Last updated: July 2011 www.ojjdp.gov/mpg

 Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 1

Residential Treatment Centers 

Residential treatment centers (RTCs) usually house youths with significant psychiatric, psychological, 

behavioral, or substance abuse problems who have been unsuccessful in outpatient treatment or 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 correctional 

facility. These facilities frequently offer a combination of substance abuse and mental health treatment 

programs, such as psychoanalytic therapy, psychoeducational counseling, special education, 

behavioral management, group counseling, family therapy, and medication management, along with 

24-hour supervision in a highly structured (often staff-secure) environment. These facilities typically

are less restrictive than an inpatient psychiatric unit, and they are not licensed as hospitals (Bettman

and Jasperson 2009).

The American Association of Children’s Residential Centers defined a residential treatment center as 

“an organization whose primary purpose is the provision of individually planned programs of mental 

health treatment, other than acute inpatient care, in conjunction with residential care for seriously 

emotionally disturbed children and youth, ages 17 and younger” (AACRC 1999). In addition, when 

exploring residential treatment and the alternatives, Bates, English, and Kouidou–Giles (1997) 

differentiated between RTCs and group homes—two terms often used interchangeably when 

discussing residential treatment. Group homes provide for the basic needs of residents, which include 

food, shelter, and assistance with daily care. There is no primary emphasis on providing residents with 

treatment for mental health problems. However, the authors noted that RTCs specifically concentrate 

on delivering therapeutic treatment services to residents, in addition to also providing for their basic 

needs (Bates, English, and Kouidou–Giles 1997). 

Lack of a Standard Definition 

Like most other residential programs, however, RTCs suffer from a lack of a standard definition. A 

2007 report by the Government Accountability Office (GAO) noted that it was difficult to develop an 

“overall picture” of RTCs and other residential treatment programs because there were no 

standardized definitions to differentiate residential programs (please see the Residential literature for 

further information on the GAO findings from the investigation that looked at cases and allegations 

of child abuse and neglect that were uncovered in residential treatment programs). Though the GAO 

report investigated allegations of abuse that youths experienced during their time in residential 

programs, the report ended up concentrating primarily on unregulated, privately run residential 

facilities such as wilderness therapy programs and boot camps, which were mistakenly labeled as 

residential treatment centers in a news article. Nevertheless, there are distinct differences between 

Suggested Reference: Development Services Group, Inc. 2011. “Residential Treatment Centers.” Literature review. Washington, 

D.C.: Office of Juvenile Justice and Delinquency Prevention.

https://www.ojjdp.gov/mpg/litreviews/Residential_Treatment_Centers.pdf

Prepared by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or 

opinions expressed in this document are those of the author and do not necessarily represent the official position or policies of 

OJJDP or the U.S. Department of Justice.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 2

these types of residential programs (Lee 2008).

Changes in Program Theory

There have been calls in the literature to re-envision the model of the RTC. McCurdy and McIntyre 

(2004), for example, argue that RTCs need to adopt a “stop-gap model,” the goals of which are to 

interrupt the downward spiral of youth in crisis and prepare youth for reintegration. Chance and 

colleagues (2010) likewise encourage a model that brings together short-term, intensive residential 

treatment with aftercare services delivered in the community’s continuum of care. Lyons and 

colleagues (2009) similarly recognize the special importance of community resources, noting that 

length-of-stay decisions should be determined in part by what is available to the youth and family 

postdischarge.

Characteristics of RTCs

The Juvenile Residential Facility Census, a biennial survey conducted by the Office of Juvenile Justice 

and Delinquency Prevention (OJJDP), found that more than 900 facilities identified themselves as 

residential treatment centers. RTCs constituted 35 percent of all reporting facilities and held 32 percent 

of juvenile offenders in placement on the census date (Hockenberry, Sickmund, and Sladky 2009). RTCs 

and group homes outnumbered all other types of facilities included on the survey (though this finding 

may be misleading, as residential facilities are asked to self-report which type of facility they are and 

the survey does not provide definitions to differentiate between the various facility types listed, 

including RTCs, detention centers, training schools, group homes, ranch/wilderness camps, boot 

camps, reception or diagnostic centers, and runaway and homeless shelters).

