A residential treatment center (RTC), sometimes called a
rehab, is a live-in
health care facility
A health facility is, in general, any location where healthcare is provided. Health facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with elaborate emergency rooms and trauma centers. The nu ...
providing therapy for
substance use disorder
Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
s,
mental illness
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating
abnormal psychology
Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of ps ...
or
psychopathology
Psychopathology is the study of abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era.
Biological psychopatholo ...
.
A residential treatment program encompasses any residential program which treats a behavioural issue, including milder psychopathology such as eating disorders (e.g.
weight loss camp
A fat camp, weight loss camp, or fat farm is a type of residential program where people who are overweight or obese go to attempt to lose weight through exercise and lifestyle changes.
Overview
One goal of weight loss camps is to help the guest ...
) or indiscipline (e.g.
fitness boot camp A fitness boot camp is a type of group physical training program that may be conducted by gyms, personal trainers or other organizations. These programs are designed to build strength and fitness through a variety of types of exercise. The activiti ...
s as
lifestyle interventions). Sometimes residential facilities provide enhanced access to treatment resources, without those seeking treatment considered residents of a treatment program, such as the
sanatorium
A sanatorium (from Latin '' sānāre'' 'to heal, make healthy'), also sanitarium or sanitorium, are antiquated names for specialised hospitals, for the treatment of specific diseases, related ailments and convalescence. Sanatoriums are often ...
s of Eastern Europe. Controversial uses of residential programs for behavioural and cultural modification include
conversion therapy
Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression to align with heterosexual and cisgender norms. In contrast to evidence-based medicine and cli ...
and mandatory
American
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
and
Canadian
Canadians (french: Canadiens) are people identified with the country of Canada. This connection may be residential, legal, historical or cultural. For most Canadians, many (or all) of these connections exist and are collectively the source of ...
residential schools for indigenous populations. A common feature of residential programs is controlled social access to people outside the program, and limited access for outside parties to witness daily conditions within the program. Within psychiatry it is understood that it can be almost impossible to change entrenched behaviour without impacting habitual relationships, at least in the short term, but the relatively closed nature of many residential programs also makes it possible to conceal abusive practice.
Upon discharge, the patient may be enrolled in an
intensive outpatient program
An intensive outpatient program (IOP), also known as an intensive outpatient treatment (IOT) program, is a structured non-residential psychological treatment program which addresses mental health disorders and substance use disorders (SUDs) t ...
for follow up outside the residential setting.
Historical background in the United States
![Brattleboro Retreat 3](https://upload.wikimedia.org/wikipedia/commons/4/43/Brattleboro_Retreat_3.jpg)
In the 1600s,
Great Britain
Great Britain is an island in the North Atlantic Ocean off the northwest coast of continental Europe. With an area of , it is the largest of the British Isles, the largest European island and the ninth-largest island in the world. It is ...
established the
Poor Law
In English and British history, poor relief refers to government and ecclesiastical action to relieve poverty. Over the centuries, various authorities have needed to decide whose poverty deserves relief and also who should bear the cost of hel ...
that allowed poor children to become trained in
apprentice
Apprenticeship is a system for training a new generation of practitioners of a trade or profession with on-the-job training and often some accompanying study (classroom work and reading). Apprenticeships can also enable practitioners to gain a ...
ships by removing them from their families and forcing them to live in group homes.
In the 1800s, the United States copied this system, but often
mentally ill
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
children were placed in jail with adults because society did not know what to do with them.
There were no RTCs in place to provide the 24-hour care they needed and they were placed in jail when they could not live in the home.
In the 1900s,
Anna Freud
Anna Freud (3 December 1895 – 9 October 1982) was a British psychoanalyst of Austrian-Jewish descent. She was born in Vienna, the sixth and youngest child of Sigmund Freud and Martha Bernays. She followed the path of her father and contribu ...
and her peers were part of the Vienna Psychoanalytic Society and they worked on how to care for children.
They worked to create residential treatment centers for children and adolescents with emotional and behavioral disorders.
The year 1944 marked the beginning of
Bruno Bettelheim's work at the
Orthogenic School
The Sonia Shankman Orthogenic School, also known simply as the Orthogenic School or informally as the O'School, is a residential treatment center a day school, and a therapeutic school for children and adolescents typically classified as emotio ...
in
Chicago
(''City in a Garden''); I Will
, image_map =
, map_caption = Interactive Map of Chicago
, coordinates =
, coordinates_footnotes =
, subdivision_type = Country
, subdivision_name ...
