Topic: Higher Levels of Placement

Scientific Ratings in this topic:

1 - Well-Supported by Research Evidence

2 - Supported by Research Evidence

3 - Promising Research Evidence

4 - Evidence Fails to Demonstrate Effect

5 - Concerning Practice

NR - Not able to be Rated

Learn more about the scale

Definition for Higher Levels of Placement:

Higher Levels of Placement are defined by the CEBC as group, residential, and community treatment facilities in California with a rating classification level of 12 and above. (Note that there are approximately 15 rating classification levels of care for children in California, each of which represents more therapeutic and more restrictive care.) For information on the different levels, please click here: Child Welfare uses foster placement as a service to ensure the protection of children and youth who must be removed from the home of their parents or guardians because of the occurrence of abuse and neglect. Law and practice dictate that children be placed in the "least restrictive setting." The least restrictive placement for a child is in the home of their parent or guardian. The range of foster placements outside of the parents' or guardians' homes, from least to most, are the following: relative or non-related extended family member, foster family home, foster family agency home, group home, residential treatment center, and community treatment facility.

  • Target population: Children and youth in, or at risk for, higher levels of placement
  • Services/types that fit: Outpatient, day treatment, and residential services in individual or group formats that target youth directly or the caregivers who work with these youth
  • Delivered by: Mental health professionals, trained paraprofessionals, or child welfare staff
  • In order to be included: Program must specifically deliver higher level of placement services (e.g., group home model) or deliver services designed to be an alternative to placement in higher levels of care (e.g., treatment foster care)
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines 1) child welfare outcomes such as reductions in the use of higher levels of placement or placement disruptions, 2) changes in placement staff attitudes and behavior such as reduction in use of seclusion or restraint, and/or 3) behavior-related outcomes for youth/children such as changes in behavior, symptom levels, and/or functioning

Programs in this Topic Area

The programs listed below have been reviewed by the CEBC and, if appropriate, been rated using the Scientific Rating Scale.

One Program with a Scientific Rating of 1 - Well-Supported by Research Evidence:

  • Treatment Foster Care Oregon - Adolescents (TFCO-A)
    [Multidimensional Treatment Foster Care - Adolescents]
    Boys and girls, 12-17 years old, with severe delinquency and/or severe emotional and behavioral disorders who were in need ...

Two Programs with a Scientific Rating of 2 - Supported by Research Evidence:

  • Positive Peer Culture (PPC)
    High-risk youth in public, private, and alternative schools, and in residential settings, including juvenile corrections
  • Treatment Foster Care Oregon for Preschoolers (TFCO-P)
    [Multidimensional Treatment Foster Care for Preschoolers]
    Preschool foster children aged 3-6 years old who exhibit a high level of disruptive and antisocial behavior which cannot be ...

Five Programs with a Scientific Rating of 3 - Promising Research Evidence:

  • Children and Residential Experiences (CARE)
    Child care staff, clinical staff, and agency administrators working with 6- to 20-year-old children and youth living in group and ...
  • Intensive Alternative Family Treatment (IAFT®)
    Children and adolescents ages 5-18 years of age (allowable up to age 21 with approval) with high behavioral health needs requiring ...
  • Sanctuary Model
    This program is not a client-specific intervention, but a full-system approach that targets the entire organization with the intention of ...
  • Stop-Gap
    Children and/or adolescents with disruptive behavior disorders (Conduct disorder [CD], Oppositional Defiant Disorder [ODD], attention-deficit hyperactivity disorder [ADHD]) living ...
  • Teaching-Family Model (TFM)
    Youth who are at-risk, juvenile delinquents, in foster care, mentally retarded/developmentally disabled, or severely emotionally disturbed; families at risk ...

Two Programs with a Scientific Rating of NR - Not able to be Rated:

Why was this topic chosen by the Advisory Committee?

The Higher Levels of Placement topic area is relevant to child welfare because for over twenty years, child welfare has been concerned about the effects of higher level placements. It has been observed and documented that children and youth who are placed in higher levels of care can become institutionalized and therefore unable to return to normal family home environments. While therapeutic treatment is provided in higher levels of care, it does not always prepare children and youth to become accustomed to the intimacy of family life. Therefore, it is often a self-perpetuating intervention that results in children and youth become habituated to living in institutional environments and unable to return to either their own families or to be placed successfully in other family environments. Child welfare invests tremendous financial resources in these placements and then cannot find alternative placements once the mental health treatment has been successfully completed. As a result children and youth often are unable to leave the institutional environment despite having addressed the mental health issues that brought them there. Children and youth who have become institutionalized by this intervention often then move from one institutional placement to another until they leave the foster care system, thereby resulting in the child welfare agency's performing very poorly in the measure of placement stability. It is believed that alternative placement milieus such as Therapeutic Foster Care and Wraparound programs, which bring therapeutic interventions to a family environment, can be as successful as higher level placements in addressing the mental health needs of children and youth while avoiding the problem of institutionalization and the concomitant placement instability.

Stuart Oppenheim
Executive Director
Child & Family Policy Institute of California
Sacramento Office
Sacramento, CA

Topic Expert

The Higher Levels of Placement topic area was added in 2008. Sigrid James, PhD, LCSW was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2008 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2008 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. James was not involved in identifying or rating them.