Two representatives from the Community Alliance for the Ethical Treatment of Youth (CAFETY), Eric Norwood and Shain Neumeier, attended a national conference held by the American Association of Children’s Residential Centers (AACRC), entitled Gathering on Common Ground, in Milwaukee, Wisconsin on July 21 and 22, 2011. Other attendees included representatives from residential treatment provider trade organizations such as AACRC and the National Association of Therapeutic Schools and Programs (NATSAP), and from organizations such as the Alliance for Safe, Therapeutic and Appropriate use of Residential Treatment (A START) and the Building Bridges Initiative which work to promote humane and effective practices in children’s mental health treatment. The conference consisted of five discussion segments, with Introductions and Residential Treatment Models on the first day and Points of Agreement and Disagreement, Upholding the Highest Standards, and Moving Forward on the second. In preparation for the conference, CAFETY prepared a 31-page report on our advocacy positions and data from our survivor survey to support them. This report was distributed to other organizations’ representatives on the second day of the conference for use in the discussions.
All the organizations present expressed genuine interest in improving residential programs and mental health care for children in general. Many, in fact, seemed opposed to at least some of the youth residential treatment industry’s more questionable practices. That being said, there was not enough time to discuss some necessary changes to the way in which the industry operates in any great depth. Furthermore, there still remain a number of fundamental disagreements on crucial points regarding what rights youth are entitled to and what constitutes effective treatment. What came out of this conference was a promise of further discussions and a decision to work together on issues upon which the organizations represented agreed.
CAFETY made the most headway with the other organizations attending the conference in advocating for measures that would ensure that residential treatment programs are truthful and clear in their advertising. CAFETY’s representatives, along with those from A START, explained the harm that can result from using fear-based advertisements that promise quick fixes for challenging youth behavior and from using euphemistic language to describe programs’ troubling treatment and behavioral management practices. Both the representatives from provider or trade organizations and those from child welfare organizations agreed that these were important issues that demanded solutions. In order to further parent, and perhaps, hopefully, youth, awareness of what practices in residential programs are acceptable, the organizations present agreed that individual programs should either post the Building Bridges Initiative’s Self-Assessment Tool for residential programs on their website or otherwise make it widely available. The group as a whole also agreed to form a taskforce that would work towards promoting truth in advertising within the industry. This task force will include, among others, Brian Lombrowski (CAFETY and the Building Bridges Initiative) and Cynthia Clark Harvey (A START).
The various organizations also supported the passage of state and perhaps federal regulations regarding residential programs, as well as the establishment of a monitoring system that would enforce these standards. The length and format of the conference did not allow for coming to any conclusions about what the regulations would require, nor about who would do the monitoring and how. That being said, the group as a whole agreed to create a task force that would work towards their establishment. In pursuing this goal, this task force will seek to establish model regulations and advocate for them to be adopted by government agencies, legislatures or some combination thereof. This task force will include Eric Norwood, Brian Lombrowski and Robert Friedman (A START), among others.
There were many points regarding to the treatment and disciplinary practices at residential programs on which the group disagreed, or on which providers and their representatives remained silent. Possibly the most significant disagreement was over the industry’s continued use of private escort companies in transporting youth to residential programs. CAFETY made its position clear that facilities should neither encourage the use of nor accept youth transported by escort companies in any circumstance because of the abuse and trauma involved. Representatives of trade organizations and providers, on the other hand, insisted that in some cases such interventions were necessary as the only option. The group eventually agreed that parents should accompany their children to residential programs whenever possible. That being said, CAFETY stands by its support of a total ban on the industry’s use of private escort companies, and will continue to advocate for measures that would achieve this.
CAFETY and its allies also met with some opposition on whether children should, in all circumstances, have access to the outside world, specifically to their parents. The representatives from provider and trade organizations did not comment on whether children should be able to contact the police, emergency medical help or child protective services, although CAFETY did advocate for this on several occasions. However, a representative from AACRC expressed doubt as to whether contact with one’s parents was a right to which children in residential programs are entitled. There was no further discussion or resolution on this issue.
Despite the fact that at least some representatives from provider and trade organizations seemed to support moving away from the punitive practices used at many residential programs, it is unclear to what extent they will join in forbidding or otherwise changing them altogether. CAFETY brought up a number of its advocacy points – regarding the use of restraint and seclusion, the use of level systems to enforce compliance, and the right to basic needs such as food, physical safety and bathroom use in all circumstances, for instance – that were not taken up for discussion or debate during the conference. Also unclear was the industry’s perspective on survivor involvement in improving residential treatment. A number of people, including representatives on behalf of providers, seemed willing to (further) include survivors in further discussions and resulting efforts. Meanwhile, however, a NATSAP representative expressed the all-too-familiar view that some of the concerns and negative reports about residential programs are exaggerated or unfounded, which is dismissive of survivors and their experiences by implication. Most worryingly when it comes to determining where providers stand is how an AACRC representative said that whether everybody at the conference could agree that youth in residential programs were entitled to basic human rights and dignity would depend on how those terms were defined. Hopefully further discussions will clarify providers’ and other organizations’ stance on these issues, if not convince them of the validity of and need to address the concerns of survivors and their supporters.
As a result of the conference, members of CAFETY and its allies will work with providers as part of the two taskforces agreed upon to establish and uphold basic standards for children’s residential programs. In addition, CAFETY will continue to be an active participant in discussions with the other organizations involved, advocating for still more stringent treatment standards and human rights protections. While CAFETY will continue to work independently on the issues upon which there was disagreement or uncertainty, we welcome the support of other organizations in establishing effective regulatory standards and monitoring and in ensuring that residential programs are truthful and clear in how they present themselves.
Download CAFETY's 30 pg handout detailing CAFETY's advocacy positions and survey results here.
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