, and
Fritz Redl Fritz Redl (9 September 1902 in Klaus near Schladming in Austria9 February 1988 in North Adams, Massachusetts) was an Austrian-American child psychoanalyst and educator.
Career
Fritz Redl was born in Klaus Austria. He witnessed his mother burn to ...
and
David Wineman's work at the Pioneer House in
Detroit
Detroit ( , ; , ) is the largest city in the U.S. state of Michigan. It is also the largest U.S. city on the United States–Canada border, and the seat of government of Wayne County. The City of Detroit had a population of 639,111 at th ...
.
Bettelheim helped increase awareness of staff attitudes on children in treatment.
He reinforced the idea that a psychiatric hospital was a community, where staff and patients influenced each other and patients were shaped by each other's behaviors.
Bettelheim also believed that families should not have frequent contact with their child while he or she was in treatment.
This differs from community-based therapy and
family therapy
Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology and clinical social work that works with families and couples in intimate relationsh ...
of recent years, in which the goal of treatment is for a child to remain in the home.
Also, emphasis is placed on the family's role in improving long term outcomes after treatment in a RTC.
The Pioneer House created a special-education program to help improve impulse control and sociability in children.
After WWII, Bettelheim and the joint efforts of Redl and Wineman were instrumental in establishing residential facilities as therapeutic-treatment alternative for children and adolescents who can not live at home
In the 1960s, the second generation of psychoanalytical RTC was created. These programs continued the work of the Vienna Psychoanalytic Society in order to include families and communities in the child's treatment.
One example of this is the Walker Home and School which was established by Dr. Albert Treischman in 1961 for adolescent boys with severe emotional or behavioral disorders. He involved families in order to help them develop relationships with their children within homes, public schools and communities.
Family and community involvement made this program different from previous programs.
Beginning in the 1980s,
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
was more commonly used in child psychiatry,
as a source of intervention for troubled youth, and was applied in RTCs to produce better long-term results.
Attachment theory
Attachment theory is a psychological, evolutionary and ethological theory concerning relationships between humans. The most important tenet is that young children need to develop a relationship with at least one primary caregiver for normal ...
also developed in response to the rise of children admitted to RTCs who were abused or neglected. These children needed specialized care by caretakers who were knowledgeable about trauma.
In the 1990s, the number of children entering RTCs increased dramatically, leading to a policy shift from institution- based services to a family-centered community system of care. This also reflected the lack of appropriate treatment resources. However, residential treatment centers have continued to grow and today house over 50,000 children. The number of residential treatment centers in the United States is currently estimated at 28,900 facilities.
Children and teens
RTCs for adolescents, sometimes referred to as teen rehab centers, provide treatment for issues and disorders such as
oppositional defiant disorder
Oppositional defiant disorder (ODD) is listed in the DSM-5 under ''Disruptive, impulse-control, and conduct disorders'' and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is us ...
,
conduct disorder
Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckles ...
, depression,
bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
(ADHD), educational issues, some
personality disorders
Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
, and phase-of-life issues, as well as substance use disorders. Most use a
behavior modification
Behavior modification is an early approach that used respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior was modified with consequences, including positive and negative reinforcement continge ...
paradigm. Others are relationally oriented. Some utilize a community or positive peer-culture model.
Generalist
A generalist is a person with a wide array of knowledge on a variety of subjects, useful or not. It may also refer to:
Occupations
* a physician who provides general health care, as opposed to a medical specialist; see also:
** General pract ...
programs are usually large (80-plus clients and as many as 250) and level-focused in their treatment approach. That is, in order to manage clients' behavior, they frequently put systems of rewards and punishments in place. Specialist programs are usually smaller (less than 100 clients and as few as 10 or 12). Specialist programs typically are not as focused on behavior modification as generalist programs are.
Different RTCs work with different types of problems, and the structure and methods of RTCs vary. Some RTCs are lock-down facilities; that is, the residents are locked inside the premises. In a locked residential treatment facility, clients' movements are restricted. By comparison, an unlocked residential treatment facility allows them 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
Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use of ...
to emotional and physical disorders as well as
mental illnesses. Various studies of youth in residential treatment centers have found that many have a history of family-related issues, often including physical or sexual abuse. Some facilities address specialized disorders, such as
reactive attachment disorder
Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children, although these issues do occasionally persist into adulthood.DSM-IV-TR (2000) American Psychiatric Ass ...
(RAD).
