Characteristics of effective, harm-free environments for children in out-of-home care.

The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.