Residential Programs for Teens May Get Federal Oversight

Mental health advocates have succeeded in convincing federal lawmakers to require stepped-up oversight of residential programs for troubled teens.

The Stop Child Abuse in Residential Programs for Teens Act of 2008 (HR 6358) was passed by the House of Representatives in June but still requires approval by the Senate.

It would provide first-time federal standards for private and public residential programs, such as wilderness camps for children with behavioral problems. The oversight is needed, said proponents of the bill, because the programs, which are only regulated in a few states, may hire undertrained staffs who sometimes have been involved in injuries or deaths of the youths they are supposed to help, among other problems.

The legislation was supported by APA and other mental health advocacy groups.

“This legislation would help end the horrendous abuse that can unfortunately occur in private residential programs,” wrote Robert Hendren, D.O., president of the American Academy of Child and Adolescent Psychiatry, in a letter to bill's author, Rep. George Miller (D-Calif.).

The legislation was introduced after the Government Accountability Office (GAO) issued a report in October 2007 that chronicled thousands of cases of abuse and injury and several deaths at residential treatment programs across the nation from 1990 to 2007.

The GAO found that although some residential programs for “troubled teens” provide effective support for participants, others had significant evidence of “ineffective management,” which led to the hiring of untrained staff, provision of inadequate nourishment, and“ reckless or negligent operating practices.”

The agency found that even understanding the scope of the problems in such programs is difficult because there is no national information source. In addition, although states often regulate publicly funded programs, many states do not license or otherwise regulate private programs. These programs are free to determine how to describe themselves, with no standard definitions for terms such as “wilderness therapy program” or “boot camp.”

The report excluded state-sponsored foster programs, juvenile-justice programs for delinquent youth, and programs that exclusively treat psychological disorders or substance abuse in a hospital setting.

The findings reinforced long-standing concerns of psychiatrists and mental health professionals about the quality of care that the unregulated or underregulated programs provide to adolescents—including many with serious mental illness and substance use problems.

“Our members who work with teenagers know well what your committee is addressing regarding abusive residential programs and are not surprised by your early findings,” wrote Hunter McQuistion, M.D., president-elect of the American Association of Community Psychiatrists, in a letter to Miller.“ Your efforts have given hope to the many families and youth who have been harmed by those in this industry who have abused their trust.”

The legislation addresses those problems by establishing national standards for a basic level of care that all such programs must provide, including a prohibition on various types of punishment and a mandate for provision of basic care, including medical care. The bill also requires that programs provide children with reasonable access to a telephone and tell them they are allowed to use it.

Training requirements for staff described in the bill include assurance that they understand what constitutes child abuse and neglect and how to report them. Programs would be required to inform parents of the qualifications, roles, and responsibilities of all staff and inform them of substantiated reports of child abuse or violations of health and safety laws at the facility.

The legislation also requires staff to inform the Department of Health and Human Services (HHS) of reports of child abuse and neglect in their programs, and HHS would have to conduct investigations to determine if a violation of the national standards occurred. The measure creates civil penalties of up to $50,000 per program for each violation of the law.

The legislation also would encourage states to develop their own oversight of the programs and provide grants to states that develop licensing standards and active oversight.

In addition, HHS would have to create a Web site listing every residential treatment program for youth, their licensing, and reports of participants' injury or death.

Mental health advocates said the legislation should provide a safety net for families and children who seek the help of such residential programs.

“Protecting vulnerable children and ensuring they receive proper treatment is paramount to helping address our nation's mental health crisis,” wrote Laurel Stine, J.D., director of federal relations for the Bazelon Center for Mental Health Law.

The measure was broadly supported in the House, although some lawmakers criticized the GAO report as a purely anecdotal work meant to make an emotional appeal. Most representatives were convinced by the stories of abuse and death and supported the bill. Miller worked with Republicans to amend the original bill to address White House concerns that it would lead to frivolous lawsuits.

The fate of the legislation depends on whether the Senate begins work on its version of the bill. Advocates, including APA, are working with several Senate offices but no bill is imminent.

The text of the Stop Child Abuse in Residential Programs for Teens Act of 2008 can be accessed at<http://thomas.loc.gov> by searching on the bill number, HR 6358. The GAO report is posted at<www.gao.gov/new.items/d08146t.pdf>.▪