Residential treatment centers generally are clinically focused and primarily provide
behavior management
Behavior management, similar to behavior modification, is a less-intensive form of behavior therapy. Unlike behavior modification, which focuses on changing behavior, behavior management focuses on maintaining positive habits and behaviors and red ...
and treatment for adolescents with
serious issues. In contrast,
therapeutic boarding schools provide therapy and academics in a residential
boarding school
A boarding school is a school where pupils live within premises while being given formal instruction. The word "boarding" is used in the sense of "room and board", i.e. lodging and meals. As they have existed for many centuries, and now exten ...
setting, employing staff 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, adolescents, and young adults. Recent trends have ensured that residential treatment facilities have more input from behavioral psychologists to improve outcomes and lessen unethical practices.
Behavioral interventions
![Therapeutic group in the Rehabilitation Center for alcohol and drug addicts](https://upload.wikimedia.org/wikipedia/commons/0/05/Therapeutic_group_in_the_Rehabilitation_Center_for_alcohol_and_drug_addicts.jpg)
Behavioral interventions have been very helpful in reducing problem behaviors in residential treatment centers. The type of clients receiving services in a facility (children with emotional or behavioral disorders versus intellectual disability versus psychiatric disorders) is a factor in the effectiveness of behavior modification. Behavioral intervention has been found to be successful even when medication interventions fail. However, there is evidence that certain populations may benefit more from interventions that fall outside of the behavior-modification paradigm. For instance, positive outcomes have been reported for neurosequential interventions targeting issues of
early childhood trauma Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists.Colombo, J. (1982). The cr ...
and attachment. (Perry, 2006). Although the majority of children who receive services in RTCs present emotional and behavioral disorders (EBDs), such as
attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
(ADHD),
Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is listed in the DSM-5 under ''Disruptive, impulse-control, and conduct disorders'' and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is us ...
(ODD), and
Conduct Disorder
Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckles ...
(CD), behavior-modification techniques can be an effective way of decreasing the maladaptive behavior of these clients. Interventions such as
response cost,
token economies,
social skills
A social skill is any competence facilitating interaction and communication with others where social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning these skills is called social ...
training groups, and the use of positive social reinforcement can be used to increase prosocial behavior in children (Ormrod, 2009).
Behavioral interventions are successful in treating children with behavioral disorders in part because they incorporate two principles that make up the core of how children learn: conceptual understanding and building on their pre-existing knowledge. Research by Resnick (1989) shows that even infants are able to develop basic quantitative frameworks. New information is incorporated into the framework and serves as the basis for the problem-solving skills a child develops as she or he is exposed to different types of stimuli (e.g., new situations, people, or environments). The experiences and environment that a child is exposed to can have either a positive or negative outcome, which, in turn, impacts how he or she remembers, reasons, and adapts when encountering aversive stimuli. Furthermore, when children have acquired extensive knowledge, it affects what they notice and how they organize, represent, and interpret information in their current environment (Bransford, Brown, & Cocking, 2000). Many of the children housed in RTCs have been exposed to negative environmental factors that have contributed to the behavior problems that they are exhibiting.
Many interventions build on children's prior knowledge of how reward works. Reinforcing children for pro-social behaviors (i.e., using token economies, in which children earn tokens for appropriate behaviors; response cost (losing previously earned tokens following inappropriate behavior; and implementing social-skills training groups, where participants observe and participate in modeling appropriate social behaviors help them develop a deeper understanding of the positive results of pro=social behavior.
Wolfe, Dattilo, & Gast (2003) found that using a token economy in concert with cooperative games increased pro-social behaviors (e.g. statements of encouragement, praise, or appreciation, shaking hands, and giving high fives) while decreasing anti-social ones (swearing, threatening peers with physical harm, name-calling, and physical aggression). The use of a response-cost system has been efficacious in reducing problem behaviors. A single-subject withdrawal design employing non-contingent reinforcement with response cost was used to reduce maladaptive verbal and physical behaviors exhibited by a post-institutional student with ADHD (Nolan & Filter, 2012). Wilhite & Bullock (2012) implemented a social-skills training group to increase the social competence of students with EBDs. Results showed significant differences between pre- and post-intervention disciplinary referrals, as well as several other elements of behavioral-ratings scales. Evidence also exists for the usefulness of social reinforcement as a part of behavioral interventions for children with ADHD. A study by Kohls, Herpertz-Dahlmann, & Kerstin (2009) found that both social and monetary rewards increased inhibition control in both the control and experimental groups. However, results showed that children with ADHD benefitted more from social reinforcement than typical children, indicating that social reinforcement can significantly improve cognitive control in ADHD children. The techniques listed are only a few of the many types of behavioral interventions that can be used to treat children with EBDs. Additional information regarding types of behavioral interventions can be found in the 2003 book ''Behavioral, Social, and Emotional Assessment of Children and Adolescents'' by Kenneth Merrell.
