{"id":19714,"date":"2022-07-15T13:00:46","date_gmt":"2022-07-15T20:00:46","guid":{"rendered":"https:\/\/www.unsilenced.org\/?page_id=19714"},"modified":"2022-07-16T08:06:57","modified_gmt":"2022-07-16T15:06:57","slug":"research","status":"publish","type":"page","link":"https:\/\/www.unsilenced.org\/research\/","title":{"rendered":"Research"},"content":{"rendered":"

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Research and Articles<\/h1><\/span>
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Please click a tag below to filter by article or research paper topic<\/p>\n<\/div>

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Restraint<\/span><\/a><\/span> Seclusion<\/span><\/a><\/span> Teen Transport Services<\/span><\/a><\/span> Residential Treatment<\/span><\/a><\/span> Wilderness Therapy<\/span><\/a><\/span> Juvenile Justice<\/span><\/a><\/span> Foster Care<\/span><\/a><\/span> Attack Therapy<\/span><\/a><\/span> Aversion Therapy<\/span><\/a><\/span> Boarding School Syndrome<\/span><\/a><\/span> Corporal Punishment<\/span><\/a><\/span> Other Datasets<\/span><\/a><\/span> <\/div>\n<\/div>\n

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\u2018\u2018When You First Get There, You Wear Red\u2019\u2019: Youth Perceptions of Point and Level Systems in Group Home Care<\/strong><\/a> – Child welfare involved youth are frequently referred to group home care. One common intervention utilized in group home care is behavior management systems. This intervention is operationalized as points, token economies, and level systems. Grounded in social learning and behavioral theories, the objective is to reinforce-prosocial behaviors and to provide mild negative consequences for undesirable behaviors. However, little is known about how child-welfare involved youth perceive these kinds of interventions and whether they believe them to be effective. Focus groups were conducted with 40 young adults known to independent living services and formerly in group home placement. The qualitative findings reveal that while youth felt structure was needed, how it was operationalized in group homes was\u00a0 restrictive, non-normative, and non-individualized. Implications for social work practice and further research using an attachment perspective are discussed.<\/div><\/div>
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\u201cScared Straight\u201d Programs are Counterproductive<\/strong><\/a> \u2013 The Pew Charitable Trusts, a non-profit, non-governmental organization, recently reported on the mixed results of \u201cScared Straight\u201d programs, which are intended to deter juveniles with a history of bad behavior from entering the criminal justice system by having them visit prisons or jails to see first-hand the consequences of breaking the law. Several studies maintain that such programs may actually increase the probability of offending by participating youths.<\/p>\n<\/div><\/div>

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2015-16 Civil Rights Data Collection – School Climate and Safety<\/strong><\/a> – The 2015\u201316 Civil Rights Data Collection (CRDC) is a survey of public schools and school districts in the United States. The CRDC measures student access to courses, programs, staff, and resources that impact education equity and opportunity for students.The CRDC has long provided critical information used by the Department of Education\u2019s Office for Civil Rights in its enforcement and monitoring activities.<\/p>\n<\/div><\/div>

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2017-18 Civil Rights Data Collection: The Use of Restraint and Seclusion on Children with Disabilities in K-12 Schools<\/strong><\/a> – The 2017\u201318 Civil Rights Data Collection (CRDC) is a survey of nearly all public schools and school districts in the United States. The CRDC measures student access to courses, programs, staff, and resources that relate to Federal civil rights laws. The CRDC has long provided important information used by the U.S. Department of Education\u2019s (Department) Office for Civil Rights (OCR) in its enforcement and monitoring activities. As a collection, the CRDC is an aggregate of self-collected and self-reported data. Almost all reporting entities are school districts, and the district superintendent or an authorized designee certifies that the data they submit are true and correct.<\/p>\n<\/div><\/div>

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50-State Comparison: State Policies on School Discipline<\/strong><\/a> – This resource provides much-needed context for these conversations on school discipline by outlining current state statute in an easily accessible format. Education Commission of the States researched school discipline statutes in all 50 states, plus the District of Columbia, and synthesized its findings according to several key questions below. It is important to note that this comparison covers state statutes and regulations only. In many states, school discipline policies are created and applied at the district or school level, and those nuances are not captured in this scan of state-level policies.<\/p>\n<\/div><\/div>

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A Closer Look at Involuntary Treatment and the Use of Transport Service in Outdoor Behavioral Healthcare<\/strong><\/a> – Outdoor behavioral healthcare (OBH or wilderness therapy) is an out-of-home adolescent treatment option serving tens of thousands of youths annually for behavioral, substance, and mental health issues in the United States. About half of OBH participants attend involuntarily and are transported by services specialized for \u201cuncooperative\u201d youth. Transportation has been argued by some researchers to have little impact on youth in treatment, and Tucker and colleagues found little difference in outcomes between not transported and transported youth. Ethical and empirical concerns arise from these findings, and we apply a critical perspective to address these concerns. Specifically, we examined the claim in OBH research that being transported has no significant bearing on client treatment outcomes. We propose that the findings of no difference were random, rather than systematic, because they were constructed on a\u00a0post hoc<\/i>\u00a0measure of perceived voluntariness. To demonstrate, we used data from OBH to construct five different measures of voluntary\/involuntary, also fabricated\u00a0post hoc.<\/i>\u00a0All five operationalizations resulted in statistically significant differences across a variety of social and psychological outcomes, demonstrating inconsistencies across the findings. Further independent and rigorous research is called for in OBH to understand the use and ethics of forced transportation, coercion, and involuntary treatment.<\/p>\n<\/div><\/div>

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A Legacy of Scandals<\/strong><\/a> – Until recently, programs and schools for struggling teens\u2014many of which are reputable, ethical, and professionally run\u2014operated with scant scrutiny by government agencies. Anecdotes about shoddy and abusive practices remained just that\u2014anecdotes\u2014until around 2003, when the media, espe-cially regional media outlets, publicized crises associated with the World Wide Association of Specialty Programs and Schools (WWASPS) that we detail later in this chapter.1 WWASPS was an umbrella organization of inter-connected companies, programs that provide residential services to struggling teens (Szalavitz 2006).<\/p>\n<\/div><\/div>

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A Summary of Participant Perspectives on Residential Treatment for Youth<\/a>\u00a0<\/strong>\u2013\u00a0 An online survey was developed and posted to gather information from young adults who participated in these types of programs when they were adolescents.\u00a0 Reports from 230 former program participants who attended programs located in 21 states across the country and 5 countries outside the United States reveal a pattern of communication and privacy rights violations, misuse of seclusion and restraint, and inhumane treatment, as well as significant distress and suffering relating to program participation.\u00a0 An analysis of the reports submitted by 49 young adults who attended programs in Montana, specifically, also revealed this pattern.<\/p>\n<\/div><\/div>

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A Summary of Reports of Restraints & Seclusion Abuse<\/strong> <\/a>– This chart summarizes accounts received through March 2000. Unless previously identified in news accounts, the names of individuals and facilities involved in each incident (and the person who made the report) are omitted in the interest of privacy and in some cases to avoid possible retaliation.<\/p>\n<\/div><\/div>

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A System of Care for Children\u2019s Mental Health: Expanding the Research Base<\/strong><\/a> – Contains several articles on youth residential. Problems can arise when placements are made without verifying that these important elements of residential care are in place. A basic source of verification of program quality is that the program is licensed by the state in which it is located; a higher source of verification is accreditation by a national organization. Neither is foolproof and questionable programs may exist with one or both of these \u201cseals of approval.\u201d Alternatively, good programs may exist with neither of these approvals. Thus, the issue of program quality is complex, but extremely important to the well-being and safety of children and precedes any consideration of treatment effectiveness. This symposium addresses the most basic measure of quality\u2014how states handle the issue of licensure; how they review or monitor the programs they license; and how they address problems that arise when the requirements for good child care, good treatment and good education are deficient.<\/p>\n<\/div><\/div>

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Abuse and Neglect in U.S.A. Residential Treatment Centers<\/strong><\/a> \u2013 This is a preliminary report on the abuse and neglect of persons in residential treatment for \u201csubstance abuse\u201d in the U.S.A. There have been violations of human rights, lack of investigation, prosecution and punishment of the offenders. This prevailing permissive environment has given de jure or de facto amnesty to those who violate human rights. Starting in the 1970\u2019s there were residential treatment facilities for teens that were found to be abusive. The SEED, Straight Inc. and its derivatives, Roloff Homes, WWASPS and, more recently, Teen Challenge were adjudicated \u201cguilty\u201d of human rights abuses. This report explores the ways these perpetrators of abuse have used the political system to protect themselves and exploit loopholes in the law to expand their network of abusive residential treatment facilities for youth.<\/p>\n<\/div><\/div>

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Abuse of Youth in Residential Placements: An Overview of the Problem<\/strong><\/a>\u00a0\u2013 Presentation to \u201cAbuse of Youth in Residential Treatment: A Call to Action,\u201d Washington, DC, February 19, 2009 by Dr. Robert M. Friedman<\/p>\n<\/div><\/div>

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Abusive Residential Care of Youth: Professional and Advocacy Response<\/strong><\/a> – This group of professionals and Advocates will introduce the audience to the phenomenon of abuse and maltreatment of youth in programs within the United States. These programs are either not regulated at all by states, or are \u201cbelow the radar\u201d of existing regulations. The audience will be treated to an example of collaboration between professionals and advocates that has begun to produce results. The chair, Dr. Huffine, will open with a brief overview of the problems in the \u201cteen-help industry.\u201d A representative of the Government Accountability Office will outline their investigation of this industry to date (or an alternate from Rep Miller\u2019s EdLabCommittee)<\/p>\n<\/div><\/div>

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Abusive Treatment Common in the USA, Not Just Asia<\/strong><\/a> – It is easier to point out the mote in another’s eye than to see the plank in one’s own. J\u00fcrgens and Csete\u00a0rightly condemn abuses in addiction treatment in a number of countries, but let us not forget the history of physically and psychologically abusive treatment in the USA that continues to this day in some institutions.<\/p>\n<\/div><\/div>

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ACLU and Human Rights Watch Seek Ban on Physical Discipline at School<\/strong><\/a> – Students with disabilities face corporal punishment in public schools at disproportionately high rates, says a report released today by the American Civil Liberties Union and Human Rights Watch. The physical discipline, which often includes beatings, can worsen these students’ medical conditions and undermine their education, says the report, which calls for an immediate moratorium on corporal punishment in US public schools.<\/p>\n<\/div><\/div>

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Addressing Abuse and Mistreatment of Youth Placed in Residential Treatment Facilities: The Context<\/strong><\/a> – Problems can arise when placements are made without verifying that these important elements of residential care are in place. A basic source of verification of program quality is that the program is licensed by the state in which it is located; a higher source of verification is accreditation by a national organization. Neither is foolproof and questionable programs may exist with one or both of these \u201cseals of approval.\u201d Alternatively, good programs may exist with neither of these approvals. Thus, the issue of program quality is complex, but extremely important to the well-being and safety of children and precedes any consideration of treatment effectiveness. This symposium addresses the most basic measure of quality\u2014how states handle the issue of licensure; how they review or monitor the programs they license; and how they address problems that arise when the requirements for good child care, good treatment and good education are deficient.<\/p>\n<\/div><\/div>

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Addressing Invisible Barriers: Improving Outcomes for Youth with Disabilities In the Juvenile Justice System<\/strong><\/a> – Many factors affect juvenile justice outcomes. One factor all-too-infrequently addressed is disability, which can place youth at great risk for contact with the juvenile justice system, as well as for poor outcomes once they have come into contact with the juvenile justice system. National studies show that a minimum of 30% to 50% of youth involved in juvenile crimes has special needs (Rutherford, Bullis, Anderson, & Griller-Clark, this series). Unfortunately, many service providers within the juvenile justice system are not sufficiently aware, not trained, or lack the resources to respond appropriately to children and youth with cognitive, emotional, and behavioral disabilities. These disabilities place them at greater risk than their peers for school suspension, school dropout, substance abuse, arrest, restrictive placement, and recidivism (DeMilio, 1989; Lexcen & Redding, 1999; Prescott, 1998).<\/p>\n<\/div><\/div>

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Addressing the Mental Health Needs of Young Children in the Child Welfare System<\/strong><\/a> – The National Center for Children in Poverty (NCCP) is the nation\u2019s leading public policy center dedicated to promoting the economic security, health, and well-being of America\u2019s low-income families and children. Using research to inform policy and practice, NCCP seeks to advance family-oriented solutions and the strategic use of public resources at the state and national levels to ensure positive outcomes for the next generation. Founded in 1989 as a division of the Mailman School of Public Health at Columbia University, NCCP is a nonpartisan,\u00a0 public interest research organization.<\/p>\n<\/div><\/div>

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Addressing the Needs of Youth with Disabilities in the Juvenile Justice System: The Current State of Knowledge<\/strong><\/a> – This report summarizes and assesses the state of knowledge about children and youth with disabilities who are at risk of delinquency and involvement in, or who have already entered, the juvenile justice system. By highlighting what is known about addressing delinquency and the diverse needs among this population, it aims to inform policy discussions among policymakers, practitioners, and researchers.<\/p>\n<\/div><\/div>

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Adolescent drug abuse treatment works better with family<\/strong><\/a> \u2013 Including parents in interventions for adolescent substance abusers may be the best way to prevent them from relapsing after treatment, according to research results presented at APA\u2019s 2003 Annual Convention and slated to be published this year in Drug and Alcohol Dependence. “This study is an important first step in the examination of the efficacy of adolescent drug treatments that coordinate family-based and cognitive-behavioral approaches,” said Latimer, a professor at Johns Hopkins University’s department of mental health. “The study findings suggest that the IFCBT model is a promising approach for the treatment of adolescent drug abuse.”<\/p>\n<\/div><\/div>

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Adult Perspectives on Totalistic Teen Treatment: Experiences and Impact<\/strong><\/a> – This thesis presents qualitative research based on interviews with adults who, as adolescents, resided within a totalistic treatment milieu. The term \u201ctotalistic\u201d refers to an array of features and methods associated with autocratic treatment programs and total institutions that utilize a closed group dynamics approach to affect fundamental personal change (De Leon, 2000; Goffman, 1961; Grant & Grant, 1959; Schein, Schneier, & Barker,1961). The term also implies the assumption that the totality of simultaneous, clustered conditions is a primary \u201cactive ingredient\u201d within such programs (Leach, 2016). The term \u201cresidential treatment\u201d is a matter of convenience and is not meant to exclude totalistic forms of intensive outpatient treatment.<\/p>\n<\/div><\/div>

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Adverse Effects Associated With Physical Restraint<\/strong><\/a> – Restraint use is not monitored in the US, and only institutions that choose to do so collect statistics. In 1999, investigative journalists reported lethal consequences proximal to restraint use, making it a life-and-death matter that demands attention from professionals. This paper reviews the literature concerning actual and potential causes of deaths proximal to the use of physical restraint.<\/p>\n<\/div><\/div>

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Against Parental Rights<\/strong><\/a> – This article begins by describing the most common, child-centered justification for parental rights: that parents are empowered in order to protect children\u2019s best interests. I argue that these child-centered accounts do not justify the current legal regime governing parental rights. Instead, current parental rights are better understood as quasi-property interests, residual from historical traditions where children were more explicitly regarded as their parents\u2019 property.<\/p>\n<\/div><\/div>

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Alternatives to the Secure Detention and Confinement of Juvenile Offenders<\/strong><\/a> – Court officials must balance the interests of public safety with the needs of youth when making decisions about which program to place a juvenile offender and which level of restriction is required. Juvenile offenders who commit serious and\/or violent crime may require confinement to protect public safety and intensive supervision and intervention to become rehabilitated. On the other hand, many offenders can be effectively rehabilitated through community-based supervision and intervention.<\/p>\n<\/div><\/div>

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American Academy of Child & Adolescent Psychiatry: ODD<\/strong><\/a>\u00a0\u2013 Experts agree that therapies given in a one-time or short-lived fashion, such as boot camps, tough-love camps, or scare tactics, are not effective for children and adolescents with ODD. These approaches may do more harm than good. Trying to scare or forcibly coerce children and adolescents into behaving may only reinforce aggressive behavior.<\/p>\n<\/div><\/div>

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American Bar Association Report 2023<\/strong><\/a> – This report will proceed in four parts. The first part of the report will discuss the scope of the issue, include a brief discussion of existing research, challenges with current nomenclature, and assessment of the number of youth currently impacted, and provide a rough analysis of the financial impact. The second part of this report will discuss the problems within youth residential programs and detail some of the more egregious abuses, including death and serious injury, psychiatric mistreatment, educational abuse, and the creation of lasting trauma. The third section will discuss the current regulatory framework and the problems and challenges of a patchwork system of inconsistent regulations. Finally, the fourth section will highlight solutions including the passage of SICAA, a federal oversight committee, comprehensive data gathering, and the creation of model state regulations.<\/p>\n<\/div><\/div>

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An Empirical Evaluation of Juvenile Awareness Programs in the United States: Can Juveniles be \u201cScared Straight\u201d?<\/a>\u00a0<\/strong>\u2013 Juvenile awareness programs like Scared Straight became popular crime prevention strategies during the 1970s. Juvenile offenders and at-risk youth who participate in these programs are taken to prisons where inmates use confrontational methods to recount stories about violence, sex, and abuse perpetrated by fellow inmates while living a life behind bars. These \u201cget tough\u201d policies have wide public and political appeal. Empirically speaking it is unclear whether juvenile awareness programs help to reduce recidivism or prevent criminal behavior. The purpose of this article is to use an evidence-based approach to determine if there is sufficient empirical evidence to suggest that these programs are effective crime prevention tools. This investigation includes a comprehensive review of the studies that have examined juvenile awareness programs. The studies are evaluated using the most widely accepted tool for assessing scholarly works in criminology, the Maryland Scientific Methods Scale. The results of this study indicate that juvenile awareness programs that use confrontational techniques do not work.
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An Exploratory Study on Adult Survivors of the Troubled Teen Industry\u2019s Therapeutic Boarding Schools and Wilderness Programs<\/a>\u00a0<\/strong>\u2013 As an increasing number of narrative reports and exploratory studies are being published on the Troubled Teen Industry (TTI), there remains a deficit of studies utilizing both qualitative and quantitative data have been published to date. Including quantitative data greatly enriches the information provided by qualitative methods and allows for comparisons to be made between these survivors and their adult peers. This study included both an open-ended survey, as well as quantitative assessments of personality, trauma, depression, anxiety, substance use, and family structure. This foundational data will facilitate steps towards better regulations on the TTI, as well as more effective treatment for these adult survivors. Ultimately, data from this study may prevent ongoing harm, as well as inform mental health providers about the needs of these individuals. Results from this study indicate that the vast majority of participants have overwhelmingly negative opinions of the TTI, even decades after leaving their programs, highlighting the intensity of their experiences and the magnitude of the impact their enrollment had on their lives. Most participants described their TTI experience as horrible and traumatic, and felt like they had been brainwashed and\/or abused. While there were exceptions to this finding, they were often because of even more abusive home environments participants were living in before TTI enrollment
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Applying International Human Rights Standards to the Restraint and Seclusion of Students with Disabilities<\/strong><\/a> – No federal law in the United States prohibits school administrators from physically restraining or secluding students. State laws diverge widely. Unlike in medical, psychiatric, and law enforcement settings, where strict national standards govern the use of physical restraint and seclusion, many schools may have no, or inconsistent, guidelines to follow in deciding when the use of force upon students is appropriate.’ This lack of industry-approved protocol and standardized training of school personnel makes restraint and seclusion susceptible to misapplication and abuse. Over a ten-year period in the 1990s, 142 restraint-related deaths were reported in the United States. While restraints are dangerous even when used on adults, children face an especially high risk of death or serious injury. The students who most often suffer the ill effects of restraint are children with disabilities, whose behaviors are often misunderstood and whose needs are often not accommodated.<\/p>\n<\/div><\/div>

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Away From Home: Youth Experiences of Institutional Placement in Foster Care<\/strong><\/a> \u2013 Since the creation of the modern child welfare system, child welfare has sent a percentage of youth in foster care to live in institutional placements, not with relatives or foster families. Of the hundreds of thousands of young people in foster care systems each year, over 43,823 (AFCARS, 2020), or 10%, are in group homes or institutional placements, but in some states, that number is much higher, topping over 30% (Children\u2019s Bureau, 2015). Over the years, many reports, investigations, and assessments have shed light on the conditions that foster youth experience in institutional placements. For instance, a 2015 Department of Health and Human Services (HHS) report found that over 40% of children in institutions do not have a clinical reason for that acute of a setting (Children\u2019s Bureau, 2015). A seminal study reported that residential treatment facilities lack oversight, and protective health and safety practices, and engage in substandard treatment, rights violations, and abuse (Behar et. al., 2007). Another study has shown how youth exposed to institutional care often suffer from \u201cstructural neglect\u201d which may include minimum physical resources, unfavorable and unstable staffing patterns, and social-emotionally inadequate caregiver-child interactions\u201d (Van IJzendoorn et al., 2011). Researchers have documented how institutions often fracture family relationships, rely on shift staff with often inadequate training and high turnover rates, expose youths to negative peer experiences (James, 2011), engage in restrictive placement policies, and mismatch placement decisions based on level of care needed (Lardner, 2015). A 2013 study by the National Disability Rights Network found that child welfare routinely placed youth with disabilities in institutions with \u201cextremely restrictive settings\u201d and \u201cin settings that are not remotely designed for their needs\u201d (National Disability Rights Network, 2013) which implicates the Americans with Disabilities Act (Juvenile Law Center, 2015). These and other reports have led to a growing movement calling for the reduction or elimination of institutional placements in foster care.<\/p>\n<\/div><\/div>

