Residential treatment as long-term treatment: An examination of some issues

Abstract

Child mental health professionals agree that high-quality residential treatment is an important element in the range of services that should be available to seriously emotionally disturbed children and adolescents (Duchnowski, Johnson, Hall, Kutash, & Friedman, 1993; Stroul & Friedman, 1986) and that because it should be used sparingly it is a radical and costly intervention. None~eless, over the past 20 years residential trea~ent has been subjected to a consistent and a withering attack for a variety of reasons. These include the assumptions that such services are overused, carry the potential for abuse and neglect of children, vary widely in effectiveness (Whittaker, 1990), and consume a disproportionate amount of funds for mental health treatment (Bums, 1991), and that residential treatment providers are either unable or unwilling to alter their programs to conform to reform agendas in child mental health and child welfare. These agendas emphasize preventing out-of-home placements of all kinds, involving families in the treatment of their children, treating children in the least restrictive enviro~ents that are cl~~c~ly approp~ate, and providing mental health and other services that are tailored to their individual needs. It is difficult, however, to evaluate the nature of the evidence pertaining to residential treatment because the issues are so complex. Residential treatment centers vary widely in size, structure, organization, treatment approach, and populations served. We lack conceptual frameworks that rationally link diagnosis, etiology, prognosis, and criteria for placement