As previously discussed by Hardy (2011) in the Journal of Therapeutic Schools and Programs (JTSP), private treatment programs for adolescents (PTPs)—those providing 24-hour supervised residential or outdoor care to non-adjudicated “at-risk” adolescent populations—have encountered increased levels of scrutiny in recent years. The American Bar Association (ABA, 2007) and United States Government Accountability Office (GAO, 2008), among others (e.g., ASTART), are two organizations that have questioned certain PTP practices. As an extreme example, the ABA (2007) purported that the following concerns were associated with the practices of some PTPs:
- Limiting the ability to contact parents over extended periods of time
- Overusing medication to control behaviors
- Confiscating children’s and youths’ shoes to prevent them from running away
- Employing physical restraint techniques, lasting for hours at a time. (The overuse of restraints has been causally linked to the death of some children and youth)
- Sexual abuse from program staff… (p. 416)
While the pervasiveness and plausibility of these issues vary across treatment contexts, and conceivably do not exist in all PTP milieus, the very suggestion of these grievances can arouse hesitation and concern among parents and professionals unfamiliar to the PTP industry. In particular to the National Association of Therapeutic Schools and Programs (NATSAP), it seems reasonable (from an insider’s perspective) to presume that the majority, if not all, of NATSAP’s member PTPs operate according to the highest ethical standards of treatment, thereby, precluding its members from any association to these grave infractions. Equally, the state of Utah—the home to many NATSAP and other PTPs—has been recognized (by both the ABA and GAO) for its exemplary oversight and licensing procedures for PTPs, suggesting Utah licensing as an additional assurance of ethical treatment practices to parents and professionals (ABA, 2007; GAO, 2008).
Notwithstanding, some organizations (e.g., GAO, ASTART) still propose that several PTPs, including NATSAP programs and those licensed in Utah and other States where oversight exists, still engage in unethical adolescent treatment practices. While a thorough analysis of these accusations is beyond the scope of this post, it is proposed that these purported concerns, or perhaps myths in some instances, can be dispelled and avoided through the increase of research. That is, as more PTPs invest and participate in research, a more accurate and evidenced based perspective of the industry can ensue. In turn, parents and professionals less familiar with the PTP industry may not only find greater confidence (or less reluctance) in considering PTP approaches, but the effectiveness of treatment can also be advanced—improving long-term outcomes and establishing PTP approaches as empirically valid alternatives. Therefore, research may be the crux to the future success of the private adolescent treatment industry, especially for those that lack a current empirical foundation or that have experienced increased scrutiny.
As this is a blog post, comments are always welcomed and appreciated!
American Bar Association (ABA) policy requiring licensure, regulation and monitoring of privately operated residential treatment facilities for at-risk children and youth. (2007). Family Court Review. 45 (3), 414-420.
Hardy, C. J. (2011). Adolescent Treatment Coercion. Journal of Therapeutic Schools & Programs, 5:1, 88-95.
United States Government Accountability Office (GAO). (2008). Residential programs: selected cases of death, abuse, and deceptive marketing. Retrieved from http://www.gao.gov/new.items/d08713t.pdf