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Balanced, Avoidant, or Preoccupied?<\/strong><\/a> \u2013 Following a review of the assessment of attachment methodologies, this research utilized the Adult Attachment Interview with twenty-six people who were educated at independent fee-paying schools: fourteen ex-boarding school and twelve ex-day school adults. Their attachment strategies were classified according to the Dynamic Maturational Model of attachment as developed by Crittenden from her doctoral thesis (1983) following her work with Bowlby\u2019s colleague, Mary Ainsworth. This thesis also acknowledges the link between attachment and psychoanalytic theory and draws on examples from both The findings were interesting in that only people in the boarding school group who had received therapy took part. While both groups used a similar attachment strategy, the boarding school group were more likely to be reorganizing towards a balanced, secure attachment style than the day school group suggesting perhaps a positive outcome for therapy. However, the research findings demonstrated that the boarding school group had experienced more traumas both prior to and after being sent to boarding school than the day school group did. These findings are discussed together with the limitations of the study and suggestions for further research.<\/p>\n<\/div><\/div>

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Banning the Use of Restraints on Pregnant Women In Custody<\/strong><\/a> – It is currently routine practice for officers in over one-third of U.S. corrections institutions to restrain pregnant and laboring women. Restraining pregnant women poses health and developmental risks to the mother and baby. Heeding these concerns, many states and federal agencies have passed policies limiting restraint use on this population. Federal legislation could ban the use of restraints on pregnant women in all corrections institutions, including jails, prisons, and detention centers, unless a legitimate safety or security concern exists.<\/p>\n<\/div><\/div>

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Behavioral Crisis Prevention and Intervention: The Dynamics of Non-Violent Care<\/strong><\/a> -This is a risk management, safety enhancement tool for organizations committed to creating a violence-free and coercion-free care environment. It is based on principles drawn from evidence-based practice (to the extent it is possible) and professional consensus, and tested in practice by various training programs.<\/p>\n<\/div><\/div>

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Beyond Point and Level Systems: Moving Toward Child-Centered Programming<\/strong><\/a> \u2013 Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and\/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of \u201cdoing things.\u201d Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.<\/p>\n<\/div><\/div>

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Beyond Point and Level Systems: Moving Toward Child-Centered Programming<\/strong><\/a> – Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and\/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of \u201cdoing things.\u201d Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.<\/p>\n<\/div><\/div>

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Boarding School Syndrome: Broken Attachments A Hidden Trauma<\/strong><\/a> \u2013 The aim of this paper is to identify a cluster of symptoms and behaviors, which I am proposing be classified as \u2018Boarding School Syndrome<\/i>\u2019. These patterns are observable in many of the adult patients, with a history of early boarding, who come to psychotherapy. Children sent away to school at an early age suffer the sudden and often irrevocable loss of their primary attachments; for many this constitutes a significant trauma. Bullying and sexual abuse, by staff or other children, may follow and so new attachment figures may become unsafe. In order to adapt to the system, a defensive and protective encapsulation of the self may be acquired; the true identity of the person then remains hidden. This pattern distorts intimate relationships and may continue into adult life. The significance of this may go unnoticed in psychotherapy. It is proposed that one reason for this may be that the transference and, especially the breaks in psychotherapy, replay, for the patient, the childhood experience between school and home. Observations from clinical practice are substantiated by published testimonies, including those from established psychoanalysts who were themselves early boarders.<\/p>\n<\/div><\/div>

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Boarding School Syndrome: Disguised Attachment-deficit and Disassociation Reinforced by Institutional Neglect and Abuse<\/strong><\/a>\u00a0\u2013 This paper is based on a talk given at the invitation of the Inner City Centre Psychotherapy Charity in 2013.<\/p>\n<\/div><\/div>

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Boarding school: the trauma of the \u2018privileged\u2019 child<\/strong><\/a> \u2013 Sending young children to boarding school may be considered a particularly British form of child abuse and social control. The trauma of the rupture with home may be followed by other ordeals such as emotional deprivation and, in extreme cases, physical and sexual abuse. The taboo on expressing emotion, which is common in such institutions, may lead to an encapsulation of the self. Consequently, the needs of the distressed child\/self remain active, but unconscious, within the adult. This maybe disguised by an armoured, and very often socially successful, persona. The psychological interplay, between these two facets of the personality, may be detrimental to intimate relationships. In clinical practice the emotional conflict between a desire for intimacy and anticipated exile comes to the fore. Three examples demonstrate how within the transference this may lead to a dependent and erotic atmosphere, which abruptly changes to sever all connection. Changes in the frame, breaks in analysis, and confessions of emotional need are all points at which vigilance is required if such disturbance in analysis is not to end in its abrupt termination.<\/p>\n<\/div><\/div>

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Boot Camps<\/strong><\/a> – Boot camp programs were developed with the promise of altering delinquent behavior by providing a regimented, quasi-military intervention. Research suggests that the programs are no more effective than other programs, and may be less effective. There are several criticisms of boot camps, including lack of a theoretical foundation, high-profile deaths and abuses, and lack of legal oversight, among others. Boot camps tend to criminalize victims, and have become less popular as a result of the high-profile negative press.<\/p>\n<\/div><\/div>

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Boot Camps for Juveniles<\/strong><\/a> – Correctional boot camps are a controversial alternative sanction for adjudicated juveniles that emphasize a militaristic style of operation. Program characteristics vary with the political atmosphere of the jurisdiction in which the boot camps are running, but most focus on rehabilitating offenders within a punitive environment. Goals are similar across the board, with most programs aiming to reduce recidivism and reconviction while controlling costs associated with juvenile detention. Empirical research indicates little or no benefit of juvenile boot camps with regard to these and other goals.<\/p>\n<\/div><\/div>

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Brief Report: Use of Psychotropic Medications by Youths in Therapeutic Foster Care and Group Homes<\/strong><\/a> – This article examines the use of psychotropic medications among youths in residential community-based placements. Data are from a study funded by the National Institute of Mental Health of therapeutic foster care (June 1999 through May 2001) and group homes (January through June 2001). Data were collected from staff by means of in-person interviews. Many youths in both settings received psychotropic medications, and approximately one-half were taking multiple psychotropic medications. After the authors controlled for demographic and clinical factors, the youths in group homes were nearly twice as likely as the youths in therapeutic foster care to receive medication.<\/p>\n<\/div><\/div>

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California State Restraint Data<\/strong><\/a> – Welfare and Institutions Code sections 4436.5 and 4659.2 require the Department of Developmental Services to publish data quarterly regarding the use of physical or chemical restraint, or both, by all regional center vendors providing residential services or supported living services, and by long-term health care facilities and acute psychiatric hospitals serving individuals with developmental disabilities. California Code of Regulations, Title 17 Section 54327 requires vendors and long-term health care facilities to report, among other incident types, incidents of reasonably suspected abuse\/exploitation including physical and\/or chemical restraint.<\/p>\n<\/div><\/div>

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Cases of Child Neglect and Abuse at Private Residential Treatment Facilities: Hearing before the Committee on Education and Labor<\/a>\u00a0<\/strong>\u2013 Hearing before the House on abuse in private residential treatment facilities<\/p>\n<\/div><\/div>

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Child abuse and neglect in institutional settings, cumulative lifetime traumatization, and psychopathological long-term correlates in adult survivors<\/strong><\/a>\u00a0\u2013 Child maltreatment (CM) in foster care settings (i.e., institutional abuse, IA) is known to have negative effects on adult survivors\u2019 mental health. This study examines and compares the extent of CM (physical, emotional, and sexual abuse; physical and emotional neglect) and lifetime traumatization with regard to current adult mental health in a group of survivors of IA and a comparison group from the community. Participants in the foster care group were adult survivors of IA in Viennese foster care institutions, the comparison group consisted of persons from the Viennese population. The comparison group included persons who were exposed to CM within their families. Participants completed the Childhood Trauma Questionnaire, the Life Events Checklist for DSM-5, the PTSD Checklist for DSM-5, the International Trauma Questionnaire for ICD-11, and the Brief Symptom Inventory-18 and completed a structured clinical interview.<\/p>\n<\/div><\/div>

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Children in residential treatment: A follow-up study<\/strong><\/a>\u00a0\u2013 Examined outcomes and service utilization among a total population of children discharged to their families from a residential treatment center (RTC) during a 3-year period. Consistent with the view that RTC treatment is frequently associated with continuing placement and dependency, the risk of replacement was 32%, 53%, and 59% by the end of the first, second, and third post discharge years, respectively.<\/p>\n<\/div><\/div>

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Children of Color With Mental Health Problems: Stuck in All the Wrong Places<\/strong><\/a> – While nationally, one out of every five youth suffers from mental health problems, in juvenile justice facilities the numbers grow to one out of every two. An average of 17,000 incidents of suicidal behavior occur each year in juvenile justice facilities in this country.\u00a0 In Maryland, in 1998, 53% of the youth in the 15 juvenile justice facilities had mental health problems.<\/p>\n<\/div><\/div>

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Children should be protected from unreasonable restraints, seclusion and searches, ABA House says<\/strong><\/a> – Resolution 103 urges governmental bodies to adopt and enforce legislation and educational policies that prohibit school personnel from using seclusion and mechanical or chemical restraints on students in preschool through 12th grade. The resolution, sponsored by the Commission on Disability Rights and Section of Civil Rights and Social Justice, also urges jurisdictions to bar personnel from physically restraining students unless they pose a danger to themselves or others. If other less intrusive interventions are deemed inappropriate or fail and physical restraint is used, the resolution says personnel should not place students face-down or in any position that hinders their ability to breathe or communicate distress.<\/p>\n<\/div><\/div>

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Children’s Oppression, Rights and Liberation (Law Review Article)<\/strong><\/a> – This paper advances a radical and controversial analysis of the legal status of children. I argue that the denial of equal rights and equal protection to children under the law is inconsistent with liberal and progressive beliefs about social justice and fairness. In order to do this I first situate children\u2019s legal and social status in its historical context, examining popular assumptions about children and their rights, and expose the false necessity of children\u2019s current legal status. I then offer a philosophical analysis for why children\u2019s present subordination is unjust, and an explanation of how society could be sensibly and stably arranged otherwise by synthesizing Eileen McDonagh\u2019s distinction between decisional autonomy and bodily integrity with Howard Cohen\u2019s writing on borrowed capabilities and child agents. My first conclusion from this analysis is that age based classifications should not be presumed to be rational.<\/p>\n<\/div><\/div>

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Client perspectives on wilderness therapy as a component of adolescent residential treatment for problematic substance use and mental health issues<\/a>\u00a0<\/strong>\u2013 Wilderness therapy is a specialized approach to adolescent substance use and mental health treatment. While empirical evidence of positive outcomes grows to support this approach, qualitative understandings are lacking in the literature, thereby limiting theoretical explanations. Additionally, the voice of adolescent clients is hardly present, and was therefore the focus for this research. A sample of 148 adolescent wilderness therapy clients at one Canadian residential treatment program for addictive behaviour and mental health issues participated in the study. A realist approach utilizing thematic analysis of written open-ended responses produced six major themes; three depicting participant experiences (social dynamics, wilderness, catalyst for change) and three for perceived outcomes (skill development, self-concept, health).<\/p>\n<\/div><\/div>

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Collaboration in the Juvenile Justice System and Youth Serving Agencies<\/strong><\/a> – In recent years policy makers and the public have been concerned about delinquency and violence, particularly offenses committed by juveniles. Evidence suggests that, although the number of juveniles referred to juvenile courts appears to be increasing, the percentage of juveniles involved in violent crime has remained relatively stable during the 1980s and 1990s (Snyder, 1998). In spite of relatively stable rates of violent juvenile offenses, media coverage and public perception have suggested that there has been a dramatic increase in the rate of violent crime (Center for Media and Public Affairs, 1993; cited in Schiraldi, 1998). One of the consequences of public perception of an increase in violent crime has been the implementation of practices and policies that have little empirical support and attack the symptoms of juvenile delinquency, not the problem itself.<\/p>\n<\/div><\/div>

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Collection of Evidence-based Practices for Children and Adolescents with Mental Health Treatment Needs<\/strong><\/a> – The recognition that children and adolescents suffer from mental health disorders is a relatively recent development. Throughout history, childhood was considered a happy period. Children were not thought to suffer from mental disorders or emotional distresses, due to the notion that they were spared the stresses that afflict adults (American Psychiatric Association [APA], 2002). It is now well-recognized that these disorders are not just a stage of childhood or adolescence, but are a result of genetic, developmental, and physiological factors.<\/p>\n<\/div><\/div>

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Commentary\u2014The Profits of Misery Revisited<\/strong><\/a> – This commentary is prompted by Dr. Sandra Thomas’ (2008) editorial on wilderness programs that was published in Issues in Mental Health Nursing.<\/p>\n<\/div><\/div>

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Community-based systems approach to children’s managed mental health services<\/strong><\/a> – The increasing implementation of managed care principles in the or<\/span>ganization<\/span> and <\/span>financing <\/span>of<\/span>\u00a0mental health services<\/span>\u00a0has now<\/span>\u00a0entered<\/span> the <\/span>area <\/span>of <\/span><\/span>children’s\u00a0mental\u00a0health\u00a0services,\u00a0especially <\/span><\/span><\/span><\/span>as <\/span>states seek <\/span>to <\/span>control <\/span>the increasing costs of Medicaid programs. Managed care <\/span>approaches <\/span>are <\/span>relatively new in mental health\u00a0and those\u00a0that\u00a0exist have been\u00a0developed <\/span><\/span><\/span>with <\/span>adult<\/span>\u00a0and<\/span>\u00a0private sector populations<\/span>\u00a0in<\/span>\u00a0mind.<\/span>\u00a0If<\/span>\u00a0applied<\/span>\u00a0to<\/span> child mental <\/span>health\u00a0services, the usual benefits restriction approach in traditional behav<\/span><\/span><\/span>ioral managed care has the potential of depriving children of timely and <\/span>effective <\/span>intervention and prevention services.<\/span><\/p>\n<\/div><\/div>

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Confrontation Group Psychotherapy with Gifted, Dually Diagnosed, and Self-Destructive Adolescents in a Residential Setting<\/strong><\/a> – An adolescent mutation has proliferated since the late 1960s who has been immune to traditional therapeutic and educational approaches. It takes a new breed of group leader to work with this difficult-to-treat youth, who either self-medicates abusing psychoactive substances and\/or takes prescribed and potent psychotropic medication. Innovative and humanistic treatment techniques are needed to convince an unconvinced youth to use, rather than abuse, superior intellectual and artistic abilities.<\/p>\n<\/div><\/div>

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Congregate Care, Residential Treatment and Group Home State Legislative Enactments 2014-2019<\/strong><\/a> \u2013 Just over 400,000 American children live in foster care, and some 55,000 reside in group homes, residential treatment facilities, psychiatric institutions, and emergency shelters. This type of placement\u2014called \u201ccongregate care\u201d\u2014may be beneficial for children who require short-term supervision and structure because their behavior may be dangerous. However, many officials believe that children who don\u2019t need that type of intense supervision are still in these group placements\u2014depending on the state, between 5% and 32%\u2014making it harder to find them permanent homes and costing state governments three to five times more than family foster care. A recent federal analysis of Adoption and Foster Care Analysis (AFCARS) data revealed important information about children and youth placed in congregate care settings in the U.S.\u00a0\u00a0The analysis defined congregate care as \u201cA licensed or approved setting that provides 24 hour care for children in a group home (7-12 children) or an institution (12 or more children).\u00a0\u00a0These settings may include a child care institution, a residential treatment facility or a maternity home.\u201d<\/p>\n<\/div><\/div>

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Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association<\/strong><\/a> – Group care for children and adolescents is widely used as a rearing environment and sometimes used as a setting in which intensive services can be provided. This consensus statement on group care affirms that children and adolescents have the need and right to grow up in a family with at least 1 committed, stable, and loving adult caregiver. In principle, group care should never be favored over family care. Group care should be used only when it is the least detrimental alternative, when necessary therapeutic mental health services cannot be delivered in a less restrictive setting<\/p>\n<\/div><\/div>

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Contemporary Family Law<\/strong><\/a> – Stories have been repeated in the media over and over again describing youth, some as young as seven, often awakened from bed in the middle of the night, taken by two large men by force or the threat thereof, while their family stands aside observing. These youths are then shipped thousands of miles away, destined to spend much of their childhood engaged in compulsory, hard labor without pay and \u201ctherapy\u201d amounting to little more than re-education type of psychological abuse, under the guise of treatment or discipline by sadistic, sometimes violent, staff. While the aforementioned description is one most commonly associated with a draconian prison camp, what is actually being described is the fate of youths whose parents, desperate to find help for their \u201ctroubled teen,\u201d were convinced to send their unwilling child to a tough-love programs run by U.S. nationals and marketed as wilderness camps, therapeutic boarding schools, and behavior modification programs. Many of these programs are located within the U.S. where they are subject to very little oversight or regulation.<\/p>\n<\/div><\/div>

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Correctional Boot Camps: Lessons from a Decade of Research<\/strong><\/a>\u00a0\u2013 Random assignment evaluations found no significant differences in recidivism rates between boot camp participants and comparison groups. In some cases, boot camp graduates had higher rates of recidivism<\/p>\n<\/div><\/div>

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Critical Failures in a Regional Network of Residential Treatment Facilities<\/strong><\/a> – The present descriptive case study reports on the state of treatment services and environmental settings in adolescent residential treatment facilities (RTFs) conducted as part of the Residential Treatment Center Evaluation Project. The project frequently uncovered poor quality of care exposing youth to deleterious conditions. Observations related to harsh treatment practices, psychiatric practice and medication management, educational and aftercare planning, and general treatment planning were closely examined. The analysis indicated that accreditation and licensing are insufficient to assure the quality of the service process in RTFs. Future research should address the relationship between treatment quality and treatment outcome.<\/p>\n<\/div><\/div>

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Cultural Islands: The Subjective Experience of Treatment and Maltreatment within Insular Programs<\/a>\u00a0<\/strong>\u2013 This is a brief, selective summary of a thesis research project titled \u201cAdult Perspectives on Totalistic Teen Treatment: Experiences and Impact.\u201d This project was approved by the University of Florida Institutional Review Board Office (UF\u2013IRB201701655). The summary presented here reports on findings most closely related to the topics of insularity, the potential for harm, and under-representation.
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Cures that Harm: Unanticipated Outcomes of Crime Prevention Programs<\/strong><\/a>\u00a0\u2013 This review highlights the importance of recognizing the possibility for doing harm when intentions are good. The author concludes with recommendations for scientifically credible evaluations to promote progress in the field of crime prevention.<\/span><\/p>\n<\/div><\/div>

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CWLA Best Practice Guidelines<\/strong><\/a> – During the past decade, lesbian, gay, bisexual, and transgender (LGBT) adolescents have become increasingly visible in our families, communities, and systems of care. A significant number of these youth are in the custody of child welfare or juvenile justice agencies. Yet the public systems that are charged with their care and well-being have been unresponsive to their needs and slow to acknowledge that LGBT children and adolescents are in urgent need of appropriate and equitable care (see, for example, Mallon, 1992, 1994, 1998). Child welfare and juvenile justice systems have not incorporated advances in research and understanding related to human sexuality and child and adolescent development that have informed the development of professional standards and guidelines for the major professional associations. As a result, these systems continue to deliver misguided, uninformed, second-class care to LGBT youth in their custody.<\/p>\n<\/div><\/div>

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Dangerous Use of Seclusion and Restraints in Schools Remains Widespread and Difficult to Remedy: A Review of Ten Cases<\/a><\/strong> – There is no evidence that physically restraining or putting children in unsupervised seclusion in the K-12 school system provides any educational or therapeutic benefit to a child. In fact, use of either seclusion or restraints in non-emergency situations poses significant physical and psychological danger to students. Yet the first round of data collected by the United States Department of Education in 2009-2010 demonstrated that these same practices that are prohibited in other settings were used in U.S. schools at least 66,000 times in a single school year. Because fifteen percent of school districts failed to report data, however, this figure likely underestimates use of seclusion and restraints.<\/p>\n<\/div><\/div>

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Dangers of labeling children ‘mentally ill’<\/strong><\/a> – Children are increasingly being given drugs by doctors to help teachers and parents cope with their troublesome behaviour. Certain behaviours or actions by children, such as not sitting still, are being judged as evidence of mental disorders and used to justify an official diagnosis. This has led to an increase in diagnoses of children with conditions such as attention deficit hyperactivity disorder (ADHD) and drug treatment with stimulants, antipsychotics and antidepressants.<\/p>\n<\/div><\/div>

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Deadly Restraint Database<\/strong> <\/a><\/p>\n<\/div><\/div>

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Definition and Accountability: A Youth Perspective<\/a><\/strong> – This paper reviews the systemic flaws of residential treatment facilities from a youth perspective concerning the lack of transparency, definition and accountability, and the subsequent mistreatment and human rights violations of youth experiencing emotional, behavioral, and cognitive challenges.<\/p>\n<\/div><\/div>

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Desperation without Dignity<\/strong><\/a> – Facilities may not provide evidence-based treatment, such as cognitive behavior therapy (CBT), dialectical behavior therapy (DBT) and trauma-informed care due to cost or staff availability. The minimal psychotherapy that may be offered has little therapeutic benefit, since the foundation of psychotherapy\u2014a trusting patient and provider relationship\u2014is lacking in many of the for-profit RFs the P&As and state licensing agencies have investigated. Lack of meaningful therapy may exacerbate a child\u2019s trauma and mental health condition, and a child\u2019s refusal to participate in therapy may result in
\nloss of privileges.<\/p>\n<\/div><\/div>

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Economic Impact of Utah\u2019s Family Choice Behavioral Healthcare Interventions Industry<\/a>\u00a0<\/strong>\u2013 This research brief examines the economic impact of the Family Choice and Behavioral Healthcare Interventions Industry in Utah in 2015. For purposes of this study, treatment programs that take insurance reimbursement for primary substance abuse treatment and detoxification facilities were not included. Utah is home to 72 Family Choice and Behavioral Healthcare Interventions Industry programs. These programs provide varying levels of residential treatment for teens and young adults and are primarily funded by families \u201cout-of-pocket,\u201d i.e. the industry is not health insurance-driven. The industry generates an economic impact in Utah by bringing in revenue from out-of-state clients, over 90 percent of industry revenue comes from outside of Utah, and through the travel expenditures of clients\u2019 families.
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Effectiveness of intensive short-term residential treatment<\/strong><\/a> \u2013 Described a model of short-term residential treatment for severely disturbed adolescents. This paper describes distinctive features of the program; presents follow-up data at 3 and 12 months post-discharge, suggesting its effectiveness; and examines the implications of these findings for treatment and further research. Analysis of follow-up data on 123 adolescents (11\u201318 yrs old) treated over a four-year period indicates that intensive short-term residential treatment that includes emphasis on work with families, involvement in community activities, and discharge planning can be an effective means of helping youngsters with severe psychiatric disorders who have not responded to briefer or less intensive forms of psychiatric treatment.<\/p>\n<\/div><\/div>

