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Historical Background in the United States

In the 1600s, Great Britain established the Poor Law that allowed poor children to become trained in apprenticeships by removing them from their families and forcing them to live in group homes. In the 1800s, the United States copied this system, but often mentally ill children were placed in jail with adults because society did not know what to do with them. There were no RTCs in place to provide the 24-hour care they needed and placed them in jail when they could not live in the home. In the 1900s, Anna Freud and her peers were part of the Vienna Psychoanalytic Society and they worked on how to care for children. They worked to create residential treatment centers for children and adolescents with emotional and behavioral disorders through psychoanalysis.

The year 1944 is important because it marks the beginning of Bruno Bettelheim’s work at the Orthogenic School in Chicago, and Fritz Redl and David Wineman’s work at the Pioneer House in Detroit. Bettelheim helped increase awareness about the impact of staff attitudes on children in treatment. He reinforced the idea that a psychiatric hospital was a community; where staff and patients influenced each other and patients were shaped by each other's behaviors. Also, Bettelheim believed families should not have frequent contact with their child in treatment. This differs from community-based and family therapy of recent years, in which the goal of treatment is for a child to return home. Also, emphasis is placed on the family's role in improving long terms outcome after treatment in a RTC. The Pioneer House created a special education program to help improve impulse control and increase sociability in children. After WWII, Bettelheim and the joint efforts of Redl and Wineman made developments to the use of residential facilities as therapeutic treatment alternative for children and adolescents who can not live at home

In the 1960s, the second generation of psychoanalytical RTC were created. These programs continued the work of the Vienna Psychoanalytic Society in order to include families and communities in the child’s treatment. One example of this is the Walker Home and School which was established by Dr. Albert Treischman in 1961 for adolescent boys with severe emotional and/or behavioral disorders. He involved families to help them develop relationships with their children within their homes, public schools and communities. The family and community involvement made this program different from previous programs.

In the 1980s and later, cognitive behavioral therapy was more commonly used in child psychiatry. It was used as a source of intervention for troubled youth, and was applied in RTCs to produce better long-term results. Attachment theory also developed due to the rise of children admitted to RTCs who were abused or neglected—these children needed specialized care by caretakers who were sympathetic to trauma.

Children and Adolescents

RTCs for children and adolescents provide treatment for issues and disorders including: Oppositional Defiant Disorder, Conduct Disorder, mood disorders, Bipolar Disorder, Attention Deficit Hyperactivity Disorder, learning disabilities, and substance abuse. Treatment styles that psychologists utilize are: behavior modification, family-focused therapy, community focused therapy, and positive peer culture model. Generalist programs are usually large with 80 to 250 residents at a time, and is more level-focused in their treatment approach. In order to manage behavior they frequently utilize systems of rewards and punishments, where a child can gain something for appropriate behavior and losing something for undesired behavior. An example of this is where a child receives stickers for every thirty minutes they do not act aggressively until they earn a special prize. If they do act aggressively, they may have to be in there room for thirty minutes and perform some kind of repair work with an adult. Specialist programs are usually smaller, with between 100 and 10 residents at a time, where the focus is on a particular disorder.

RTCs work with different severity levels, and so the structure and methods of RTCs vary. Some RTCs are lock-down facilities, where residents are not allowed to leave. In a locked residential treatment facility, patients movements are severely restricted, usually to a single room. By comparison, an unlocked residential treatment facility allows patients to move about the facility with relative freedom, but they are only allowed to leave the facility under specific conditions and with an adult.

Various studies on youth in residential treatment centers have found that many children in these facilities have a history of abuse or neglect. Some facilities address specific disorders only, such as reactive attachment disorder (RAD): where a child cannot build healthy relationships with adults and peers.

RTCs can have varying degrees of education depending on the type of center. Some programs provide only clinical treatment, while others have no education, little education, or more education than a public or private school setting. There are also specific residential education programs that focus mostly on educating at-risk children on residential campuses. These therapeutic boarding schools provide therapy and academic assistance to youth. There has been a recent demand for RTCs to work with behavioral psychologists to improve treatment and decrease the chance of unethical practice.

Race

Three racial groups are identified as directly influenced by residential treatment: Caucasian, African American, and Hispanic. African American youth are less likely than Caucasian youth to have accessed residential services for mental health disorders in 2009. If African American and Hispanic children are from a low-income family they are more likely to not use mental health services. One study found that Hispanic children are 2.6 times less likely that white children to receive appropriate resources for a mentally ill child

Income

Children of low-income families have the greatest risk of mental health disorders, but either do not access services or receive shorter treatments According to a 2005 study, poverty can lead to higher rates of depression, anxiety, antisocial behavior and aggression, which are all common symptoms of youth in RTCs

Sex

In RTCs, girls have a higher risk than boys for suicide. Even when girls were not diagnosed with depression, they reported more symptoms of depression than boys who did have the diagnosis.

Acknowledgements

I would like to thank ENGL3301 for their help in the writing of this page. As well as Dr. Musselman, Dylan Kaufman, Tina Vivio, and Caitlin Morelli for their assistance in formulating ideas, suggestions, and guidelines for this assignment.