The number of residents held in facilities that self-identified as RTCs varied. Only 18 percent of RTCs 

reported currently holding 10 or fewer residents. Most (57 percent) reported currently holding 11 to 50 

residents in the facility. About one third of RTCs reported being at their standard bed capacity; only 3 

percent reported being over capacity of their standard beds. Security features also varied across RTCs. 

Fewer than half (43 percent) reported using one or more confinement features, such as locked doors or 

gates, to restrict youth (Hockenberry, Sickmund, and Sladky 2009). 

The survey asked facilities about the counseling and therapy services that were provided to youth. Of 

the 919 self-identified RTCs, 532 (about 58 percent) reported providing counseling services to youth in 

residence. Of those providing therapy, 89 percent provided individual therapy, 91 percent provided 

group therapy, and only half provided family therapy. In addition, of the 919 RTCs, 658 (about 72 

percent) reported providing therapy services. Ninety-three percent provided individual therapy, 92 

percent provided group therapy, and 58 percent provided family therapy. The survey did not 

differentiate between therapy and counseling services (Hockenberry, Sickmund, and Sladky 2009).

In addition, the survey found the RTCs and group homes were more likely then other residential 

placements to have in-house mental health professionals who evaluate all youths for mental health 

needs. Seventy-three percent of RTCs reported having in-house mental health professional available to 

evaluate youths’ mental health needs (Hockenberry, Sickmund, and Sladky 2009).

Variation in Treatment Centers

Though there are some common characteristics among facilities, RTCs can dramatically differ on 

numerous factors. For example, there are variations in staff education and qualifications, treatment 

organization, site theoretical orientation, and client psychopathology. In addition, individual and 

parental participation, family therapy involvement, vocational training components, and postdischarge 
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support can also vary among programs. For example, some residential treatment programs function 

from an ecological perspective, addressing individual problems with youths and concentrating on the 

interaction between youths and their environments. Other programs may take a therapeutic 

community approach, addressing problem behaviors through peer influence. However, there is a lack 

of research that measures or examines the influence of these factors on the success of treatment, so it 

remains unclear what program elements are important and beneficial to the treatment process (Bettman 

and Jasperson 2009).

Target Population

In 2004, Federal funding supported the placement of 200,000 youths in government or private 

residential facilities, which include youths not involved in the juvenile justice system (GAO 2008b). 

Between 15 percent and 30 percent of youths in out-of-home care reside in RTCs (Whittaker 2004). The 

Survey of Youth in Residential Placement, another survey conducted by OJJDP, found that in 2003 

approximately 14,070 juveniles were in a residential treatment program, which includes RTCs and 

other types of residential programs (Sedlak and McPherson 2010). Youths in residential treatment made 

up 14 percent of the total population of youths in placement.

There appears to be a general acceptance that the youths being sent to RTCs present increasingly intense 

and severe behavioral and emotional problems, academic problems, and substance use problems 

(Baker, Fulmore, and Collins 2008; Baker, Ashare, and Charvat 2009; Lyons et al. 2009). The 2000 

American Association of Children’s Residential Centers National Survey identified four main reasons 

for admission into an RTC: 

 Severe emotional disturbance

 Aggressive/violent behaviors

 Family/school/community problems

 Abuse (Foltz 2004)

However, there is almost no research on the best target population for this type of facility and treatment. 

As Whittaker (2004) points out, because this treatment option is so expensive and radical, it must be 

used where it will be most effective. Mental health and substance abuse professionals have also 

repeatedly called for clearer admission criteria for RTCs, to avoid incarcerating youths in inappropriate 

settings or with inappropriate and potentially dangerous peer groups.