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Eliminating Level Systems in Residential Treatment Centers<\/strong><\/a>\u00a0\u2013 TNOYS negotiated with a local RTC to interview youth who had recently eliminated the level system on their cottage. TNOYS met with a group of five residents and asked them about the impact of eliminating the level system; how it was better, what was different, and what they would want other programs who were considering doing this to know.<\/p>\n<\/div><\/div>

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Empowering Children and Families through Strength-Based Assessment<\/strong><\/a> – The purpose of this article is to provide a rationale for using a strength-based assessment approach in planning services for children. First, a definition of strength-based assessment, its advantages, and principles are provided. Then, a standardized measure, the\u00a0Behavioral and Emotional Rating Scale\u00a0(BERS), that assesses the emotional and behavioral strengths of children is described. Finally, a case study is presented to demonstrate the use of the BERS in assessing emotional and behavioral strengths and involving families, professionals, and natural supports in service planning.<\/p>\n<\/div><\/div>

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Escorting: Adjusting to life after being held hostage or kidnapped<\/strong><\/a>\u00a0\u2013 Hostage and kidnap survivors can experience stress reactions including denial, impaired memory, shock, numbness, anxiety, guilt, depression, anger, and a sense of helplessness.<\/p>\n<\/div><\/div>

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Escorting: The Impact of Kidnapping, Shooting and Torture on Children<\/strong><\/a>\u00a0\u2013 \u00a0Trauma, in general, and coercive trauma specifically, impacts children differently than adults. Children do not have the psychological mechanisms in place to understand and integrate the trauma experience. Being less mature, a child is more likely to be overwhelmed by the experience.<\/p>\n<\/div><\/div>

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Escorting: The Psychological Impact of Kidnappin<\/strong>g<\/strong><\/a> \u2013 Kidnapping is the deliberate creation and marketing of human grief, anguish, and despair.<\/p>\n

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Estimating the number of children in formal alternative care: Challenges and results<\/strong><\/a> \u2013 Given the relatively large body of literature documenting the adverse impacts of institutionalization on children\u2019s developmental outcomes and well-being, it is essential that countries work towards reducing the number of children in alternative care (particularly institutional care), and, when possible, reunite children with their families. In order to do so, reliable estimates of the numbers of children living in such settings are essential. However, many countries still lack functional administrative systems for enumerating children living outside of family care. The purpose of this paper is to provide a snapshot of the availability and coverage of data on children living in residential and foster care from some 142 countries covering more than 80 per cent of the world\u2019s children. Utilizing these country-level figures, it is estimated that approximately 2.7 million children between the ages of 0 and 17 years could be living in institutional care worldwide. Where possible, the article also presents regional estimates of the number of children living in residential and foster care.<\/p>\n<\/div><\/div>

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Evaluation of a Congressionally Mandated Wraparound Demonstration<\/strong><\/a> – In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the cost-effectiveness of the demonstration. The results showed that children in the Wraparound Group received more wraparound services than those in the treatment as usual (TAU) Comparison Group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Multiple methods were used to investigate the impact of wraparound. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Several possible explanations of these results are provided.<\/p>\n<\/div><\/div>

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Evaluation of a Program Model for Minimizing Restraint and Seclusion<\/strong><\/a> – This study conducted a longitudinal evaluation of an organizational change effort to minimize restraint and seclusion within a behavioral healthcare facility that serves at-risk and high-risk clients with intellectual, developmental, and psychiatric disabilities, using a context, input, process, and product model. The change effort was developed and implemented at an agency in the mid-Atlantic region of the USA that provided a continuum of care to children and adults in residential, educational, and home settings. There was a 99% decrease in restraint frequency, a 97% decrease in staff injury from a restraint, a 64% decrease in client-induced staff injury, and an increase in client goal mastery 133% from 2003 to 2016. Trauma-informed, less restrictive treatment methods provided safer treatment for individuals with a variety of disabilities, while increasing mastery of individualized goals. It also saved the organization over $16 million in lost time expenses, turnover costs, and workers\u2019 compensation policy costs.<\/p>\n<\/div><\/div>

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Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System<\/strong><\/a> – State policymakers must sometimes take action even when relevant, credible evidence identifying the best policy approach may not be available, such as during a recent, emerging crisis impacting the health of children, adults and families. This brief explores successful state responses to dramatic increases in antipsychotic prescription rates in Medicaid-enrolled children, including children in foster care. In August 2018, the National Academy for State Health Policy (NASHP) convened researchers and a cross-agency group of officials with expertise in financing and operating Children\u2019s Health Insurance Program (CHIP) and Medicaid programs, children\u2019s health, and health policy and pharmacy research. Participants from multiple states discussed state strategies to ensure the appropriate use of antipsychotic drugs in youth in foster care. Strategies discussed and shared in this brief include payment reforms, delivery system innovations, and quality supports for clinical care. Other areas for improvement include increasing monitoring rates for side effects, advancing psychosocial and trauma-informed care, enhancing patient engagement, and improving data collection and use<\/p>\n<\/div><\/div>

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Evidence-Based Psychosocial Treatments for Adolescents With Disruptive Behavior<\/strong><\/a> – This article updates the earlier reviews of evidence-based psychosocial treatments for disruptive behavior in adolescents (Brestan & Eyberg, 1998; Eyberg, Nelson, & Boggs, 2008), focusing primarily on the treatment literature published from 2007 to 2014. Studies were identified through an extensive literature search and evaluated using\u00a0Journal of Clinical Child and Adolescent Psychology<\/i>\u00a0(JCCAP<\/i>) level of support criteria, which classify studies as\u00a0well-established, probably efficacious, possibly efficacious, experimental<\/i>, or of\u00a0questionable efficacy<\/i>\u00a0based on existing evidence. The\u00a0JCCAP<\/i>\u00a0criteria have undergone modest changes in recent years. Thus, in addition to evaluating new studies from 2007 to 2014 for this update, all adolescent-focused articles that had been included in the 1998 and 2008 reviews were reexamined. In total, 86 empirical papers published over a 48-year period and covering 50 unique treatment protocols were identified and coded. Two multicomponent treatments that integrate strategies from family, behavioral, and cognitive-behavioral therapy met criteria as\u00a0well-established<\/i>. Summaries are provided for those treatments, as well as for two additional multicomponent treatments and two cognitive-behavioral treatments that met criteria as\u00a0probably efficacious<\/i>. Treatments designated as\u00a0possibly efficacious, experimental<\/i>, or of\u00a0questionable efficacy<\/i>\u00a0are listed. In addition, moderator\/mediator research is summarized. Results indicate that since the prior reviews, there has been a noteworthy expansion of research on treatments for adolescent disruptive behavior, particularly treatments that are multicomponent in nature. Despite these advances, more research is needed to address key gaps in the field. Implications of the findings for future science and clinical practice are discussed.<\/p>\n<\/div><\/div>

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Evidence-Based Use of Second-Generation Antipsychotics in a State Medicaid Pediatric Population<\/strong><\/a> – The purpose of this study was to identify children in a state Medicaid population who were newly treated with second-generation antipsychotics from 2001 through 2005, to classify each use of these agents as evidence based or not depending on the child\u2019s diagnoses, and to identify factors associated with the likelihood of evidence-based use of the medication.<\/p>\n<\/div><\/div>

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Experiences of Adolescents in a Private Residential Treatment Program<\/strong><\/a> – A significant number of adolescents experiencing severe psychiatric, psychological, emotional, behavioral, or substance abuse problems are placed in private residential treatment programs annually (Connor et al., 2004). These programs, sometimes referred to as \u201cbehavior modification schools,\u201d offer the most restrictive form of on-site services for adolescents other than inpatient care. The present qualitative and retrospective study was designed to elicit the elements having the most salient impact on former patients, and thus to help professionals gain an understanding of how this intervention might benefit adolescents manifesting serious emotional and\/or behavioral issues. Ten adults who identified as former patients in a private residential treatment center were interviewed about their experiences. Research questions addressed the reasons for referral, the process by which participants entered the center, their experiences within the program, their discharge, and their post-treatment reflections and recommendations. Data were analyzed using a grounded theory methodology to reveal major themes (Corbin & Strauss, 2014). Themes identified included: (a) from struggling child to scapegoat; (b) treatment versus oppression; (c) experiences of maltreatment, trauma, and the conspiracy of silence; and (d) the ability to find solace, sanctuary, and support. The findings of this study suggested important implications for research, residential treatment programs, practitioners, policymakers, and parents. These included the need for: (a) further research into private residential treatment programs; (b) more advanced training of front-line staff in adolescent mental health; (c) increased effectiveness and humane management of misbehavior; (d) an assessment of biases and perceptions of \u201ctroubled youth\u201d within treatment; (e) an examination of the dynamics of power and privilege embedded in roles and policies of the institution; (f) a focus on family-centered and youth-driven approaches; (g) enhanced industry regulation, oversight and transparency; and (g) greater involvement of parents as decision makers concerning placement options and their active participation in treatment.<\/p>\n<\/div><\/div>

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Experiences of secure transport in outdoor behavioral healthcare: A narrative inquiry<\/strong><\/a> – Often synonymous with wilderness therapy, outdoor behavioral healthcare (OBH) is a residential treatment in the United States for young people, more than half of whom are sent via secure transport services. While empirical evidence suggests the secure transport of adolescents to OBH does not impact quantitative outcomes, limited research exists exploring client voice and the lived experience of OBH participants. This qualitative study, utilizing narrative inquiry, builds knowledge on experiences of secure transport services from nine past OBH adolescent participants. Findings are analyzed, interpreted, and discussed through a social work and trauma-informed lens. Recommendations for ethical practice, linking with human rights, and future research are provided.<\/p>\n<\/div><\/div>

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Exploitation in the Name of “Specialty Schooling”<\/strong><\/a> – A multi-disciplinary taskforce has formed at the Louis de la Parte Florida Mental Health Institute to study the issues raised in this article, and the authors wish to thank and acknowledge the other members of this taskforce: Lenore Behar, Amy Green, Barbara Huff, Christina Kloker-Young, Wanda B. Mohr and Christine Vaughn.<\/p>\n<\/div><\/div>

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Exploitation of Youth & Families: Perspectives on Unregulated Residential Treatment<\/strong><\/a> – On August 10, 2006, the American Psychological Association issued a statement reaffirming its unequivocal position against torture and abuse. APA President Gerald P. Koocher, Ph.D., stated, “Our intention is to empower and encourage members to do everything they can to prevent violations of basic human rights – at Guantanamo Bay or anywhere else they may occur. It is not enough for us to express outrage or to codify acceptable practices. As psychologists, we must use every means at our disposal to prevent abuse and other forms of cruel or degrading treatment<\/p>\n<\/div><\/div>

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Fact Sheet: Children in RTC’s From the Bazelon Center for Mental Health Law and Policy<\/strong> <\/a><\/p>\n<\/div><\/div>

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Fact Sheet: Preventing Racial Discrimination in Special Education<\/strong> <\/a>– The Office for Civil Rights (OCR) at the U.S. Department of Education issued the Dear Colleague Letter on Preventing Racial Discrimination in Special Education on December 12, 2016, to help ensure that all students, regardless of race, color, or national origin, have equitable access to high quality general and special education instruction.<\/p>\n<\/div><\/div>

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Factors Associated With Overuse of Health Care Within US Health Systems<\/strong><\/a> – Overuse of health care is a pervasive threat to patients that requires measurement to inform the development of interventions. In this cross-sectional study of 676 US health care systems, those that were overusing health care had more beds, had fewer primary care physicians, had more physician practice groups, were more likely to be investor owned, and were less likely to include a major teaching hospital.<\/p>\n<\/div><\/div>

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Family-Based Intervention Lowers Long-Term Suicide Risk in Youth<\/strong><\/a> – Over the last 20 years, suicide rates have increased in the U.S. by 24%, with the largest increases occurring in females ages 10-14 and African American children aged 5-11. These statistics highlight the critical need for better ways to understand and prevent suicide in youth and adolescents. In a recent study supported by the National Institute of Mental Health, researchers examined the impact of a family-based intervention on suicide risk in youth and found risk-reduction benefits up to 10 years later.<\/p>\n<\/div><\/div>

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Federal Trade Commission: Consumer Information \u2013 Residential Treatment Programs for Teens<\/a>\u00a0<\/strong>\u2013\u00a0 The programs are not regulated by the federal government, and many are not subject to state licensing or monitoring as mental health or educational facilities, either. A 2007 Report to Congress by the Government Accountability Office (GAO) found cases involving serious abuse and neglect at some of these programs.<\/p>\n<\/div><\/div>

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Forced Drugging of Children in Foster Care: Turning Child Abuse Victims into Involuntary Psychiatric Patients<\/strong><\/a> – The use of psychotropic medication by children and youth within the child welfare system is examined. The increasing use of these medications by this population is presented as problematic through a case study and by identifying general aspects of the social systems that have contributed to its development and entrenchment. The needs of children and youth in the child welfare system, the influence of the pharmaceutical industry and historical trends in child psychiatry supplement a narrative of a child who was misdiagnosed as severely mentally disturbed and subjected to intense psychotropic medication. The article concludes by stating that resisting the forces that attempt to enforce the use of psychotropic medication by these children and youth is possible through self-education and assertive advocacy for non-chemical alternatives.<\/p>\n<\/div><\/div>

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Foreign Policy and Disability: Legislative Strategies and Civil Rights Protections To Ensure Inclusion of People with Disabilities<\/strong><\/a> –\u00a0 Individuals with disabilities are subject to a broad pattern of discrimination and segregation in almost every part of the world. In most countries, people with disabilities and their families are socially stigmatized, politically marginalized, and economically disadvantaged. The economic cost to society of excluding people with disabilities is enormous. No nation in the world will achieve its full potential for economic development while it leaves out people with disabilities. No society will be a complete democracy unless people with disabilities can participate in public life. Failure to respond to the concerns of people with disabilities ignores one of the great humanitarian and human rights challenges of the world today.<\/p>\n<\/div><\/div>

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From Coercive to Strength-Based Intervention: Responding to the Needs of Children in Pain<\/strong><\/a> –\u00a0 Recent clinical and brain studies indicate that troubled children and youth are reacting to distressing life circumstances with \u201cpain-based behavior.\u201d Those who deal with such behavior often lack the necessary skills to prevent and manage crisis situations. Instead, pain-based behavior is met with coercive interventions. Among the most controversial behavior management practices are restraint and seclusion. Debates about these methods reflect three different viewpoints: humanistic values, research findings, and practice reality. Effective interventions should be consistent with all three perspectives.<\/p>\n<\/div><\/div>

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GAO Child Welfare: HHS Should Facilitate Information Sharing Between States to Help Prevent and Address Maltreatment in Residential Facilities Feb 2022<\/strong><\/a> – State and local agencies are primarily responsible for helping to prevent abuse and neglect in youth residential facilities, but incidents continue to occur. Stakeholders and others told us that states could take additional steps to address maltreatment in these facilities<\/p>\n<\/div><\/div>

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GAO Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions<\/strong><\/a> – Foster children in the five states GAO analyzed were prescribed psychotropic drugs at higher rates than nonfoster children in Medicaid during 2008, which according to research, experts consulted, and certain federal and state officials, could be due in part to foster children\u2019s greater mental health needs, greater exposure to traumatic experiences and the challenges of coordinating their medical care. However, prescriptions to foster children in these states were also more likely to have indicators of potential health risks. According to GAO\u2019s experts, no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and nonfoster children in the five states had such a drug regimen. Similarly, thousands of foster and nonfoster children were prescribed doses higher than the maximum levels cited in guidelines developed by Texas based on FDA-approved labels, which GAO\u2019s experts said increases the risk of adverse side effects and does not typically increase the efficacy of the drugs to any significant extent. Further, foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which GAO\u2019s experts said have no established use for mental health conditions in infants; providing them these drugs could result in serious adverse effects.<\/p>\n<\/div><\/div>

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GAO Report on Seclusion and Restraints – May 2009<\/strong><\/a> – GAO recently testified before the Committee regarding allegations of death and abuse at residential programs for troubled teens. Recent reports indicate that vulnerable children are being abused in other settings. For example, one report on the use of restraints and seclusion in schools documented cases where students were pinned to the floor for hours at a time, handcuffed, locked in closets, and subjected to other acts of violence. In some of these cases, this type of abuse resulted in death. Given these reports, the Committee asked GAO to (1) provide an overview of seclusion and restraint laws applicable to children in public and private schools, (2) verify whether allegations of student death and abuse from the use of these methods are widespread, and (3) examine the facts and circumstances surrounding cases where a student died or suffered abuse as a result of being secluded or restrained. GAO reviewed federal and state laws and abuse allegations from advocacy groups, parents, and the media from the past two decades. GAO did not evaluate whether using restraints and seclusion can be beneficial. GAO examined documents related to closed cases, including police and autopsy reports and school policies. GAO also interviewed parents, attorneys, and school officials and conducted searches to determine the current employment status of staff involved in the cases.<\/p>\n<\/div><\/div>

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GAO Report: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth Oct 2007<\/a><\/strong> \u2013\u00a0 GAO found thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007. Allegations included reports of abuse and death recorded by state agencies and the Department of Health and Human Services, allegations detailed in pending civil and criminal trials with hundreds of plaintiffs, and claims of abuse and death that were posted on the Internet. For example, during 2005 alone, 33 states reported 1,619 staff members involved in incidents of abuse in residential programs. GAO could not identify a more concrete number of allegations because it could not locate a single Web site, federal agency, or other entity that collects comprehensive nationwide data<\/p>\n<\/div><\/div>

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GAO Report: Residential Programs Selected Cases of Death, Abuse and Deceptive Marketing Apr 2008<\/a><\/strong> \u2013 In the eight closed cases GAO examined, ineffective management and operating practices, in addition to untrained staff, contributed to the death and abuse of youth enrolled in selected programs. To identify case studies, we reviewed numerous closed criminal or civil cases in which a court or state agency was asked to decide whether a private residential program was responsible for the death or abuse of an enrolled teenager. We also reviewed administrative cases where state agencies made rulings regarding the death or abuse of a teenager. When identifying cases, we specifically excluded public programs such as state-sponsored foster programs, juvenile justice programs for delinquent youth, or programs that exclusively treat psychological disorders or substance abuse in a hospital setting. We also excluded cases related to the programs we examined for our October 10, 2007, testimony. We focused on deaths or instances of abuse between the years 1994 and 2006 to illustrate the long-standing issues presented by private residential programs. We limited our cases to closed criminal cases and, thus, did not include ongoing cases from the last several years. We selected eight cases\u2014four cases of death and four cases of abuse\u2014based on several factors including the victim\u2019s age, the program location, the type of program the victim attended, and the date of death or abuse. We then examined, in more detail, the facts and circumstances of the case. To validate the facts and circumstances, and to the extent possible, we conducted interviews with related parties, including current and former program staff and officials, attorneys and law enforcement officials involved in the cases, and the parents of the victims. Further, we reviewed available documentation to support the facts of each case including, but not limited to, marketing materials, police reports, autopsy reports, and state agency oversight reviews and investigations.<\/p>\n<\/div><\/div>

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GAO Report: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers May 2009<\/a><\/strong> \u2013 GAO recently testified before the Committee regarding allegations of death and abuse at residential programs for troubled teens. Recent reports indicate that vulnerable children are being abused in other settings. For example, one report on the use of restraints and seclusions in schools documented cases where students were pinned to the floor for hours at a time, handcuffed, locked in closets, and subjected to other acts of violence. In some of these cases, this type of abuse resulted in death. Given these reports, the Committee asked GAO to (1) provide an overview of seclusions and restraint laws applicable to children in public and private schools, (2) verify whether allegations of student death and abuse from the use of these methods are widespread, and (3) examine the facts and circumstances surrounding cases where a student died or suffered abuse as a result of being secluded or restrained. GAO reviewed federal and state laws and abuse allegations from advocacy groups, parents, and the media from the past two decades. GAO did not evaluate whether using restraints and seclusions can be beneficial. GAO examined documents related to closed cases, including police and autopsy reports and school policies. GAO also interviewed parents, attorneys, and school officials and conducted searches to determine the current employment status of staff involved in the cases.<\/p>\n<\/div><\/div>

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GAO Report: State and Federal Oversight Gaps May Increase Risk to Youth Well-being Apr 2008<\/a><\/strong>\u00a0 \u2013 Youth maltreatment and death occurred in government and private residential facilities across the nation, according to states we surveyed; however, data limitations hinder efforts to quantify the full extent of the problem. State-reported data collected by HHS in 2005 showed 1,503 incidents of maltreatment by facility staff in 34 states, including physical abuse, neglect or deprivation of necessities, and sexual abuse. Moreover, 28 states responding to our survey reported at least one death in residential facilities in 2006, with accidents and suicides among the most common types of fatalities. These reported data, however, did not capture information from all facilities. Many states lack authority under state law to collect data on exclusively private facilities, and data that states did report were often incomplete. As a result, the number of adverse incidents was likely more numerous and widespread than reported.<\/p>\n<\/div><\/div>

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Guidelines for the Use of Restraint or Containment in Community Crisis Homes in California<\/strong><\/a> – The purpose of these Guidelines, although primarily to provide guidance to CCH providers regarding the use of restraint or containment, is multifaceted. The ability to manage a behavioral crisis is critically important for all staff who work with individuals residing in CCHs, including direct support professionals (DSPs), consultants and administrators. All staff must receive training regarding how to manage crisis situations, including the use of restraint as an emergency measure of last resort when the risk of serious harm to self or others is imminent. However, with the goal of minimizing and avoiding the use of restraint, staff must also be skilled in preventing conflict and remediating crisis situations in the least restrictive way.<\/p>\n<\/div><\/div>

