Is Residential Treatment Misunderstood?

Abstract

What lies at the heart of its weak evidence base, changing ideology, and funding reductions, is the lack of a clear understanding of exactly what defines or constitutes residential treatment. This is not a new or novel idea, as others have echoed this same concern for years (Durkin & Durkin, 1975; Epstein, 2004). Residential treatment is not standardized. There is no sanctioned manual or protocol for delivery of residential treatment services. Residential treatment is used as an umbrella term to describe a plethora of different types of models of service delivery. The lack of clarification about what defines residential treatment helps maintain the idiosyncratic views of these services and makes residential treatment an easy target for criticism. Whittaker (2004) noted that the turn-of-the-century notion, institutional life is contrary to a child's nature, still exists today. This sustains the existence of an archaic and inaccurate perception of residential treatment as a single type of ineffective, institutional, congregate care for children. This negative and narrow view may be at the core of why residential care remains so unclearly defined. Simply put, it is not a popular service. Just as various outpatient treatment modalities are acknowledged as such yet studied independently, recognition and distinction of the many alternative, individualized, interdisciplinary types of residential treatment has not yet occurred. The Surgeon General's Mental Health Report (U.S. Department of Health & Human Services, 1999) acknowledged that the types of care and treatment available in residential care settings include institutional, community-based, and home-based. Indeed, many configurations of care and treatment are labeled residential treatment (e.g., group homes, therapeutic foster homes, treatment foster care, campus-based homes, locked facilities, congregate care), and provide a range of care and treatment provisions. Residential treatment can be brief and intense, or longer and moderate. Some providers offer more independent living with paraprofessional oversight. Others include a full team of professionals (e.g., psychiatry, psychology, social work, occupational therapy, speech therapy) working in an integrated fashion. Others use all or some of these professionals more independently of one another. But when grouped together as residential treatment, the constellation of systems and levels of integration, the specific types of therapies provided, the milieu characteristics, and the quality of staff are lost details. Using the term residential treatment to describe the multitude of types of residential care and treatment provisions only does the field a disservice.