U.S. reports show a decreasing preference for residential care placements within child welfare: In the past five years there has been a 25% decline. Child welfare utilization rates for residential care are comparatively low, but data gaps exist for private placements and those in mental health and behavioral health residential settings. Recent national child welfare reform legislation (Family First) sets out standards and requirements for a class of short-term, treatment-focused residential treatment programs with strict standards for use. The chapter concludes with a standardized matrix that provides information on the current policy context, key trends and initiatives, characteristics of children and youth served, preparation of residential care personnel, promising programmatic innovations, and present strengths and challenges.