Use of Group Care for Children in Foster Care

Use of Group Care for Children in Foster Care

May 12, 2015
Use of Group Care for Children in Foster Care
Foster care is a temporary living arrangement meant to
Nationally, the number of children in group care fell 37%,
ensure a child’s safety. Children most commonly enter
from 89,000 on the last day of FY2004 to 56,000 on the last
foster care due to neglect or abuse experienced at the hand
day of FY2013. As shown in Figure 1, on the low end four
of their parent, and some children may also have significant
states had 5% or less of their foster children in group care,
behavior problems. Foster care is provided on a 24-hour
while on the high end four states had from one-fourth (25%)
basis in a foster family home of a relative or non-relative or
to about one-third (34%) in group care (WV, WY, RI, CO).
in various non-family settings. Those non-family settings,
referred to collectively in this brief as “group care,” range
Figure 2. Foster Children in Group Care by Age
from those that provide specialized treatment or other
As a % of all children in the given age group in care on the last day
services to more general care settings or shelters. They may
of FY2013
be settings serving as few as seven children or institutions
serving hundreds. Among children entering foster care in
FY2008, 20% experienced group care at some point during
the next five years and their average length of stay in group
care was nine months.
Some argue that group care should only be used to meet
specialized mental or behavioral health needs of foster
children (and for a limited treatment time), that it should
rarely or never be used for younger children, and that better

Source: Prepared by CRS based on state-reported Adoption and
quality services are needed. At the same time, states may
Foster Care Analysis and Reporting System (AFCARS) data.
struggle to assess and place children in foster families on an
emergency basis and may have few foster families willing
Notes: Group care includes “group homes” or “institutions.”
and qualified to care for foster children with specialized
The use of group care also varies significantly by age, with
needs (e.g., pregnant teens, medically fragile children or
the likelihood that a foster child is in group care increasing
those with behavioral or mental health needs). Additionally,
with a child’s age. (See Figure 2.) Although on a given day
teens who have shuttled between multiple foster family
teenagers are far more likely to be in group care than younger
homes may seek group care.
children, among children who entered care in FY2008 and
experienced some time in group care over the next five years,
Foster Children in Group Care
fully 31% had entered foster care before age 12. Compared to
teens who spent time in group care, these younger foster
On the last day of FY2013 there were more than 402,000
children were more likely to have a very short stay (less than
children in foster care and 14% of these children were
one week) and were far less likely to have a reported clinical
living in group care. This percentage varies considerably by
or behavioral concern that might suggest a need for
state. See Figure 1.
specialized care.
Figure 1. Foster Children in Group Care by State
Federal Support for Foster Care
As a % of all children in state’s caseload on last day of FY2013
Under Title IV-E of the Social Security Act (SSA) the federal
government repays states for a part of the cost of providing
foster care to every child who meets all federal eligibility
criteria. There are multiple criteria, and they pertain to the
reason for a child’s removal from home, household income,
and the child’s age and placement setting. In FY2013, about
40% of children in foster care met all federal IV-E eligibility
criteria. During that year, states spent $8.0 billion for foster
care under the Title IV-E program and received federal
reimbursement for $4.3 billion (53%) of those costs.
Foster children are not eligible for Title IV-E support (and

