Therapeutic boarding school
A therapeutic boarding school (TBS), alternatively known as an emotional growth boarding school, is a boarding school based on the therapeutic community model that offers an educational program together with specialized structure and supervision for students with emotional and behavioral problems, substance abuse problems, or learning difficulties.
In contrast with residential treatment programs, which are more clinically focused and primarily provide Behaviour therapy and treatment for adolescents with serious issues, the focus of a TBS is toward emotional and academic recovery involving structure and supervision for physical, emotional, behavioral, family, social, intellectual and academic development. Therapeutic and educational approaches vary greatly; with the approaches best described as a “tapestry” of interventions. The typical duration of student enrollment in a TBS range from one to two years. Students may receive either high school diplomas or credits for transfer to other secondary schools. Some therapeutic boarding schools hold educational accreditation. In his 2005 book, journalist David L. Marcus estimated that dozens of therapeutic schools have been established in the United States since the 1970s, operated by both private corporations and nonprofit agencies. Marcus described one of these schools as follows:
[The school's] curriculum defies easy explanations. It was a patchwork of theories of leading behavioral psychologists of the twentieth century, mixed with techniques from twelve-step programs, California feel-good movements, Big Sur group processing, and Esalen-style encounters. The curriculum drew from the pioneering Swiss philosopher and psychologist Jean Piaget, who believed that children must learn at their own pace. And Erik Erikson, who argued that a person’s ability to resolve conflicts during critical transitions early in life is an indicator for later happiness. And, especially at base camp, [The school] borrowed from Abraham Maslow. He had charted a hierarchy of needs, starting with the physical – air, food, water – and ascending through self-esteem, belonging, love, and finally to truth and beauty.
The school wasn't trying to turn rampaging teenagers into cherubic clones. It was trying to help kids rediscover their talents, to give them tools to deal with inevitable setbacks and pain. [The school] started by reducing newcomers to coping with primordial needs – potable water, shelter, a comfortable temperature. As they fulfilled Maslow’s hierarchy, they started to think about who they really were.
Emotional Growth Education
The term "emotional growth education" was created by Linda Houghton in the early 1980s to describe workshops and other specialty programs at the first CEDU School. The term was intended to clearly define how the curriculum used child development principles and healthy stages of growth to create self-esteem and develop greater skills in communication, work ethic, self-awareness and academic study. She used the principles of child development as described by Erik Erikson to bring understanding of the emotional growth workshop curriculum to parents, faculty and referring professionals. Ms. Houghton went on to found two schools (Mount Bachelor Academy and the King George School) attempting to refine what she calls "holistic education" or "a new way of looking at things". These schools and programs were designed as models for the integration of emotional growth, academics, the arts and other specialized learning.
There are subtle differences between emotional growth and therapeutic schools. Emotional growth theory developed from the idea that immaturity was the reason for behavior problems in teens. With a tightly structured community where consequences for behavior were immediate and appropriate, the student might learn from his/her mistakes and grow appropriately. However, a strictly emotional growth curriculum is considered ineffective for students with deep-seated trauma or serious psychiatric disorders such as bipolar, anorexia, etc. A TBS will add clinical treatments to the emotional growth curriculum, including medications, for students with more serious disorders. The original emotional growth programs rarely incorporated medications for the students. Over the years, as more schools and programs were created, the term "emotional growth" was used and misused to describe vastly different therapeutic schools that sometimes did not adhere to the basic components needed for true emotional growth education.
Troubled Teen Industry
The National Association of Therapeutic Schools and Programs listed 140 schools and programs as of 2005. Educational consultants say the total number of programs available is closer to 300. The market for this industry appears to be expanding; there seemed to be less of a stigma about seeking therapy today. Educational consultant Lon Woodbury stated "All indications are that the market is still growing. The consensus is that increasing numbers of children are in trouble and are not growing up very well."
Bazelon Center for Mental Health Law, a disability rights organization, opposes placement in therapeutic boarding schools, equating them with residential treatment centers. The organization questions the appropriateness and efficacy of group placements, citing failure of some programs to address problems in the child’s home and community environment, lack of mental health services, and substandard educational programs. Concerns specifically related to private therapeutic boarding schools include inappropriate discipline techniques, medical neglect, restricted communication (such as lack of 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 coalition of medical and psychological organizations that included 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.
U.S. Government Accountability Office Report
According to the U.S. Government Accountability Office Report:
GAO reviewed thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007. Allegations included reports of abuse and death recorded by state agencies and the Department of Health and Human Services, allegations detailed in pending civil and criminal trials with hundreds of plaintiffs, and claims of abuse and death that were posted on the Internet. GAO did not attempt to evaluate the benefits of residential treatment programs or verify the facts regarding the thousands of allegations it reviewed.
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In 2006, the results of a study conducted between 2003 and 2005 involving 993 students from 9 schools was presented at the 114th Annual Convention of the American Psychological Association. The study made use of the Youth outcome questionnaire certified by BYU in terms of internal consistency, test-retest reliability, and concurrent validity as well as being a valid and reliable self-report measure of psychosocial distress in youth psychotherapy research.
In addition, many therapeutic boarding schools in the United States are relatively unregulated. The United States Federal Trade Commission (FTC) has recommended that decision makers ensure that any therapeutic program is accredited by JACHO, COA, or CARF International. Instead, however, many of these programs are instead members of NATSAP, a non-accrediting membership body, which does not enforce ethical nor any other kind of regulations on its member programs and does not investigate allegations of professional misconduct and/or abuse of students.
- NATSAP Program Definitions, NATSAP National Association of Therapeutic Schools and Programs, accessed January 4, 2009
- Types of Boarding School, Boarding School Review website, accessed January 5, 2009
- Ellen Behrens and Kristin Satterfield, Report of Findings from a Multi-Center Study of Youth Outcomes in Private Residential Treatment, Presented at the 114th Annual Convention of the American Psychological Association, New Orleans, Louisiana, August 2006
- Vera Fahlberg MD, 1990
- Selecting The “Right” School or Program, NATSAP National Association of Therapeutic Schools and Programs, accessed January 4, 2009
- David L. Marcus, 2005
- http://www.nytimes.com/2005/08/17/business/17teen.html?_r=1&ex=1281931200 A Business Built on the Troubles of Teenagers, Louise Story, The New York Times, August 17, 2005
- U.S. Supreme Court to Decide Forest Grove v. T.A.: Parents Should Win, But Bazelon Center Opposes Therapeutic Boarding Schools, Bazelon Center for Mental Health Law, Retrieved May 1, 2009
- "Stop Child Abuse in Residential Programs for Teens Act of 2008." Official bill language from the U.S. Congress. Retrieved May 1, 2009.
- , U.S. Government Accountability Report - GAO-08-146T, accessed October 21, 2013
- http://www.ncbi.nlm.nih.gov/pubmed/19693961 Ridge NW, Warren JS, Burlingame GM, Wells MG, Tumblin KM, Reliability and validity of the youth outcome questionnaire self-report, Brigham Young University
- Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask, FTC Federal Trade Commission, Retrieved May 1, 2009
- Evaluating Private Residential Treatment Programs for Troubled Teens, FTC Urges Caution When Considering 'Boot Camps', FTC Federal Trade Commission, Retrieved May 1, 2009