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Guiding Principles: A Resource Guide for Improving School Climate and Discipline<\/strong><\/a> – No student or adult should feel unsafe or unable to focus in school, yet this is too often a reality. Simply relying on suspensions and expulsions, however, is not the answer to creating a safe and productive school environment. Unfortunately, a significant number of students are removed from class each year \u2014 even for minor infractions of school rules \u2014 due to exclusionary discipline practices, which disproportionately impact students of color and students with disabilities.<\/p>\n<\/div><\/div>

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Hospital Patient Behavior: Reactance, Helplessness, or Control?<\/a>\u00a0<\/strong>\u2013 Hospitals are commonly regarded as unpleasant places to be. The reason is that, as a total institution, the hospital creates a depersonalizing environment that forces the patient to relinquish control over his or her daily existence. It is suggested that patients cope with depersonalizing loss of control by assuming \u201cgood patient\u201d behavior or \u201cbad patient\u201d behavior. Predictions are offered as to who will show which behavior pattern under which circumstances. However, a review of these patterns suggests that some \u201cgood patients\u201d may actually be in a state of anxious or depressed helplessness, whereas \u201cbad patients\u201d are exhibiting anger and reactance against the perceived arbitrary removal of freedoms. An analysis of the behavioral, cognitive, affective and physiological correlates of these patterns, as well as the behaviors they elicit in staff, suggests that both the \u201cgood patient\u201d and the \u201cbad patient\u201d sustain health risks. It is argued that a more informed and participative role for the hospital patient can eliminate or offset many of these risks and actually improve the level of physical and psychological health in the hospital setting.
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How Safe Is the Schoolhouse? An Analysis of State Seclusion and Restraint Laws and Policies<\/strong><\/a> – This report was revised in 2019 to discuss new state restraint and seclusion statutes, regulations, rules, and policies. It includes all laws in effect as of July 1, 2019. This updates earlier versions of the report. The first version was published in 2012, and it has been updated several times since. The report presents research analyzing and comparing state approaches to restraint and seclusion that may be helpful to parents, professionals, educators, people with disabilities, and advocates.<\/p>\n<\/div><\/div>

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How to Turn Around Troubled Teens<\/a><\/strong> \u2013 In a 2010 review of 69 controlled studies, criminologists revealed that such programs produced little or no overall improvement in offender recidivism. The negative data on get-tough programs remind us that we should be wary of our subjective impressions of strategies that simply seem right or that we feel ought to work. Although we lost track of Mike S., we now know that a concerted effort to teach him more adaptive behaviors would have been more likely to put him on a productive path than would any attempt to scare him straight.<\/p>\n<\/div><\/div>

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Impairing Education<\/strong><\/a> – In this 70-page report, the ACLU and Human Rights Watch found that students with disabilities made up 18.8 percent of students who suffered corporal punishment at school during the 2006-2007 school year, although they constituted just 13.7 percent of the total nationwide student population. At least 41,972 students with disabilities were subjected to corporal punishment in US schools during that year. These numbers probably undercounted the actual rate of physical discipline, since not all instances are reported or recorded.<\/p>\n<\/div><\/div>

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Improving the Effectiveness of Juvenile Justice Programs<\/strong><\/a> – To demonstrate the need for a new approach, contemplate this scenario and whether it sounds familiar. A juvenile justice director is delighted to identify a number of \u201cgold standard\u201d programs that could be used to benefit his or her clients, whether found in the Blueprints for Violence Prevention developed by Dr. Delbert Elliott, or in OJJDP\u2019s Model Programs Guide, or in the Substance Abuse and Mental Health Services Administration\u2019s National Registry of Evidence-based Programs and Practices. The new programs are implemented with as much fidelity as possible in light of budget constraints and workforce limitations, while at the same time local programs that do not have rigorous evidence of success are diminished.<\/p>\n<\/div><\/div>

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Influence of Selected Aggression, Demographic, Gender Role, and Temperament Factors on the Level of Physical Restraint Among Staff in Residential Treatment Centers<\/strong><\/a> – The purpose of this study was to examine the predictability of the aggression (physical, hostility, indirect aggression, verbal, and anger), demographic (age, education level, gender, length of employment, level of agitation by youth, and support of no corporal punishment standard), gender role (androgynous, feminine, masculine, and undifferentiated) and temperament (activity level, adaptability, intensity and mood) factors on physical restraints of residential treatment center (RTC) staff employed in RTC settings. Currently, there is no evidenced based method to either determine the influence of these factors or assess the impact o f a staff member\u2019s previous exposure to violence in predicting how they may respond to an aggressive youth. This may place RTC administrators and youth at a great disadvantage.<\/p>\n<\/div><\/div>

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Institutional abuse and societal silence: An emerging global problem<\/strong><\/a>\u00a0\u2013 The Australian Royal Commission into Institutional Responses to Child Sexual Abuse was announced by Australian Prime Minister Julia Gillard on 11 January 2013. Examining how institutions with a responsibility for children \u2018have managed and responded to allegations and instances of child sexual abuse and related matters\u2019 (Australian Government, 2013) arguably represents the most wide-ranging attempt by any national government in history to examine the institutional processes (or lack thereof) for addressing such abuse.<\/p>\n<\/div><\/div>

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Institutional Victimization<\/strong><\/a> – The home is the most dangerous place for children everywhere for it is in the home that most of the harm inflicted upon them takes place. However, no less dangerous are the schools, orphanages, correctional institutions, or club rooms in which almost all of the world\u2019s children find themselves each day, but from which they are rarely able to escape. \u201cInstitutional victimization\u201d consists of a host of harmful acts (usually by caregivers) to which children are subjected in institutional settings. Data on the extent and forms of child victimization occurring in institutions across the globe are presented. Victimization may involve direct abuse, such as beatings or emotionally trauma. But indirect victimization, such as neglect by care givers or abusive or inadequate institutional programs or facilities, is also pervasive in institutions around the world. The problem of abuse in schools, orphanages, and residential care is described in depth, and graphic examples of some of the more pervasive and flagrant instances of institutional abuse are highlighted. Programs such as counseling to help people who have been abused by teachers, care givers, or others are described. Diverse efforts to stop the abuse of children in institutional settings are discussed, as are laws designed to protect children in institutional settings. The obstacles to the prevention of institutional abuse are discussed and the prospects for worldwide reform are assessed.<\/p>\n<\/div><\/div>

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Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development<\/strong><\/a> \u2013 Millions of children worldwide are brought up in institutional care settings rather than in families. These institutions vary greatly both in terms of their organizational principles and structure and in terms of the quality of care provided. Although institutions are universally recognized as providing sub-optimal care-giving environments, a consensus is still needed on how to interpret the evidence relating to the size, range, and persistence of the effect of institutional care on the development and wellbeing of children. This absence of consensus has led to disagreement as to whether the policy should focus on eliminating, transforming, or improving institutions.<\/p>\n<\/div><\/div>

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Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors<\/strong><\/a>\u00a0\u2013 Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalization and the benefits of deinstitutionalization of child welfare systems. In this part of the Commission, international experts in reforming care for children identified evidence-based policy recommendations to promote family-based alternatives to institutionalization. Family-based care refers to caregiving by extended family or foster, kafalah (the practice of guardianship of orphaned children in Islam), or adoptive family, preferably in close physical proximity to the biological family to facilitate the continued contact of children with important individuals in their life when this is in their best interest. 14 key recommendations are addressed to multinational agencies, national governments, local authorities, and institutions. These recommendations prioritize the role of families in the lives of children to prevent child separation and to strengthen families, to protect children without parental care by providing high-quality family-based alternatives, and to strengthen systems for the protection and care of separated children. Momentum for a shift from institutional to family-based care is growing internationally\u2014our recommendations provide a template for further action and criteria against which progress can be assessed.<\/p>\n<\/div><\/div>

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Institutionalized Child Abuse: The Troubled Teen Industry<\/strong><\/a> – Deciding to send a child to one of these facilities is no easy decision. Behavior modification programs often are the last option after parents consult with mental health professionals, counselors, juvenile probation officers, and judges. These parties all fall victim to the deceptive marketing techniques of \u201ceducational consultants\u201d employed by the facilities. Parents are provided brochures with images and testimonies of happy, healthy, transformed children. Desperate for help and comforted by the promise of specialized treatment, once set on sending their child to a facility, parents sign over their parental rights to the facility.<\/p>\n<\/div><\/div>

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Institutions vs. Foster Homes<\/strong><\/a> – The debate about the role of institutional care vs. family-centered care is well into its second century. Institutional (or group) care has many forms and purposes, including serving as a component of the child welfare services system of care and as a treatment component of the children\u2019s mental health systems system of care. Within the child welfare role, institutional care may be used as a large or small shelter care facility, as a place for children to go when family care is not immediately available, and as a place where children go who have not been able to be maintained in foster family care. The varied roles of institutional care make an analysis of its efficacy difficult. This is made more difficult because of the lack of third-party studies of institutional care and, more generally, of out-of-home care<\/p>\n<\/div><\/div>

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Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care<\/strong><\/a> – High rates of treating children in foster care with second-generation antipsychotics, both singly and in combination with other psychotropics, have focused public interest on the use of these medications, and motivated some states to implement programs to curtail usage.<\/p>\n<\/div><\/div>

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Involuntary Hospitalization Deters Youth from Seeking Mental Healthcare<\/strong><\/a> – A new study documents the negative impacts of involuntary hospitalization for youth experiencing mental health challenges. Researchers, led by Nev Jones from the University of South Florida, found that young people who were hospitalized for mental health reasons against their will experience the treatment as punitive and report high levels of distrust for mental health providers. The study was published in the journal\u00a0Social Psychiatry and Psychiatric Epidemiology<\/em>.<\/p>\n<\/div><\/div>

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Involuntary Psychiatric Interventions: A Breach of the Hippocratic Oath?<\/strong><\/a> – In this article the author argues that involuntary psychiatric interventions are inherently dangerous and potentially harmful to their subjects, thus challenging the Hippocratic ethical principle of “first do no harm.” Damages arising from coercion in common clinical situations are analyzed, as well as the motives of psychiatrists for persistently promoting an expansion of involuntary interventions. Alternate strategies to coercion are explored.<\/p>\n<\/div><\/div>

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Involuntary Treatment – National Mental Health Association<\/strong><\/a> – The National Mental Health Association (NMHA) believes that mental health consumers deserve the same degree of personal autonomy as other citizens without disabilities when they receive services. This includes contributing to the decision-making process regarding treatment. This position is an extension of a value articulated in our Vision, Mission, Values and Goals statement that states, “Justice demands that everyone, regardless of disability, has the rights and responsibilities of full participation in society.”<\/p>\n<\/div><\/div>

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Involuntary Youth Transport (IYT) to Treatment Programs: Best Practices, Research, Ethics, and Future Directions<\/strong><\/a> – Involuntary youth transport (IYT) is a controversial practice used to admit adolescents into residential care. Critics point out that IYT is in need of regulation and is best used as a last resort. This article examines the risks and benefits of IYT, especially the longterm effects on the client, in order to ensure that all facets of a client\u2019s treatment are trauma-informed and guided by research-based practices and ethical principles. Practices that re-traumatize youth need to be replaced with informed practices that facilitate positive outcomes. This article utilizes an ethical decision-making framework developed for behavioral health professionals to assess and improve the ethical use of IYT. Based on this ethical framework, a more effective and collaborative model is presented that results in less restrictive approaches, greater levels of willingness by the adolescent to enter treatment, and trauma-informed management of difficult emotional or physical behaviors. This model also guides professionals and caregivers on how to proceed when IYT services are deemed necessary. The article presents past research and addresses ethical guidelines and best practices for IYT. Steps for practitioners and future directions are discussed.<\/p>\n<\/div><\/div>

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ISAC Online Survey Results<\/strong><\/a> – An online survey that was conducted of Troubled Teen Industry survivors in 2003. ISAC wishes to remind the reader that this is NOT a scientific study.<\/p>\n<\/div><\/div>

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Issues in the Evaluation of Residential and Inpatient Treatment Programs<\/strong><\/a> – The funding of mental health services for children in the United States has undergone substantial modification in the 1980s. The emphasis of the current administration has been to reduce federal involvement in social services and to encourage the states to assume responsibility. As state legislatures and social service administrators have made decisions on the allocation of scarce funds, individual service providers have been required to demonstrate that their programs are accomplishing intended goals. Increasingly, funding requests have been accompanied by documentation that services are reaching the intended clients, that favorable outcomes have been experienced by these clients, and that cost-effective treatment practices have been followed.<\/p>\n<\/div><\/div>

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It\u2019s No Breakfast Club: A Look at the Due Process Requirements of Children in Private Residential Treatment Centers<\/strong><\/a> – In many states, youths are put into private residential treatment centers (RTC) without the youths\u2019 consent or judicial review of the admission decision. Every state has a statute that addresses the due process rights of a person being civilly committed to a state-run psychiatric institute. While some states have statutorily extended those rights to youth, and some states have gone as far as to expand the statutes to include private institutions, there remains a gap in the protections for many youth in all states. This purpose of this article is to argue that a federal statute should be enacted to ensure equal protections across states lines that will prevent private hospitals from admitting youth without meeting the admission criteria for civil commitments. As the Supreme Court has recognized that these youth are entitled to due process rights, the statute should extend protections to the youth.<\/p>\n<\/div><\/div>

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Journal of Knowledge and Best Practices in Juvenile Justice & Psychology<\/strong><\/a> – The purpose of this study was to determine the influence of responsibility-based physical activity instruction on post-adjudicated youths\u2019 personal and social responsibility perception, physical fitness levels, as well as juvenile correctional officers\u2019 attitudes toward its implementation. An embedded mixed-method design was used. Based on the results, responsibility-based physical activity instruction had no statistically significant effect on youth\u2019s personal and social responsibility perception. However, it positively influenced intervention groups\u2019 personal and social responsibility perception at a rate of 1.19 times per session and did not negatively impact their fitness levels. Furthermore, responsibility-based physical activity may influence juvenile correctional officers\u2019 attitudes toward importance of physical activity for rehabilitation.<\/p>\n<\/div><\/div>

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Juvenile Delinquency and Mental Health<\/strong><\/a> – In today\u2019s world of rapidly-rising crime, we are compelled to expand our knowledge about crime through an increased understanding of its beginnings in juvenile delinquency. The decade of 1990 saw more youth transferred to criminal court, longer sentences, and lower minimum ages at which juveniles could be prosecuted in the criminal justice system as if they were adults. This increase in juvenile delinquent acts has been accompanied by large increases in both the rate of juvenile drug use and the rate of admission to residential treatment centers for emotionally disturbed children. These temporally-correlated phenomena raise important questions about their possible interrelationship and subsequent effect on the nature of today\u2019s juvenile delinquent. As awareness of the high prevalence of mental health problems among juvenile offenders has grown, researchers and practitioners have recognized the need for reliable and efficient methods of assessing such problems among large numbers of offenders to ensure that limited treatment resources are applied to those with the greatest need. The primary aim of this chapter is to present an overview of studies throughout the world determining the prevalence and types of mental health disorders among youth in the juvenile system in order to gain some understanding of the extent of psychological maladjustment in this population.<\/p>\n<\/div><\/div>

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Juvenile Mental Health Court: Rationale and Protocols<\/strong><\/a> – On Feb. 14, 2001, the nation\u2019s first juvenile mental health court processed its debut calendar in Santa Clara County (San Jose), California. This debut was the culmination of nine months of judicially convened meetings to establish ground rules and develop relationships. It took the efforts of many contributors\u2014 from multiple disciplines under strong judicial sponsorship and leadership\u2014to realize the goal of becoming the first county in the nation aimed at making mental health concerns a priority in dealing with certain juvenile offenders. Although the court required the realignment of existing resources, it did not require significant new financial resources or personnel for its operation.<\/p>\n<\/div><\/div>

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Juvenile Residential Facility Census Databook<\/strong><\/a>\u00a0\u2013 The JRFC Databook was developed to facilitate independent analysis of national data on the characteristics of youth residential placement facilities, including detailed information about facility operation, classification, size, and capacity.<\/p>\n<\/div><\/div>

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Karen VanderVen\u2019s Updated 2016 Pack<\/strong><\/a>\u00a0\u2013 A documented analysis of the literature on the destructiveness of \u201cPoint and Level Systems\u201d commonly employed in group and residential settings, and schools<\/p>\n<\/div><\/div>

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Keeping All Students Safe Act<\/strong><\/a> – A bill to prohibit and prevent seclusion, mechanical restraint, chemical restraint, and dangerous restraints that restrict breathing, and to prevent and reduce the use of physical restraint in schools, and for other purposes.<\/p>\n<\/div><\/div>

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Keeping America’s Children Safe from Abuses in the use of Psychotropic Drugs and Seclusion\/Restraint<\/strong><\/a> – The absence of specific federal and, often, state standards governing the use of restraints and seclusion in schools, and practices governing psychotropic drug prescribing for children and adolescents where parental consent is not available, such as foster care, are no excuse for these practices to continue. All of these practices not only are inappropriate, but also are dangerous, expensive and, at times, can be fatal. They are problems of national significance given the tremendous number of children and youth with behavioral disorders or I\/DD; the just-released CDC report showing a sharp rise in the prevalence of autism spectrum disorders; and a recent Department of Education finding that seclusion and restraints are being used on tens of thousands of students nationwide. And it\u2019s an issue that demands local, community-based attention and action.<\/p>\n<\/div><\/div>

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Kidnapping Incorporated: The Unregulated Youth-Transportation Industry and the Potential for Abuse<\/a>\u00a0<\/strong>\u2013 Strangers come into a child’s room in the middle of the night, drag her kicking and screaming into a van, apply handcuffs, and drive her to a behavior modification facility at a distant location. What sounds like a clear-cut case of kidnapping is complicated by the fact that the child’s parents not only authorized this intervention, but also paid for it. This scarcely publicized practice-known as the youth-transportation industry-operates on the fringes of existing law. The law generally presumes that parents have almost unlimited authority over their children, but the youth-transportation industry has never been closely examined regarding exactly what the transportation process entails or whether it is in fact legal. The companies provide a service to parents who want to send their children to behavior-modification facilities, including boot camps and other residential re- form schools, but who are unable or unwilling to deliver the children themselves. A transportation company contracts with the parents to arrange for pickup and conveyance; the parents delegate rights over their children to the company, usually by signing a power of attorney. Due to the circumstances in which these transports typically take place, however, this delegation of rights has far greater implications than simply authorizing the transportation of a child from point A to point B. After suffering the emotional trauma of being taken from their parents, children may suffer physical abuse as well, as the companies often use force in the form of handcuffs and other restraints. This Article examines the details of the transport process and raises legal questions about the disciplinary authority that parents possess, including the extent to which they can grant this authority to a third party.<\/p>\n<\/div><\/div>

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Long-Term Outcomes of Residential Treatment for Children and Adolescents<\/strong><\/a> – The long-term outcomes of residential treatment for children and adolescents depends on many factors, which make it difficult to pinpoint what those long-term outcomes are right away. First, outcomes depend on the population of who is utilizing residential treatment. Population factors can be the disorders children are diagnosed with, legal situations, culture, family and living situation. Discharge planning is an important factor on long-term outcomes of residential treatment because it sets up resources for the child and family to use and for continuity of care. Family involvement plays a factor not only in long-term outcomes by making their own personal changes, but also in the treatment model a child might be in programs who have well-trained staff, are culturally sensitive, have better education programs, use evidenced-based models, are properly licensed and monitored, and are client-centered produce more positive long-term outcomes compared to programs who do not meet those criteria. Lack of access and funding for alternative, less restrictive treatment models is a barrier in improving the residential treatment model because of current public policy. Other improvements the residential treatment model can make is employing more evidenced-based practices, fine-tune requirements for licensing and monitoring across the board to eliminate inconsistency, effectively training staff in behavioral techniques, and become more culturally diverse with treatment models.<\/p>\n<\/div><\/div>

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Milieu Therapy: A Therapeutic Loophole<\/strong><\/a>\u00a0\u2013 Milieu therapy has significant deficiencies as a practice theory for inpatient psychiatric nursing. First, it lacks sound conceptual definition. Second, there is no consensus in the scientific community as to the essential dimensions of the construct. Third, none of the interpretations of milieu therapy has been operationally elaborated with protocols, procedures, or outcomes.<\/p>\n<\/div><\/div>

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More Harm Than Good: A Summary of Scientific Research on the Intended and Unintended Effects of Corporal Punishment on Children<\/strong><\/a> \u2013 The research evidence has led many leading professional organizations to call for a ban on corporal punishment in school. The research evidence has led many\u00a0 leading professional organizations to call for a ban on corporal punishment in schools, including the American Academy of Pediatrics, the American Bar Association, the American Civil Liberties Union, the American Medical Association, the American Psychological Association, the National Association of Elementary School Principals, the National Association of Social Workers, and Prevent Child Abuse America. Fewer such organizations have called for an outright ban of corporal punishment in American homes, although prominent professional organizations including the American Academy of Pediatrics and the American Medical Association have endorsed a recent report summarizing the research to date and recommending parents avoid its use.<\/p>\n<\/div><\/div>

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NASMHPD Position Statement on Seclusion and Restraint<\/strong><\/a> – “The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including “chemical restraints,” are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. P> It is NASMHPD’s goal to prevent, reduce and ultimately eliminate the use of seclusion and restraint…”<\/p>\n<\/div><\/div>

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National Data Archive on Child Abuse and Neglect<\/a><\/strong>\u00a0\u2013 The National Data Archive on Child Abuse and Neglect (NDACAN) distributes the data for each study listed. All datasets are distributed free of charge.<\/p>\n<\/div><\/div>

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National Disability Rights Network Releases Report on Seclusion and Restraint in U.S. Schools – 2009<\/a><\/strong> – The report shows an unsettling use of seclusion and restraint tactics, which resulted in physical and emotional injuries as well as deaths, in schools affecting students from grades K-12.The report documents cases that range from students being locked in rooms or even boxes for hours to students who were encouraged to release their aggression by wrestling in \u201cWWF Rooms.\u201d<\/p>\n<\/div><\/div>

