‘And what about residential…?’ Re‐conceptualizing residential treatment as a stop‐gap service for youth with emotional and behavioral disorders

Abstract

The need for residential services for youth with the most intractable emotional and behavioral problems continues to exist despite advances made in developing community-based systems of care. Residential treatment centers (RTCs), considered one of the most restrictive service settings, have changed little over the years and have not fared well in outcome evaluations. Despite these factors, admissions to RTCs continue to increase. In an attempt to contemporize and bring the RTC more in line with current practice, a stop-gap model of service delivery is recommended. The stop-gap model, incorporating evidencebased practices, is intended to have an immediate and positive impact on the barrier behaviors that keep youths in the most restrictive environments. The twofold goal of the stop-gap model is to interrupt the youth's downward spiral imposed by increasingly disruptive behavior and, simultaneously, to prepare the post-discharge environment for the youth's timely reintegration. Strategies for evaluating the effectiveness of the stop-gap model are recommended.

In, out and after care: Young adults' views on their lives, as children, in a therapeutic residential establishment

“…On the one hand, demand is said to be on the rise: the number of children who require these specialist interventions is reported to be increasing (Armour and Schwab, 2005;McCurdy and McIntyre, 2004;Pavkov, Negash, Lourie and Hug, 2010) and the children referred to these facilities are presenting with more severe symptoms (Hukkanen, Sourander, Bergroth and Piha, 2005;Lieberman, 2004). Set against this, there are pressures on supply: the economic crises currently affecting many developed countries has resulted in drastic cut-backs to many publicly-funded services, of which TCHs must be particularly vulnerable in light of their high costs (Boyd et al 2007;Kott, 2010).…”

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

“…Since children and youth with severe and potentially dangerous disorders do, at times, require safe and highly restrictive settings, inpatient hospitalization will continue to be a major component of the mental health continuum of care for children and adolescents (Burns et al 1999;McCurdy and McIntyre 2004). Given this continued need and use of inpatient hospitalization facilities for children and adolescents, and the finding that nonclinical factors (e.g., race/ethnicity, custody status, availability of services, and hospital referral patterns) influence aftercare decisions for psychiatrically hospitalized youth (Fontanella et al 2007), rigorous investigation of the benefit of such placements is long overdue.…”

“…These adolescents often exhibit 'barrier behaviors' like physical aggression and damage to property that keep them from re-entering successfully into their communities (Isett et al 1980). Just as residential treatment centers are focusing their services on a 'stop-gap' model (McCurdy and McIntyre 2004), so should inpatient hospitalization facilities. This 'stop-gap' model focuses goals on reducing the ''downward spiral of increasingly disruptive and antisocial behavior'' (p. 141) by decreasing the length of stay in restrictive settings and preparing caregivers for success after discharge.…”

Wat maakt het verschil?

“…Ook internationaal zien we op dit punt een herwaardering ontstaan (zie bv. Anglin & Knorth, 2004;Berridge, 2002;Gabriel & Winkler, 2003;McCurdy & McIntyre, 2004;Underwood, Barretti, Storms, & Safonte-Strumolo, 2004;Whittaker, 2001).…”