High Quality Care

There is no one dimension that defines quality in residential care. Quality encompasses a combination of criteria, including general research on residential care’s positive outcomes, evidence-based practices, evidence-based programs (milieu-wide models), research-based program dimensions, performance standards and socially valid program observations.

Children whose needs are not addressed and who are further traumatized in failed family and out-of-home interventions can be successful in quality residential programs, according to general research findings.

Evidence-based practices are necessary to ensure and promote quality residential care for children. Merely placing children in care programs that may be substandard is not sufficient. These programs often fall short either because they do not address a child’s specific needs or because they are poorly implemented.

Milieu-wide, evidence-based models such as the Teaching Family Model, Stop Gap, Positive Peer Culture and Sanctuary are listed on research-evidence registries such as the California Evidence-Based Clearinghouse. All four models are rated as “promising,” but Teaching Family Model programs have the most research evidence AND are family-style in nature.

There are generally acknowledged “performance standards” that any quality residential program should meet. These include:

• individualized plans and service
• safe environments
• positive group culture
• effective response to needs/problems
• consumer-friendly
• family is involved/engaged
• cultural competence
• adhere to least-restrictive guidelines
• health care needs addressed
• educational and developmental needs met
• staff and program accountability
• post-care needs addressed
• outcomes addressed and produced

These standards should be present in one form or another in any quality residential program.

Finally, one of the best ways to determine the quality of any residential environment is the “social validity test.” This can be conducted by simply observing children, staff and the overall environment. Are children happy? Are children and staff engaged with one another? Are most of the children behaving well and showing an eagerness to learn? Is the program environment clean and organized? Do staff members have skills like enthusiasm, empathy, caring, positive affect, prosocial modeling and others that will promote and enhance learning by the children? Is the program family-style or family-like? If the answer to all these questions is “Yes,” the program is likely to produce positive long-term, lasting results.  

It's imperative that residential care programs hold themselves to the highest standards. Download a copy of what we measure ourselves against.