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National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs<\/strong><\/a> – In the United States, the estimated number of office-based visits by youth that included antipsychotic treatment increased from approximately 201 000 in 1993 to 1 224 000 in 2002. From 2000 to 2002, the number of visits that included antipsychotic treatment was significantly higher for male youth (1913 visits per 100 000 population) than for female youth (739 visits per 100 000 population), and for white non-Hispanic youth (1515 visits per 100 000 population) than for youth of other racial or ethnic groups (426 visits per 100 000\u00a0 population). Overall, 9.2% of mental health visits and 18.3% of visits to psychiatrists included antipsychotic treatment. From 2000 to 2002, 92.3% of visits with prescription of an antipsychotic included a second-generation medication. Mental health visits with prescription of an antipsychotic included patients with diagnoses of disruptive behavior disorders (37.8%), mood disorders (31.8%), pervasive developmental disorders or mental retardation (17.3%), and psychotic disorders (14.2%).<\/p>\n<\/div><\/div>

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NCCP – Facts About Trauma for Policymakers July 2007<\/strong> <\/a>– Trauma can result in long- and short-term problems. Research suggests that these can include physical and emotional health conditions and put those exposed to trauma at increased risk for chronic ill health and premature death.<\/p>\n<\/div><\/div>

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Neuropsychological Findings in Pediatric Maltreatment: Relationship of PTSD, Dissociative Symptoms, and Abuse\/Neglect Indices to Neurocognitive Outcomes<\/strong><\/a> – Although maltreated children represent a small percentage of the pediatric population, the effects of maltreatment on an individual and society are disproportionately high (Wang & Holton, 2007). Developmental traumatology is the systemic investigation of the psychobiological impact of chronic interpersonal violence on the developing child (De Bellis, 2001). This field provides a theoretical framework for increasing our understanding of psychopathology, brain differences, and neuropsychological deficits associated with child maltreatment. In developmental traumatology research, youth identified as maltreated by child protective services (CPS) are an unfortunate naturalistic model of the psychobiological effects of chronic and severe stress in childhood.<\/p>\n<\/div><\/div>

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Off-label psychopharmacologic prescribing for children: History supports close clinical monitoring<\/strong><\/a> – Most medications are approved for marketing based on favorable benefit to risk assessments from clinical trial data in adults. Pediatric medical practice has been primarily off-label, i.e., permissible even though the drug was not specified for this age group, or indication in the product label approved by the Food and Drug Administration (FDA). Off-label use of a drug is a common practice representing approximately 50\u201375% of pediatric medication use. In Europe, medication use may be characterized as either unlicensed, i.e. not approved for use in a particular age group, or off-label, i.e. outside the terms of their product license or marketing authorizations. Occasionally, products not approved for use in children have statements declaring inadequate data or have warnings in their product label of potential dangers associated with pediatric use<\/p>\n<\/div><\/div>

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Orphanages, Training Schools, Reform Schools and Now This?<\/strong><\/a> \u2013 For centuries we have been searching for a humane way to treat children with \u201cbad\u201d behavior, and still we have not found our way. We have locked them up in orphanages, so-called schools for the \u201cretarded,\u201d \u201cmental hospitals,\u201d training and reform schools. We have dispatched them across the nation on orphan trains, farmed them out, drugged them, shocked, lobotomized and beaten them. We have exorcised and broken their spirits. We have scared them straight, made them climb mountains in wilderness camps and dig holes in boot camps, hoping they would learn to behave through starvation and sheer exhaustion. We have tortured our children and youth with all manner of horrors, from pepper spray to cattle prods. As if this isn\u2019t bad enough, now we have decided these children are criminals and lock them up in juvenile justice facilities, adult jails, and prisons, sometimes placing them in solitary confinement (the \u201cHole,\u201d or the \u201cBox\u201d) for weeks and months at a time. And, we treat some children worse than others. Prevalence studies have found that 65-70 percent of youth in the justice system meet the criteria for a disability, a rate that is more than three times higher than that of the general population. The difference between then and now is that we know better.<\/p>\n<\/div><\/div>

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Outcomes for youth receiving intensive in-home therapy or residential care<\/strong><\/a> \u2013 This study compares outcomes for behaviorally troubled children receiving intensive in-home therapy (IIHT) and those receiving residential care (RC). Propensity score matching is used to identify matched pairs of youth (n = 786) with equivalent propensity for IIHT. The majority of pretreatment differences between the IIHT and RC groups are eliminated following matching. Logistic regression is then conducted on outcome differences at 1 year postdischarge. Results show that IIHT recipients had a greater tendency (.615) toward living with family, making progress in school, not experiencing trouble with the law, and placement stability compared with RC youth (.558; p < .10). This suggests that IIHT is at least as effective for achieving positive outcomes. Given IIHT’s reduced restrictiveness and cost, intensive in-home services should be the preferred treatment over RC in most cases.<\/p>\n<\/div><\/div>

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Outdoor Therapies An Introduction to Practices, Possibilities, and Critical Perspectives<\/strong><\/a> – Drawing on the leading voices of international researchers and practitioners,\u00a0Outdoor Therapies<\/i> provides readers with an overview of practices for the helping professions. Sharing outdoor approaches ranging from garden therapy to wilderness therapy and from equine-assisted therapy to surf therapy, Harper and Dobud have drawn common threads from therapeutic practices that integrate connection with nature and experiential activity to redefine the “person-in-environment” approach to human health and well-being. Readers will learn about the benefits and advantages of helping clients get the treatment, service, and care they need outside of conventional, office-based therapies. Providing readers with a range of approaches that can be utilized across a variety of practice settings and populations, this book is essential reading for students, practitioners, theorists, and researchers in counseling, social work, youth work, occupational therapy, and psychology.<\/p>\n<\/div><\/div>

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Pediatric bipolar disorder: An object of study in the creation of an illness<\/strong><\/a> – In the past decade bipolar disorder in children has been diagnosed with rapidly increasing frequency in North America, despite a century of psychiatric consensus that manic-depressive illness rarely had its onset before adolescence. This emergence has happened against a background of vigorous pharmaceutical company marketing of bipolar disorder in adults. In the absence of a license demonstrating efficacy for their compound for bipolar disorder in children, however, companies cannot actively market pediatric bipolar disorder. This paper explores some mechanisms that play a part in spreading the recognition of a disorder in populations for which pharmaceutical companies do not have a license. These include the role of academic experts, parent pressure groups, measurement technologies and the availability of possible remedies even if not licensed.<\/p>\n<\/div><\/div>

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Physical punishment of children: lessons from 20 years of research<\/strong><\/a>\u00a0\u2013 Over the past two decades, we have seen an international shift in perspectives concerning the physical punishment of children. In 1990, research showing an association between physical punishment and negative developmental outcomes was starting to accumulate, and the Convention on the Rights of the Child had just been adopted by the General Assembly of the United Nations; however, only four countries had prohibited physical punishment in all settings. The Joint Statement on Physical Punishment of Children and Youth finds that the evidence is clear and compelling \u2014 physical punishment of children and youth plays no useful role in their upbringing and poses only risks to their development.<\/p>\n<\/div><\/div>

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Point and level systems: Another way to fail children and youth<\/strong><\/a>\u00a0\u2013 On the premise that the pervasive use of point and level systems in group care programs can be counter to therapeutic and developmental goals for children and youth, this article describes the specific nature of these practices, provides an analysis of their effects, and suggests constructive alternatives.<\/p>\n<\/div><\/div>

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Predictors of Residential Placement Following a Psychiatric Crisis Episode Among Children and Youth in State Custody<\/strong><\/a> – This study examined the extent and correlates of entry into residential care among 603 children and youth in state custody who were referred to psychiatric crisis services. Overall, 27% of the sample was placed in residential care within 12 months after their 1st psychiatric crisis screening. Among the children and youth placed in residential care, 51% were so placed within 3 months of their 1st crisis screening, with an additional 22% placed between 3 and 6 months after screening. Risk behavior and functioning, psychiatric hospitalization following screening, older age, placement type, and caregiver\u2019s capacity for supervision were associated with increased residential placement. The findings highlight the importance of early identification and treatment of behavior and functioning problems following a crisis episode among children and youth in state custody to reduce the need for subsequent residential placement. Having an inpatient psychiatric episode following a crisis episode places children at greater risk for residential placement, suggesting that the hospital is an important point for diversion programs. Children and youth in psychiatric crisis may also benefit from efforts to include their families in the treatment process.<\/p>\n<\/div><\/div>

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Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents<\/strong><\/a> – This study identified predictors of seclusion or restraint use among licensed and\/or accredited residential treatment centers (RTCs) for children and youth in the United States responding to a federally-sponsored survey of mental health services. 693 licensed and\/or accredited child and adolescent RTCs responded to questions about the demographic and admission status of clients served on an identified date, services offered, size, ownership, funding, and their use of seclusion or restraint practices within the preceding 12\u00a0months. Logistic regression was used to determine factors predicting facility use of seclusion or restraint. A large majority of licensed and\/or accredited child and adolescent RTCs (82\u00a0%) reported using seclusion or restraint in the prior year. Contrary to prior research, individual patient characteristics (percent of males, minorities, and involuntary admissions) did not predict the use of coercive techniques. Instead facility and funding variables accounted for approximately 27\u00a0% of the variance in the use of seclusion or restraint. Larger, privately-owned RTC\u2019s funded primarily through public monies and which offered medication and programming for SED youth were more likely to endorse having used seclusion or restraint in the previous year. Despite visible policy and advocacy efforts to reduce seclusion and restraint use over the past decade, a majority of licensed and\/or accredited RTCs for children and adolescents report using such practices. Findings emphasize the importance of examining facility-level variables in predicting their use, and highlight the disconnect between nationally espoused goals and current practices regarding coercive techniques in child and adolescent RTCs.<\/p>\n<\/div><\/div>

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Preventing Fatal Incidents<\/strong><\/a> – Apart from deliberate deaths or some deaths associated with transport to or from a program, counterfactual analysis of incidents shows capable individuals responsible for a program could prevent most outdoor education deaths. This chapter summaries what is required of organizations and individuals to take all reasonable fatality prevention measures. Fatality prevention requires knowledge of past fatal incidents, prevention-focused knowledge of programs, locations, conditions, and activities, and monitoring of precautions. Usually it entails expert supervision of young people in the outdoors. It requires prevention to be an overriding priority, and could incur costs or cause inconvenience. Fatality prevention poses no threat to outdoor education overall, but it could require some programs to be modified or cancelled. This chapter lists seven priorities for fatality prevention in outdoor education, and discusses some limitations to case-based prevention. Fatality prevention is subject to the overall competence of individuals and effectiveness of organizations. It is constrained and enabled by the quality and availability of case reports; the chapter concludes with a discussion of the role of those who work in the outdoor education field in producing and reproducing case-based knowledge. In particular, future fatality prevention must contend with organizational tendencies to suppress information in order to protect reputations.<\/p>\n<\/div><\/div>

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Preventing the Use of Restraint and Seclusion with Young Children: The Role of Effective, Positive Practices<\/strong><\/a> – In recent years, there have been major concerns expressed regarding the use of restraint and seclusion to control the behavior of children with disabilities and\/or challenging behavior. In May of 2009, for example, the US Government Accountability Office (GAO) released findings regarding a number of cases in which seclusion and restraint were abused to the point that children were physically and psychologically injured. Some children even died while being restrained. The great potential for abuse and injury has led many school districts, state agencies, and state governments to issue policies, regulations and laws that limit the use of restraint and seclusion. Many of these regulations and statutes effectively prohibit the use of restraint and seclusion except in cases of orthopedic necessity and obvious emergencies in which a child is in imminent danger. Still, there remains uncertainty about what constitutes restraint and seclusion and what should be done as an alternative. The purpose of this document is to review these issues and discuss positive strategies that can be used to prevent behaviors that could lead to considerations of these invasive and potentially-dangerous practices.<\/p>\n<\/div><\/div>

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Prison Policy Initiative<\/strong><\/a>\u00a0\u2013 On this page, the Prison Policy Initiative has curated all of the research about youth in the criminal justice system that we know of.<\/p>\n<\/div><\/div>

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Promoting Healthy Outcomes Among Youth with Multiple Risks: Innovative Approaches<\/strong><\/a> – A number of systematic reviews have examined the effects of various forms of residential treatment for sentenced youth, including intensive wilderness programs. Although the reviews’ assessments of program effectiveness differed\u2014some programs showed positive effects and others showed no effects or negative effects \u2014considerable evidence suggests that greater therapeutic time and higher-quality treatment are associated with stronger positive effects . In contrast, boot camps did not show positive effects as compared with effects from traditional detention centers for sentenced youth. Thus, one could conclude that rehabilitation-focused programs are more effective than programs relying on sanctions and punishment. The Pathways to Desistance study indicated that neither institutional placement of high-end offenders nor length of sentence were related to recidivism. However, youth who received substance abuse treatment for at least 90 days were less likely to reoffend.<\/p>\n<\/div><\/div>

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Prone restraint is neither safe nor is it therapeutic<\/a> <\/strong>– A prone, or facedown, restraints begin with a \u201ctakedown.\u201d Staff then turn the student onto his front and secure his arms and legs. Staff is told to avoid putting pressure on the student\u2019s back, which can inhibit breathing due to postural asphyxia, a form of asphyxia that occurs when one\u2019s position prevents them from breathing adequately. Suggesting that prone restraint aids in de-escalation is absurd. The use of any form of restraint is an indication that de-escalation has failed miserably and the situation has escalated to a crisis, that in the judgment of the staff, required the use of potentially deadly force.<\/p>\n<\/div><\/div>

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Protecting Youth Placed in Unlicensed, Unregulated Residential Treatment Facilities<\/strong><\/a> – Throughout the country, there is considerable inconsistency in how states regulate residential treatment programs for youth. In states with little oversight, the health and safety of youth are unprotected and they may be subject to substandard treatment, rights violations, and\/or abuse. Three initiatives to address this issue are reported: (1) an Internet survey of youth who are former residents, (2) a four-state pilot study of how states regulate and monitor residential programs, and (3) a bridge-building conference between residential treatment providers and mental health leaders. Recommendations address the next steps for lawmakers, lawyers, judges, mental health and education professionals, and parents.<\/p>\n<\/div><\/div>

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Protecting Youth Placed in Unregulated Residential \u201cTreatment\u201d Facilities<\/a>\u00a0<\/strong>\u2013 Depending on the state, failure to provide state oversight of residential programs for minors may occur because these programs (1) do not accept public funds; (2) are affiliated with religious organizations; or (3) describe themselves (inappropriately) as outdoor programs, boarding schools, or other types of nontreatment programs.<\/span><\/p>\n<\/div><\/div>

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Providing a legally-appropriate special education for students with bipolar disorder: issues and analysis<\/strong><\/a> – To determine what a legally-appropriate special education is for students with bipolar disorder, this study analyzed litigation trends involving students with bipolar disorder who brought cases under the Individuals with Disabilities Education Act (IDEA). Through review of the IDEA, its regulations, the pivotal Supreme Court and Circuit Court decisions interpreting the meaning of a free, appropriate public education (FAPE) and least restrictive environment (LRE), and cases involving students with bipolar disorder, this study identified patterns, trends, and relevant facts that appeared to influence courts decisions in favor of school districts and courts decisions in favor of students. The majority of the cases held in favor of the school district on both questions of eligibility and questions of placement. Furthermore, most of the cases involved the appropriateness of school district-proposed placements versus parentally-proposed private placements. In several cases, school districts argued that psychiatric hospitalization was a medical exclusion under the IDEA, since the hospitalizations were not diagnostic or evaluative and required physicians to implement the services. Two courts agreed that the residential setting was purely for psychiatric purposes and was not educational. In two cases, however, courts held that the psychiatric, emotional, and behavioral services provided to these students in residential facilities were so intertwined with the students educational services that they were covered under IDEA as related services.<\/p>\n<\/div><\/div>

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Psychiatric Effects of Solitary Confinement<\/strong><\/a> – Solitary confinement\u2014that is the confinement of a prisoner alone in a cell for all, or nearly all, of the day with minimal environmental stimulation and minimal opportunity for social interaction\u2014can cause severe psychiatric harm. It has indeed long been known that severe restriction of environmental and social stimulation has a profoundly deleterious effect on mental functioning; this issue has been a major concern for many groups of patients including, for example, patients in intensive care units, spinal patients immobilized by the need for prolonged traction, and patients with impairment of their sensory apparatus (such as eye-patched or hearing-impaired patients).<\/p>\n<\/div><\/div>

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Psychiatrised childhoods<\/strong><\/a> – \u2018Psychiatrisation\u2019 describes the process by which an ever-expanding assemblage of human life experiences have come to be observed, understood, enacted and acted upon through the language, theories, technologies and institutional practices of Western biomedical psychiatry. Ever since the medical profession seized its opportunity to profit in the \u2018mad trade\u2019 during the late 18th and early 19th centuries and \u2018psychiatry\u2019 established itself as a new sub-specialty of medicine, various cognitive, behavioural and emotional states have been governed by \u2018illness\u2019 and \u2018disorder\u2019 categories which draw boundaries around \u2018normality\u2019 and \u2018abnormality\u2019 (Coppock and Hopton, 2000). The normal\/abnormal binary is the organising mechanism for psychiatrisation, while diagnosis is the process by which individuals are marked out as \u2018mentally ill\/disordered\u2019; an exercise operationalised by the use of professional manuals such as the\u00a0Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition<\/i>\u00a0(DSM<\/i>-5) of the\u00a0American Psychiatric Association (APA, 2013) and the World Health Organization\u2019s\u00a0International Classification of Diseases and Related Health Problems, Tenth Revision<\/i>\u00a0(ICD-10<\/i>) (WHO, 1992). Those who meet specified criteria can be classified as having a mental disorder, thus \u2018marking certain mental and emotional states and experiences as different, abnormal and pathological against preconceived notions of \u2018normal mental health\u2019 (Liegghio, 2016: 114).<\/p>\n<\/div><\/div>

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Psychiatrised Children and their Rights: Starting the Conversation<\/strong><\/a> – The rights of children diagnosed with psychiatric disorders are a neglected area in the field of childhood studies and the sociology of childhood. Although children\u2019s rights scholars have demonstrated a commitment to documenting, supporting and researching the needs of marginalised children through the discourse of multiple childhood(s), psychiatrised children have received relatively little attention within the academic literature in this area. The aims of this special issue are to work towards redressing this absence as well as to document some of the work that is being done in this area by children\u2019s rights researchers, theorists and advocates around the world.<\/p>\n<\/div><\/div>

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Psychological Impact on Adult Women Who Attended a Therapeutic Boarding School<\/strong><\/a> – Adolescence is viewed as a significant time of developmental growth and self-exploration (Gilligan, 1982; Newman & Newman, 2009). In his model of eight stages of psychosocial development, psychologist Erik Erikson (1968) described adolescence as a natural phase of increased conflict characterized by a fluctuation in ego strength complemented by a high growth potential. He explained that this stage stimulates dormant anxiety and creates new conflict but also supports new and expanded confidence in searching for and interaction with new opportunities and associations. Challenges may occur, however, when this stage of growth is disrupted by an enforced transition to long-term residential treatment, where the adolescent is separated from family, peers, and familiar social environments. For the purpose of this study, the term therapeutic boarding school (TBS) is defined as a long-term residential program that houses adolescent females from ages 13-18 years with a minimum stay of 12 months and offers intensive psychological counseling and academic services<\/p>\n<\/div><\/div>

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Quality of experience in residential care programmes: Retrospective perspectives of former youth participants<\/strong><\/a> – This exploratory study examined perceptions of care quality within parent-pay youth treatment programmes such as therapeutic boarding schools, residential treatment centres, wilderness therapy programmes, and intensive outpatient programmes. Reflecting on their personal experiences as youths, 214 adults reported on a total of 75 different treatment settings. Two indices developed for this study measured participants’ perceptions of quality of experience and the totalistic programme characteristics of their care settings. Regression analyses and ANOVA tests of means indicated a negative relationship between totalistic programme characteristics and quality of experience index scores. Significant relationships were not found between quality of experience and forcible transport, intake decade, or the amount of time in treatment.<\/p>\n<\/div><\/div>

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Re-Arrest among Juvenile Justice-Involved Youth<\/strong><\/a> – The purpose of this study is to investigate the static and dynamic risk factors for re-arrest among detained youth by examining gender, race\/ethnicity, age, special education and mental health variables (i.e., anger\/irritability, depression\/anxiety, somatic complaints, suicide ideation, thought disturbances, and traumatic experiences). The demographic profiles of detained youth with one admit were also compared with those with multiple admits to the juvenile detention center. With regards to static risk factors, older, white, and special education were significantly at risk of re-arrest. Concerning dynamic risk factors, only anger\/irritability predicted re-arrest. Practice implications are also discussed.<\/p>\n<\/div><\/div>

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Rehabilitating the \u2018drugs lifestyle\u2019: Criminal justice, social control, and the cultivation of agency<\/a>\u00a0<\/strong>\u2013 This study examines rehabilitative practice within a residential drug treatment facility that works closely with the criminal justice system. In the face of rising imprisonment costs, drug treatment has become an increasingly popular alternative to incarceration. Yet little work has been done concerning the nature of the treatment systems for offenders. This study examines rehabilitative practice within a residential drug treatment facility that works closely with the criminal justice system. The target of rehabilitative reform is revealed to be a \u2018drugs lifestyle\u2019 whose description strongly recalls earlier discussions of the \u2018culture of poverty\u2019. Residents are deemed to be in need of disciplinary control in order to foster an emotional disposition oriented toward accepting boredom, following rules, responding calmly to being yelled at by supervisors, and other skills useful in the low-wage labor market. Given its apparent functions in terms of social control, the fact that some participants find the harsh disciplinary system beneficial requires explanation, and it is argued that rehabilitation fosters new forms of agency that are associated with leaving the informal labor market and entering the lower tiers of formalized labor. Understanding the benefits of drug treatment requires a careful conceptualization of agency, treating it as a characteristic that emerges from within social formations rather than in opposition to them.<\/span><\/p>\n<\/div><\/div>

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Report of Plaintiff’s Expert Witness Dr. Roderick S. Hall<\/strong><\/a><\/p>\n<\/div><\/div>

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Research on Institutional Care of Vulnerable Children<\/strong><\/a> – The purpose of this document is to give a brief overview of the key findings of academic research into the effects of institutional care for vulnerable children. We selected studies that used scientific sampling techniques, and the studies that are included used standardized measuring tools, comparison groups, or long-term tracking of subjects. We chose a literature review that examined the children served by group care, outcomes, cost, and policy implications. Other literature reviews examined the mental health implications of group care.<\/p>\n<\/div><\/div>

