American Psychiatric Association Annual Meeting

165th Annual Meeting - Integrated Care

Philadelphia, PA

CAFETY Presents:

Psychiatrists Response to Young Adult Patients Who Have Had Inappropriate or Abusive Care In Residential Treatment as Adolescents

Objective
Appreciate of the risks for youth and families of certain for profit residential treatment programs for adolescents

Objective1
Understand the lack of standards for regulation 0f clinical care for teens in the for profit residential treatment industry

Objective2
Appreciation the phenomenon of compounding trauma and its consequences on youth who have suffered inappropriate care in residential treatment and are not believed by family, therapists or psychiatrists



Abstract

Problems with for profit residential care for troubled youth have been well documented by the House Education and Labor Committee through a thorough investigation by the General Accountability Office (GAO) and several advocacy groups such as the Alliance for Safe, Therapeutic and Appropriate Residential Treatment (A START) and the Community Alliance For the Ethical Treatment of Youth. (CAFETY). At hearings in October of 2007 and April of 2008 inadequate regulation, non-professional staff, use of hard labor, forced silenced and shunning, humiliation, forced wilderness activities with inadequate attention to medical problems, and extreme punishments such as beatings, being kept in dog cages and in stress positions were found to be common. Parent sponsored early AM kidnapping of youth with threat of force has been said to be the most traumatic event for many youth forced into such programs. Traumatized youth with a lingering sense of betrayal by their parents are in need of understanding and appropriate trauma focused treatment. Parents too experience being duped by the claims on websites that say they have the only answer to every conceivable behavioral problem of youth. Only recently have organizations of survivors, parents and concerned professionals begun to address these problems.

Differences between public system and non-profit contract residential programs and for-profits will be discussed in terms of regulation and quality of care. The appropriate role in the spectrum of care for residential programs will be addressed vis a vis the needs of adolescents for increasing doses of autonomy and some acceptable risk taking.

Psychiatrist who work with youth and young adults need to understand the variability in residential care.  They need reliable ways to evaluate the veracity of claims of their patients regarding inappropriate or abusive care. Our colleagues need to honor the claims of youth as they share with us their maltreatment. Many youth bear the secrets of abusive care. There parents who mortgaged their homes to pay for such treatment are loath to admit their money was taken from them leaving their child with worse problems. Entering such a family as a therapist takes skills, compassion, and an ability to understand varying perspectives. This program aims to inform psychiatrists about the risks of residential treatment, how to evaluate specific programs treatment sophistication and ethics, and when and how to warn parents as they contemplate sending their troubled youth away. This program will share ways to approach youth who have been harmed by bad programs, find peer supports, intervene in the youth’s trauma based difficulties and address daunting family difficulties stemming from varying perspectives of the care the young person received.