Dispelling The Accusations & Myths Associated With NATSAP Adolescent Treatment Programs Through Research

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!

 

References

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

 

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2012 Study Suggests An Adolescent’s Readiness to Change When Entering Wilderness Treatment May Not Impact Long-term Outcomes

In their 2012 publication, Bettmann, Russell, & Parry discussed that adolescent treatment coercion can sometimes involve an adolescent literally being escorted by a third-party service (e.g., youth transport service) into treatment via physical force or implied intimidation.  In reasoning that entering treatment unwillingly or coercively (perhaps third-party escort/transport) might impact an adolescent’s readiness (motivation) to change, Bettmann and colleagues suggested that their findings–adolescent readiness to change when entering wilderness treatment did not relate to post-treatment outcomes at 6 months and 12 months–may be applicable to coerced adolescents as well.  More explicitly, Bettmann and colleagues’ central finding was that an adolescent’s (initial) readiness to change was not related to the post treatment outcomes of the adolescents in their study.  From this, they surmised that parents admitting their adolescent teens into wilderness treatment coercively (i.e., against adolescent’s own volition) might not impair post treatment outcomes.  Thus, coercing an adolescent into wilderness treatment (e.g., via a third-part youth escort/transport service) may not obstruct the therapeutic process.  Rather they may stand to benefit from wilderness treatment as much as those entering non-coercively or with greater treatment motivation.

Notwithstanding this suggestion—especially considering coercive admission practices for adolescents—this study was limited in scope and more robust data is essential before drawing any absolute conclusions.  Specifically, the population of investigation was limited to one wilderness program of privately placed (middleclass) adolescents.  Also the first author of this article (although highly reputable) is directly affiliated (with ownership) in this particular wilderness program, indicating a potential bias in both the design and data interpretation.  Importantly, wilderness treatment is distinct from traditional residential treatments (e.g., therapeutic board schools, residential treatment centers):  Wilderness programs are relatively shorter in their duration and treatment occurs in an open outdoor setting, which may lessen an adolescent’s perception of coercive pressures during treatment per se.  Therefore, these findings should not be extended to traditional residential treatment contexts until supporting data is collected.

Despite the mentioned (and likely other) limitations, Bettmann and colleague’s (2012) study has offered sound evidence that more research is essential to understanding the practices of private wilderness programs and their long-term implications (e.g., post-treatment outcomes) for adolescent participants in particular.  Furthermore, there is a pronounced need to better understand the perceptions and responses of adolescents to treatment contexts that enroll adolescents unwillingly (or coercively).  Although this discussion is far from conclusive, at this point (according to this publication) it seems plausible that some adolescents can experience positive results from participating in wilderness treatment, even if they are not ready (or perhaps willing) to change at the onset of (wilderness) treatment.

I look forward to future research contributing to these issues.  The reference of this article is enclosed below.

Bettmann, J. E., Russell, K. C., & Parry, K. J. (2012). How substance abuse recovery skills, readiness to change and symptom reduction impact change in wilderness therapy participants. Journal of Child Family Studies. doi: 10.1007/s10826-012-9665-2

 

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Dr. Phil: What to Look for When Choosing Residential Treatment Centers or Therapeutic Schools

Dr. Phil aired an episode in January of this year (2013) that discussed teen children who had been sent away to residential schools where they were allegedly trapped and abused.  In recognizing that there are many qualified therapeutic options for parents and their children, Dr. Phil provided a list of recommendations to help parents choose an appropriate teen treatment center or therapeutic school.

This list can be viewed at the following url: http://www.drphil.com/articles/article/724.

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Negative Pressures and Adolescent Treatment Admission Reactions

A current research study by Clinton Hardy (NST founder) at the University of Utah is indicating that certain procedures, particularly those involving negative coercive pressures, significantly relate with adverse affective reactions, or attitudes, at the time of entering a youth/teen treatment program.  Specifically, negative coercive pressures refer to the adolescent’s perceptions of “threat” or overt “force” when entering treatment.  While coercion is a broad treatment concept—encompassing many different pressures—this study focusses on the negative pressures of coercion, expressly those that pertain to physical force, threat, and intimidation.  Interestingly, research in adult treatment contexts has suggested that it is the perception of these pressures, including coercion in general, that is more implicative than the actual form of coercion used.  In other words, an intervention, such as a youth transport, that admits adolescents unwillingly into treatment can structure its approach to where less coercion, especially negative pressures, is experienced during the intervention process.  For example, a youth transport service that uses blatant verbal threats, intimidation, or unnecessary force may provoke more perceived negative coercive pressures versus a youth transport service that focuses on verbal negotiating strategies and avoids using intimidation and threatening.  More generally, the predicted implications of this study illustrate a need for additional inquiry into how negative admission pressures might adversely impact (a) initial adjustment into treatment or the concomitant delays in participation and outcome, (b) treatment outcomes, and (c) the adolescent’s willingness to seek future treatment.

