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CLM Releases Report on High Acuity Youth in Congregate Care

March 31, 2023

March 31, 2023

The Children's League of Massachusetts (CLM) released a report on “high acuity” adolescents living in congregate care within the child welfare system.

In Massachusetts, the reliance on congregate care in child welfare has been slowly declining. This decline has led to a reduction in the number and types of care setting spaces and more selective removal of children, which has resulted in a higher concentration of "high acuity" adolescents residing in congregate care. Youth whom we think of as “high acuity” youth are those whose behavioral, mental health, and/or medical management needs are mismatched to the care setting in which they are placed. These mismatches create situations where youth can be highly disruptive; can cause harm to themselves, their peers and staff; and negatively impact the environment and effectiveness of these care settings.

CLM surveyed our members who provide residential care to adolescents and young adults to learn more about these youth, to understand what we mean by "high acuity" and the impact of these behaviors, and to identify solutions to improve our ability to meet the needs of these youth while also maintaining safe and healing environments.

"During times of escalation, this youth struggled to self-regulate independently. She became both verbally and physically assaultive to adults, causing staff injury and peers, causing injury and the need for medical treatment…She went missing for several days and sometimes weeks at a time, ending up in other states. During that time, she also engaged in substance use and high-risk sexual behavior. This behavior was not present upon intake, but as time in congregate care lengthened, her behaviors regressed, as did her engagement in treatment. Her substance use was also becoming daily, and she was exposing other youth and encouraging them to leave the program and use substances with her."

- Regarding female youth, age 15

The Findings:
There are six key recommendations that CLM urges the Department of Children and Families (DCF), partner agencies, and other organizations to adopt in order to better serve vulnerable youth in congregate care and better support provider staff who work directly with these youth.

  1. Commit to the partner relationship-building necessary to make thoughtful placement decisions.
  2. Improve transparency, completeness, and collaboration between DCF and providers when making referrals in order to set programs and youth up for success.
  3. Foster opportunities for local system-building that bring together all agencies and providers who contribute to youth care in a community.
  4. Stand up more robust and secure care settings that meet the needs of higher intensity youth who don’t fit the standard congregate care model.
  5. Stand up more options for older youth who are getting ready to age out of DCF but need significant and deliberate support to either independent living or adult treatment services.
  6. Continue investing in solutions that reduce child removal and reliance on congregate care for children and families with lower-level needs.

CLM member providers working on the front lines contributed their stories and expertise for inclusion in the League's report. In order to collect this data, CLM also worked with agency partners and others who provided valuable feedback on the development of the high acuity youth survey and this report.

To open the full report in a different tab, click here.

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