Policy Statement on Youth Access to Residential Treatment Facilities
Background
Residential Treatment Facilities (RTFs) play a vital role in the continuum of a healthy, child-serving system of care. They provide specialized treatment for youth with a wide range of emotional, behavioral, and/or substance use concerns who cannot be safely maintained in the community. Currently, there is insufficient access to high-quality residential treatment facilities for youth requiring out-of-home treatment for mental health and/or substance use disorder treatment. RTFs are distinguished from custodial care and wilderness and boot camps.
Out-of-home treatment is designed to be comprehensive and intensive, including diagnostic assessment, medication evaluation, family therapy, education and evidence-based group and individual therapies. The milieu, or treatment environment, offers the opportunity for youth to be coached by staff to practice necessary skills in a safe, structured, and trauma-informed setting. Psychiatric Residential Treatment Facilities (PRTFs) represent the most comprehensive RTF setting with a medical model and interprofessional psychiatrist-directed team approach.
RTFs require adequate reimbursement to provide intensive, high-quality treatment. It is critical that the environment be safe and trauma-informed, well-staffed by trained professionals, and free of harsh and punitive measures. It is also crucial that treatment be voluntary whenever possible, and that youth and family voice are centered in all treatment decisions.
To ensure that youth with the most intensive mental health care needs have access to the mental health care service array available in residential treatment facilities, the American Academy of Child and Adolescent Psychiatry recommends:
- Clear admission criteria for RTFs that justify the need for out-of-home placement in a restrictive setting;
- Federal, state and county investment in RTF programs sufficient to support recruitment and retention of a well-trained workforce to deliver appropriate treatment services for youth with severe and complex needs;
- Inclusion of evidence-based practices provided in a safe and trauma-informed environment promoting safer, clinically appropriate lengths of stay with a focus on reintegration back into the community; and
- Quality oversight of outcomes and restrictive procedures including seclusion and restraint.