Residential Treatment Centers for Children and Adolescents with Conduct Disorders

Abstract

Any discussion of residential treatment is complicated by the fact that the term can encompass a variety of program settings and models. Residential treatment has been construed to include acute hospitalization, secure (locked) and open (unlocked) units, group homes, and at times, treatment foster care. This lack of definitional consensus has created considerable confusion and has made it difficult to summarize current research. Although RTCs continue to serve a significant portion of children and adolescents with serious mental health disorders, including those with conduct problems such as oppositional defiant disorder (ODD) and conduct disorder (CD), their effectiveness remains controversial. The landmark Report of the Surgeon General on Mental Health concluded that residential treatment programs, especially for youth, have "only weak evidence for their effectiveness". It is our position that this view of residential treatment is now outdated and does not reflect more recent approaches and evaluation research, especially in intensive treatment settings, which suggest the positive value of residential treatment for youth, families, and society. In the past decade, a variety of studies has demonstrated that residential treatment for youth can have positive effects, which generalize to the community and are often sustained for years. For example, Blackman, Eustace, and Chowdhury assessed the functioning of 40 clients, 10 of whom had CD or ODD, at admission, discharge, and 1-3 years post-discharge. The treatment program, which was designed for high-risk adolescents with a history of unsuccessful treatment, emphasized the development of coping skills within a multimodal family systems approach. The residential program was also integrated with community-based placements including group homes. The typical length of stay was 4-6 months. This study is noteworthy in that it used independent raters who were not involved in the care of the youth and included follow-up data on more than three quarters of the sample. Outcomes were assessed using the Global Assessment Scale, the Level of Functioning Scale, and the Adolescent Functioning Scale. (PsycINFO Database Record (c) 2012 APA, all rights reserved)