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September 18, 2008

Out-of-Home Services for Emotional or Behavioral Problems among Youths Aged 12 to 17: 2002 to 2006

In Brief
  • Combined data from 2002 to 2006 indicate that an estimated 2.6 percent of youths aged 12 to 17 reported receiving out-of-home services for emotional or behavioral problems in the past 12 months in a hospital, a residential treatment center, or a foster care or therapeutic foster care setting
  • Among youths aged 12 to 17 who received any type of out-of-home services for emotional or behavioral problems in the past 12 months, about half reported staying only for 1 or 2 nights
  • The reported length of time spent in out-of-home service settings in the past year varied by gender; in general, male youths aged 12 to 17 were more likely to report having stayed for 1 night, while their female counterparts were more likely to report having stayed for 7 nights or longer

During the past two decades, there have been marked changes in inpatient, residential, and foster care services (hereinafter referred to as "out-of-home mental health services") for children and adolescents with emotional or behavioral problems. For example, the median length of stay for inpatient care fell by more than half from 12.2 days in 1990 to 4.5 days in 2000.1 Although there is concern about the negative effects of out-of-home placements on youths with emotional or behavioral problems, these services are sometimes necessary. However, very short stays are a concern as health professionals may not have enough time to effectively evaluate an initial course of treatment.2

The National Survey on Drug Use and Health (NSDUH) includes questions for youths aged 12 to 17 about treatment and counseling received in the past 12 months for problems with behavior or emotions not caused by alcohol or drugs. In NSDUH, "out-of-home mental health services" for emotional or behavioral problems among youths include services delivered in an overnight or longer stay in (a) any type of hospital, (b) a residential treatment center (RTC),3 or (c) a foster care or therapeutic foster care (FC/TFC) home.4 Those who have received services during the past year in any of these settings are asked to report how many nights during the past year they spent in each service setting.5

This issue of The NSDUH Report examines utilization of out-of-home mental health services among youths aged 12 to 17. All findings presented in this report are annual averages based on combined 2002 to 2006 NSDUH data.


Out-of-Home Mental Health Services among Youths

Combined data from 2002 to 2006 indicate that an estimated 2.6 percent of youths aged 12 to 17 (approximately 657,000 persons) reported receiving out-of-home services for emotional or behavioral problems in the past 12 months in a hospital, a residential treatment center, or a foster care or therapeutic foster care setting (Table 1). Overall, 2.0 percent of youths reported staying overnight or longer in a hospital, 1.0 percent reported staying overnight or longer in an RTC, and 0.6 percent reported staying at least one night in an FC/TFC home. Of the youths who reported receiving any out-of-home mental health services, 74.6 percent received services in a hospital, 36.8 percent received services in an RTC, and 23.3 percent received services in an FC/TFC home.6

Table 1. Percentages of Youths Aged 12 to 17 Who Received Out-of-Home Services for Emotional or Behavioral Problems in the Past Year, by Gender and Age Group: 2002 to 2006
Out-of-Home Service Total Gender Age in Years
Male Female 12 or 13 14 or 15 16 or 17
Any Type of Overnight or Longer Stay 2.6% 2.8% 2.5% 2.3% 2.7% 2.9%
Overnight or Longer Stay in Any Type of Hospital 2.0% 2.1% 1.8% 1.7% 2.0% 2.2%
Overnight or Longer Stay in a Residential Treatment Center 1.0% 1.0% 1.0% 0.7% 1.0% 1.2%
Overnight or Longer Stay in Foster Care or in a Therapeutic Foster Care Home 0.6% 0.7% 0.6% 0.5% 0.6% 0.7%
Source: SAMHSA, 2002-2006 NSDUHs.

The percentage of youths aged 12 to 17 who received out-of-home mental health services in the past year differed by gender and age group. Overall, male youths were more likely than female youths to report receiving any out-of-home mental health services in the past 12 months (2.8 vs. 2.5 percent) and to have received those services in a hospital (2.1 vs. 1.8 percent). Youths aged 12 or 13 were less likely than older youths to report receiving out-of-home mental health services in any setting in the past 12 months and to have received such services either in a hospital or in an RTC. There was no difference across age groups in the rates of services received in an FC/TFC home.


Time Spent in Out-of-Home Mental Health Service Settings in the Past Year

Among youths aged 12 to 17 who received any type of out-of-home services for emotional or behavioral problems in the past 12 months, about half reported staying only 1 or 2 nights (Figure 1). Overall, 33.3 percent of them stayed for only 1 night, and another 16.5 percent stayed for 2 nights.

Figure 1. Percentages of Youths Aged 12 to 17 Who Received Any Out-of-Home Services for Emotional or Behavioral Problems in the Past Year, by Length of Stay*: 2002 to 2006
This figure is a pie graph comparing percentages of youths aged 12 to 17 who received any out-of-home services for emotional or behavioral problems in the past year, by length of stay*: 2002 to 2006

Figure 1 Table. Percentages of Youths Aged 12 to 17 Who Received Any Out-of-Home Services for Emotional or Behavioral Problems in the Past Year, by Length of Stay*: 2002 to 2006
Length of Stay Percent
1 Night 33.3%
2 Nights 16.5%
3 to 6 Nights 21.0%
7 to 24 Nights 17.5%
25 or More Nights 11.8%
Source: SAMHSA, 2002-2006 NSDUHs.

