Direct Care Staff Vacancies and Adverse Youth Events in Illinois Child Welfare Residential Treatment During the COVID-19 Pandemic

Direct care staff provide 24/7 care and supervision in residential treatment for youth; vacancy rates for these positions increased significantly during the COVID-19 pandemic. This study used multi-level, two-stage least squares regression to examine the relationship between staff vacancies and adverse events experienced by 1352 youth in Illinois child welfare residential care during October 2019-February 2022. Hierarchical cluster analysis was used to explore whether particular adverse event clusters were differentially related to vacancy rates. We hypothesized that direct care staff vacancies would be related to an increased number of adverse events overall and a specific increase in safety-related events. Although direct care staff vacancies were not significantly related to the overall number of adverse events, they were significantly associated with the magnitude of adverse events related to school suspensions, substance use, and law enforcement encounters. Several other novel, unanticipated findings emerged, with various youth- and facility-level factors (e.g. race, age, length of admission, facility level of clinical acuity) showing significant relationships with the magnitude of adverse events. This study fills a notable gap in the literature in its novel empirical approach to exploring administrative data capturing direct care staffing and adverse events in child welfare residential care.