Residential Treatment

Discipline Issues with FASD-Affected Persons

Consistent discipline and structure are key because:

  • People with alcohol-related disabilities have trouble learning or following societal rules.
  • People with FASD generally cannot internalize morals, ethics or values (all of which are abstract and situational) like neurotypical (NT) individuals; therefore, they cannot modify their behavior to meet society’s expectations.
  • Some individuals with FASD are unable to learn from past experience, and they are bound to repeat the same mistakes over and over again. Effective discipline delivered consistently and predictably may help break this pattern.
  • Learning to live with and abide by society’s rules, laws and expectations is a life-long process for people affected by maternal alcohol use. Teaching and discipline must start in early childhood and continue through adulthood. The process and need for structure never ends.
group of teens

If you are a parent or caregiver who has utterly exhausted community mental health care resources, you may be considering sending your child to a residential treatment center. 

A residential treatment center (RTC) is a licensed 24-hour facility (although not licensed as a hospital), which offers mental health treatment. The types of treatment vary widely; the major categories are psychoanalytic, psychoeducational, behavioral management, group therapies, medication management, and peer-cultural. While formerly for long-term treatment (e.g., a year or more), RTCs under managed care are now serving more seriously disturbed youth for as briefly as one month for intensive evaluation and stabilization.

According to the National Alliance on Mental Illness (NAMI):

“While some residential programs offer nurturing and caring environments and use evidence-based interventions, others are highly dangerous and damaging. The most concerning programs are those that operate under the philosophy that young people must be broken before they can be helped. These programs use disciplinary techniques such as degrading confrontation, deprivation of basic physical needs, and alienation from family. These abusive methods can confer permanent psychological damage and divide the young person from his or her family.”

Some children and adolescents with FASD have physical or behavioral needs that require the structure and services of residential or group settings. These settings include community-based group homes, campus-style residential facilities, and secure facilities. 

Residential programs, and the staff who work in them, are generally focused on working with children who have certain types of special needs. Settings range from structured ones, resembling psychiatric hospitals, to those that are more like group homes or halfway houses. Examples include community-based group homes for adolescent males who are involved in the juvenile justice system and residential campus facilities for children and youth with serious mental health problems. Very few programs offer specialized or modified services for FASD-affected persons. 

Residential programs may be operated by public or private agencies. They often provide an array of services, including therapeutic services for children and families, educational services, and medical services.

Educational Residential Services

The Individuals with Disabilities Education Act (IDEA) authorizes residential care for students with disabilities in Section 300.104 of Title 34 of the Code of Federal Regulations(CFR):

If placement in a public or private residential program is necessary to provide special education and related services to a child with a disability, the program, including non-medical care (including mental health services) and room and board, must be at no cost to the parents of the child.

Evaluating Residential Treatment Programs

NAMI cautions families to be very cautious and to do the following when considering residential treatment. These suggestions include:

  1. Take a series of Action Steps
  2. Complete a Licensing and Accreditation Checklist
  3. Consider specific issues to discuss with the facility
  4. Be aware of the rights of the patient and the family to prevent  abuse and neglect
  5. Review additional information available on the Internet, which include accrediting agencies and other mental health sites targeted to consumers of services and their loved ones.

The following are tips from the American Academy of Child and Adolescent Psychiatry (AACAP) for evaluating residential treatment programs:

  • Identify and research the programs that are licensed to provide care. States differ in how they license programs, and some programs are accredited by national agencies.
  • Check online and with the program to hear about families’ and youths’ experiences with the program.
  • If possible, speak to a family whose child completed the program.
  • If the program has been reported to state authorities, find out why, and ask about the outcomes of any investigations.
  • Seek out programs that are close to home to provide appropriate care for your child.
  • If the program is far from home, be sure that there is a plan for intensive family and community involvement. Be wary of programs that withhold family contact.
  • Be sure that the residential program has a method of maintaining safe behaviors, promoting positive behaviors, and preventing aggression.
  • Make sure that punishments and verbal intimidation (bullying, threatening) are prohibited.
  • Look for programs experienced in helping youth with similar issues.
  • Make sure that their treatments are based on therapies that have proven helpful for you with issues similar to those of your child.
  • Ask questions of the staff at the program. If staff is unable to answer your questions, they should refer you to someone at the program who can.
  • Ask how you can monitor your child’s progress. You should be able to find out about how your child is doing at any time.
  • Ask the therapist or psychiatrist who works with your child in your community for his or her view on potential programs, and to help you obtain more information.

Out-of-State Residential Treatment

The Interstate Compact on the Placement of Children establishes procedures for the placement of children and fixes responsibility for agencies and individuals involved in placing children.

In California, requests for out-of-state placements into residential treatment facilities and group homes are centralized and processed by the California Department of Social Services (CDSS) Out-of-State Placement Policy Unit. The CDSS has delegated the responsibility and functions associated with interstate placement requests in relative homes, foster family homes and prospective adoptive homes to counties and licensed adoption agencies. Each county has an ICPC Liaison who processes interstate foster care placements, including relative and non-offending parent placements.