Unlicensed residential programs: The next challenge in protecting youth.

Abstract

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

A Multi-Center Study of Private Residential Treatment Outcomes

“…Outcomes of youth treated in these programs are largely unknown (Friedman, Pinto, Behar, Bush, Chirolla, Epstein … & Young, 2006). Previous research has focused almost entirely on public residential treatment programs (RTPs) Curtis, Alexander, & Longhofer, 2001;Hair, 2005;Leichtman, Leichtman, Barbet, & Nese, 2001;Lieberman, 2004;Whittaker, 2004).…”

“…Private RTP services typically feature adventure activities, challenge courses, art therapy, and equine programs (Young & Gass, 2007). Services are most often funded by parents or, in some cases, by insurance companies (Friedman et al, 2006;Young & Gass, 2007). The large number of coeducational and female-only programs suggests that female youth are well represented within private RTPs.…”

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

“…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).…”

“…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).…”

Experiential Therapy in the Mental Health Treatment of Adolescents

“…Some of these issues have also been detailed in several articles by a group of researchers called ASTART (Alliance for the Safe, Therapeutic, and Appropriate Use of Residential Treatment), with a particular focus on mistreatment and abuse of youth in residential care. Examples of these articles include Behar, Friedman, Pinto, Katz-Leavy, & Jones, (2007) ;Friedman, Pinto, Behar, Bush, Chirolla, & Epstein, et al (2006);and Pinto, Friedman, & Epstein (2005) and make a strong case for regulations to stop abuses occurring primarily at unlicensed and unregulated facilities. They advocate adoption of policies recommended by the American Bar Association (2007) that included closing facilities who cannot provide evidence of their efficacy.…”