The present descriptive case study reports on the state of treatment services and environmental settings in adolescent residential treatment facilities (RTFs) conducted as part of the Residential Treatment Center Evaluation Project. The project frequently uncovered poor quality of care exposing youth to deleterious conditions. Observations related to harsh treatment practices, psychiatric practice and medication management, educational and aftercare planning, and general treatment planning were closely examined. The analysis indicated that accreditation and licensing are insufficient to assure the quality of the service process in RTFs. Future research should address the relationship between treatment quality and treatment outcome. Efforts should also be made to develop strategies for organizational change to support high-quality services in RTFs.

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This study assesses the quality of services in the therapeutic foster care programs used by one county in the Midwest. Using a consultative quality assurance review methodology, evaluators examined 67 randomly sampled cases across seven agencies to assess the service quality issues experienced by children. Following interviews with staff, foster parents, and children, and a review of case records, reviewers observed failures in service and in adherence to national program model standards and state regulations. The research indicates the need for consistent monitoring of child-placing agencies and the need for additional research linking service quality with foster care outcomes.