Emerging Roles of Residential Treatment Centers in the Child and Adolescent Mental Health Services System

Prepared for
Center for Health Care Strategies
The Annie E Casey Foundation
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration

Developing a system of care that provides an appropriate continuum of mental health services is imperative for youth who need mental health care and for their families. In many communities, efforts to strengthen home and community services have neglected the role of existing residential treatment centers (RTCs) even though many children continue to be placed in these settings. At the same time, many RTCs have remained focused on delivering traditional out-of-home care and have not adopted core system of care practices, such as including families and youth in decisionmaking.

In response, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored the Building Bridges Summits to promote collaboration between community-based and residential treatment providers. Mathematica built on the work of these summits by examining (1) the extent to which residential treatment providers operationalize systems of care values and principles and whether there are barriers to doing so, (2) the extent to which families, both youth and caregivers, are partners in the development, oversight, and operation of RTC services, and (3) whether residential treatment providers assess the need for residential treatment versus nonresidential alternatives.

The project included key informant interviews with a range of stakeholders as well as a structured survey of residential treatment providers. Survey data were combined with data from the SAMHSA National Survey of Mental Health Treatment Facilities to examine how structural and organizational characteristics of residential treatment centers are associated with the adoption of systems of care practices.