Unlicensed Residential Programs: The Next Challenge in Protecting Youth

• Published in: American journal of orthopsychiatry 2006-07, Vol.76 (3), p.295-303
• Main Authors: Friedman, Robert M, Pinto, Allison, Behar, Lenore, Bush, Nicki, Chirolla, Amberly, Epstein, Monica, Green, Amy, Hawkins, Pamela, Huff, Barbara, Huffine, Charles, Mohr, Wanda, Seltzer, Tammy, Vaughn, Christine, Whitehead, Kathryn, Young, Christina Kloker
• Format: Article
• Language: English
• Subjects: Accreditation - ethics; Accreditation - legislation & jurisprudence; Adolescent; Boarding Schools; Child; Child Abuse; Child abuse & neglect; Child Abuse - ethics; Child Abuse - legislation & jurisprudence; Child Abuse - prevention & control; Child protection; Child Welfare; Child Welfare Services; Children & youth; Consumer Organizations - ethics; Consumer Organizations - legislation & jurisprudence; Ethics, Institutional; Health facilities; Human; Humans; institutional abuse; Institutional Schools; Licensing; Licensure, Hospital - ethics; Medical ethics; Mental Disorders - psychology; Mental Disorders - therapy; Mental health; Mental health care; Mental Health Programs; Mental health services; Patient Care Team - ethics; Patient Care Team - legislation & jurisprudence; Quality Assurance, Health Care - ethics; Quality Assurance, Health Care - legislation & jurisprudence; Residential care; Residential Care Institutions; Residential Institutions; Residential treatment; Residential Treatment - ethics; Residential Treatment - legislation & jurisprudence; Restraints; Schools; Substandard; therapeutic boarding school; Therapy; Treatment Programs; United States; Young people
• ISSN: 0002-9432; 1939-0025
• DOI: 10.1037/0002-9432.76.3.295

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.