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Research Summary: Ensuring that youth in out-of-home care are only Prescribed Psychotropic Medication when it is in their best interest<\/strong><\/a> – Psychotropic medications can be a helpful part of a comprehensive treatment approach to address mental health challenges in youth in foster care, but every year, tens of thousands of children and youth in foster care nationwide suffer damage to their health as a result of being unnecessarily prescribed multiple psychotropic medications.<\/p>\n<\/div><\/div>

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Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth. Testimony before the Committee on Education and Labor, House of Representatives<\/strong><\/a> – Residential treatment programs provide a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for troubled boys and girls with a variety of addiction, behavioral, and emotional problems. This testimony concerns programs across the country referring to themselves as wilderness therapy programs, boot camps, and academies, among other names. Many cite positive outcomes associated with specific types of residential treatment. There are also allegations regarding the abuse and death of youth enrolled in residential treatment programs. Given concerns about these allegations, particularly in reference to private programs, the Committee asked the US Government Accountability Office (GAO) to: (1) verify whether allegations of abuse and death at residential treatment programs are widespread; and (2) examine the facts and circumstances surrounding selected closed cases where a teenager died while enrolled in a private program.To achieve these objectives, GAO conducted numerous interviews and examined documents from closed cases dating as far back as 1990, including police reports, autopsy reports, and state agency oversight reviews and investigations. GAO did not attempt to evaluate the benefits of residential treatment programs or verify the facts regarding the thousands of allegations it reviewed. Ten closed cases from private programs were selected to examine in greater detail. Specifically, these cases were focused on the death of a teenager in a private residential treatment program that occurred between 1990 and 2004. GAO found significant evidence of ineffective management in most of these ten cases, with many examples of how program leaders neglected the needs of program participants and staff. Three factors played a significant role in most of the deaths examined: untrained staff, inadequate nourishment, and reckless or negligent operating practices.<\/p>\n<\/div><\/div>

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Residential Treatment vs Wraparound Summary<\/strong><\/a> – The U.S. Surgeon General has referenced the issue of treatment of children for mental health issues, specifically residential treatment centers (RTCs) and other alternative treatments. The 1999 Mental Heath\u2014A report of the Surgeon General states, \u201cResidential treatment centers (RTCs) are the second most restrictive form of care (next to inpatient hospitalization) for children with severe mental disorders. In the past, admission to an RTC was justified on the basis of community protection, child protection, and benefits of residential treatment (Barker, 1982). However as of today, none of these justifications have stood up to research scrutiny. In particular, youth who display seriously violent and aggressive behavior do not appear to improve in such settings, according to limited evidence (Joshi & Rosenberg, 1997).\u201d<\/p>\n<\/div><\/div>

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Residential Treatment: The Potential for Cultic Evolution<\/strong><\/a> – The residential treatment center provides an invaluable holding environment where the severely impaired are helped to develop intrapersonal awareness, interpersonal skills, and the ability to function autonomously.\u00a0In real and symbolic terms, the residential treatment setting serves as a second-chance family. Here residents are given the opportunity to experience and grow within a close-knit community with a goal of enhancing the sense of self.\u00a0As with all psychotherapeutic efforts, the individual’s ultimate growth is the product of an initial period of dependency and regression.\u00a0In this context, responsible mental health professionals have questioned whether or not the development of intense dependency bonds may render individuals incapable of functioning outside of this “protective” setting.\u00a0This concern is especially acute when working with individuals so lacking in ego strength that their primary mode of relating to the outside world often entails repeated abuse of several substances.<\/p>\n<\/div><\/div>

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Restraint & Seclusion in Schools<\/strong><\/a> – Restraint and seclusion are often implemented by untrained personnel, resulting in injury, trauma and even death. In January 2009, the National Disability Rights Network issued a report detailing the harmful use of these interventions in over two-thirds of states, involving children as young as three years old in both public and private school settings. Following that report, the Government Accountability Office conducted an investigation finding no federal laws regulating the use of these interventions in schools, and that state laws vary widely if they exist at all. In fact, many states have no laws regulating restraint and seclusion in schools.<\/p>\n<\/div><\/div>

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Restraint and Seclusion of Students with Disabilities<\/strong><\/a> – According to the CRDC, during the 2013-14 school year, students with disabilities were subjected to mechanical and physical restraint and seclusion at rates that far exceeded those of other students. Specifically, students with disabilities served by the Individuals with Disabilities Education Act (IDEA) represented 12% of students enrolled in public schools nationally, but 67% of the students who were subjected to restraint or seclusion in school. Based on data reported to OCR, approximately 100,000 students were placed in seclusion or involuntary confinement or were physically restrained at school to immobilize them or reduce their ability to move freely, including more than 69,000 students with disabilities served by the IDEA. Data disparity alone does not prove discrimination. The existence of a disparity, however, does raise a question regarding whether school districts are imposing restraint or seclusion in discriminatory ways.<\/p>\n<\/div><\/div>

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Restraint and Seclusion: A Risk Management Guide<\/strong><\/a> – Courts have long recognized that people with mental illnesses have the right to be free from the improper use of seclusion and restraint. In the landmark 1982 case Youngberg v. Romeo, the Supreme Court recognized that the use of restraint is a drastic deprivation of personal liberty, holding that \u201cthe right to be free from undue bodily restraint is the core of the liberty interest protected by the Due Process Clause from arbitrary governmental action.\u201d Youngberg v. Romeo, 457 U.S. 307, 316 (1982). Over the past decade, however, a clear consensus has emerged that restraint and seclusion are safety interventions of last resort and that the use of these interventions can and should be reduced significantly. In evaluating the potential legal risks associated with the use of restraint and seclusion, risk managers should understand this emerging consensus as critical to a determination about whether a particular use of these interventions reflects \u201cthe exercise of professional judgment.\u201d<\/p>\n<\/div><\/div>

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Restraint and Seclusion: Resource Document by US Department of Education<\/strong><\/a> – As education leaders, our first responsibility must be to ensure that schools foster learning in a safe and healthy environment for all our children, teachers, and staff. To support schools in fulfilling that responsibility, the U.S. Department of Education has developed this document that describes 15 principles for States, school districts, schools, parents, and other stakeholders to consider when developing or revising policies and procedures on the use of restraint and seclusion. These principles stress that every effort should be made to prevent the need for the use of restraint and seclusion and that any behavioral intervention must be consistent with the child\u2019s rights to be treated with dignity and to be free from abuse. The principles make clear that restraint or seclusion should never be used except in situations where a child\u2019s behavior poses imminent danger of serious physical harm to self or others, and restraint and seclusion should be avoided to the greatest extent possible without endangering the safety of students and staff. The goal in presenting these principles is to help ensure that all schools and learning environments are safe for all children and adults.<\/p>\n<\/div><\/div>

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Restraint use in residential programs: why are best practices ignored?<\/strong><\/a> – Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction\/prevention strategies have been identified, implemented, and reported. Both states and residential providers have implemented prevention approaches, made significant changes, reduced restraint\/seclusion use, and offered their experience and positive outcomes.<\/p>\n<\/div><\/div>

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Review of the evidence base for treatment of childhood psychopathology<\/strong><\/a> \u2013 This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit\/hyperactivity disorder (ADHD). The review was based on a literature review of nonresidential treatments for youths ages 6-12. The pool of studies for this age group was limited, but results suggest positive outcomes for a variety of interventions (particularly parent training and community-based interventions for disruptive behavior disorders and medication for ADHD). The review also highlights the need for additional research examining effectiveness of treatments for this age range and strategies to enhance the implementation of effective practices.<\/p>\n<\/div><\/div>

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Risks, Outcomes, and Evidence-Based Interventions for Girls in the US Juvenile Justice System<\/strong><\/a> – The proportion of the juvenile justice population that comprises females is increasing, yet few evidence-based models have been evaluated and implemented with girls in the juvenile justice system. Although much is known about the risk and protective factors for girls who participate in serious delinquency, significant gaps in the research base hamper the development and implementation of theoretically based intervention approaches. In this review, we first summarize the extant empirical work about the predictors and sequelae of juvenile justice involvement for girls. Identified risk and protective factors that correspond to girls\u2019 involvement in the juvenile justice system have been shown to largely parallel those of boys, although exposure rates and magnitudes of association sometimes differ by sex. Second, we summarize findings from empirically validated, evidence-based interventions for juvenile justice-involved youths that have been tested with girls. The interventions include Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Treatment Foster Care Oregon (formerly known as Multidimensional Treatment Foster Care). We conclude that existing evidence-based practices appear to be effective for girls. However, few studies have been sufficiently designed to permit conclusions about whether sex-specific interventions would yield any better outcomes for girls than would interventions that already exist for both sexes and that have a strong base of evidence to support them. Third, we propose recommendations for feasible, cost-efficient next steps to advance the research and intervention agendas for this under-researched and underserved population of highly vulnerable youths.<\/p>\n<\/div><\/div>

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Roadmap to Seclusion and Restraint Free Mental Health Services<\/strong><\/a> – In 2003, the Substance Abuse and Mental Health Services Administration (SAMHSA) set forth a bold vision to reduce and ultimately eliminate the use of seclusion and restraint in behavioral healthcare settings. SAMHSA has established seclusion and restraint as a priority area and has developed a National Action Plan to reach our vision of seclusion and restraint free mental health services. Roadmap to Seclusion and Restraint Free Mental Health Services represents a key component of this National Action Plan. It will increase the knowledge and skills of mental health service direct care staff, administrators, and consumers on alternatives to the use of seclusion and restraint. We also see this training as a tool to assist you with mental health system transformation\u2014creating mental health services and supports that facilitate recovery and promote resiliency.<\/p>\n<\/div><\/div>

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School is Not Supposed to Hurt: Investigative Report on Abusive Restraint and Seclusion in Schools<\/strong><\/a> – Our examination of the current patchwork of laws, regulations, and guidelines is outlined. The findings show that forty-one percent (41%) have no laws, policies, or guidelines concerning restraint or seclusion use in schools; almost ninety percent (90%) still allow prone restraints, and only forty-five percent (45%) require or recommend that schools automatically notify parents or guardians of restraint\/seclusion use. Finally, the report proposes recommendations for immediate actions that must be taken by the Administration, the United States Congress, states and territories, and local schools \u2013 if we are to protect our nation\u2019s children.<\/p>\n<\/div><\/div>

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School is not Supposed to Hurt: Update on Progress in 2009 to Prevent and Reduce Restraint and Seclusion in Schools<\/strong><\/a> – In January 2009, the National Disability Rights Network released a report entitled School is Not Supposed to Hurt. The report revealed that students in every region of the country were being injured, and even killed, by being abusively restrained and secluded at the hands of school staff. It uncovered that restraint and seclusion was often misused to force a student to stay on task or as a disciplinary measure, despite the consensus that restraint and seclusion are not therapeutic. There were no federal laws to prevent or reduce restraint or seclusion of school children when the initial report was released, and no federal action to point to at all. Almost half of the states had no laws or policies either, and existing state laws and policies varied greatly and were often inadequate.<\/p>\n<\/div><\/div>

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Seclusion and Restraint And Children<\/strong><\/a> – The New Commission on Mental Health found that \u201crestraint and seclusion pose significant risks, including \u2018serious injury or death, re-traumatizing of people with a history of trauma or abuse, loss of dignity, and other psychological harm\u2019\u201d.<\/p>\n<\/div><\/div>

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Seclusion and restraint practices in residential treatment facilities for children and youth<\/strong> <\/a>– Policymakers, advocates, and families remain concerned about the use of seclusion and restraint in residential treatment facilities for children and youth. This study used data from 2 national surveys to examine the extent to which residential treatment facilities consistently implement certain practices following incidents of seclusion or restraint. The study found that 76% of facilities reported having secluded or restrained youth in the previous year; 34% of these facilities reported that, following such incidents, they always debrief the youth, family, and staff; notify the attending physician; and record the incident in the treatment plan. Accredited facilities and those that conduct a trauma assessment upon admission were more than twice as likely as others to consistently implement these practices. States and providers should continue to monitor seclusion and restraint practices and identify opportunities for quality improvement.<\/p>\n<\/div><\/div>

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Seclusion and Restraints: A Failure, Not a Treatment<\/strong><\/a> – Seclusion and restraint of psychiatric patients are known to be dangerous practices that can result in serious injury, trauma and even death. The Harvard Center for Risk Analysis estimates that 50 to 150 deaths occur nationally each year because of psychiatric seclusion and restraints. Here in California, at least 14 people have died and at least one has become permanently comatose while being subjected to these practices since July of 1999. This does not reflect those who are injured or traumatized \u2013 California does not keep track of those data. We do know, however, that at a very conservative estimate, over 100,000 Californians are involuntarily committed to psychiatric facilities each year, and that along with voluntary patients, they are at risk of being subjected to seclusion and restraints (S\/R).<\/p>\n<\/div><\/div>

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Self-Regulation: The Impact of Trauma<\/strong><\/a> – To this day, many children are still experiencing the effects of the trauma that their grandparents and parents went through in residential schools. Other events in a child\u2019s life can also be traumatic and have a similar long-term impact. Understanding why and how trauma affects the brain can help children overcome these effects and have a full and rewarding life.<\/p>\n<\/div><\/div>

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Sexual Victimization Reported by Youth in Juvenile Facilities, 2018<\/strong><\/a> \u2013 This report defines sexual victimization as any forced or coerced sexual activity with another youth or any sexual activity with facility staff that takes place in a juvenile correctional facility. In 2018, an estimated 7.1% of youth in juvenile facilities reported being sexually victimized during the prior 12 months, down from 9.5% in 2012. This report defines sexual victimization as any forced or coerced sexual activity with another youth or any sexual activity with facility staff that takes place in a juvenile correctional facility.<\/p>\n<\/div><\/div>

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Social Injustice and Public Health<\/strong><\/a> – This book defines social injustice as the denial or violation of economic, sociocultural, political, civil, or human rights of specific populations or groups in society. These groups are socially defined in terms of racial or ethnic status, language, country of origin, socioeconomic status, age, gender, sexual orientation or other perceived group characteristics. Social injustice manifests in many ways ranging from various forms of overt discrimination to the wide gaps between the “haves” and the “have-nots” within a country or between richer and poorer countries. It increases the prevalence of risk factors and hazardous exposures, which in turn lead to higher rates of disease, injury, disability, and premature death.<\/p>\n<\/div><\/div>

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Speaking Truth to Power: Challenging the Power of Parents to Control the Education of Their Own<\/strong><\/a> – Civil rights activists have long believed that progress toward full human rights is built on “speaking truth to power.” Speaking truth to power takes both courage and insight. After all, the authority of power seems so self-evident and power is, inherently, self-perpetuating. Yet periodically we have been called upon by marginalized groups – women, people of color, people with disabilities – to re-examine long-held beliefs and measure them against what we hope is a progressively more enlightened standard of human rights. Children are one such group, and the new frameworks for thinking about the rights of children have pushed us to re-think some of our most cherished beliefs and most hallowed traditions.<\/p>\n<\/div><\/div>

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State-level Data for Understanding Child Welfare in the United States<\/strong><\/a>\u00a0\u2013 This comprehensive child welfare resource provides state and national data on child maltreatment, foster care, kinship caregiving, and adoption from foster care. The data are essential to help policymakers understand how many children and youth came in contact with the child welfare system, and why. States can use this information to ensure their child welfare systems support the safety, stability, and well-being of all families in their state.<\/p>\n<\/div><\/div>

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Sticker Shock: Calculating the Full Price for Youth Incarceration<\/strong><\/a> \u2013 For nearly a decade and a half, the vast majority of states have made substantial progress in reducing reliance on incarceration to address behavior by the nation\u2019s youth. Levels and rates of commitment of adjudicated youth have dropped: Between 2001 and 2011, there has been a 45 percent decline in the rate of youth committed and in residential placement.\u00a0 Temporary confinement of youth does play a role in the overall public safety system. Government uses incarceration both for adults and youth in incapacitation, deterrence, and retribution. That said, as highlighted by the National Research Council of the National Academies in their comprehensive review of juvenile justice policy, a \u201cdevelopmental model of juvenile justice rejects many of the punitive law reforms of the late 20th century as often excessively harsh and therefore unfair to young offenders and as likely to increase rather than decrease the threat to public safety. Indeed, the evidence suggests incarceration likely increased the risk of recidivism for many youth.\u201d<\/p>\n<\/div><\/div>

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Still shackled in the land of liberty: denying children the right to be safe from abusive \u201ctreatment\u201d<\/a>\u00a0<\/strong>\u2013\u00a0 The troubled-teen industry has come under federal scrutiny after over a decade of reported abuses and the reported deaths of at least 10 children. This article provides a brief overview of the development of the troubled-teen industry, addresses the thorny issue of parents\u2019 right to send their children to these facilities vis-a-vis the rights of their children, and argues that nurses and other health professionals have a collective obligation to speak out against them in the strongest possible terms. Suggestions for action by nurses are proposed that could protect vulnerable children against this continuous cycle of institutionalized child abuse masquerading as therapy.
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Students Traumatized in Special Education Across America, Seclusion, Restraint, and Aversives<\/strong><\/a> – For over a decade, the United States Health & Human Services Department’s Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized that seclusion and restraint are traumatic NOT therapeutic.\u00a0 Mental health experts have developed tools and protocols that have successfully helped many mental health facilities and schools significantly reduce seclusion and restraints. While America’s special needs children are traumatized at school, sometimes physically injured to the point of death, legislators still debate whether or not to support a federal law to keep all children safe. Some debate whether to support a “federal” law because they are “pro-states rights”. Yet, disabled children can’t wait around for individual states to “do the right thing” and pass similar laws. If states were capable of doing the right thing, they would have already done it. Other legislators listen to the lobbyists who demand they “need” to use seclusion and restraint even though these methods are not evidence based or therapeutic.<\/p>\n<\/div><\/div>

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Summary of the UN Convention on the Rights of the Child<\/strong><\/a> – The Convention defines a ‘child’ as a person below age 18, unless the laws of a particular country set a younger age limit. The Convention applies to all children, regardless of gender, race, ethnicity, culture, religion, family status, or ability.\u00a0 Governments are responsible for ensuring children are protected from any form of discrimination.<\/p>\n<\/div><\/div>

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Survey of Youth in Residential Placement: Conditions of Confinement<\/strong><\/a>\u00a0\u2013 This report presents findings from the Survey of Youth in Residential Placement about the conditions of confinement for youth in a range of different facilities and programs. Results focus on the structural and operational characteristics of these environments and indicate how youth offenders are distributed across various programs and facilities of different size and complexity.<\/p>\n<\/div><\/div>

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Systematic violations of patients\u2019 rights and safety: Forced medication of a cohort of 30 patients<\/strong><\/a> – We assessed the records for 30 consecutive patients who had appealed decisions about forced medication with antipsychotics to the Psychiatric Appeals Board in Denmark. In all 21 cases where there was information about the effects of previous drugs, the psychiatrists stated that antipsychotics had had a good effect whereas none of the patients shared this view. The harm caused by earlier or currently used antipsychotics did not seem to have played any role in the psychiatrists\u2019 decision-making. The legal requirements for using force to protect the patients\u2019 health were never met and less intrusive treatments than antipsychotics, eg, benzodiazepines or psychotherapy, were never mentioned as options. The power imbalance was extreme, the patients felt misunderstood and ignored, their legal protection was a sham, and the harm done was immense. The violation of patient rights is a global problem. We suggest that forced medication be abandoned.<\/p>\n<\/div><\/div>

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Teaching troubled teens: a qualitative case study of educating students with emotional and behavioral disorders in a private special education school<\/strong><\/a> – This qualitative case study investigated the impact of one private special education school on the students it serves who have been diagnosed with emotional and behavioral disorders (EBD). Wehlage’s theory of school membership and the role that plays in helping students progress as well as Prochaska’s theory of the Stages of Change informed the research. With these theories in mind the researcher attempted to answer the following two research questions: How and to what extent does this private special education school impact students with emotional and behavioral disorders engagement and participation in school different than the typical public school environments, as perceived by the students, administrators, and teachers of the private school serving them? And, what specific strategies and school-based practices used by the private school are the most effective at helping students change their behavior and become more engaged in school and connected to the school community, as perceived by students and school personnel? Data collection included interviews and focus groups with students and school personnel at the state approved private special education school in Massachusetts, as well as an analysis of student outcome data, and document review The goal of data analysis was to help identify strategies and practices that could be employed at other schools serving students with EBD as well as how the particular strategies and practices identified contribute to students with EBD feelings of school membership and their engagement in the stages of change.<\/p>\n<\/div><\/div>

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Ten Principles of the Wraparound process<\/strong><\/a> – Family voice and choice. Family and youth\/child perspectives are intentionally elicited and prioritized during all phases of the wraparound process. Planning is grounded in family members\u2019 perspective, and the team strives to provide options and choices such that the plan reflects family values and preferences.<\/p>\n<\/div><\/div>

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Testimony of Dr Stuart Grassian<\/strong><\/a> – The author, Dr. Grassian, is a Board Certified Psychiatrist who was on the faculty of the Harvard Medical School for over twenty-five years. He has had extensive experience in evaluating the psychiatric effects of solitary confinement, and in the course of his professional involvement, has been involved as an expert regarding the psychiatric impact of federal and state segregation and disciplinary units in many settings.<\/p>\n<\/div><\/div>

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The Anthropology of Twice Exceptionality<\/strong><\/a> – Some anthropologists and psychologists suggest that the ADD\/ADHD arrangement of the prefrontal cortex may have been an evolutionary advantage 20,000 years ago when humans had a greater need to respond rapidly to stimuli in the environment and to consider creative or non-linear approaches to solving problems.<\/p>\n<\/div><\/div>

