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Considering a Private Residential Program for a Troubled Teen? Questions/warning

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survivorami:
Considering a Private Residential Treatment Program for a Troubled Teen?
Questions for Parents and Guardians to Ask/Warning from the FTC: original doc- http://astartforteens.org/assets/files/FTC-Warning-Signs-2009.pdf

Private residential treatment programs for young people offer a range of services,
including drug and alcohol treatment, confidence building, military-style discipline,
and psychological counseling for a variety of addiction, behavioral, and emotional problems.

Many of these programs are intended to provide a less-restrictive alternative to incarceration or
hospitalization, or an intervention for a troubled young person.

If you are a parent or guardian and think you have exhausted intervention alternatives for a
troubled teen, you may be considering a private residential treatment program. These programs go
by a variety of names, including “therapeutic boarding schools,” “emotional growth academies,”
“teen boot camps,” “behavior modification facilities,” and “wilderness therapy programs.”

No standard definitions exist for specific types of programs. The programs are not regulated by
the federal government, and many are not subject to state licensing or monitoring as mental health
or educational facilities, either. A 2007 Report to Congress by the Government Accountability
Office (GAO) found cases involving serious abuse and neglect at some of these programs. Many
programs advertise on the Internet and through other media, making claims about staff credentials,
the level of treatment a participant will receive, program accreditation, education credit transfers,
success rates, and endorsements by educational consultants.

The Federal Trade Commission (FTC), the nation’s consumer protection agency, cautions
that before you enroll a youngster in a private residential treatment program, check it out: ask
questions; ask for proof or support for claims about staff credentials, program accreditation, and
endorsements; do a site visit; and get all policies and promises in writing.

Facts for Consumers

Questions to Ask
Here are some questions to ask representatives
of any program you may be considering. The
responses may help you determine if the program is
appropriate for your child.

1. Are you licensed by the state?

If the answer is yes, find out what aspects of the
program the license covers: educational, mental/
behavioral health, and/or residential?
If the program claims to be licensed, get the name
of the state agency that issued the license and
contact the agency to verify that the license is
current. Often, the licensing will be through a state
Department of Health and Human Services or its
equivalent. If the program’s representative can’t
provide the name of the licensing agency, consider it
a red flag.

If the program is unlicensed and you still want
to consider it, contact the state Attorney General
(www.naag.org), the Better Business Bureau
(www.bbb.org), and the local consumer protection
office (www.consumeraction.gov/state.shtml) where
the program is located.

Regardless of whether a program is licensed, when
contacting any of these groups:
Ask for copies of all publicly available
information, including any complaints or
actions filed against the program, site visit
evaluations, violations, and corrective actions.
Pay particular attention to any reports of
unsanitary or unsafe living conditions,
nutritionally compromised diets, exposure to
extreme environmental conditions or extreme
physical exertion, inadequate staff supervision
or a low ratio of staff to residents, medical
neglect, physical or sexual abuse of youth
by program staff or other residents, and any
violation of youth or family rights.

2. Do you provide an academic curriculum? If so,
is it available to all program participants? Do you
have teachers who are certified or licensed by
your state?

Some programs may offer only self-study or distance
education. Sometimes, educational options are
not made available until a resident has reached an
advanced phase of the program. In addition, some
programs may claim that academic credits will
transfer to the resident’s home school and count
toward a high school diploma. Check with the board
of education in the state where the program operates
– and with your state board if you live out-of-state
– to verify that academic credits will transfer.

3. What about accreditation?

Several independent nonprofit organizations, like
the Joint Commission (JACHO), the Council on
Accreditation (COA), and the Commission on
Accreditation of Rehabilitation Facilities (CARF),
accredit mental health programs and providers.
JACHO accredits and certifies more than
15,000 health care organizations and programs
in the U.S. (www.jointcommission.org)
COA is an international child- and family
service and behavioral healthcare organization
that accredits 38 different service areas,
including substance abuse treatment, and more
than 60 types of programs. (www.coanet.org)
CARF International is an independent accreditor
of human services providers in areas including
behavioral health, child and youth services, and
employment and community services.
(www.carf.org)

Ask whether all components of the program are
accredited, for example, the base program, the
drug and alcohol component, and the wilderness
program. Then contact the accrediting organization
for confirmation.

The GAO’s Report noted that one program claimed
to be accredited by the JACHO, but in fact, only the
base program was accredited. Neither the wilderness
program nor the drug and alcohol component was
accredited.

The organizations above grant accreditation
and certification after evaluating the quality of
services provided by a treatment program. Parents
and guardians should be aware that some other
organizations that claim to accredit schools may
serve merely as membership organizations, and
may not conduct site inspections or otherwise
evaluate the quality of the programs they certify.

If a treatment program claims to be certified or
accredited, parents and guardians should contact the
accrediting organization and ask about the standards
the organization uses when issuing a certification.

