Unlicensed residential programs: The next challenge in protecting youth

Child and Family Studies, University of South Florida, Tampa, Florida, United States
American Journal of Orthopsychiatry (Impact Factor: 1.36). 08/2006; 76(3):295-303. DOI: 10.1037/0002-9432.76.3.295
Source: PubMed


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.

Download full-text


Available from: Robert M Friedman
  • Source
    • "Although this description is an inaccurate representation of many wilderness programs and the current OBHIC guidelines, such programs do exist. As a result, wilderness therapy programs—particularly those which are unlicensed or unregulated—have recently come under intense scrutiny in media (Krakauer 1995; ''When 'tough love''' 2007), academic (Behar et al. 2007; Friedman et al. 2006; Meyer 2007), and political (Government Accountability Office [GAO] 2007, 2008; ''Stop Child Abuse'' 2008) forums. Importantly, Koocher's (2003) sentiment that wilderness programs are void of therapeutic content highlights several of the challenges that currently face the field, and the onus is on the wilderness therapy programs and practitioners to provide high-quality professional and ethical treatment that counters this view. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Wilderness therapy is a growing treatment modality for adolescents presenting with a variety of clinical concerns, and wilderness therapy clinicians and referring mental health professionals must carefully consider the ethical issues that are unique to this modality. Following an overview of wilderness therapy as a mental health treatment, relevant ethical issues for mental health professionals are described and discussed, including the distinction between therapy and therapeutic experiences, the use of efficacious treatment, consent and confidentiality, therapeutic boundaries, a continuum of care and family involvement, and aftercare. A thorough reflection of the unique ethical issues faced by wilderness therapists is not only necessary, but will also assist in moving the field of wilderness therapy and outdoor behavioral healthcare forward in its establishment as both a recognizable and ethical treatment option.
    Full-text · Article · Feb 2010 · Child and Youth Care Forum
  • Source
    • "In the past year, A START has highlighted the problems of private, unregulated residential treatment facilities through presentations at major conferences of professional and parent organizations (Friedman et al., 2006a; Pinto et al., 2006) and published papers in key professional journals (Pinto et al., 2005; Friedman et al., 2006b). To clarify, the focus has been on facilities that are not licensed and not operated by public or governmental systems but operate private, residential facilities for troubled or difficult children or youth under the age of 18. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Throughout the country, there is considerable inconsistency in how states regulate residential treatment programs for youth. In states with little oversight, the health and safety of youth are unprotected and they may be subject to substandard treatment, rights violations, and/or abuse. Three initiatives to address this issue are reported: (1) an Internet survey of youth who are former residents, (2) a four-state pilot study of how states regulate and monitor residential programs, and (3) a bridge-building conference between residential treatment providers and mental health leaders. Recommendations address the next steps for lawmakers, lawyers, judges, mental health and education professionals, and parents.
    Full-text · Article · Jun 2007 · Family Court Review
  • [Show abstract] [Hide abstract]
    ABSTRACT: The troubled-teen industry has come under federal scrutiny after over a decade of reported abuses and the reported deaths of at least 10 children. 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. Suggestions for action by nurses are proposed that could protect vulnerable children against this continuous cycle of institutionalized child abuse masquerading as therapy.
    No preview · Article · Apr 2009 · ANS. Advances in nursing science
Show more