Residential treatment center
A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems.
Within psychiatry, it is understood that it can be almost impossible to change entrenched behaviour without impacting habitual relationships, at least in the short term, but the relatively closed nature of many residential programs also makes it possible to conceal abusive practice.
[1][failed verification] In the 1800s, the United States copied this system, but often mentally ill children were placed in jail with adults because society did not know what to do with them.
[2] After WWII, Bettelheim and the joint efforts of Redl and Wineman were instrumental in establishing residential facilities as therapeutic-treatment alternative for children and adolescents who can not live at home[4] In the 1960s, the second generation of psychoanalytical RTC was created.
Beginning in the 1980s, cognitive behavioral therapy was more commonly used in child psychiatry,[2] as a source of intervention for troubled youth, and was applied in RTCs to produce better long-term results.
[4] In the 1990s, the number of children entering RTCs increased dramatically, leading to a policy shift from institution- based services to a family-centered community system of care.
Residential treatment centers for children and adolescents treat multiple conditions from drug and alcohol addictions to emotional and physical disorders as well as mental illnesses.
Various studies of youth in residential treatment centers have found that many have a history of family-related issues, often including physical or sexual abuse.
Recent trends have ensured that residential treatment facilities have more input from behavioral psychologists to improve outcomes and lessen unethical practices.
New information is incorporated into the framework and serves as the basis for the problem-solving skills a child develops as she or he is exposed to different types of stimuli (e.g., new situations, people, or environments).
The experiences and environment that a child is exposed to can have either a positive or negative outcome, which, in turn, impacts how he or she remembers, reasons, and adapts when encountering aversive stimuli.
Furthermore, when children have acquired extensive knowledge, it affects what they notice and how they organize, represent, and interpret information in their current environment (Bransford, Brown, & Cocking, 2000).
Wolfe, Dattilo, & Gast (2003)[16] found that using a token economy in concert with cooperative games increased pro-social behaviors (e.g. statements of encouragement, praise, or appreciation, shaking hands, and giving high fives) while decreasing anti-social ones (swearing, threatening peers with physical harm, name-calling, and physical aggression).
A single-subject withdrawal design employing non-contingent reinforcement with response cost was used to reduce maladaptive verbal and physical behaviors exhibited by a post-institutional student with ADHD (Nolan & Filter, 2012).
Narrative family therapy views human issues from those roots as emerging and being sustained by dominant stories that control the life of an individual.
[22] Multi Systemic Therapy: The model has shown success in sustaining long-standing improvements in children's and adolescents' antisocial behaviors.
Families in MST have demonstrated improved family stability and post-treatment adaptability and growing support, and reduced conflict- hostility[23] The method's ultimate objectives include a) eliminating behavior problems, b) enhancing family functioning, c) strengthening the adolescents' ability to perform better at school and other community settings, and d) decreasing out-of-home placement [24] Disability rights organizations, such as the Bazelon Center for Mental Health Law, oppose placement in RTC programs, calling into question the appropriateness and efficacy of such placements, noting the failure of such programs to address problems in the child's home and community environment, and calling attention to the limited mental-health services offered and substandard educational programs.
[26] From late 2007 through 2008, a broad coalition of grass-roots efforts, as well as prominent medical and psychological organizations such as the Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART) and the Community Alliance for the Ethical Treatment of Youth (CAFETY), provided testimony and support that led to the creation of the Stop Child Abuse in Residential Programs for Teens Act of 2008 by the United States Congress Committee on Education and Labor.
Despite the controversy surrounding the efficacy of (RTCs), recent research has revealed that community-based residential treatment programs have positive long-term effects for children and youth with behavioral problems.
Participants in a pilot program employing family-driven care and positive peer modeling displayed no incidence of elopement,[clarification needed] self-injurious behaviors, or physical aggression, and just one case of property destruction when compared to a control group (Holstead, 2010).
Children who displayed lower rates of internalizing and externalizing behavior problems at intake and had a lower level of exposure to negative environmental factors (e.g., domestic violence, parental substance use, high crime rates), showed better results than children whose symptoms were more severe (den Dunnen, 2012).
Long-term results for children using planned treatment showed that they are 21% less likely to engage in criminal behavior and 40% less likely to need hospitalization for mental-health problems (Lindqvist, 2010).
However, although there is a great deal of research supporting the validity of RTCs as a way of treating children and youth with behavioral disorders, little is known about the outcomes-monitoring practices of such facilities.
