Can We Transform Children’s Residential Treatment?
by Lisa DiFalco
The number of children in residential treatment centers continues to grow. Children in residential treatment may not have meaningful contact with family or previous friends, and they often have difficulty accessing the services required to process trauma or the mental and emotional stress placed on them as displaced children. The Alliance for Strong Families and Communities provides leadership in child and family behavioral health initiatives and supports systems-wide efforts in the improvement of child outcomes. A mind shift in residential treatment must occur — from simply housing and placing children — into providing the means to stabilize and enable them to benefit from permanent and loving relationships. How can the residential treatment model be transformed? Lawmakers, behavioral analysts, case managers, social workers and other health professionals must work together to develop the current model and address the present problems to enact the change needed. Understand the highlights and takeaways of the guide, Transformation We Live By, to improve children’s residential treatment programs and address these problems.
The Problems Within Children’s Residential Treatment Programs
In a historical context, the request for change in children services is nothing new. Orphanages were once asked to become residential care facilities, and residential care facilities became residential treatment centers. This last move was not easy because of the need for additional and, at times, extensive documentation. Now a request is again being asked of residential treatment programs: to integrate the family and community perspective and work in coordination with systems within and outside of our own sector. Residential treatment programs are to now guide families toward stability for better outcomes. A range of services, including safety, financial and social needs, will have to be accessible for children and their families in this new vision of a children’s residential treatment program. Transformation We Live By provides general goals for residential treatment providers to move the process forward. Objectives toward a model of child and family behavioral health include:
- Initiatives rooted in evidence-informed or evidence-based services;
- A balance between family- and child-centered approaches and related values orientation; and
- Full integration of residential treatment with community- and home-based services and supports.
The Alliance for Strong Families and Communities strives for behavioral health providers, residential treatment providers and the network of related health professionals to offer:
“A comprehensive, evidence-based, coordinated continuum of care that integrates residential and community services within a family-centered approach so that children maintain a pathway to health and well-being.”
This sounds like a tall order, but joint collaboration and alignment across sectors can create the change necessary to better serve the children and families within our care. Residential treatment centers, as they stand, have not demonstrated the ability to provide the level of care necessary to garner the support they need. They have been found to be too costly and less effective than alternative treatments. A change is necessary to help children and families get the level of care required for optimal outcomes, which is part of the reason that other forms of intervention should be incorporated within the umbrella of the current residential treatment program model. Otherwise, RTCs themselves will face a crisis and possibly be replaced with alternative interventions. The Surgeon General stated:
“The most convincing evidence of effectiveness is for home-based services and therapeutic foster care.”
This runs contrary to the current model of RTC and would significantly reduce the amount of children served in the residential treatment program as it is today. A paradigm change in how children are served within RTCs is crucial to improve their outcomes and the continued existence of all residential treatment programs.Click To Tweet
What Changes Does the Alliance Advocate?
The individual residential program provider, case manager and behavior technician all need guidance on making the transition within their children’s residential treatment program and all attendant services and related programs. It is a challenge, but one that must be faced. Alignment of incremental change to agreed-upon objectives will assist in moving the process forward. The straightforward Blueprint for Transformation positions RTCs and service providers for success. The top three goals of the Blueprint for Transformation 10 objectives are:
- Adoption of an organizational identity that will work equally as hard to strengthen communities and families to best provide for the well-being and permanency of youth.
- Construction of an environment in which the core of the work done is within children’s homes and community.
- Development and maintenance of a culture and climate that promotes autonomy, recognition, trust, mutual support, fairness and innovation.
Specific activities needed at the early stages of residential program change fall within three areas: building investment and support activities, strategic planning activities and early implementation activities. The leading activities from each category required are:
- Review of changes in the field with staff and the board (1).
- Clear communication of the necessity of a balanced perspective that includes the needs of the child, the family and the community (2).
- Development of a three-year strategic plan that would provide the path toward adaptation (6).
- Selection of quarterly activities to be implemented to achieve annual objectives (7).
- Establishment of processes to evaluate current service offerings (9).
- Creation of processes to evaluate job descriptions as they relate to the strategic plan (10).
- Development of trauma awareness skills for all staff (12).
- Initiate engagement with families of the children (13).
According to the Alliance for Strong Families and Children, it is commonly observed that children “raised by the system” have difficulty forming relationships, maintaining employment and have higher-than-average rates for mental health problems and chemical dependency. The effort here is to bring stability to the lives of children and their families, and when the child’s own family is not deemed safe, to provide a safe and healthy alternative “permanent” family.
Whether we choose to change or to hold onto our current model, a judgment will be made as to the effectiveness of the chosen children’s residential treatment program. Action needs to follow a vision statement, and collective effort is necessary to garner credibility from the public. The public’s support and additional feedback may help us take important initial steps to transform a system before it is too late.