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The Business Case for Preventing and Reducing Restraint and Seclusion Use<\/strong><\/a> – Examine the economic base of restraint and seclusion, and create a business case for reducing their use. Restraint and seclusion are violent, expensive, largely preventable, adverse events. The rationale for their use is inconsistently understood. They contribute to a cycle of workplace violence that can reportedly claim as much as 23 to 50 percent of staff time (LeBel & Goldstein, 2005; Flood, Bowers, & Parkin, 2008), account for 50 percent of staff injuries (Short et al., 2008), increase the risk of injury to consumers and staff by 60 percent (Florida taxwatch, 2008), and increase the length of stay, potentially setting recovery back at least 6 months (Florida taxwatch, 2008) with each occurrence. Restraint and seclusion increases the daily cost of care (Cromwell et al., 2005) and contributes to significant workforce turnover reportedly ranging from 18 to 62 percent (Paxton, 2009), costing hundreds of thousands of dollars to several million (LeBel & Goldstein, 2005; Besemer, Siler, & Vargas, 2008). These procedures also raise the risk profile to an organization and incur liability expenses that can adversely impact the viability of the service. Many hospitals and residential programs, serving different ages and populations, have successfully reduced their use and redirected existing resources to support additional staff training, implement prevention-oriented alternatives, and enhance the environment of care. Significant savings result from reduced staff turnover, hiring and replacement costs, sick time, and liability-related costs.<\/p>\n<\/div><\/div>

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The Comparative Costs and Benefits to Reduce Crime<\/strong><\/a> \u2013 This review of the ten existing evaluations of juvenile boot camps indicated that, relative to comparison groups, juvenile offenders in these programs had higher, not lower, subsequent recidivism rates. This report describes the \u201cbottom-line\u201d economics of programs that try to reduce crime. For a wide range of approaches\u2014from prevention programs designed for young children to correctional interventions for juvenile and adult offenders\u2014we systematically analyze evaluations produced in North America over the last 25 years. We then independently determine whether program benefits, as measured by the value to taxpayers and crime victims from a program\u2019s expected effect on crime, are likely to outweigh costs. This procedure allows direct \u201capples-to-apples\u201d comparisons of the economics of different types of programs designed for widely varying age groups. Our overall conclusion is one of good news: In the last two decades, research on what works and what doesn\u2019t has developed and, after considering the comparative economics of these options, this information can now be used to improve public resource allocation. These estimates can assist decision-makers in directing scarce public resources toward economically successful programs and away from unsuccessful programs, thereby producing net overall gains to taxpayers, even in the absence of new funding sources.<\/p>\n<\/div><\/div>

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The Cost of Waiting<\/strong><\/a> – A report on restraint, seclusion and aversive procedures one year after the passage of the Keeping All Students Safe Act in the U.S. House of Representatives<\/p>\n<\/div><\/div>

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The Dangers of Detention: The Impact of Incarcerating Youth in Detention and Other Secure Facilities<\/strong><\/a> \u2013 Despite the lowest youth crime rates in 20 years, hundreds of thousands of young people are locked away every year in the nation\u2019s 591 secure detention centers. Detention centers are intended to temporarily house youth who pose a high risk of re-offending before their trial, or who are deemed likely to not appear for their trial. But the nation\u2019s use of detention is steadily rising, and facilities are packed with young people who do not meet those high-risk criteria\u2014about 70 percent are detained for nonviolent offenses<\/p>\n<\/div><\/div>

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The Effects of WWASPS Institutionalization on the Lives of Troubled Teens: A Retrospective Qualitative Analysis<\/strong><\/a> – This qualitative study examined the psychological impact that a private agency of residential treatment centers had on troubled teenagers. World Wide Association of Specialty Programs and Schools (WWASPS), first opened in 1998, advertised themselves as a behavioral modification program for adolescents with behavioral, emotional, and psychological troubles. Students with a wide range of issues, from poor grades to depression, were accepted. Due to the limited legality around private institutions, there is minimal public information about the structure of WWASPS interventions. Moreover, scant evidence exists that the tough love practices employed by the institutions were based in psychological or behavioral science. The aim of this study was to develop an understanding of how the teens sent to programs under this institution experienced their treatment and how they feel it has impacted them in the long run. Six adults in their late 20s and early 30s were interviewed about their teenage experience in the program and their current level of functioning. Interviews were recorded, transcribed, and analyzed using NVivo12 software and modified grounded theory. The process exposed 43 subthemes shared by three or more of the participants that fell under five major categories: Before institutionalization, incidents endured while in the program, their personal process at the WWASPS, post-discharge reactions, and perceived enduring consequences of today. Overall, participants saw the program as having many detrimental effects on their well-being, effects that many continue to counter in their adult lives.<\/p>\n<\/div><\/div>

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The Efficacy of Strategies to Reduce Juvenile Offending<\/strong><\/a> – The purpose of this report was to examine the national and international research literature relating to the efficacy of a range of strategies to reduce juvenile offending. These strategies were categorized according to Tonry and Farrington\u2019s (1995) framework of four groupings of crime\u00a0 prevention strategies: (i) developmental and early interventions, (ii) law enforcement and criminal justice approaches, (iii) community crime prevention, and (iv) situational crime prevention (SCP).<\/p>\n<\/div><\/div>

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The impact of incarceration on juvenile offenders<\/strong><\/a> – Increasingly, research points to the negative effects of incarcerating youth offenders, particularly in adult facilities. Literature published since 2000 suggests that incarceration fails to meet the developmental and criminogenic needs of youth offenders and is limited in its ability to provide appropriate rehabilitation. Incarceration often results in negative behavioral and mental health consequences, including ongoing engagement in offending behaviors and contact with the justice system. Although incarceration of youth offenders is often viewed as a necessary means of public protection, research indicates that it is not an effective option in terms of either cost or outcome. The severe behavioral problems of juvenile offenders are a result of complex and interactive individual and environmental factors, which elicit and maintain offending behavior. Therefore, the focus of effective treatment must be on addressing such criminogenic needs and the multiple \u201csystems\u201d in which the young person comes from. Recent research demonstrates that in order to achieve the best outcomes for youth offenders and the general public, community-based, empirically supported intervention practices must be adopted as an alternative to incarceration wherever possible.<\/p>\n<\/div><\/div>

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The impact of institutionalization on child development<\/strong> <\/a>– During the past 10 years researchers studying children adopted from Romanian orphanages have had the opportunity to revisit developmental questions regarding the impact of early deprivation on child development. In the present paper the effects of deprivation are examined by reviewing both the early and more recent literature on studies of children who spent the first few years of life in institutions. Special attention is given to the Canadian study of Romanian adoptees in which the author has been involved. Findings across time and studies are consistent in showing the negative impact of institutionalization on all aspects of children\u2019s development (intellectual, physical, behavioral, and social\u2013emotional). Results of studies show, however, that institutionalization, although a risk factor for less optimal development, does not doom a child to psychopathology. However, the impact of institutionalization is greater when coupled with risk factors in the post-institutional environment. Methodological and conceptual difficulties in research with institutionalized samples of children are discussed and future directions for research are considered.<\/p>\n<\/div><\/div>

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The Impact of Residential Placement on Child Development: Research and Policy Implications<\/strong><\/a> – For all types of residential settings, Dansokho et. al. (2003) estimate that fewer than one in 120 children in the United States will sleep in a residential placement each night, a ratio that increases to about one in 85 in England. Out of this group, on any single night in the school year, around 200,000 U.S. and 80,000 U.K. children (about half of one per cent of the school age children in the U.S. and one per cent in the U.K.) are placed in various forms of boarding schools (Dansokho, Little, & Thomas, 2003; Department of Health, 1998). It is also estimated that each night around 100,000 U.S. children (about one-fifth of the state care population) and 10,000 U.K. children are in the variety of residential settings purchased or provided by child welfare agencies (Department of Health, 1998; U.S. Department of Health and Human Services Administration for Children and Families Administration on Children Youth and Families Children’s Bureau, 2001). In the U.S., it seems reasonable to assume that between 20,000 and 40,000 children will be placed in various types of residence that cater to mental health problems, and that about 140,000 to 210,000 children will pass through these settings each year (Center for Mental Health Services, 2000; The National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment, 2001). These latter rates are much higher than for the U.K. (Department of Health, 1998). In the juvenile justice sector there are approximately 100,000 in the U.S. (Sickmund, Sladky, & Kang, 2004) and 3,000 in the U.K (Hagell, Hazel, & Shaw, 2000). There are also children in hospitals for physical health needs but national data is unable to provide a good estimate of their numbers.<\/p>\n<\/div><\/div>

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The Importance of Institutional Culture to the Adjustment of Incarcerated Youth and Young Adults<\/strong><\/a> – In this article, we discuss key findings from research that focuses on the experiences and adjustment of youth in custody and pre-trial detention. Problems with the overuse of segregation for both adolescents and young adults are debated. Complemented by theory and research on emerging adulthood \u2013 the developmental period following adolescence \u2013 we highlight the need for attention to the experiences of young adults in prison.<\/p>\n<\/div><\/div>

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The influence of residential workers social climate on the use of restraint and seclusion<\/strong><\/a> – Restraint and seclusion (R&S) are two types of interventions residential workers can use to manage aggressive behaviors in youth residential treatment centers (RTC). Factors related to the environment, children, and residential workers have all been associated with their use. Although research in psychiatric settings has shown a relationship between social climate and the use of R&S, no similar studies have been conducted in RTC. The first objective of this paper was to assess the extent to which social climate was associated with the use of R&S in RTC. The second objective was to observe how each dimension of social climate predicted the use of R&S. To accomplish this, a sample of 198 residential workers completed a monthly questionnaire on their unit\u2019s social climate at three different time points. Crossed-lagged analyses were performed to test associations between different dimensions of social climate and the use of R&S over time. Results suggest that good communication and openness among team members are associated with lower rates of R&S use while the focus on common objectives and planning are associated with an increased use of these measures. Perceptions of a negative team climate were not associated with the use of R&S. Results imply that if residential workers had the time and the training needed to meet the needs of individual children they would favor alternative interventions instead of worrying about creating tensions with colleagues.<\/p>\n<\/div><\/div>

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The Influence of Youth Gender and Complex Trauma on the Relation Between Treatment Conditions and Outcomes in Therapeutic Residential Care<\/strong><\/a> – Complex trauma (CT) is the experience, or witness, of prolonged abuse or neglect that negatively affects children\u2019s emotional and psychological health. Youth in residential care experience higher incidences of complex trauma than youth in community-based care, with notable gender differences and presentation of psychological symptoms. This study examined the effects of trauma-informed residential care and the relation between CT and gender. A sample (n<\/i>\u2009=\u2009206) from an evaluation of a youth psychiatric residential facility in the Midwest that transitioned from a traditional care model to a trauma-informed care model was used. A hierarchical regression was used to model the main effects of model of care, gender, CT, length of stay, and crisis response on treatment outcomes; and the moderating effects of gender and CT. The results support the high prevalence of CT in residential care populations. The final model explained 30.2% of the variance with a statistically significant interaction between gender and length of stay in treatment, indicating that longer lengths of stay in treatment are associated with less change in functional impairment for girls than boys. Youth gender and prior trauma are important factors to consider when monitoring experiences and treatment outcomes in youth residential care.<\/p>\n<\/div><\/div>

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The Issue of Children\u2019s rights in America<\/strong><\/a> – Today in America thousands of children across the country will be abused, neglected, and tormented \u2013 and not by their parents. Allow me to introduce to you, Dear Reader, the Troubled Teen Industry. The TTI is a multi-million dollar a year market built upon the exploitation of children with behavioral problems and their vulnerable families. Despite the heavy nature of these allegations, the businessmen who derive their wealth from this industry are not directly breaking any laws. Just the opposite in fact, they are highly regarded and upstanding citizens, with public ties to politicians running the gamut from local, to the very highest levels of government. In order to reconcile this with the harsh reality of what often happens to the children caught in the cross-hairs, one must call to attention the issue of children\u2019s rights, and whether or not this countries stance regarding them can stand up to basic ethical scrutiny.<\/p>\n<\/div><\/div>

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The outcome of non-residential youth care compared to residential youth care: A multilevel meta-analysis<\/strong><\/a> – This multilevel meta-analysis compared the outcomes of Treatment Foster Care Oregon for Adolescents (TFCO-A) and home-based treatment programs (HBT) with residential youth care for children and youth aged 0 to 23 years. We found a small statistically significant overall effect (d<\/em>\u00a0=\u00a00.21), 95% CI [0.090-0.338], which indicated that non-residential youth care was slightly more effective than residential youth care. However, moderator analysis revealed that TFCO-A yielded a larger effect size (d<\/em>\u00a0=\u00a00.36) than HBT (d<\/em>\u00a0=\u00a00.08).<\/p>\n<\/div><\/div>

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The Problem<\/strong><\/a> – The growth of the largely unregulated and improperly monitored troubled teen industry (sometimes called boot camps, wilderness camps, therapeutic boarding schools) has given rise to wide spread inhumane treatment of youth. Between July 17 and December 26, 2006, the Alliance for the Safe, Therapeutic, and Appropriate use of Residential Treatment (ASTART) posted an online survey. Over 700 youth and young adults from 85 programs, located in 23 states and 5 countries responded. (Click here to download CAFETY’s 2011 report revealing similar findings).<\/p>\n<\/div><\/div>

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The Quiet Rooms<\/strong><\/a> – For this investigation, ProPublica Illinois and the Tribune obtained and analyzed thousands of detailed records that state law requires schools to create whenever they use seclusion. The resulting database documents more than 20,000 incidents from the 2017-18 school year and through early December 2018.<\/p>\n<\/div><\/div>

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The Research and Training Center for Children\u2019s Mental Health: Systems of Care<\/strong><\/a> – Since the publication of the Child and Adolescent Service System Program (CASSP) principles two decades ago (Stroul & Friedman, 1986), parent-professional collaboration has been a core value of the children\u2019s mental health system. Despite general agreement that behavioral health services for children should be \u201cfamily-focused,\u201d this remains an elusive goal. For instance, active parent participation in school Individualized Education Plan (IEP) meetings is still not the norm. Turnbull, Turbiville and Turnbull (2000) summarize the research in this area by asserting that, \u201cthe IEP experience is a passive experience for most parents\u201d (p. 637).<\/p>\n<\/div><\/div>

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The Right to Consent, Competency and Responsibility in Teens<\/strong><\/a> – A rather exceptional stand was taken in the 1970’s by Washington State regarding youth rights.\u00a0 Their legislature acted to lower the age of consent for mental health and substance abuse treatment to 13. This came on the heels of legislation assuring the right to consent to reproductive healthcare from the time of fertility, a woman\u2019s rights issue with youth rights implications. I have practiced adolescent psychiatry in a social climate influenced by this policy my entire professional life. It seems to me to have had a positive impact on the nature of treatment in our state as it has forced caregivers to focus more on treatment relationships.\u00a0 It certainly has positively shaped my work with youth. These Washington state laws have less to do with the right to obtain mental health or substance abuse treatment independent of parental approval (a right rarely exercised) than with the corollary of the right to consent; the right to refuse care.<\/p>\n<\/div><\/div>

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The Rights of Children and Parents In Regard to Children Receiving Psychiatric Diagnoses and Drugs<\/strong><\/a> – This article deals with negative rights that is, the right to be free of certain kinds of interferences in one’s life. In regard to children, these rights are protected by society, often regardless of parental wishes, such as legal prohibitions against physical or sexual abuse. In making judgments about children, this analysis will, like in the USA courts, rely upon the standard of the child’s best interests (Child Welfare Information Gateway, 2012; also see Gottstein, 2012), including the ‘the physical, mental, emotional and moral well-being’ of the child (FindLaw, undated: 1). However, I will argue that when it comes to the psychiatric drugging of children, which, I maintain, can be seen as a form of child abuse, this standard cannot be relied upon to protect children. Using the examples of stimulant drugs for Attention Deficit Hyperactivity Disorder (ADHD) and antipsychotic drugs for Bipolar Disorder, I ask. ‘Is it ever in a child’s best interest to be psychiatrically diagnosed and medicated?’<\/p>\n<\/div><\/div>

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The Risk of Harm to Young Children in Institutional Care<\/strong><\/a> \u2013 Young children are frequently placed in institutional care throughout the world. This occurs despite wide recognition that institutional care is associated with negative consequences for children\u2019s development (Carter, 2005; Johnson, Browne and Hamilton-Giachritsis, 2006). For example, young children in institutional care are more likely to suffer from poor health, physical underdevelopment and deterioration in brain growth, developmental delay and emotional attachment disorders. Consequently, these children have reduced intellectual, social and behavioural abilities compared with those growing up in a family home.<\/p>\n

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The Sexual Abuse to Prison Pipeline: The Girls\u2019 Story<\/strong><\/a> \u2013 Violence against girls is a painfully American tale. It is a crisis of national proportions that cuts across every divide of race, class, and ethnicity. The facts are staggering: one in four American girls will experience some form of sexual violence by the age of 18.\u00a0 Fifteen percent of sexual assault and rape victims are under the age of 12; nearly half of all female rape survivors were victimized before the age of 18. And girls between the ages of 16 and 19 are four times more likely than the general population to be victims of rape, attempted rape, or sexual assault.3<\/p>\n<\/div><\/div>

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The State of Research on the Effects of Physical Punishment<\/strong><\/a> \u2013 Long considered an effective, and even necessary, means of socialising children, physical punishment has been revealed to be a predictor of a wide range of negative developmental outcomes. Research findings about the effects of physical punishment on outcomes for children provide a persuasive argument in favor of changing policies on the use of physical punishment within families.2 A research team from the Children\u2019s Issues Centre recently reviewed research on the guidance and discipline of children (Smith et al. 2005). This paper summarizes and updates a section of that report.<\/p>\n<\/div><\/div>

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The Troubled Teen Industry and Its Effects: An Oral History<\/strong><\/a> – The\u00a0troubled teen industry<\/em>\u00a0(TTI) is a term used to describe a system of underregulated residential youth treatment facilities that operate primarily in the United States. My research, which was funded by a 2021 Summer Undergraduate Research Fellowship (SURF) through the Hamel Center for Undergraduate Research, focused on gaining firsthand insight into the effects of one such treatment facility. These facilities, also referred to as treatment programs and treatment centers, constitute a multibillion-dollar industry and are infamous for numerous abuse charges (Stull, 2021). Adolescents are sent to these facilities for a myriad of reasons, ranging from severe mental health symptoms to more mundane forms of misbehavior (e.g., truancy). Parents are often manipulated through fear tactics into believing their children desperately need this type of facility, and are then manipulated to not believe their children if they say anything bad about the facility (Behar et al., 2007). Introduction to such facilities often includes involuntary youth transport, which consists of being woken up in the middle of the night by strangers; physical force is used if the adolescent does not comply (Stull, 2021).<\/p>\n<\/div><\/div>

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The Troubled Teen Industry: Commodifying Disability and Capitalizing on Fear<\/strong><\/a> \u2013 The \u201cTroubled Teen\u201d behavior reform industry is comprised of financially interconnected wilderness programs, residential treatment centers, and reform schools that incarcerate thousands of minors each year by marketing a supposed cure to non-normativity, and monetizing the discrimination and abuse of children with a myriad of disabilities, including mental illness, substance abuse and dependence, eating disorders, cognitive difference, or who simply exhibit subjectively \u201cnegative\u201d- in the parents\u2019 eyestraits or habits, such as LGBT status or genuinely problematic behaviors that make them difficult to parent. These programs claim to treat or change teenager behavior that parents find troubling via \u201ctough love\u201d behavior modification, which has generated a wide spectrum of existing criticism documenting the abuse and neglect of teenagers that is endemic to its nature and mode of treatment, one predicated on discriminatory principles that stigmatize and condemn facets of non-normativity. Justifying this maltreatment with quasi-psychological terminology and bastardized clinical practices makes a mockery of mental healthcare, and promotes the idea of othering persons who do not conform to normative ideas of \u201cacceptable\u201d behavior and cognition.
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The Use of Confrontation in Addiction Treatment History, Science, and Time for Change<\/strong><\/a> \u2013 The use of confrontational strategies in individual, group and family substance abuse counseling emerged through a confluence of cultural factors in U.S. history, pre-dating the development of methods for reliably evaluating the effects of such treatment. Originally practiced within voluntary peer-based communities, confrontational approaches soon extended to authority-based professional relationships where the potential for abuse and harm greatly increased. Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.<\/p>\n<\/div><\/div>

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The Use of Restraint and Seclusion in Residential Treatment Care for Youth: A Systematic Review of Related Factors and Interventions<\/strong><\/a> – Children placed in residential treatment centers (RTCs) typically present challenging behavior including aggression. In this context, restraint and seclusion (R&S) are seen as \u201clast resort\u201d strategies for educators to manage youth aggression. The use of R&S is controversial, as they can lead to psychological and physical consequences for both the client and the care provider and have yet to be empirically validated as therapeutic. The objectives of this systematic review are to identify the factors related to R&S use in RTCs for youth and to review the interventions aiming to reduce the use of R&S.<\/p>\n<\/div><\/div>

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Thought Reform and the Psychology of Totalism<\/strong><\/a> – Excerpts from Chapter 22 of Robert Jay Lifton’s book,”Thought Reform and the Psychology of Totalism: A Study of ‘Brainwashing’ in China.” Lifton, a psychiatrist and distinguished professor at the City University of New York, has studied the psychology of extremism for decades. He testified at the 1976 bank robbery trial of Patty Hearst about the theory of “coercive persuasion.” First published in 1961, his book was reprinted in 1989 by the University of North Carolina Press.<\/p>\n<\/div><\/div>

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Torture in the Name of Treatment: The Mission to Stop the Shocks in the Age of Deinstitutionalization<\/strong><\/a> – As autistic activists, Shain M. Neumeier and Lydia X. Z. Brown have been working to close the Judge Rotenberg Center in the US, which has engaged in some of the most egregious forms of such abuse, and more generally to end the use of coercive and abusive forms of \u201ctreatment\u201d for autistic and other disabled people, for the past ten years. During that time, both of them have worked toward this goal through multiple avenues, including policy and legal advocacy, grassroots organizing, and media outreach. They believe that the neurodiversity movement\u2019s history is rife with instances of individual and systemic abuse, violence, and trauma which they have been focused on naming and ending.<\/p>\n<\/div><\/div>