Types of Family Therapy used in Residential Treatment Center
Narrative Therapy: Narrative therapy has shown an increase in popularity in the field of family therapy. Narrative therapy developed out from the postmodern viewpoint, which is expressed in its principles: (a) not one universal reality exists, but socially constructed reality; (b) reality is created by language; (c) narrative maintains reality (d) not all narratives are equivalent (Freedman and Combs, 1996).
Narrative family therapy views human issues from those roots as emerging and being sustained by dominant stories that control the life of an individual. Problems arise when individual stories do not match with their experience of living. According to the narrative viewpoint, by offering a new and distinct perspective
In a problem-saturated narrative, therapy is a process of rewriting personal narratives. The process of rewriting the narrative of the client involves (a) expressing the problem(s) they are experiencing; (b) breaking down narratives that trigger problems through questioning; (c) recognizing special outcomes or occasions where a person has not been constrained by their situation; (d) connecting specific results to the future and providing an alternate and desired narrative; (e) inviting supports among the community to spectate the new narrative and (f) logging new document
Since postmodern viewpoints prioritize concepts rather than techniques, in narrative therapy, formal methods are restricted. However, some researchers have described techniques that are useful in helping an individual rewrite a specific experience, like retelling stories and writing letters.
Children admitted to a residential treatment center have behavior problems so extreme that residential treatment is their last hope. Parents seem to think the child is the problem needed to be fixed, and everything will be okay; on the other hand, the child generally sees themselves as a victim. Narrative therapy enables these perspectives to be broken down and troubling behaviors of the child to be externalized, which could encourage both the child and the family members to achieve a new perspective no one feels prosecuted or blamed.
Multi Systemic Therapy:
The model has shown success in sustaining long-standing improvements in children's and adolescents' antisocial behaviors. Families in MST have demonstrated improved family stability and post-treatment adaptability and growing support, and reduced conflict- hostility
The method's ultimate objectives include a) eliminating behavior problems, b) enhancing family functioning, c) strengthening the adolescents' ability to perform better at school and other community settings, and d) decreasing out of home placement
Controversy
Disability rights
The disability rights movement is a global social movement that seeks to secure equal opportunities and equal rights for all people with disabilities.
It is made up of organizations of disability activists, also known as disability advocat ...
organizations, such as the
Bazelon Center for Mental Health Law
The Bazelon Center for Mental Health Law is a national legal-advocacy organization representing people with mental disabilities in the United States. Originally known as The Mental Health Law Project, the Center was founded as a national public-in ...
, oppose placement in RTC programs, calling into question the appropriateness and efficacy of such placements, noting the failure of such programs to address problems in the child's home and community environment, and calling attention to the limited 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
In the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so. It can be a result of carelessness, indifference, or unwillingness an ...
,
*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.
[U.S. Supreme Court to Decide Forest Grove v. T.A.: Parents Should Win, But Bazelon Center Opposes Therapeutic Boarding Schools](_blank)
, Bazelon Center for Mental Health Law
The Bazelon Center for Mental Health Law is a national legal-advocacy organization representing people with mental disabilities in the United States. Originally known as The Mental Health Law Project, the Center was founded as a national public-in ...
, Retrieved May 1, 2009
A 2007 Report to Congress by the
Government Accountability Office
The U.S. Government Accountability Office (GAO) is a legislative branch government agency that provides auditing, evaluative, and investigative services for the United States Congress. It is the supreme audit institution of the federal govern ...
(
GAO
Gao , or Gawgaw/Kawkaw, is a city in Mali and the capital of the Gao Region. The city is located on the River Niger, east-southeast of Timbuktu on the left bank at the junction with the Tilemsi valley.
For much of its history Gao was an impor ...
) found cases involving serious abuse and neglect at some of these programs.
From late 2007 through 2008, a broad coalition of
grass-roots
A grassroots movement is one that uses the people in a given district, region or community as the basis for a political or economic movement. Grassroots movements and organizations use collective action from the local level to effect change at t ...
efforts, as well as prominent
medical
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...
and
psychological
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
organizations such as the Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART) and the
Community Alliance for the Ethical Treatment of Youth
The Community Alliance For the Ethical Treatment of Youth (CAFETY) is an advocacy group for people enrolled in residential treatment programs for at-risk teenagers. The group's mission includes advocating for access to advocates, due process, al ...
