Residential treatment of children and adolescents: Past, present, and future.

Abstract

This paper reviews the history of residential treatment, examines the central concepts that define the therapeutic modality, and shows how those concepts provide means of addressing criticisms that have been raised about it in the past and adapting residential programs to meet challenges facing them in the future.

Preliminary Data from the NATSAP Research and Evaluation Network: Client Characteristics at Admission

“…If such advocacy is to work effectively, it must be supported by accurate and useful information. The recent emergence of private-pay "specialty" residential treatment programming indicates that they may be finding new alternative ways to meet some of the many needs exhibited by adolescents and their families (Friedman et al, 2006;Leichtman, 2006),. If, however, this sector of residential treatment is to be a part of the regulatory conversa¬tion, and not just an object within it, then clear definitions of private pay programs and their clients becomes necessary.…”

“…For example, public concern for ethical treatment of youth in residential treatment has led to recent publications and policy initiatives calling for increased accountability and oversight for residential programming (Friedman et al, 2006;HR 911: Stop Child Abuse in Residential Programs for Teens Act, 2009;Lieberman & Bellonci, 2007) One specific subset of residential treatment for youth in the North America consists of privately owned programs where the majority of the cost of treatment is paid for by families without the reimbursement or support of third-party payers. These "privatepay" programs fill the needs of families who are not part of publicly funded social, mental health, or juvenile justice services (and may not want to be); whose insurance plans do not cover residential treatment; and who are not succeeding in treatment with either hospitalizations or out-patient clinical services (Friedman et al, 2006;Leichtman, 2006). The majority of programs that are members of the National Association of Therapeutic Schools and Programs (NATSAP) 1 fall into this category (Friedman et al, 2006;Young & Gass, 2008).…”

“…This clarity is particularly important in light of the fact that residential treatment is currently practiced within a difficult political and ethical context: often serving some of the most challenging cases within a public policy culture emphasizing leastrestrictive settings and shorter lengths of stay in treatment. Such dynamics have fostered intense criticism and scrutiny of residential programming (Frensch & Cameron, 2002;Leichtman, 2006;Pumariega, 2006;Whitehead, Keshet, Lombrowski, Domenico, & Green, 2007;Zimmerman, 1998). For example, public concern for ethical treatment of youth in residential treatment has led to recent publications and policy initiatives calling for increased accountability and oversight for residential programming (Friedman et al, 2006;HR 911: Stop Child Abuse in Residential Programs for Teens Act, 2009;Lieberman & Bellonci, 2007) One specific subset of residential treatment for youth in the North America consists of privately owned programs where the majority of the cost of treatment is paid for by families without the reimbursement or support of third-party payers.…”

Out of Home Care in Australia: Looking Back and Looking Ahead

“…We need to develop funding models that provide for a holistic approach to support and treatment; that allow agencies to provide a range of accommodation, treatment, and family intervention or support options; that provide for smooth transitions across these options; and that promote relationship continuity with youth workers, case managers and therapists, as well as with school communities (see also Leichtman, 2006). My hope for the coming decades is that such flexible, holistic program models will become the norm.…”

Factors Affecting Long-Term Outcomes Following Intensive In-Home Services

“…Within the psychological literature, the terms children and adolescents are sometimes used interchangeably or grouped together under the more general term of 'youth' (see, for example, Bennett, 2008;Hoagwood, Jensen, Petti, & Burns, 1996;Leichtman, 2006), with no distinctions made between these groups in terms of their developmental needs or accomplishments. Many researchers do, however, see a distinction between younger and older youth (Weisz & Hawley, 2002), although a precise boundary between childhood and adolescence is extremely difficult to identify.…”