Congregate Care and Risk of Delinquency: A Reexamination Accounting for Pre-Existing Youth Behavioral Risk

Purpose: Efforts to reduce the use of congregate care (CC) as an out-of-home placement (OHP) are motivated by studies linking CC to delinquency and other adverse outcomes. However, because CC is an OHP of last resort, associations may reflect pre-existing behavioral health differences between adolescents in CC versus other OHPs. Thus, this study examines the following 3 questions: (1) Is CC associated with delinquency, net of pre-existing behavioral health?; (2) Does the association between CC and delinquency vary as a function of children's pre-existing behavioral health?; and (3) Do these associations differ during verse after placement? Methods: The study examines all youth (11–17 years) entering OHP in Pennsylvania in 2015–2018. Youth behavioral health risk is measured using pre-OHP indicators from child welfare, juvenile justice, and Medicaid records. We estimate the probability of a new delinquency referral within 12 months of OHP and whether delinquency is occurring during or after the OHP. Results: Less than 10% of youth without known behavioral health risk were in CC. Accounting for pre-existing behavioral risk modestly attenuates the association between CC and delinquency. Moderation analyses reveal that the association is strongest for low-risk youth and disappears for youth with a history of delinquency before placement. Rates of delinquency were highest after OHP, regardless of placement type. Discussion: Given the limited alternatives for placement, youth with high levels of behavioral health risk may benefit more from efforts to increase the quality of CC. Rates of delinquency referral are highest postplacement, regardless of prior placement type.