(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
The United States Congress is the legislature of the federal government of the United States. It is bicameral, composed of a lower body, the House of Representatives, and an upper body, the Senate. It meets in the U.S. Capitol in Washing ...
Committee on Education and Labor
The Committee on Education and Labor is a standing committee of the United States House of Representatives. There are 50 members in this committee. Since 2019, the chair of the Education and Labor committee is Robert Cortez Scott of Virginia.
Hi ...
.
["Stop Child Abuse in Residential Programs for Teens Act of 2008."](_blank)
Official bill language from the U.S. Congress
The United States Congress is the legislature of the federal government of the United States. It is Bicameralism, bicameral, composed of a lower body, the United States House of Representatives, House of Representatives, and an upper body, ...
. Retrieved May 1, 2009.
Jon Martin-Crawford and Kathryn Whitehead of CAFETY testified at a hearing of the United States Congressional Committee on Education and Labor on April 24, 2008,
["Child Abuse and Deceptive Marketing by Residential Programs for Teens."]
Official testimony to the U.S. Congress. Retrieved May 1, 2009. and described abusive practices they had experienced at the
Family Foundation School
Allynwood Academy, formerly the Family Foundation School, was a private school, private, co-educational, college preparatory school, college preparatory, therapeutic boarding school located in Hancock (town), New York, Hancock, New York (state), ...
and
Mission Mountain School, both therapeutic boarding schools.
["Transcript of testimony of Jon Martin-Crawford."]
Official transcript from the U.S. Congress. Retrieved May 1, 2009.["Transcript of testimony of Kathryn Whitehead."]
Official transcript from the U.S. Congress. Retrieved May 1, 2009.
Due to the absence of regulation of these programs by the federal government and because many are not subject to state licensing or monitoring,
[Evaluating Private Residential Treatment Programs for Troubled Teens, FTC Urges Caution When Considering 'Boot Camps'](_blank)
FTC Federal Trade Commission, Retrieved May 1, 2009 the Federal Trade Commission has issued a guide for parents considering such placement.
[Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask](_blank)
FTC Federal Trade Commission, Retrieved May 1, 2009
Residential treatment programs are often caught in the cross-fire during custody battles, as parents who are denied custody try to discredit the opposing spouse and the treatment program.
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.
[A National Evaluation of Treatment Outcomes for Cocaine Dependence; D. Dwayne Simpson, PhD; George W. Joe, EdD; Bennett W. Fletcher, PhD; Robert L. Hubbard, PhD; M. Douglas Anglin, PhD; Arch Gen Psychiatry. 1999;56:507-514]
Abstract
/ref>[Effectiveness of coerced addiction treatment (alternative consequences) A review of the clinical research; Norman S. Miller M.D. and Joseph A. Flaherty M.D.b.; Journal of Substance Abuse Treatment, Volume 18, Issue 1, Pages 9-16 (January 2000]
Abstract
/ref>
/ref>[ ttp://www.drugabuse.gov/PODAT/PODATIndex.html U.S. Department of Health and Human Services. Principles of Drug Addiction Treatment: A Research Based Guide. Feb. 2005. 18 Oct. 2007./ref> RTCs offer a variety of structured programs designed to address the specific need of the inmates. Despite the controversy surrounding the efficacy of (RTCs), recent research has revealed that community-based residential treatment programs have positive long-term effects for children and youth with behavioral problems.
Participants in a pilot program employing family-driven care and positive peer modeling displayed no incidence of elopement, self-injurious behaviors, or physical aggression, and just one case of property destruction when compared to a control group (Holstead, 2010). The success of treatment for children in RTCs depends heavily on their background i.e., their state, situation, circumstances and behavioral status before commencement of treatment. Children who displayed lower rates of internalizing and externalizing behavior problems at intake and had a lower level of exposure to negative environmental factors (e.g., domestic violence, parental substance use, high crime rates), showed better results than children whose symptoms were more severe (den Dunnen, 2012).
Additional research demonstrates that planned treatment, or knowing the expected duration of treatment, is strongly correlated with positive treatment outcomes. Long-term results for children using planned treatment showed that they are 21% less likely to engage in criminal behavior and 40% less likely to need hospitalization for mental-health problems (Lindqvist, 2010). Further evidence exists supporting the long-term effectiveness of RTCs for children exhibiting severe mental health issues. Preyde (2011) found that clients showed a statistically significant reduction in symptom severity 12–18 months after leaving an RTC, results which were maintained 36–40 months after their discharge from the facility.