4. Do you have a clinical director? What are his/
her credentials?

Typically, a clinical director is responsible for
overseeing, supporting, and maintaining the
quality of care for the program. A clinical director
may have an advanced degree in a related field,
like clinical psychology, and may be involved
in providing individual therapy, assessment and
consultation, staff training and development, and
managing or supervising the components of the
program.

5. What are the credentials of the staff,
especially the counselors and therapists, who will
be working with my child?

Do they have appropriate and relevant advanced
degrees like a Masters in Social Work, a license
to do clinical social work (LCSW), a Ph.D., or
an M.D.? Are they certified or licensed within the
state? If they are, by what agency or organization?

Ask to see copies of relevant documents, and
consider contacting the certifying or licensing
organization to confirm the staff credentials. The
GAO found that some program leaders falsely
claimed to have credentials in therapy or medicine,
which led some parents to trust them with teens
who had serious mental or physical disabilities
requiring different levels of treatment.

6. How experienced is your staff? Have they
worked at other residential treatment programs?
If yes, where and for how long?

Ask to see current certifications in CPR and other
emergency medicine. For wilderness programs, also
ask for proof of relevant training and expertise.

7. Do you conduct background checks on your
employees?

If the answer is yes, find out who does the
background check and how extensive it is. Call the
company to confirm that it provides background
check services for the treatment program. If the
answer is no or the program does not conduct
background checks, consider it a red flag.

8. What are the criteria for admission ? Do you
conduct pre-admission assessments? Are they
in person, by phone, or over the Internet? Who
conducts them?

If your child has serious addiction problems or
psychological issues, take special care to ensure
that the program is equipped to deal with them.
Discuss the appropriateness of the program with
your child’s psychologist, psychiatrist, or other
healthcare provider.

9. Will you provide an individualized program
with a detailed explanation of the therapies,
interventions, and supports that will address my
child’s needs? When is this done? How often will
my child be reassessed?

Ask whether your child will have group or
individual therapy sessions. If the answer is yes,
ask how often the sessions will take place and who
will conduct them. Once enrolled, confirm with
your child that the promised level of care is being
received.

10. How do you handle medical issues like illness
or injury? Is there a nurse or doctor on staff?
On the premises? Will you contact me? Will I
be notified or consulted if there’s a change in
treatment or medication?

Ask for copies of procedures the program follows
on dealing with medical emergencies.

11. How do you define success? What is your
success rate? How is it measured?

Some programs make specific success claims in
their advertising materials. To date, there is no
systematic, independently collected descriptive or
outcome data on these programs.

12. How do you discipline program participants?

Ask about policies and procedures for discipline.

13. Can I contact/speak with my child when I
want? Can my child contact me when he wants?

Some programs prohibit, monitor, or otherwise
restrict verbal or written communication between
you and your child. Find out what is allowed and
prohibited before you enroll your child.

14. What are the costs? What do they cover?
What is your refund policy if the program doesn’t
work out?

Private residential treatment programs often charge
hundreds of dollars per day. While health insurance
sometimes may pay a limited amount, for the most
part, the youngster’s family is responsible for paying
the fees and bills.

15. Do you have relationships with companies and
individuals that provide educational and referral
services?

Some companies may provide services, claiming to
match troubled kids with an appropriate treatment
program. Be aware that although some of these
services represent themselves as independent, they
may not be. They may actually be operated or paid
by one or more of the treatment programs. Ask the
service if it receives commissions from the treatment
programs.

Facts for Consumers
1-877-FTC-HELP FOR THE CONSUMER
FEDERAL TRADE COMMISSION ftc.gov
July 2008
Federal Trade Commission
Bureau of Consumer Protection
Division of Consumer and Business Education

For More Information
Among the sources of information for families
researching private residential treatment programs
for troubled youngsters are:
The Government Accountability Office’s (GAO)
Report to Congress: “Residential Treatment
Programs: Concerns Regarding Abuse and
Death in Certain Programs for Troubled Youth”
(October 2007) – www.gao.gov
The U.S. Department of Health and Human
Services, Centers for Disease Control and
Prevention’s list of state mental health agencies
– www.cdc.gov/mentalhealth/state_orgs.htm

The U.S. Department of State Fact Sheet:
“Behavior Modification Facilities” –
www.state.gov
Your State Attorney General – www.naag.org
The Alliance for the Safe, Therapeutic and
Appropriate use of Residential Treatment
(A START) – http://astart.fmhi.usf.edu

A START is sponsored by the Department of
Child and Family Studies of the University of
South Florida. The Alliance includes leaders in
psychology, psychiatry, nursing, mental health
law, policy and family advocacy, as well as
individuals with direct program experience as
director, evaluator, parent, or participant in
such programs.


About the FTC
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marketplace and to provide information to help consumers spot, stop, and avoid them. To file a complaint
or to get free information on consumer issues, visit ftc.gov or call toll-free, 1-877-FTC-HELP (1-877-382-
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