Developing a Clear Picture of Psychiatric Residential Treatment for Children: National Survey Results

Background:  Recent tragic events have focused attention on challenges with the availability of mental health services for children with serious emotional disorders.  Some of these children receive care in residential treatment centers (RTCs), however it is difficult to define exactly what residential care for children is.  In response to this issue, this paper focuses on describing what is currently known about RTCs that serve children.  This project’s objective is to: 1) utilize existing data from the National Mental Health Services Survey (N-MHSS) to describe the availability of residential mental health services for children, and 2) discuss current and future data needs for evaluative and planning purposes.

Methods:  Analyses were conducted using data from the 2010 N-MHSS regarding the demographic characteristics of RTC residents, as well as sources of RTC funding and the types of licensure or certification the RTCs reported. An ordinal logistic regression model was constructed to see whether RTC size (categories of number of beds) was predicted by facility operation type, Medicaid licensure status, religious affiliation, or languages spoken by staff.

Results: There were 781 residential treatment centers that served children.  The majority of RTCs reported that they were operated as non-profit organizations (80%).  Most RTCs indicated that they accepted Medicaid as payment or funding for mental health treatment services (69%).  About 43% of RTCs were licensed by Medicaid.  Approximately two-thirds of the youth in residential care were male (67%).  Of the youth for whom race/ethnicity data were available, more than a third of them were white (37%) while about 21% were African American and 9% were Latino.  The average number of beds among the 774 RTCs that reported bed counts was 39.99, with a combined total of 30,952 beds on April 30, 2010.  RTCs that had a religious affiliation and Medicaid licensure had greater odds of being associated with increasing levels of facility size.

Discussion:  This study’s results suggested that there were approximately 781 RTCs nationwide that had 30,952 beds.  Most of these RTCs were non-profit organizations that accepted Medicaid funding.  The majority of RTC clients were white and male.  RTCs that were larger were more likely to have a religious affiliation and Medicaid licensure.  While these findings are important, more comprehensive national data are needed to assess the availability of RTCs that are a critical treatment setting in the child mental health system because this setting is the only one that serves children with long-term functional impairment.  Although N-MHSS data are the best national data available and the definition of an RTC used in the survey is an improvement over previous versions, there is confusion in the research literature regarding a consensus definition of an RTC, possibly stemming from differences in the way some RTCs define themselves.   The broader RTC stakeholder community’s development of a consensus definition of RTCs, an expanded and focused RTC client-level data collection effort, followed by the evaluation of the services that these facilities offer for youth, would be crucial next steps in order to improve outcomes for children with SED.