Comparing the Effectiveness of Home-based and Group-care Programs for Children and Young People: The Challenge and Path Forward

It is not unusual to see research studies or published opinion pieces that claim to demonstrate that home-based interventions (HBI) are more effective than group-care (GC) programs for young people with emotional and behavioral difficulties. The claim about the comparative effectiveness of HBIs in contrast to GC programs can only be true if they serve the same population of young people by age, gender, and degree of emotional and behavioral difficulties and that the outcomes for HBIs are statistically significantly better than those for GC. There is a long-standing argument between those who think that GC programs are unnecessary in comparison to those who think a mature child welfare system will always need some GC programs, albeit for a few young people with extreme difficulties. This article explores this issue in terms of how legitimate comparisons can be made between these two forms of service and how case-mix adjustment provides an established method for doing this. The purpose is to move away from ideological posturing by advocates from either side of the argument and put the debate about these forms of service and their effectiveness onto a firmer evidence base.