must be supported with non-Title IV-E dollars) if they are
Source: Prepared by CRS based on HHS, Children’s Bureau, A
placed in an unlicensed family or group care setting or in
National Look at the Use of Congregate Care in Child Welfare, (2015).
“detention facilities, forestry camps, training schools, or any
Notes: Group care includes “group homes” or “institutions.”
other facility operated primarily for the detention of children
Jurisdictions of DC (8%) and PR (17%) not shown.
who are determined to be delinquent.” Further, IV-E support
is only available for foster children placed in a public
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Use of Group Care for Children in Foster Care
institution if it houses 25 or fewer children; there is no limit
Among children 13 or older who entered foster care in
on the size of a private institution (Sec. 472(c) of the SSA).
FY2008 and who spent some time in group care during the
next five years, 45% had a “child behavior problem” as a
Family care, especially for young children, is believed to best
reason for removal, 29% had no reported clinical or
nurture children’s development and is generally less
behavioral indicators, 20% had a mental health diagnosis,
expensive than group care. In finding a safe place for a child
and 6% had a non-mental health clinical diagnosis. Among
to live while in foster care, federal law has long required
these teens without a clinical or behavioral indicator, 52%
states to identify the “least restrictive” and most family-like
were placed directly in group care; 21% spent one week or
setting that is appropriate to the child’s need and in close
less in group care, but a nearly equal share (19%) spent
proximity to the child’s home (Sec. 475(5)(A) of the SSA).
more than a year in group care. Among those teens with a
At the same time, some children in foster care may have
mental health diagnosis and who spent time in group care,
treatment needs that are best met, or have traditionally been
9% had been adopted prior to their FY2008 entry to foster
met, in group care settings. The Children’s Bureau, the
care, most (62%) lived in three or more placements while in
agency within the Administration for Children and Families
foster care and 38% spent more than a year in group care.
(ACF) at the U.S. Department of Health and Human Services
These findings may suggest a need for better mental health
(HHS) that administers federal child welfare programs,
assessment at entry to care or other steps to reduce
analyzed current usage of group care for children in foster
placement instability and length of stay in group care.
care and suggests that children who entered foster care in
some part due to a “child behavior problem” and those with a
Actions or Proposals to Reduce Use of
professionally diagnosed mental health issue have the
Group Care for Foster Children
greatest need for specialized care.
Among states that have shown reduced use of group care,
challenges included a lack of appropriate family placement
Clinical or Behavioral Indicators
settings, workforce development and training issues, and
While a sizeable minority (29%) of foster children living in
limits on financial and staff resources. Strategies to reduce
group care on the last day of FY2013 had no reported
the use of group care have included expanding family-based
clinical or behavioral indicators, most did. (See Figure 3.)
placement options by locating kin, and by paying foster
Foster children living in group care were six times more
families to keep beds available for emergency placements.
likely than other children in foster care to have a “child
For children with specialized needs, some states have
behavior problem” reported as a reason for foster care entry
worked with group care providers to re-structure services to
and were almost three times as likely to have been
allow for community-based services; and others partnered
professionally diagnosed with a mental health disorder
child welfare and medical case managers to support family-
(based on the classifications used in the Diagnostic and
based care. As part of ensuring appropriate use of group
Statistical Manual of Mental Disorders, DSM). Among
care for children in foster care, these states stressed the
foster children with a non-mental health clinical diagnosis
importance of skilled staff, use of data to examine use of
(e.g., cognitively impaired) the share in group care was
group care, an assessment and review process to determine
similar to those not in group care.
if and when group care must be used or continued, and
evaluation of outcomes achieved by group care providers.
Figure 3. Foster Children in Group Care by Any
Reported Clinical or Behavioral Indicator
Some recent proposals, both on and off Capitol Hill, have
As a % of all foster children in group care on last day of FY2013
sought to limit federal Title IV-E support for children
placed in most group care settings, including by barring it
entirely for younger children, or by limiting the length of
time a foster child may be in group care and receive Title
IV-E assistance. In its FY2016 budget, the Administration
seeks legislative changes that would require greater review
of group care placement decisions by state child welfare
agencies, including court oversight. The Administration
also seeks to increase availability of family-based
therapeutic care through training and federal IV-E support
for salaries for foster parents providing a therapeutic
environment for children in care; specialized caseworker
training and enhanced federal support for caseworkers
supporting these families; and new federal Title IV-E

support for daily supervision costs related to day treatment
Source: Prepared by CRS based on HHS, Children’s Bureau, A
programs for children who are able to live in family-based
National Look at the Use of Congregate Care in Child Welfare, (2015).
care but continue to require such interventions.
Notes: Categories are mutually exclusive. “Other clinical diagnosis”
refers to non-DSM diagnosis made by a professional (e.g., physical
Emilie Stoltzfus, Specialist in Social Policy
impairment, severe medical condition, cognitive disability).
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Use of Group Care for Children in Foster Care

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