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. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology. Upon discharge, the patient may be enrolled in an intensive outpatient program for follow-up outside the residential setting.
Children and teens
Target Diagnoses and Program Models RTCs for adolescents, sometimes referred to as teen rehab centers if they also deal with addiction, provide treatment for issues and disorders such as oppositional defiant disorder, conduct disorder, depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), educational issues, some personality disorders, and phase-of-life issues, as well as substance use disorders. Most use a behavior modification paradigm. Others are relationally oriented. Some use a community or positive peer-culture model. Generalist programs are usually large (80-plus patients and as many as 250) and level-focused in their treatment approach. That is, to manage patients' behavior, they frequently put systems of rewards and punishments in place. Specialist programs are usually smaller (less than 100 patients and as few as 10 or 12). Specialist programs typically are not as focused on behavior modification as generalist programs are.
Facility Types and Security levels Different RTCs work with different types of problems, and the structure and methods of RTCs vary. Some RTCs are lock-down facilities; that is, the residents are locked inside the premises. In a locked residential treatment facility, patients' movements are restricted. By comparison, an unlocked residential treatment facility allows them to move about the facility with relative freedom, but they are only allowed to leave the facility under specific conditions. Residential treatment centers should not be confused with residential education programs, which offer an alternative environment for at-risk children to live and learn together outside their homes.
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. Some facilities address specialized disorders, such as reactive attachment disorder (RAD).
Residential treatment centers generally are clinically focused and primarily provide behavior management and treatment for adolescents with serious issues. In contrast, therapeutic boarding schools provide therapy and academics in a residential boarding school setting, employing a staff of social workers, psychologists, and psychiatrists to work with the students on a daily basis. This form of treatment has a goal of academic achievement as well as physical and mental stability in children, adolescents, and young adults. Recent trends have ensured that residential treatment facilities have more input from behavioral psychologists to improve outcomes and lessen unethical practices.
Behavioral interventions
Behavioral interventions have been very helpful in reducing problem behaviors in residential treatment centers. The type of clients receiving services in a facility (children with emotional or behavioral disorders versus intellectual disability versus psychiatric disorders) is a factor in the effectiveness of behavior modification. Behavioral intervention has been found to be successful even when medication interventions fail.Luiselli, J.K. & Evans, T.P. (1987) However, there is evidence that certain populations may benefit more from interventions that fall outside of the behavior-modification paradigm. For instance, positive outcomes have been reported for neurosequential interventions targeting issues of early childhood trauma and attachment. (Perry, 2006).Perry, B.D. (2006) The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27-52). New York: The Guilford Press. Although the majority of children who receive services in RTCs present emotional and behavioral disorders (EBDs), such as attention deficit hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), behavior-modification techniques can be an effective way of decreasing the maladaptive behavior of these clients. Interventions such as response cost, token economies, social skills training groups, and the use of positive social reinforcement can be used to increase prosocial behavior in children (Ormrod, 2009).Ormrod, J.E. (2009). Essentials of Educational Psychology (2nd ed.). Upper Saddle River, NJ: Merrill.
Behavioral interventions are successful in treating children with behavioral disorders in part because they incorporate two principles that make up the core of how children learn: conceptual understanding and building on their pre-existing knowledge. Research by Resnick (1989) shows that even infants are able to develop basic quantitative frameworks. 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).Bransford, J.D., Brown, A.L., & Cocking, R.R. (2000). How People Learn: Brain, Mind, Experience, and School. Washington, DC: National Academy Press. Many of the children housed in RTCs have been exposed to negative environmental factors that have contributed to the behavior problems that they are exhibiting.
Many interventions build on children's prior knowledge of how reward works. Reinforcing children for pro-social behaviors (i.e., using token economies, in which children earn tokens for appropriate behaviors; response cost (losing previously earned tokens following inappropriate behavior; and implementing social-skills training groups, where participants observe and participate in modeling appropriate social behaviors help them develop a deeper understanding of the positive results of pro=social behavior.
Wolfe, Dattilo, & Gast (2003) 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). The use of a response-cost system has been efficacious in reducing problem behaviors. 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). Wilhite & Bullock (2012) implemented a social-skills training group to increase the social competence of students with EBDs. Results showed significant differences between pre- and post-intervention disciplinary referrals, as well as several other elements of behavioral-ratings scales. Evidence also exists for the usefulness of social reinforcement as a part of behavioral interventions for children with ADHD. A study by Kohls, Herpertz-Dahlmann, & Kerstin (2009) found that both social and monetary rewards increased inhibition control in both the control and experimental groups. However, results showed that children with ADHD benefitted more from social reinforcement than typical children, indicating that social reinforcement can significantly improve cognitive control in ADHD children. The techniques listed are only a few of the many types of behavioral interventions that can be used to treat children with EBDs. Additional information regarding types of behavioral interventions can be found in the 2003 book Behavioral, Social, and Emotional Assessment of Children and Adolescents by Kenneth Merrell.
Types of Family Therapy used in Residential Treatment Center
Narrative Therapy Narrative therapy has shown an increase in popularity in the field of family therapy. Narrative therapy developed out from the postmodern viewpoint, which is expressed in its principles: (a) not one universal reality exists, but socially constructed reality; (b) reality is created by language; (c) narrative maintains reality (d) not all narratives are equivalent (Freedman and Combs, 1996). Narrative family therapy views human issues from those roots as emerging and being sustained by dominant stories that control the life of an individual. Problems arise when individual stories do not match with their experience of living. According to the narrative viewpoint, by offering a new and distinct perspective
In a problem-saturated narrative, therapy is a process of rewriting personal narratives. The process of rewriting the narrative of the client involves (a) expressing the problem(s) they are experiencing; (b) breaking down narratives that trigger problems through questioning; (c) recognizing special outcomes or occasions where a person has not been constrained by their situation; (d) connecting specific results to the future and providing an alternate and desired narrative; (e) inviting supports among the community to spectate the new narrative and (f) logging new document Since postmodern viewpoints prioritize concepts rather than techniques, in narrative therapy, formal methods are restricted. However, some researchers have described techniques that are useful in helping an individual rewrite a specific experience, like retelling stories and writing letters.
Children admitted to a residential treatment center have behavior problems so extreme that residential treatment is their last hope. Parents seem to think the child is the problem needed to be fixed, and everything will be okay; on the other hand, the child generally sees themselves as a victim. Narrative therapy enables these perspectives to be broken down and troubling behaviors of the child to be externalized, which could encourage both the child and the family members to achieve a new perspective no one feels prosecuted or blamed.
MultiSystemic 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 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
Controversy 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. Concerns specifically related to a specific type of residential treatment center called therapeutic boarding schools include:
inappropriate discipline techniques, medical neglect,