Residential Treatment and Wilderness

“Point and level systems”: Another way to fail children and youth – On the premise that the pervasive use of point and level systems in group care programs can be counter to therapeutic and developmental goals for children and youth, this article describes the specific nature of these practices, provides an analysis of their effects, and suggests constructive alternatives.
A Summary of Participant Perspectives on Residential Treatment for Youth – An online survey was developed and posted to gather information from young adults who participated in these types of programs when they were adolescents.
Abuse and Neglect in U.S.A. Residential Treatment Centers – This is a preliminary report on the abuse and neglect of persons in residential treatment for “substance abuse” in the U.S.A. There have been violations of human rights, lack of investigation, prosecution, and punishment of the offenders.
Abuse of Youth in Residential Placements: An Overview of the Problem – Presentation to “Abuse of Youth in Residential Treatment: A Call to Action,” Washington, DC, February 19, 2009 by Dr. Robert M. Friedman
Adolescent drug abuse treatment works better with family – Including parents in interventions for adolescent substance abusers may be the best way to prevent them from relapsing after treatment, according to research results presented at APA’s 2003 Annual Convention and slated to be published this year in Drug and Alcohol Dependence.
American Academy of Child & Adolescent Psychiatry: ODD – Experts agree that therapies given in a one-time or short-lived fashion, such as boot camps, tough-love camps, or scare tactics, are not effective for children and adolescents with ODD. These approaches may do more harm than good. Trying to scare or forcibly coerce children and adolescents into behaving may only reinforce aggressive behavior.
An Exploratory Study on Adult Survivors of the Troubled Teen Industry’s Therapeutic Boarding Schools and Wilderness Programs – This study included both an open-ended survey, as well as quantitative assessments of personality, trauma, depression, anxiety, substance use, and family structure.
Beyond Point and Level Systems: Moving Toward Child-Centered Programming – This article contends that continuing such programming is antithetical to providing individualized, culturally, developmentally, and cognitively appropriate treatment and we examine the resistance and barriers to changing the traditional ways of “doing things.”
Cases of Child Neglect and Abuse at Private Residential Treatment Facilities: Hearing before the Committee on Education and Labor – Hearing before the House on abuse in private residential treatment facilities
Children in residential treatment: A follow-up study – Examined outcomes and service utilization among a total population of children discharged to their families from a residential treatment center (RTC) during a 3-year period. Consistent with the view that RTC treatment is frequently associated with continuing placement and dependency, the risk of replacement was 32%, 53%, and 59% by the end of the first, second, and third post discharge years, respectively.
Client perspectives on wilderness therapy as a component of adolescent residential treatment for problematic substance use and mental health issues – A realist approach utilizing thematic analysis of written open-ended responses produced six major themes; three depicting participant experiences (social dynamics, wilderness, catalyst for change) and three for perceived outcomes (skill development, self-concept, health).
Cultural Islands: The Subjective Experience of Treatment and Maltreatment within Insular Programs – This is a brief, selective summary of a thesis research project titled “Adult Perspectives on Totalistic Teen Treatment: Experiences and Impact.”
Economic Impact of Utah’s Family Choice Behavioral Healthcare Interventions Industry – This research brief examines the economic impact of the Family Choice and Behavioral Healthcare Interventions Industry in Utah in 2015. For purposes of this study, treatment programs that take insurance reimbursement for primary substance abuse treatment and detoxification facilities were not included.
Effectiveness of intensive short-term residential treatment – Described a model of short-term residential treatment for severely disturbed adolescents.
Eliminating Level Systems in Residential Treatment Centers – TNOYS negotiated with a local RTC to interview youth who had recently eliminated the level system on their cottage. TNOYS met with a group of five residents and asked them about the impact of eliminating the level system; how it was better, what was different, and what they would want other programs who were considering doing this to know.
Escorting: Adjusting to life after being held hostage or kidnapped – Hostage and kidnap survivors can experience stress reactions including denial, impaired memory, shock, numbness, anxiety, guilt, depression, anger, and a sense of helplessness.
Escorting: The Impact of Kidnapping, Shooting and Torture on Children – Trauma, in general, and coercive trauma specifically, impacts children differently than adults. Children do not have the psychological mechanisms in place to understand and integrate the trauma experience. Being less mature, a child is more likely to be overwhelmed by the experience.
Escorting: The Psychological Impact of Kidnapping – Kidnapping is the deliberate creation and marketing of human grief, anguish, and despair.
Federal Trade Commission: Consumer Information – Residential Treatment Programs for Teens – The programs are not regulated by the federal government, and many are not subject to state licensing or monitoring as mental health or educational facilities, either. A 2007 Report to Congress by the Government Accountability Office (GAO) found cases involving serious abuse and neglect at some of these programs.
GAO Report: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth Oct 2007 – GAO found thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007.
GAO Report: Residential Programs Selected Cases of Death, Abuse and Deceptive Marketing Apr 2008 – In the eight closed cases GAO examined, ineffective management and operating practices, in addition to untrained staff, contributed to the death and abuse of youth enrolled in selected programs.
GAO Report: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers May 2009 – Reports indicate that vulnerable children are being abused in these settings.
GAO Report: State and Federal Oversight Gaps May Increase Risk to Youth Well-being Apr 2008 – Nearly all states (49) responding to our survey reported investigating complaints of youth maltreatment in residential facilities in 2006, including facilities operated by government as well as private entities, and located in both urban or rural areas.
