Residential treatment center

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance abuse, mental illness, or other behavioral problems. Residential treatment should, in many cases, be considered the "last-ditch" approach to helping a child with severe problems.

Children and teens

RTCs for adolescents provide treatment for issues and disorders such as Oppositional Defiant Disorder, Conduct Disorder, Depression, Bi-polar Disorder, ADHD and ADD, educational issues, some personality disorders, phase of life issues, drug and alcohol abuse, etc. [2] Most work from a behavior modification paradigm. A few are more relationally oriented. A smaller few utilize a community or positive peer culture model. Generalist programs are usually large (80 plus and as many as 250 at times) and level-focused in their treatment approach. In order to manage student behavior they frequently put systems of rewards and punishments in place. Specialist programs are usually smaller (less than 100 and as few as 10 or 12). Specialist programs are not as overwhelmingly focused on behavior modification as generalist programs are.

Different RTCs work with different grades of problems, and so the structure and methods of RTCs varies. Some RTCs are lock-down facilities; that is, the residents are locked inside the premises; however, other RTCs don't lock the residents in. In a locked residential treatment facility, patients movements are severely restricted, usually to a single room or cell. By comparison, an unlocked residential treatment facility allows patients to move about the facility with relative freedom, but they are only allowed to leave the facility under specific conditions. Residential treatment centers should not be confused with residential education programs, which offer an alternative environment for at-risk children to live and learn together outside their homes.

Residential treatment centers for children and adolescents treat multiple conditions from drug and alcohol addictions, to emotional and physical disorders as well as mental illnesses. Various studies on youth in residential treatment centers have found that many children in these facilities have had a history of family-related issues, often including physical or sexual abuse. Some facilities like Change Academy Lake of the Ozarks (CALO) address specialized disorders such as Reactive Attachment Disorder.

Residential treatment centers generally are clinically focused and primarily provide behavior management and treatment for adolescents with serious issues.[3] In contrast, therapeutic boarding schools provide therapy and academics in a residential boarding school setting, employing staffs of social workers, psychologists, and psychiatrists to work with the students on a daily basis. This form of treatment has a goal of academic achievement as well as physical and mental stability in children and young adults.[4] Recent calls have occurred to ensure that residential treatment facilities have more input from behavioral psychologists to improve outcomes and lessen unethical practice

Behavioral Interventions

Behavioral interventions have been very helpful in reducing some problem behaviors in residential treatment centers.[6] The type of most residential (conduct disorder youth versus mental retardation versus psychiatric populations) does appear to be a factor in the effectiveness of behavioral programming.[7] Behavioral intervention has been found to be successful even when medication interventions fail (i.e.[8]). There are some indications that some populations are better served by interventions outside the behavior modification paradigm. For instance, positive outcomes have been reported for neurosequential interventions targeting issues of early childhood trauma and attachment. ((Perry, B. D. (2006) . The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27-52 ). New York: The Guilford Press.))

Controversy

Disability rights organizations, such as the Bazelon Center for Mental Health Law, oppose placement in such programs and call into question the appropriateness and efficacy of such group placements, the failure of such programs to address problems in the child’s home and community environment, the limited or no mental health services offered and substandard educational programs. Concerns specifically related to a specific type of residential treatment center called therapeutic boarding schools include:

• inappropriate discipline techniques,
• medical neglect,
• restricted communication such as lack access to child protection and advocacy hotlines, and
• lack of monitoring and regulation.

Bazelon promotes community-based services on the basis that they are more effective and less costly than residential placement.

From late 2007 through 2008, a broad coalition of grass roots efforts, prominent medical and psychological organizations that including members of Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART) and the Community Alliance for the Ethical Treatment of Youth (CAFETY), provided testimony and support that led to the creation of the Stop Child Abuse in Residential Programs for Teens Act of 2008 by the United States Congress Committee on Education and Labor.

Jon Martin-Crawford and Kathryn Whitehead of CAFETY testified at a hearing of the United States Congress Committee on Education and Labor on April 24, 2008, where they described abusive practices they had experienced at the Family Foundation School and Mission Mountain School, both therapeutic boarding schools.

Due to the absence of regulation of these programs by the federal government and because many are not subject to state licensing or monitoring, the Federal Trade Commission has issued a guide for parents considering such placement.

Research on effectiveness

Studies of different treatment approaches have found that residential treatment is effective for individuals with a long history of addictive behavior or criminal activity. RTCs offer a variety of structured programs used to accommodate their residents' needs.

See also

Related topics

• Anti-psychiatry
• Behavior modification facility
• Therapeutic boarding school

Specific Programs

• CALO - Change Academy at Lake of the Ozarks (Missouri)
• Bridges To Recovery
• C. K. Post Addiction Treatment Center
• Provo Canyon School
• West Ridge Academy
• Sorenson's Ranch School

External links

• RESIDENTIAL TREATMENT PROGRAMS Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth
• RESIDENTIAL FACILITIES State and Federal Oversight Gaps May Increase Risk to Youth Well-Being
• RESIDENTIAL PROGRAMS Selected Cases of Death, Abuse, and Deceptive Marketing