Predictors of Residential Placement Following a Psychiatric Crisis Episode Among Children and Youth in State Custody Jung Min Park, PhD University of Illinois at Urbana–Champaign Neil Jordan, PhD Northwestern University Richard Epstein, PhD Vanderbilt University David S. Mandell, ScD University of Pennsylvania John S. Lyons, PhD University of Ottawa This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care, 51% were so placed within 3 months of their 1st crisis screening, with an additional 22% placed between 3 and 6 months after screening. Risk behavior and functioning, psychiatric hospitalization following screening, older age, placement type, and caregiver’s capacity for supervision were associated with increased residential placement. The findings highlight the importance of early identification and treatment of behavior and functioning problems following a crisis episode among children and youth in state custody to reduce the need for subsequent residential placement. Having an inpatient psychiatric episode following a crisis episode places children at greater risk for residential placement, suggesting that the hospital is an important point for diversion programs. Children and youth in psychiatric crisis may also benefit from efforts to include their families in the treatment process. Keywords: residential care, children and youth in state custody, psychiatric crisis Of 513,000 U.S. children and adolescents in out-of-home care in 2005, 18% were in a residential or group care setting (U.S. Department of Health and Human Services [DHHS], 2006). Place- ment in residential care mainly aims to provide a safe living environment that can protect youth from their own dangerous behavior, protect others from the youth’s dangerous behavior, or facilitate the treatment of emotional or behavioral problems (Wells & Whittington, 1993; Whittaker, 2004; Whittaker & Pfeiffer, 1994). Although widely regarded as a necessary placement option in any comprehensive continuum of care, residential care is both restrictive and expensive, and its effectiveness has not been clearly demonstrated (Burns, Hoagwood, & Mrazek, 1999; Farmer, Dorsey, & Mustillo, 2004; Lyons, 2004). Residential care costs 6.6 times more than traditional foster care and more than twice as much as treatment foster care (Barth, 2002). Care in residential treatment facilities costs between $80,000 and $350,000 per child annually (Lyons, 2004). As a consequence, although only 8% of youth who receive mental health services are in residential care nationally, they account for approximately 25% of total mental health care expenditures (Burns et al., 1999), with considerable variation by state. In California, the 8% of children in residential care account for 37% of out-of-home care expenditures for chil- dren in foster care (Barth, 2002). Evidence on the benefits of residential care, even for children with serious mental disorders, is mixed. For example, a follow-up of 123 adolescents with severe psychiatric problems reported that intensive, short-term residential treatment resulted in a significant decline in symptoms and a reliable improvement in functioning from admission to discharge, and those changes were sustained for the year following discharge (Leichtman, Leichtman, Barber, & Neese, 2001). Another study of youth in treatment foster care and family-style group care showed that group care youth were more likely to be favorably discharged, more likely to return home, and less likely to experience a subsequent formal placement in the first 6 months after discharge (Lee & Thompson, 2008). A statewide study found that residential treatment is effective at reducing Jung Min Park, PhD, School of Social Work, University of Illinois at Urbana–Champaign; Neil Jordan, PhD, Mental Health Services and Policy Program, Northwestern University; Richard Epstein, PhD, Department of Psychiatry, Vanderbilt University; David S. Mandell, ScD, Departments of Psychiatry and Pediatrics, University of Pennsylvania; John S. Lyons, PhD, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. This project was supported by the Children and Family Research Center, School of Social Work, University of Illinois at Urbana–Champaign, which is funded in part by the Department of Children and Family Services. For reprints and correspondence: Jung Min Park, PhD, School of Social Work, University of Illinois at Urbana–Champaign, 1010 East Nevada Street, Urbana, IL 61801. E-mail: parkjm@illinois.edu American Journal of Orthopsychiatry © 2009 American Psychological Association 2009, Vol. 79, No. 2, 228 –235 0002-9432/09/$12.00 DOI: 10.1037/a0015939 228