Hospital Patient Behavior: Reactance, Helplessness, or Control? – A review of these patterns suggests that some “good patients” may actually be in a state of anxious or depressed helplessness, whereas “bad patients” are exhibiting anger and reactance against the perceived arbitrary removal of freedoms.
Karen VanderVen’s Updated 2016 Pack – A documented analysis of the literature on the destructiveness of “Point and Level Systems” commonly employed in group and residential settings, and schools
Kidnapping Incorporated: The Unregulated Youth-Transportation Industry and the Potential for Abuse – This Article examines the details of the transport process and raises legal questions about the disciplinary authority that parents possess, including the extent to which they can grant this authority to a third party.
Milieu Therapy: A Therapeutic Loophole – Milieu therapy has significant deficiencies as a practice theory for inpatient psychiatric nursing. First, it lacks sound conceptual definition. Second, there is no consensus in the scientific community as to the essential dimensions of the construct. Third, none of the interpretations of milieu therapy has been operationally elaborated with protocols, procedures, or outcomes.
Outcomes for youth receiving intensive in-home therapy or residential care – This study compares outcomes for behaviorally troubled children receiving intensive in-home therapy (IIHT) and those receiving residential care (RC). Data suggest that in-home treatment has a more positive impact on youth’s outcomes than residential care.
Protecting Youth Placed in Unregulated Residential “Treatment” Facilities – Depending on the state, failure to provide state oversight of residential programs for minors may occur because these programs (1) do not accept public funds; (2) are affiliated with religious organizations; or (3) describe themselves (inappropriately) as outdoor programs, boarding schools, or other types of nontreatment programs.
Review of the evidence base for treatment of childhood psychopathology – This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit/hyperactivity disorder (ADHD).
Still shackled in the land of liberty: denying children the right to be safe from abusive “treatment” – This article provides a brief overview of the development of the troubled-teen industry, addresses the thorny issue of parents’ right to send their children to these facilities vis-a-vis the rights of their children, and argues that nurses and other health professionals have a collective obligation to speak out against them in the strongest possible terms.
Survey of Youth in Residential Placement: Conditions of Confinement – This report presents findings from the Survey of Youth in Residential Placement about the conditions of confinement for youth in a range of different facilities and programs. Results focus on the structural and operational characteristics of these environments and indicate how youth offenders are distributed across various programs and facilities of different size and complexity.
The outcome of non-residential youth care compared to residential youth care: a multilevel meta-analysis – We found a small statistically significant overall effect which indicated that non-residential youth care was slightly more effective than residential youth care.
The Risk of Harm to Young Children in Institutional Care – Young children are frequently placed in institutional care throughout the world. This occurs despite wide recognition that institutional care is associated with negative consequences for children’s development (Carter, 2005; Johnson, Browne and Hamilton-Giachritsis, 2006).
The Troubled Teen Industry: Commodifying Disability and Capitalizing on Fear – The “Troubled Teen” behavior reform industry is comprised of financially interconnected wilderness programs, residential treatment centers, and reform schools that incarcerate thousands of minors each year by marketing a supposed cure to nonnormativity, and monetizing the discrimination and abuse of children.
Totalistic Teen Treatment: A Qualitative Analysis of Retrospective Accounts – This original qualitative research analyzes adult reports about the experiences and impacts of totalistic teen programs.
Treatment programs for youth with emotional and behavioral disorders – Results confirmed high rates of comorbidity in this population for externalizing and internalizing disorders. A significant Treatment x Program interaction was evident for internalizing disorders.
Treatment Research Lacks Good Science: A detailed scientific critique of Behrens study findings – ASTART has been concerned about the marketing of teen residential programs that highlights the findings from a study by Ellen Behrens and Kristin Satterfield. Two reports are widely cited in youth residential treatment marketing and promotional materials.
Troubled Affluent Youth’s Experiences in a Therapeutic Boarding School: The Elite Arm of the Youth Control Complex and Its Implications for Youth Justice” – This study provides insight into a mostly unregulated private troubled teen industry, relying on interviews and a survey of affluent youth sent to a therapeutic boarding school. The main sections of this article explore the wide variety of behaviors that caused youth to be sent to the program, the key aspects of their experiences, and the very mixed outcomes.
Troubling the ‘troubled teen’ industry: Adult reflections on youth experiences of therapeutic boarding schools – The article’s central aim is to center the perspectives of former students and critique social control of young people in therapeutic boarding schools.
Unlicensed Residential Programs: The Next Challenge in Protecting Youth – This review is a summary of the information gathered by this group, the Alliance for the Safe, Therapeutic, and Appropriate use of Residential Treatment (ASTART).
Vulnerable citizens: The oppression of children in care – This paper frames children in out-of-home care as a singularly oppressed group. Children as citizens are considered in terms of their rights, evolving capacities, best interests, and voice. Using recognized criteria determining oppression, the situation of youth in care as an associative group is contrasted with that of children in general, as an aggregate group.
Wayward Elites: From Social Reproduction to Social Restoration in a Therapeutic Boarding School – Findings suggest that students engage in social restoration by constructing an overarching restorative narrative that works through three mechanisms: (1) experiential reframing, (2) appropriated therapeutic discourse, and (3) boundary maintenance through “othering.”
Wilderness therapy settings: An industry in need of legal and regulatory oversight – This article reviews wilderness therapy and other outdoor programs that vary in their structure and focus. It also 1) looks at a number of domestic and international lawsuits; 2) examines the minimal extent to which there has been regulatory oversight; and 3) provides recommendations