Residential treatment centers (RTCs) are residential treatment facilities offering a combination of substance abuse and mental health treatment programs and 24-hour supervision in a highly structured (often staff-secure) environment. They usually house youth with significant psychiatric or substance abuse problems who have proved too ill or unruly to be housed in foster care, day treatment programs, and other nonsecure environments, but who do not yet merit commitment to a psychiatric hospital or secure corrections facility. Although such treatment centers must be licensed by the State, they are frequently run by private, for-profit and nonprofit institutions, and the treatment approaches and admissions criteria used by RTCs vary widely from State to State and institution to institution.

Types of treatment offered may include psychoanalytic therapy, psychoeducational counseling, behavioral management, group counseling, and medication management, while settings range from extremely structured, hospital-like environments to group homes and halfway houses. As with most treatment options where there is enormous diversity in the type and quality of services being offered, the literature regarding RTCs shows mixed results. A summary of research findings prepared by the Surgeon General in 1999 reports that “in the past, admission to an RTC has been justified on the basis of community protection, child protection, and the benefits of residential treatment.” However, numerous studies have demonstrated that equally efficacious results can be achieved in less restrictive, community-based settings (Joshi and Rosenberg, 1997). Mental health and substance abuse professionals have also repeatedly called for clearer admission criteria for RTCs, to avoid incarcerating youth in inappropriate settings or with inappropriate and potentially dangerous peer groups.

Despite such mixed results, at least some privately run RTCs (especially those with intensive aftercare programs) do appear to produce a positive impact on at-risk youth and juvenile offenders. A 1992 comparison of 254 graduates of Ohio's Paint Creek Youth facility and a comparable control group found that recidivism for the treatment group remained lower than that of the control group for up to 24 months (Gordon, 2000). A National Council on Crime and Delinquency study of the first 56 graduates from Maryland's Thomas O' Farrell Youth Center (TOYC) also showed a “dramatic decline” (77 percent) in the number of offenses by youth following their stay. Although the TOYC study was not controlled, OJJDP's Guide for Implementing the Comprehensive Strategy for Serious, Violent, and Chronic Offenders concludes that “these findings are promising in that they compare favorably with that of the best community-based youth corrections nationwide.”

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