The purpose of this study was to evaluate the “Exceptional Care Pilot Project” initiated by a state child welfare agency for its 30 most difficult-to-place children. Their problems were so severe that no residential treatment center or psychiatric hospital would admit them. Two residential facilities contracted to provide these services.


A modified single system design was used to plot a timeline by week for each child based on progress measures constructed from daily treatment records. Outcome data was collected from the information system of a private agency under state contract to designate changes in children’s’ level of care, level of care domains, and global assessments of functioning (CGAS). A profile of the population was created by the extraction and assignment of pertinent data from case files to pre-established categories.


Aggregated descriptive statistics from each child’s timeline data were derived across subjects over time. Although findings from daily treatment recoreds were not significant, children who completed E6 placements showed less volatility in patterns and a decreased need for special treatment restrictions or physical restraints. Outcome data showed that 85% of children had reductions in state-designated level of care and movement to less restrictive treatment placements. Moreover, mean score changes in CGAS for the full population were significant (t = -45.947; df = 24, p<.0001). Finally, the evaluation provided a detailed profile of the children who needed this type of care.


This study provides information to other states about the outcome of a specialized program to treat this emerging population of increasingly difficult-to-place children. It also highlights the challenge of how to determine an appropriate design to evaluate outcomes when the number of participants is small, no comparison group exists, and data are limited to existing records.