This pilot study presents findings from a project to evaluate a program initiated by a state child welfare agency for its most hard-to-serve youth (N = 46). This emerging population is so dangerous and unmanageable that they are difficult, if not impossible, to place or treat. One state responded to this challenge by providing exceptional care through two residential treatment facilities who followed a no-eject, no-reject policy. Outcome data show that 85% of children had reductions in state-designated level of care and movement to less restrictive treatment placements. Differences in Children's Global Assessment Scale scores for Cohort 1 were statistically significant (t = –4.947, df = 24, p < .001). Staff assessment interviews delineated target behaviors, putative causes, mechanisms for change, and outcomes for children who successfully completed the program.
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