Check back later for publication updates.

Posted in Clinton Hardy, Crisis Intervention, News and Updates, Research, Treatment Coercion, Troubled Teen, Wilderness Programs, Youth Transport | Tagged , , , , , | Leave a comment

Check Out Our Parent Resource Blog for parents of adolescent teens and adults

NST also authors a Parent Resource Blog, in addition to our Troubled Teenager Programs blog, via New Start Resources.  Please feel free to view and register for this blog at the link posted below.  Further, NST would like to thank its subscribers and those who contribute to our blogs and effort to increase education and awareness within the “troubled teen” industry.

Parent Resource Blog: http://www.newstartresources.com/blog/

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JTSP Publication – Adolescent Treatment Coercion

Clinton Hardy published an article “Adolescent Treatment Coercion” in the Journal of Therapeutic Schools & Programs (JTSP) 2011 volume. Clint’s article raises awareness to the deficit of empirical research design regarding coercive treatment and argues the need for it as the industry moves forward.  Resultant of his publication, there is at least one empirical study currently being conducted on this subject matter.  Clint and the rest of NST hope that more research designs will ensue.  Such research can help establish more effective coercive practices while bringing attention to those that may be ineffective.

Clint’s article can be accessed directly through the JTSP website or via this link, Online-JTSP-Vol5 “Adolescent Treatment Coercion”.

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Anderson Cooper Show Looking for Troubled Teenage Girl and Mother

The Anderson Cooper Show is a new daytime talk show based in New York City.  The show contacted Clinton Hardy of New Start Transports for help in finding a troubled teenage girl and mother to appear on the show this Friday September 30, 2011.

If you are a treatment program, educational consultant, or parent of a troubled teen, please contact the New Start Transports office immediately if you can help.

We appreciate your assistance and support,

Clinton Hardy
President
New Start Transports
www.newstarttransports.com

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Clinton Hardy’s Article to be Published in The Journal of Therapeutic Schools and Programs (JTSP)

As a recent update, President, Clinton Hardy, of New Start Transports recently had an article accepted for publication in the Journal of Therapeutic Schools and Programs (JTSP), also referred to as the NATSAP Journal.  Clint’s article encompasses the widely debated topic of treatment coercion among adolescent populations within the United States.  While several possible assertions are presented, he maintains that additional empirical research is paramount to supporting and improving the treatment tool of coercion among appropriate at-risk youth populations.

NST expresses its gratitude for the patience, support, and guidance of the JTSP staff, particularly, Dr. Michael Gass of the University of New Hampshire and Editor of the JTSP.

Posted in Adolescent Autonomy, Clinton Hardy, Media, NATSAP, NATSAP Journal, News and Updates, Parenting, Research, Treatment Coercion, Troubled Teen, Youth Transport | Leave a comment

NATWC Staff Training/Counselor Certification

The National Association of Therapeutic Wilderness Camping (NATWC) will be holding a two-day intensive training for staff working in therapeutic wilderness or residential settings.  This counselor training will be held October 24th and 25th in Henderson, North Carolina.  The cost of attending ranges from $270-$300 per person and includes room $ board and all training.

The NATWC training certification course will encompass the following:

  • Adventure based Facilitation
  • Adolescent Development
  • Communication Skills
  • Theoretical Perspectives
  • Boundaries & Ethics
  • Developing a Therapeutic Alliance
Posted in Conferences, Intervention Staff, NATWC, Residential Programs, Training, Wilderness Programs | Leave a comment

Vao Tiatia KSL News Interview – Polynesian Service

To view the news clip on KSL, please click here: http://www.ksl.com/index.php?nid=148&sid=17318576

Vao Tiatia, Artist for Vaopele Design and Transport Interventionist for New Start Transports is recognized by KSL for his art, culture, and contributions to youth within his community.  The Tiatia family has a history of polynesian culture and serving youth within the community.  To view the news clip on KSL, please click here: http://www.ksl.com/index.php?nid=148&sid=17318576.  To view more of Vao’s art, please visit his website: www.vaopele.com.

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