Developing a Research Framework for Improving Residential Psychiatric Treatment for Children and Youth in the United States

In July of 2024, the U.S. Senate Finance Committee issued a report entitled 'Warehouses of Neglect: How Taxpayers are Funding Systemic Abuse in Residential Treatment Facilities.' The report publication was followed by a hearing to interrogate the topic. The report reflects renewed attention to longstanding concerns about the safety, quality, and effectiveness of psychiatric residential treatment. Numerous documentaries, podcasts, and news articles have reported on the practices and long-term effects of this industry on youth, and 'survivor' celebrities have publicly campaigned against them. However, stakeholders in the 'troubled teen' industry argue for its expansion as demand for residential treatment substantially outpaces the capacity of existing facilities and the broader mental health services continuum. Many clinicians, policymakers, and researchers agree that psychiatric residential treatment plays an important role in the continuum of mental health care essential to supporting youth with complex behavioral health needs. Additionally, recent federal legislation (i.e., the Family First Prevention Services Act) has aimed to increase safety and quality in these facilities by requiring practice standards and oversight reforms.

Despite the recent criticisms, increased public scrutiny, and policy reform proposals, there is limited scientific knowledge available regarding the size, scope, quality, and practices of psychiatric residential care. While the use of restraint, seclusion and other restrictive interventions in these facilities has been widely documented and studied, we know very little about the risk factors for placement in residential care, the relative clinical or cost effectiveness of residential psychiatric care as an intervention, the clinical effectiveness of interventions provided within residential facilities, or the long-term effects of treatment on youth and adult outcomes. Further, because residential care is funded through a wide range of public agencies, including juvenile justice, child welfare, and Medicaid, and many families pay out of pocket or use private insurance to cover this service, comprehensive assessments of the number of children using residential care annually and total lifetime utilization are nonexistent.

To address these gaps, this roundtable session will begin a dialogue with social work researchers who study the needs and experiences of youth with significant behavioral health needs and who may encounter residential psychiatric care through educational, foster care, juvenile justice, or the behavioral healthcare systems. Participants will collaborate to develop and refine a framework to organize social work research that addresses essential informational needs to improve youth and family experiences of residential psychiatric treatment. Areas of inquiry will include, but not be limited to, better understanding the strengths and weakness of residential psychiatric care, the social, political and financing systems that shape it, the children and families who are served in it, and the role it plays in a well-functioning system of mental health care now and in the future. Presenters and facilitators will include social work researchers with expertise in residential psychiatric treatment, residential foster care, community-based alternatives to residential care, and child and youth behavioral health policy, as well as social work and medical professionals working in national and state policymaking in youth behavioral health care. care.