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Torture, not Treatment: Electric Shock and Long-Term Restraint in the United States on Children and Adults with Disabilities at the Judge Rotenberg Center<\/strong><\/a> \u2013 This report is the product of an investigation by Mental Disability Rights International (MDRI) into the human rights abuses of children and young adults with mental disabilities residing at the Judge Rotenberg Center (JRC) (formerly known as the Behavior Research Institute) in Canton, Massachusetts, United States of America (US). This report is an urgent appeal to the United Nations Special Rapporteur on Torture or other Cruel, Inhuman or Degrading Treatment or Punishment, by Mental Disability Rights International (MDRI).<\/p>\n<\/div><\/div>

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Totalistic Teen Treatment: A Qualitative Analysis of Retrospective Accounts<\/a><\/strong> \u2013 This research used a purposeful stratified sampling technique to identify interview participants with a wide range of experiences within 25 different totalistic teen programs. Data were collected in an online questionnaire (N=223) and in one-hour phone interviews conducted nationally (N=30). Using categorical, comparative, topical, and thematic approaches to analysis, this research answers questions about the experiences, immediate effects, and long-term impacts of totalistic teen treatment methods. This thesis applies key findings to policy recommendations and concludes there is a need for multidisciplinary research toward greater protections for youth in totalistic treatment settings.
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Trauma within the Psychiatric Settings: A Preliminary Empirical Report<\/strong><\/a> – Because empirical data on the phenomena of “sanctuary trauma” and “sanctuary harm” (trauma within the psychiatric setting) are virtually non-existent, the present study was designed to gather preliminary empirical data related to (a) the frequency of such experiences among mental health consumers with a history of psychiatric hospitalization and outpatient treatment in a state-funded mental health system, (b) the perceptions that these consumers have regarding such experiences, and (c) the consequences of these experiences, as measured by the association between hospital experiences, subjective reactions to these experiences, and PTSD symptoms. Subjects were 57 men and women (aged 19-73 yrs) with a history of psychiatric hospitalization who were attending 1 of 5 mental health center clinics in a state public mental health system. This study provides initial empirical support for concerns raised by consumer and advocacy groups that the psychiatric setting often can be a frightening and\/or dangerous environment. In general, the results of this study indicate that mental health consumers have experienced a number of traumatic, humiliating, or distressing events during their hospitalization. In addition, results indicate that consumers are adversely affected by these experiences.<\/p>\n<\/div><\/div>

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Treatment of Offender Populations: Implications for Risk Management and Community Reintegration<\/strong><\/a> – Traditionally, one of the goals of incarceration has been rehabilitation. However, there has been a great debate in the literature about the efficacy of different treatment interventions for offenders and the ability of these treatments to decrease recidivism rates. In the 1950s and 1960s there was some evidence that treating offenders worked (Bailey, 1966; Logan, 1972). However in 1974, Martinson conducted a review of 230 treatment studies and concluded that nothing works in the treatment of offenders (Martinson, 1974). These findings supported the growing movement in the criminal justice system from a rehabilitative approach to a punitive one.<\/p>\n<\/div><\/div>

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Treatment of Young People With Antipsychotic Medications in the United States<\/strong><\/a> – Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States. A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765 829), 2008 (n = 858 216), and 2010 (n = 851 874), including a subset from calendar year 2009 with service claims data (n = 53 896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population.<\/p>\n<\/div><\/div>

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Treatment Planning and Medication Monitoring Were Lacking for Children in Foster Care Receiving Psychotropic Medication<\/strong><\/a> – In five States, one in three children in foster care who were treated with psychotropic medications did not receive treatment planning or medication monitoring as required by States.\u00a0 Additionally, the Administration for Children and Families (ACF) has suggested that States consider practice guidelines from professional organizations, including the American Academy of Child and Adolescent Psychiatry, (AACAP) related to treatment planning and medication monitoring. We found that State requirements for oversight of psychotropic medication did not always incorporate these professional practice guidelines. Treatment planning is critical to enhancing continuity of care; improving coordination of services between health and child welfare professionals; and reducing the risk of harmful side effects. Effective medication monitoring can reduce the risk of inappropriate dosing and inappropriate medication combinations.<\/p>\n<\/div><\/div>

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Treatment programs for youth with emotional and behavioral disorders<\/strong><\/a> \u2013 Youth with severe emotional and behavioral disorders (EBD) were randomly assigned for 3 months of intensive treatment to a 5-day residential program (5DR Program) or a community-based alternative, family preservation program (FP Program). Programs differed not only in method of service delivery (residential unit vs. home-based), but also in treatment philosophy (solution focused brief therapy vs. cognitive behavioral). Results confirmed high rates of comorbidity in this population for externalizing and internalizing disorders. A significant Treatment x Program interaction was evident for internalizing disorders. At 1-year follow-up, significantly higher percentages of youth from the FP Program revealed a reduction of clinical symptoms for ADHD, as well as, general anxiety and depression, whereas significant proportion of youth from the 5DR Program demonstrated clinical deterioration and increased symptoms of anxiety and depression. Results have implications for future treatment of youth with EBD and suggest that greater emphasis be placed on research linking treatment to specific symptom clusters, especially highly comorbid clusters in this hard to serve population.<\/p>\n<\/div><\/div>

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Treatment Research Lacks Good Science: A detailed scientific critique of Behrens study findings<\/a>\u00a0<\/strong>\u2013 ASTART has been concerned about the marketing of teen residential programs that highlights the findings from a study by Ellen Behrens and Kristin Satterfield. Two reports are widely cited in youth residential treatment marketing and promotional materials. There is a dearth of research on the effectiveness of residential programs, and this study does provide some information for consideration. However, there are striking conflicts of interest in the research and several flaws in the methodology of the study that make its findings questionable. Further, industry websites make several claims about the findings and their meaning that go far beyond what the data shows, and that our experts believe are misleading to parents, providers and youth.
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Treatment, Services, and Intervention Programs for Child Delinquents. Child Delinquency Bulletin Series<\/strong><\/a> – Compared with juveniles who start offending in adolescence, child delinquents (age 12 and younger) are two to three times more likely to become, tomorrow’s serious and violent offenders. This propensity, however, can be minimized. These children are potentially identifiable either before they begin committing crimes or at the very early stages of criminality-times when interventions are most likely to succeed. Therefore, treatment, services, and intervention programs that target these very young offenders offer an exceptional opportunity to reduce the overall level of crime in a community. This Bulletin is part of the Office of Juvenile Justice and Delinquency. Prevention’s Child Delinquency Series, which presents the findings of the Study Group on Very Young Offenders. This series offers the latest information about child delinquency, including analyses of child delinquency statistics, insights into the origins of very young offending, and descriptions of early intervention programs and approaches that work to prevent the development of delinquent behavior by focusing on risk and protective factors. The Bulletin reviews treatment and services available to such child delinquents and their families and examines their efficacy. At a time of limited budgets, it is imperative to consider the cost effectiveness of specific programs because children who are not diverted from criminal careers will require significant resources in the future. The timely provision of the kinds of treatment, services, and intervention programs described in this Bulletin while child delinquents are still young and impressionable may prevent their progression to chronic criminality, saving the expense of later interventions.<\/p>\n<\/div><\/div>

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Trends in Mental Health Care among Children and Adolescents<\/strong><\/a> – Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment. Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996\u20131998 and 2010\u20132012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010\u20132012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.)<\/p>\n<\/div><\/div>

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Troubled Affluent Youth\u2019s Experiences in a Therapeutic Boarding School: The Elite Arm of the Youth Control Complex and Its Implications for Youth Justice\u201d<\/a>\u00a0<\/strong>\u2013\u00a0 Criminology focuses on street crime and crimes of the poor. Surveys, however, indicate that deviance among middle- and upper-class youth is widespread, and that their experience of social control is not researched, despite its importance for a more complete understanding of youth justice. This study provides insight into a mostly unregulated private troubled teen industry, relying on interviews and a survey of afuent youth sent to a therapeutic boarding school. The main sections of this article explore the wide variety of behaviors that caused youth to be sent to the program, the key aspects of their experiences, and the very mixed outcomes. (All participants graduated high school and most completed college, but many others committed suicide or overdosed.) While a degree and the lack of a criminal record ultimately benefted these privileged youth, the strong-arm rehabilitation tactics of this kind of total institution are a problematic model to use to advance youth justice.<\/p>\n<\/div><\/div>

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Troubled Teen or Troubled System? TV Interprets the Zion Malpractice Case<\/strong><\/a> – The wrongful death suit filed by Sidney Zion against New York Hospital for the death of his daughter, Libby, in 1984, became famous not only for the issues of possible malpractice that arose from case, but also because it drew attention to the long hours and overburdened schedules young doctors are expected to keep as part of their training. The case revealed how these common circumstances could potentially endanger patients. Using contemporary theory about documentary, Joan McGettigan examines two television programs devoted to the Zion Malpractice case. She explores how the two programs reach different conclusions about the responsibilities of physicians and their patients, and yet also re-establish the public’s faith in the medical profession as a whole.<\/p>\n<\/div><\/div>

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Troubled Teens, Troubled Thinking: The Part-Object Position as the Whole Enchilada<\/strong><\/a> – Reviews the book, Adolescence and delinquency: An object relations theory approach by Bruce R. Brodie (see record 2007-07975-000 ). Through the tightly focused lens of object relations theory, Bruce Brodie examines the lives and healing of troubled teens at a “Level 14 equivalent” detention center, the most intense and restrictive form of residential treatment next to psychiatric hospitalization. Brodie demonstrates a command of contemporary object relations theory, especially as the theory has been clarified and modified by Ogden (1986, 1994, 1997). As the title indicates, the book centers on an object relations approach to understanding the unique mental and emotional states of these traumatized and victimizing adolescents. Brodie argues that the adolescent delinquents’ primary disturbance is their “thinking.” Throughout the book Brodie consistently exudes sincere respect and care for his teen clients, seeing this as key to not only their improvement but also their ability to thrive and flourish. His genuineness and goodwill shine through in his clinical vignettes. This book is a clear articulation of what adolescent thinking looks like when anchored primarily in the part-object position. Students and beginning practitioners of object relations theory working with this population will view Brodie’s case vignettes as useful exemplars of splitting, the depressive position, and therapeutic containment.<\/p>\n<\/div><\/div>

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Troubling the \u2018troubled teen\u2019 industry: Adult reflections on youth experiences of therapeutic boarding schools<\/a>\u00a0<\/strong>\u2013 In the United States, thousands of young people reside in private schools aimed at reforming \u2018troubled teens\u2019. These \u2018troubled teens\u2019 are young people who are considered to have emotional, behavioural and\/or substance misuse problems. Therapeutic boarding schools are programms that combine educational classes and group therapy in a self-contained residential facility that runs year-round. Case study interviews with former US-based therapeutic boarding school students demonstrate the role of sanism, adultism and epistemic injustice in constructing and regulating the \u2018troubled teen\u2019. The schools\u2019 strict structure and surveillance culture could not override students will and their ability to find means to resist. The article\u2019s central aim is to centre the perspectives of former students and critique social control of young people in therapeutic boarding schools.<\/p>\n<\/div><\/div>

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Understanding Evidence-Based Practices<\/strong><\/a> – Just as treatments for other chronic illnesses change based on new advances in research and science, so, too, do treatments for substance abuse and mental disorders, whether occurring separately or co-occurring in a single individual. The challenge to mental and substance abuse professionals – and to the field as a whole – is to ensure that the services being provided, in fact, are the most appropriate for the individual and are the best possible from the perspectives of effectiveness and appropriateness. Those principles undergird the concept of evidence-based services and evidence-based practice<\/p>\n<\/div><\/div>

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Unexpected spaces of confinement: Aversive technologies, intellectual disability, and \u2018\u2018bare life\u2019\u2019<\/strong><\/a> – Giorgio Agamben describes the \u2018\u2018camp\u2019\u2019 as the \u2018\u2018zone of indistinction between law and violence\u2019\u2019 where bodies located in exceptional spaces are stripped of citizenship rights and embody \u2018\u2018bare life.\u2019\u2019 We deploy Agamben\u2019s analysis to the context of the everyday violence of aversive technologies meted out against students living at the dangerous intersections of race, class, gender, and disability and located in unexpected spaces of confinement such as schools, developmental centers, and family homes. We argue here that the logic of the \u2018\u2018state of exception\u2019\u2019 applies to disabled children and adults where acts of violence enacted via disciplinary practices are justified as being outside the realm of the legal and subject to sovereign power. The locus of our study is the Judge Rothenberg Center that over the past 40 years has utilized behavioral techniques that have been investigated as abusive and only very recently has been held accountable for these infractions. We examine the discourses used to justify these forms of inhumane punishment as well as the discourses that oppose them to foreground the real material implications of \u2018\u2018how we understand the role of systems and institutions of punishment\u2019\u2019 in unexpected spaces of confinement of children\/adults with intellectual disabilities.<\/p>\n<\/div><\/div>

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Unlicensed Residential Programs: The Next Challenge in Protecting Youth<\/a>\u00a0<\/strong>\u2013 Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. Unregulated residential programs have been linked with reports of youth mistreatment, abuse, and death, as well as exploitation of families. In the fall of 2004, a multi-disciplinary group of mental health and child-serving professionals was formed through a collaboration between the Florida Mental Health Institute and the Bazelon Center for Mental Health Law, in response to rising concerns about reports from youth, families and journalists describing mistreatment in unregulated programs. This review is a summary of the information gathered by this group, the Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START). It provides an overview of common program features, marketing strategies and transportation options that seem to characterize many of the unregulated programs. It describes the range of mistreatment and abuse experienced by youth and families in such programs, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions conducted by unqualified staff, medical and nutritional neglect, and rights violations. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who select residential treatment options.<\/p>\n<\/div><\/div>

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Unpacking the Black Box of Wilderness Therapy: A Realist Synthesis<\/strong><\/a> – Despite considerable progress within wilderness and adventure therapy research over the last decade, researchers are still unable to precisely answer why, how, and for whom this treatment modality works. There is also a need for more knowledge regarding the circumstances under which the treatment does not appear to be effective. In this realist synthesis, we attempt to unpack this \u201cblack box\u201d of wilderness therapy more specifically, defined as a specialized approach to mental health treatment for adolescents.<\/p>\n<\/div><\/div>

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Unregulated Private Residential Treatment Facilities<\/strong> <\/a>– Growing concerns about unlicensed and unregulated residential programs are shared by mental health professionals, program staff, parents, youth and advocates. These concerns are described in the following statements, which are provided by a panel of individuals representing a range of perspectives. Further details of counter-therapeutic treatment, restricted family rights, substandard education, poor quality medical care, parental distress and negative after-effects are provided by youth and families who have expressed their willingness to share further information about their first-hand experiences. This information is provided to increase awareness regarding this alarming phenomenon and to substantiate the call for increased protections to safeguard youth and families served by unregulated residential treatment facilities.<\/p>\n<\/div><\/div>

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Unsafe in the Schoolhouse: Abuse of Children with Disabilities<\/strong> <\/a>– Throughout America, schoolchildren with disabilities are placed in restraints, confined in locked seclusion rooms, and subject to painful aversive interventions. COPAA, along with other organizations that make up the Alliance to Prevent Restraint, Aversive Interventions and Seclusion (APRAIS), has been working to combat these practices.1 In June 2008, COPAA issued a Declaration of Principles condemning the use of abusive interventions and advocating for change. In March-May 2009, we conducted a survey that identified 185 cases in which children were subjected to aversive interventions. We received reports of children subject to prone restraints; injured by larger adults who restrained them; tied, taped and trapped in chairs and equipment; forced into locked seclusion rooms; made to endure pain, humiliation and deprived of basic necessities, and subjected to a variety of other abusive techniques.<\/p>\n<\/div><\/div>

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Using Evidence to Accelerate the Safe and Effective Reduction of Congregate Care for Youth Involved with Child Welfare<\/strong> <\/a>– The child welfare system\u2019s use of congregate care is in a period of rapid transition. Building on years of professional interest in offering more home-like placement options, legislative and administrative pressure at the state and federal levels is accelerating the pace of change. Congregate care has long been viewed as a viable placement alternative for children and adolescents, especially those whose histories, mental health needs, and current behavior render them difficult to manage in home-based settings. In our current fiscal and cultural climate, the appropriateness and effectiveness of congregate care is increasingly being called into question. Changing federal and state policies, as well as clinical guidelines, now suggest that congregate care be reserved for the short-term treatment of acute mental health problems to enable stability in subsequent community-based settings (Blau et al., 2010). In response to these changing expectations, the demand for congregate care will likely decline. From a public policy perspective, it is vital that we establish the infrastructure necessary to support the type of children and youth often served in group and residential care in more home-like environments.<\/p>\n<\/div><\/div>

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Vulnerable citizens: The oppression of children in care<\/strong><\/a> \u2013 This paper frames children in out-of-home care as a singularly oppressed group. Children as citizens are considered in terms of their rights, evolving capacities, best interests and voice. Using recognized criteria determining oppression, the situation of youth in care as an associative group is contrasted with that of children in general, as an aggregate group. Children’s rights and participation\u00a0– called for in the UN Convention on the Rights of the Child\u00a0– are examined with particular focus on children’s voice in relation to regulated care. Child and youth practitioners are urged to become champions for children’s rights and to speak out on behalf of youth in care, a most particularly oppressed group.<\/p>\n<\/div><\/div>

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Wayward Elites: From Social Reproduction to Social Restoration in a Therapeutic Boarding School<\/a>\u00a0<\/strong>\u2013 In the past few decades, a multi-billion-dollar \u2018\u2018therapeutic boarding school\u2019\u2019 industry has emerged largely for America\u2019s troubled upper-class youth. This article examines the experiences of privileged youth in a therapeutic boarding school to advance social restoration as a new form of social reproduction. Drawing on interviews and fieldwork inside a Western therapeutic boarding school for young men struggling with substance abuse, I explore how students leverage a stigmatized, addict identity in ways that can restore privilege. Findings suggest that students engage in social restoration by constructing an overarching restorative narrative that works through three mechanisms: (1) experiential reframing, (2) appropriated therapeutic discourse, and (3) boundary maintenance through \u2018\u2018othering.\u2019\u2019 Using these narrative strategies, students are able to transform a stigma into a symbolic marker of character that they use to reclaim privileged positions and dominant roles. This process of social restoration illuminates previously unexamined issues at the intersections of power and privilege, stigma, and inequality.
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What are the outcomes for youth placed in congregate care settings?<\/strong><\/a> – Congregate care is costly on many levels: it is more expensive and produces poorer outcomes than family-based settings, and it poses roadblocks to the timely achievement of permanency. Over the past ten years, the field has seen a 37 percent reduction in the number of children living in congregate care nationwide. Data indicate that children and youth who live in congregate settings spend an average of eight months there. This information packet provides an overview of the use of congregate care in child welfare, highlights of research about outcomes for youth placed in congregate care, and selected resources on congregate care.<\/p>\n<\/div><\/div>

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What makes youth run or stay? A review of the literature on absconding<\/a>\u00a0<\/strong>\u2013 This literature review focuses on why youth abscond from out-of-home care. It found that absconding behavior is common in out-of-home care settings, moreover the risk and harm associated with absconding behavior is considerable to both the absconder and society. Second, it is important to consider individual, familial and contextual factors that surround a young person when attempting to understand absconding behavior. What’s more, none of these factors should be considered in isolation, as each factor continually exerts influence on each young person. Thus, in order to most effectively understand the factors at play when young people abscond, it is recommended that multiple avenues of their environment should be considered. Understanding absconding behavior is a key first step in order to reduce rates of absconding, and ultimately to prevent its occurrence. There is a need for international research to explore absconding, its causes and possible solutions.
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What Works in Managing Young People who Offend? A Summary of the International Evidence<\/a><\/strong> – This review was commissioned by the Ministry of Justice and considers international literature concerning the management of young people who have offended. It was produced to inform youth justice policy and practice. The review focuses on the impact and delivery of youth justice supervision, programmes and interventions within the community, secure settings, and during transition into adult justice settings or into mainstream society.<\/p>\n<\/div><\/div>

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When Treatment is Torture: Protecting People with Disabilities Detained in Institutions<\/strong><\/a> – Throughout the world, people with disabilities are subject to mistreatment in psychiatric hospitals, orphanages, nursing homes, and other institutions. Much of this abuse is a product of neglect and lack of care \u2014 poor, unhygienic conditions, a lack of treatment, and outmoded service systems that segregate people from society. In some circumstances, however, pain and suffering is a direct consequence of treatment practices whose stated purpose is to provide treatment, care, or protection. There is a growing recognition that pain inflicted in the name of treatment may violate international law. In some circumstances, it rises to the level of torture.<\/p>\n<\/div><\/div>

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Who are They? A Descriptive Study of Adolescents in Wilderness and Residential Programs<\/strong><\/a> – Although residential and wilderness treatment programs are growing in popularity, little is known about the adolescents placed within them. This study analyzed a random sample of 473 psychological evaluations of adolescents in residential and wilderness treatment centers for participants’ cognitive functioning, aggression, family history of mental health, substance abuse, trauma, past treatment experiences, and reasons for current placement. The results suggest that participants were primarily delinquent, substance-abusing, and oppositional. Results also revealed nearly a third of the sample reported self-harming behaviors and nearly half reported recent traumatic events. The profile of this population carries important implications for residential treatment providers.<\/p>\n<\/div><\/div>

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Wilderness therapy settings: An industry in need of legal and regulatory oversight<\/strong><\/a> \u2013 This article reviews wilderness therapy and other outdoor programs that vary in their structure and focus. It also 1) looks at a number of domestic and international lawsuits; 2) examines the minimal extent to which there has been regulatory oversight; and 3) provides recommendations for ensuring that wilderness therapy programs are facilitated in a way that maximizes safety and effectiveness.<\/p>\n<\/div><\/div>

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Wilderness Therapy: Ethical Considerations for Mental Health Professionals<\/strong><\/a> – As the field of wilderness therapy continues to grow and evolve as a treatment modality, it is important for mental health professionals to consider the unique ethical issues that may arise when therapy moves far beyond the four walls of a therapist\u2019s office. This article raises several relevant ethical issues, including the distinction between therapy and therapeutic experiences, the use of efficacious treatment and aftercare, a continuum of care and family involvement, consent and confidentiality, and therapeutic boundaries. None of the ethical issues discussed have been systematically evaluated in current wilderness therapy research, and so it is currently unclear how programs are\u2014or are not\u2014addressing these ethical challenges.<\/p>\n<\/div><\/div>

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