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Residential Treatment Centers

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residential treatment centers

Out-of-home placements where the child receives help with many areas of his or her life that have gone awry, particularly psychological and/or behavioral problems. Centers are funded either through public or private funds or a combination of both.

According to the book Residential Treatment: A Tapestry of Many Therapies, edited by Dr. Vera Fahlberg, "Residential care is usually reserved for the child who is having problems in all three major areas of his life-family, school and peers-and even then only when the problems have not been amenable to out-patient treatment."

Residential treatment is 24-hour care and is different from a GROUP HOME, which is usually staffed by one couple and where the children are able to attend local schools. (Some children in group homes may need residential treatment or will need it in the future.)

A residential treatment center is also different from psychiatric hospitals, which are generally used for severely disturbed children who are suicidal or who are undergoing detoxification, receiving treatment for psychoses and so forth.

Residential treatment is not a short-term solution to a problem, and the average child who needs residential treatment remains at the facility for eighteen months to two years.

Says Sandra Mooney, chief clinical social worker at Episcopal Child Care of North Carolina, "Usually the child comes to the program with numerous problems which have been identified by various community agencies, police, foster families, schools and sometimes biological parents."

Common problems of children placed in residential institutions include low self-esteem, inability or inadequacy at forming relationships with others, poor control of emotions, learning disabilities and other problems.

Fahlberg's book also discusses a variety of children who have done well in a residential treatment center where she has had extensive experience: Forest Heights Lodge in Evergreen, Colorado. These include children with attachment problems, children who have suffered a parental loss or separation, children who are "stuck" at a childhood stage earlier than their chronological age and children with perceptual problems. Children who are not suitable for the facility are handicapped children or teenagers who are sociopathic or have other personality disorders.

It is partially the milieu as well as separation from the primary caretakers as well as other factors that will, hopefully, lead the child to recovery and an ability to function in the world. The "milieu" refers to the daily environment and its structure, and in a residential treatment center, the milieu describes a setting in which the child can grow to trust the caretakers of the center, empowering the child to change.

Children placed in residential treatment may be placed by a social worker, their biological parents or their adoptive parents or other guardians.

According to social workers Judith McKenzie and Drenda Lakin, such children "are often youngsters for whom no other resource has been available or whose medical, cognitive, behavioral and emotional difficulties have led to residential placement usually after they have experienced many moves in the foster care system."

The children may be able, with time, to return to their adoptive or biological homes; however, therapists often have biases against adoptive parents who wish to temporarily place their children in a residential treatment facility. There may be biases against adoption on the part of the staff and an overeagerness to "rescue" the child and the adoptive parents from each other.

Children from adoptions that have disrupted or dissolved may be placed in residential treatment and will hopefully learn to cope with the pain and rejection they may feel. They may have problems with attachment to adults and sometimes may find it difficult to attach to more than one adult.

Adopting parents need to be aware of the problems of the child who has previously resided in a residential treatment center. The adoption agency and the residential treatment center should both fully educate the adopting parents on the child's problems.

Adoptive parents who expect the child to be grateful he or she was "saved" from the institution will be disappointed, because the child will probably not bond readily: He or she has been disappointed too many times before.

Other issues include the capacity of the child to attach to new parents. Because of past problems forming strong relationships, the child is wary of familial-type relationships. The child may also have difficulty in attaching to both parents.

In addition, the child may have formed relationships with residential treatment center staff and suffer separation anxiety when it's time to leave the residential treatment center. (See also ADOLESCENT ADOPTED PERSONS; BONDING AND ATTACHMENT; PSYCHIATRIC PROBLEMS OF ADOPTED PERSONS.)

For assistance in locating a residential treatment center, the following organizations may be consulted:

American Association of Children's Residential Centers
440 First St. NW, Suite 310
Washington, DC 20001
(202) 638-1604

National Association of Psychiatric Treatment Centers for Children
2000 L St. NW, Suite 200
Washington, DC 20036
(202) 955-3828


Vera Fahlberg, M.D., editor, Residential Treatment: A Tapestry of Many Therapies (Indianapolis, Ind.: Perspectives Press, 1990).

Joan Laird and Ann Hartman, editors, A Handbook of Child Welfare: Context, Knowledge, and Practice (New York: Free Press, 1985).

Judith K. McKenzie, M.S.W., and Drenda Lakin, M.S.W., "Residential Services on the Continuum of Adoption Services," The Roundtable: Journal of the National Resource Center for Special Needs Adoption, 4:1 (1989): 1-2.

Ruth G. McRoy, Harold D. Grotevant and Louis A. Zurcher Jr., Emotional Disturbance in Adopted Adolescents: Origins and Development (New York: Praeger, 1988).

Sandra Mooney, "Coordination Among the Residential Treatment Center, Guardian Ad Litem, and the Department of Social Services," in Adoption for Troubled Children: Prevention and Repair of Adoptive Failures Through Residential Treatment (New York: Haworth Press, 1983).

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