At the Capitol Steps
In October, 2005, A START(Alliance for the Safe and Therapeutic Application of Residential Treatment) coordinated a press briefing on Capitol Hill to increase awareness of concerns relating to unregulated residential facilities for youth, and to support the federal legislation proposed in the End Institutionalized Abuse Against Children Act and the Keeping Families Together Act. This press conference was co-sponsored by the following organizations:
• American Psychological Association • American Association of Community Psychiatrists • American Orthopsychiatric Association • Child Welfare League of America • Federation of Families for Children’s Mental Health • National Alliance for the Mentally Ill • National Mental Health Association
A concern about a growing number of reports from youth, families and the public media regarding the exploitation, mistreatment, and abuse of youth in unregulated, private residential treatment programs has given rise to an alliance of individuals and organizations that are working together to address this problem.
We recommend that you beware of residential programs that:
1. Are not state-licensed and accredited with regard to all 3 aspects of the program: the (1) educational, (2) mental/behavioral health and (3) residential components
2. Claim to be able to assess your child and make program recommendations by internet or by phone and then urge you to "act now" to prevent serious harm to your child and family
3. Recommend or support the use of private "escort" or "transport" services to take your child to the program
4. Do not respect the wisdom and expertise of parents and youth
• Do not allow your family and child to visit the program, see all the facilities and meet all the staff before deciding to admit your child
• Tell you to expect that your child will lie to you while in the program, and encourage you not to believe reports of abuse because these will be "attempts at manipulation"
• Do not encourage you as parents to be active participants throughout all stages of the program
• Do not welcome feedback (praise or criticism) from your child regarding the program
5. Restrict youth & family rights in terms of:
• Contact with family by phone, mail and in person (for example, no phone contact or visits for first month; censored mail; monitored visits with no opportunities for parent/child discussion in private)
• Dress code (for example: require youth to wear jumpsuits or flip-flops)
• Typical age-appropriate behavior (for example: forbid eye contact with youth of the opposite sex; forbid speaking, smiling, or moving without permission)
• Parental rights (for example: do not contact parents immediately in the case of illness, injury, emergency or treatment/medication changes)
• Do not provide hotlines for youth and families to call at any time if they feel that their rights are being violated or they are being mistreated
6. Use harsh and excessive discipline practices that include: seclusion, restraint, corporal punishment, punitive "behavioral modification," fear tactics, humiliation, peer-on-peer discipline / peer pressure, forced labor, heightened physiological stress* or sedation by medication
* for example, excessive exercise, sleep deprivation, exposure to the elements, forced retention of bodily waste or nutritional deprivation
7. Provide sub-standard therapeutic intervention
• Do not provide an individualized program with a detailed explanation of the therapies, interventions & supports that will address your child’s specific needs
• Do not provide the kinds of therapies and supports that are recognized as most effective for the problem(s) or symptom(s) your child is experiencing
• The majority of participating youth are experiencing problems very different from the types of difficulties your child is experiencing—this suggests that the program emphasis will not be optimally focused on the needs of your child
• Claim to serve youth with specific psychiatric diagnoses* but do not have full-time licensed mental health professionals** on staff
• Provide individual, family or group psychotherapy that is delivered by staff who are not trained and licensed mental health professionals
• Force youth to self-disclose personal information and/or admit to having problems as proof of "therapeutic progress" or "recovery" or as a prerequisite for "graduating" from the program
8. Provide sub-standard education that is:
• Limited to some variety of monitored study halls, videotaped lessons or independent study
• Delivered by staff who are not licensed/certified teachers with degrees from accredited colleges
• Provided in an environment with a high student: teacher ratio (i.e. very few teachers for the number of students)
• Not providing credits that will be recognized by your child’s home school district, the State Department of Education where the program is located or by future college admissions departments
• Unwilling or incapable of recognizing your child’s IEP (Individualized Education Plan)
9. Admit youth with psychiatric diagnoses but then do not provide appropriate medical treatment:
• Do not complete an initial physical exam and psychiatric evaluation or review a physical exam/psychiatric evaluation conducted immediately prior to admission
• Do not request (prior to or upon admission to the program) your consent to contact psychiatrists, therapists and teachers who are currently working with your child or have worked with your child in the past
• Do not ensure that child/adolescent psychiatrists are regularly available to prescribe, monitor and adjust medications as needed
• Do not ensure that youth who are prescribed medications are administered medications by trained/qualified staff
• Over-medicate youth in order to sedate them
• Explicitly state that the program follows an anti-medication philosophy, particularly if your child is currently taking medication(s) for a diagnosed disorder
10. Require parents to sign contracts with unreasonable terms:
• Parents must agree to relinquish their custody rights
• Parents must agree to pay for services not rendered if youth leaves program
• Parents must agree not to hold program responsible for providing services as described in promotional materials or specified in original contract
• Parents must agree to pay rates and fees that are not clarified up front
• Parents must agree not to file suspected child abuse reports against program staff or participants
• Parents must agree not to sue program if their child or family is mistreated
11. Have been reported, investigated or cited by at least one source* for:
• Unsanitary or unsafe living conditions
• Nutritionally compromised diets
• Exposing youth to extreme environmental conditions or physical over-exertion
• Lack of supervision by staff (low staff: youth ratio)
• Medical neglect
• Physical or sexual abuse of youth by program staff or by other program youth
• Violation of youth/family rights
* for example: Dept. of Health, Dept. of Child Welfare, Dept. of Child Protection, Dept. of Education, Police Department, Family Advocacy Group, newspapers
* for example, ADHD, Bipolar Disorder, PTSD, Eating Disorders, Depressive Disorders, Anxiety Disorders, Substance Abuse
** for example, licensed psychologists, psychiatrists, clinical social workers, marriage/family therapists and psychiatric nurses.
Before considering residential programs, we strongly recommend that your child receive a thorough assessment to clarify his or her needs and strengths. When you do begin to research particular programs, we suggest that you gather information from a variety of sources and about all aspects of the program. Watch for the website http://cfs.fmhi.usf.edu/projects/ASTART.htm for further information about steps to take and questions to ask to evaluate the programs you are considering.
The complex process involved in considering a residential placement for your child or adolescent can be challenging for any parent. We wish you strength, wisdom and ongoing support throughout the process as you advocate for your child and family.
If you need assistance in dealing with issues related to residential placement, please contact:
National Disability Rights Network
900 Second Street, NE, Suite 211
Washington, DC 20002
P: 202-408-9514
F: 202-408-9520
TTY: 202-408-9521
General inquiries: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or
Federation of Families for Children’s Mental Health
P: 703-684-7710
For further information regarding A START, please contact:
Allison Pinto, Ph.D.
Department of Child and Family Studies
Louis de la Parte Florida Mental Health Institute
13301 Bruce B. Downs Blvd.
MHC 2222
University of South Florida
Tampa, Florida 33612
P: 813-974-9179
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
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