Physician Leadership in Residential Treatment for Children and Adolescents

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History of residential treatment for children and adolescents in the United States

The role of residential treatment centers (RTCs) in the mental health services array for youth is the direct result of 3 historic trends.1 The first trend relates to changes in social welfare policy. Many RTCs began as orphanages in the nineteenth century with little or no physician involvement. In the 1960s, social welfare policies changed, and orphanages fell out of favor in the United States.2 Many of these former orphanages were left without a clear mission. The second trend in the 1970s

Current practice and controversies

Modern RTCs have recognized and responded to the changing clinical needs of their population by providing multidisciplinary treatment of intermediate duration and acuity between inpatient and outpatient levels of care. RTCs have become tertiary care mental health settings. Children must “fail-up” to gain access.8 Typically, children will have had multiple prior hospitalizations, many failed medication trials, and multiple attempts at various psychotherapies and behavioral interventions before

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References (12)

  • M. Olfson et al.

    National trends in the use of psychotropic medications in children

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • R.E. Lieberman

    Future directions in residential treatment

    Child Adolesc Psychiatr Clin N Am

    (2004)
  • Redefining the role of residential treatment, first in a series of position papers

  • C.N. Shealy

    From boys town to Oliver twist, separating fact from fiction in welfare reform and out-of-home placement of children and youth

    Am Psychol

    (1995)
  • M. Leichtman

    Residential treatment of children and adolescents: past, present, and future

    Am J Orthop

    (2006)
  • F. Redl

    The concept of a therapeutic milieu

    Am J Orthop

    (1959)
There are more references available in the full text version of this article.

Note: Throughout the text, youth and child are used interchangeably to represent the varied age group that residential treatment centers serve.

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