A systematic review of the effectiveness of children’s behavioral health interventions in psychiatric residential treatment facilities

Antipsychotic medications and admission to psychiatric residential treatment facilities among youth in foster care diagnosed with disruptive behavior disorders.

“…The objective of preventing or reducing the risk of admission to PRTFs among youth in this population by identifying treatments that keep youth in the community is worthwhile. PRTFs are restrictive and present challenges for the social development and educational progress of children in their care, and they lack clear evidence of effectiveness in treating underlying behavioral conditions (Lanier et al, 2020). Case studies report on the difficult conditions experienced by children in these facilities (e.g., Pumariega, 2006).…”

“…Besides leading to unwanted admissions, these admissions take beds away from children who need them. Child welfare agencies could, for example, recruit more foster care and therapeutic foster care providers (Turner & Macdonald, 2011; Lanier et al, 2020). This could reduce unneeded PRTF admissions.…”

“…Although medical necessity is a prerequisite for admission, experiences with child protective services and out-of-home placements independently predict admission: most CPS investigations do not result in removal; some youth placed in foster care come from the juvenile justice system or voluntary placement; and both of these characteristics may proxy for other unobserved characteristics (Lanier & Rose, 2017). Further, a systematic review argues that PRTF placements are a costly residential setting (more than $55,000 per year per resident) in which numerous practices and treatments are typically implemented despite limited evidence supporting the effectiveness of this heterogeneous approach to care (Lanier et al, 2020). Given the system of care goal of treating youth in the community, effective community-based behavioral treatments that can reduce the risk of institutionalization, such as therapeutic foster care, are critical (Stroul et al, 2010; Turner & Macdonald, 2011).…”

“…Preventing or reducing admissions to PRTFs is desirable. Evidence of PRTF effectiveness at promoting youth well-being is mixed at best, and care is costly, at an annual per capita cost of more than $55,000 (Lanier et al, 2020; Seibert et al, 2018). Further, a National Disability Rights Network report cited research showing that youth in many of these facilities experience abuse, seclusion, and both physical and chemical restraint, including overuse of psychiatric medications (2021).…”

“…numerous practices and treatments are typically implemented despite limited evidence supporting the effectiveness of this heterogeneous approach to care (Lanier et al, 2020). Given the system of care goal of treating youth in the community, effective community-based behavioral treatments that can reduce the risk of institutionalization, such as therapeutic foster care, are critical (Stroul et al, 2010;Turner & Macdonald, 2011).…”