is more narrow than its original conceptualization, which described evidence-based practice as the integration of expert clinical practice, empirical support and client preference (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).

4. It is important to emphasize again that there are many countries where residential care is not seen as a ‘last-resort placement’ (e.g., Ainsworth & Thoburn, 2014; Courtney & Iwaniec, 2009). Compared to other countries, the United States has a very low rate of residential care utilization.

5. While CARE has not yet been reviewed and rated by the California Evidence-Based Clearinghouse, it is expected to receive a rating of “promising evidence” based on the outcome studies that have been conducted to date.

6. Readers are referred to (James et al., 2015) and (James et al., 2017) for a description of the survey’s methods.