However, although there is a great deal of research supporting the validity of RTCs as a way of treating children and youth with behavioral disorders, little is known about the outcomes-monitoring practices of such facilities. Those that track clients after they leave the RTC only do so for an average of six months. In order to continue to provide effective long-term treatment to at-risk populations, further efforts are needed to encourage the monitoring of outcomes after discharge from residential treatment (J.D. Brown, 2011).
One problem that hinders the effectiveness of RTCs is elopement or "running". A study by Kashubeck found that runaways from RTCs were "more likely to have a history of elopement, a suspected history of sexual abuse, an affective-disorder diagnosis, and parents whose rights had been terminated."] By employing these characteristics of patients in the design of treatment, RTCs may be more successful in reducing elopement and otherwise improving the probability of clients' success.
See also
* Anti-psychiatry
Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionabl ...
* Behavior modification facility
* Child abandonment
Child abandonment is the practice of relinquishing interests and claims over one's offspring in an illegal way, with the intent of never resuming or reasserting guardianship. The phrase is typically used to describe the physical abandonment of a ...
* Child abuse
Child abuse (also called child endangerment or child maltreatment) is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to a ...
* Child and family services
Child and family services is a government or non-profit organisation designed to better the well being of individuals who come from unfortunate situations, ''environmental'' or ''biological''. People who seek or are sought after to participate in ...
* Child and Youth Care
Child and Youth Care (CYC) is a profession which focuses on the developmental needs of children and families within the space and time of their daily lives.Adapted from Stuart, C. (2013). Foundations of child and youth care. Dubuque: Kendall Hunt. ...
* Community-based care Community-based care serves as a "bridge" between orphanage and settlement house. Adolescents are placed in a family in their community. The guardians will provide individual care and nurture in the context of a family and community. This teaches ...
* Congregate care
* Cottage Homes
* Family support Family support is the support of families with a member with a disability, which may include a child, an adult, or even the parent in the family. In the United States, family support includes "unpaid" or "informal" support by neighbors, families, an ...
* Foster care in the United States
Foster care is the term used for a system in which a minor who has been made a ward is placed in an institution, group home (residential child care community, residential treatment center, etc.), or private home of a state certified caregiver (ref ...
* Foster care
Foster care is a system in which a minor has been placed into a ward, group home (residential child care community, treatment center, etc.), or private home of a state-certified caregiver, referred to as a "foster parent" or with a family mem ...
* Group home
A group home, congregate living facility, or care home (the latter especially in British English and Australian English) is a residence model of medical care for those with complex health needs. Traditionally, the model has been used for children ...
* Kinship care
Kinship care is a term used in the United States and Great Britain for the raising of children by grandparents, other extended family members, and unrelated adults with whom they have a close family-like relationship such as godparents and close f ...
* Orphanage
An orphanage is a Residential education, residential institution, total institution or group home, devoted to the Childcare, care of orphans and children who, for various reasons, cannot be cared for by their biological families. The parent ...
* Residential care
Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home.
There are various residential care options available, depending on the needs of the individual. P ...
* Residential child care community Residential child care communities or children's homes are a type of residential care, which refers to long-term care given to children who cannot stay in their birth family home. There are two different approaches towards residential care: The fami ...
* Teaching-family model
The Teaching-Family Model (TFM) is a model of care for persons in need of services and care necessary to support an improved quality of life and increase opportunities to live to their potential. The TFM is used internationally in residential homes ...
* Therapeutic boarding school
A therapeutic boarding school is a residential school offering therapy for students with emotional or behavioral issues. Description
The National Association of Therapeutic Schools and Programs listed 140 schools and programs as of 2005. Therapeut ...
* Total institution
A total institution is a place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life. Privacy is limited in ...
* Wraparound (childcare)
The wraparound process is an intensive, individualized care management process for youths with serious or complex needs. Wraparound was initially developed in the 1980s as a means for maintaining youth with the most serious emotional and behaviora ...
References
Further reading
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External links
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Residential Treatment Programs — Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth
- United States Government Accountability Office
Residential Facilities — State and Federal Oversight Gaps May Increase Risk to Youth Well-Being
- United States Government Accountability Office
Residential Programs — Selected Cases of Death, Abuse, and Deceptive Marketing
- United States Government Accountability Office
{{DEFAULTSORT:Residential Treatment Center
Behavior modification
Psychotherapy
Substance-related disorders
Residential treatment centers