Residential Treatment Center - Historical Background in The United States

Historical Background in The United States

In the 1600s, Great Britain established the Poor Law that allowed poor children to become trained in apprenticeships by removing them from their families and forcing them to live in group homes. In the 1800s, the United States copied this system, but often mentally ill children were placed in jail with adults because society did not know what to do with them. There were no RTCs in place to provide the 24-hour care they needed and they were placed in jail when they could not live in the home. In the 1900s, Anna Freud and her peers were part of the Vienna Psychoanalytic Society and they worked on how to care for children. They worked to create residential treatment centers for children and adolescents with emotional and behavioral disorders.

The year 1944 is important because it marks the beginning of Bruno Bettelheim’s work at the Orthogenic School in Chicago, and Fritz Redl and David Wineman’s work at the Pioneer House in Detroit. Bettelheim helped increase awareness of staff attitudes on children in treatment. He reinforced the idea that a psychiatric hospital was a community, where staff and patients influenced each other and patients were shaped by each other's behaviors. Bettelheim also believed that families should not have frequent contact with their child while he or she was in treatment. This differs from community-based therapy and family therapy of recent years, in which the goal of treatment is for a child to remain in the home. Also, emphasis is placed on the family's role in improving long term outcomes after treatment in a RTC. The Pioneer House created a special-education program to help improve impulse control and sociability in children. After WWII, Bettelheim and the joint efforts of Redl and Wineman were instrumental in establishing residential facilities as therapeutic-treatment alternative for children and adolescents who can not live at home

In the 1960s, the second generation of psychoanalytical RTC was created. These programs continued the work of the Vienna Psychoanalytic Society in order to include families and communities in the child’s treatment. One example of this is the Walker Home and School which was established by Dr. Albert Treischman in 1961 for adolescent boys with severe emotional or behavioral disorders. He involved families in order to help them develop relationships with their children within homes, public schools and communities. Family and community involvement made this program different from previous programs.

Beginning in the 1980s, cognitive behavioral therapy was more commonly used in child psychiatry, as a source of intervention for troubled youth, and was applied in RTCs to produce better long-term results. Attachment theory also developed in response to the rise of children admitted to RTCs who were abused or neglected. These children needed specialized care by caretakers who were knowledgeable about trauma.

In the 1990's, the number of children entering RTCs increased dramatically, leading to a policy shift from institution- based services to a family-centered community system of care. This also reflected to the lack of appropriate treatment resources. However, residential treatment centers have continued to grow and today house over 50,000 children