The number of nights spent in out-of-home settings in the past year varied by setting (Figure 2). For example, 48.1 percent of youths aged 12 to 17 who reported receiving hospital care stayed for only 1 night compared with 40.4 percent of those who reported staying in an FC/TFC home and 36.2 percent of those who reported staying in an RTC.

Figure 2. Percentages of Youths Aged 12 to 17 Who Received Out-of-Home Services for Emotional or Behavioral Problems by Service Setting and Length of Stay*: 2002 to 2006
This figure is a vertical bar graph comparing percentages of youths aged 12 to 17 who received out-of-home services for emotional or behavioral problems by service setting and length of stay*: 2002 to 2006. Accessible table located below this figure.

Figure 2 Table. Percentages of Youths Aged 12 to 17 Who Received Out-of-Home Services for Emotional or Behavioral Problems by Service Setting and Length of Stay*: 2002 to 2006
Length of Stay Any Type of Hospital Residential Treatment Center Foster Care or Therapeutic
Foster Care Home
1 Night 48.1% 36.2% 40.4%
2 Nights 14.7% 16.1% 15.6%
3 to 6 Nights 18.7% 17.8% 12.8%
7 to 24 Nights 14.8% 20.5% 11.9%
25 or More Nights   3.6%   9.5% 19.2%
Source: SAMHSA, 2002-2006 NSDUHs.

The reported length of time spent in out-of-home service settings in the past year also varied by gender. In general, male youths aged 12 to 17 were more likely to report having stayed for 1 night, while their female counterparts were more likely to report having stayed 7 nights or longer (Figure 3). For example, 36.4 percent of male youths spent only 1 night in the past year in out-of-home service settings for emotional or behavioral problems compared with 29.8 percent of female youths, while female youths were more likely than male youths to have stayed 7 to 24 nights (21.9 vs. 13.6 percent).

Figure 3. Percentages of Youths Aged 12 to 17 Who Received Out-of-Home Services for Emotional or Behavioral Problems in Any Setting by Gender and Length of Stay*: 2002 to 2006
This figure is a horizontal bar graph comparing percentages of youths aged 12 to 17 who received out-of-home services for emotional or behavioral problems in any setting by gender and length of stay*: 2002 to 2006

Figure 3 Table. Percentages of Youths Aged 12 to 17 Who Received Out-of-Home Services for Emotional or Behavioral Problems in Any Setting by Gender and Length of Stay*: 2002 to 2006
Length of Stay Male Female
1 Night 36.4% 29.8%
2 Nights 17.8% 15.0%
3 to 6 Nights 21.8% 20.1%
7 to 24 Nights 13.6% 21.9%
25 or More Nights 10.4% 13.3%
Source: SAMHSA, 2002-2006 NSDUHs.


End Notes
1 Case, B. G., Olfson, M., Marcus, S. C., & Siegel, C. (2007). Trends in the inpatient mental health treatment of children and adolescents in US community hospitals between 1990 and 2000. Archives of General Psychiatry, 64, 89-96.
2 Martin, A., & Leslie, D. (2003). Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997-2000. American Journal of Psychiatry, 160, 757-764.
3 Residential treatment centers (RTCs) provide facility-based care 24 hours a day, 7 days per week, for children and adolescents with serious emotional disturbance. RTCs offer mental health services in a controlled environment.
4 Therapeutic foster care (TFC) is a service for children with serious emotional or behavioral needs who cannot be cared for in their own homes. TFC programs recruit, train, and support foster families, who generally take in only one child, although they also may have biological or adopted children of their own. The families are closely supervised and supported, and they receive a monthly stipend.
5 Respondents with unknown data on the number of days spent in these out-of-home settings in the past year, and those whose total number of days added to more than 366, were excluded from the analyses.
6 Respondents could report receiving services in multiple settings; thus, these response categories are not mutually exclusive and do not add to 100 percent.


Figure Note
* See End Note 5.

Suggested Citation
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (September 18, 2008). Out-of-Home Services for Emotional or Behavioral Problems among Youths Aged 12 to 17: 2002 to 2006. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2002 to 2006 data used in this report are based on information obtained from 114,016 youths aged 12 to 17. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Office of Applied Studies. (2007). Results from the 2006 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 07-4293, NSDUH Series H-32). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Information for earlier NSDUHs is available in the following publications:

2005 NSDUH: (DHHS Publication No. SMA 06-4194, NSDUH Series H-30)
2004 NSDUH: (DHHS Publication No. SMA 05-4062, NSDUH Series H-28)
2003 NSDUH: (DHHS Publication No. SMA 04-3964, NSDUH Series H-25)
2002 NSDUH: (DHHS Publication No. SMA 03-3836, NSDUH Series H-22)

Also available online: http://oas.samhsa.gov.
Because of improvements and modifications to the 2002 NSDUH, estimates from the 2002 through 2006 surveys should not be compared with estimates from the 2001 or earlier versions of the survey to examine changes over time.

The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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This page was last updated on December 30, 2008.