Outcome Evidence

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. Bettmann and Jasperson (2009) 

conducted a review of the outcome literature on adolescent residential treatment programs, including 

RTCs. Examining 13 studies they found to fit their review criteria, they concluded that “the outcome 

literature of adolescent residential and inpatient treatment indicates that these therapeutic settings are 

successful interventions for many clients” (2009, 174). However, they also observed several significant 

deficits in the existing literature that limit any definitive conclusions about the effectiveness of 

residential treatment programs. They note that there is a lack of research that assesses the effectiveness 

of specific program elements; there is no consensus in the research on a definition of residential 

treatment and little agreement on what constitutes treatment success; insufficient details and 

descriptions are provided in evaluation studies that look at the effectiveness of specific programs 

(making it difficult to replicate a particular treatment approach); and there is a need for outcome 

research to examine the cultural sensitivity of child and adolescent residential treatment (Bettman and 

Jasperson 2009). (See the Residential literature for further information on the limitations of research.)
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 4

In addition to these limitations, many of the treatments and services, whether psychotropic or 

psychosocial, delivered to youth in RTCs lack a foundation in research (Foltz 2004). For instance, Foltz 

calls attention to the widespread use of medications that have largely been tested only on adult 

populations and are prescribed “off label” to adolescents in treatment. Few evidence-based practices 

have been tested in RTCs, because of, in part, issues such as the lack of fit between Medicaid 

reimbursement and many evidence-based interventions (Bright et al. 2010). Moreover, a lack of funding 

can mean that inadequate services are available. In a survey of New York State RTCs, it was found that, 

because of budget constraints, facilities were forced to hire staff with limited formal education (Baker, 

Fulmore, and Collins 2008).

Some individual RTC programs have been evaluated and were shown to make a positive impact on 

youth who received treatment services. For instance, the treatment model used by the Phoenix House 

Academy (a therapeutic community for substance-abusing adolescents) was associated with better 

outcomes than the average expected outcome of alternative probation dispositions. In an evaluation 

using a quasi-experimental nonequivalent comparison group design, the outcome results over a 1-year 

follow-up period for 125 youths who were enrolled in the Phoenix Academy were compared with 274 

control youths who received alternative probation dispositions. Compared with the control group, 

Phoenix House Academy youths had significantly better outcomes for most substance use and 

psychological functioning outcomes (Morral, McCaffrey, and Ridgeway 2004). However, a recent study 

that looked at a 7- to 8-year follow-up period found no evidence of positive effects on the outcomes 

measuring substance use problems, criminal activity, and psychological functioning. Although Phoenix 

Academy appeared to have short-term effects, no long-term effects were evident.

Moreover, an evaluation of the Mendota Juvenile Treatment Center (MJTC), an intensive treatment 

program designed for serious and violent juvenile offenders, found positive effects on youths who 

received treatment in the program. Caldwell and Rybroeck (2005) compared 101 youths who were 

treated through MJTC with 147 youths who were briefly assessed at MJTC but who then returned to a 

secured correctional institution for the remainder of their sentence. Using propensity scores to control 

for nonrandom group assignment, the study found that youths treated at MJTC were only one sixth as 

likely to commit felony violent offenses as the comparison group youths were. MJTC treatment, in 

addition to reducing the number of youths involved in offending, increased the time youths were in 

the community before they reoffended.

Finally, the Residential Student Assistance Program (RSAP) was shown to make positive impacts on 

the alcohol, marijuana, and tobacco use of youths. The program, which provides culturally sensitive 

alcohol and drug prevention and intervention services to mostly African American and Latino youth, 

was evaluated using a quasi-experimental design with two nonequivalent groups: the treatment group, 

consisting of 125 youths who participated in RSAP, and the control group, consisting of 211 youths who 

either chose not to participate in RSAP or participated in another residential facility that did not use the 

RSAP model (Morehouse and Tobler 2000). The results showed reductions in measures of alcohol, 

marijuana, and tobacco use for youths who participated in RSAP, compared with youths in the control 

group.

Alternatives to Residential Placement

Critics of residential placement often express concerns about decisions to remove youths from their 

homes and communities to treat them in settings such as RTCs. Some argue that placing youths with 

psychiatric or behavioral problems together in a residential environment may cause more harm to an 

individual’s treatment process. Youths may be traumatized by the experience of being removed from 
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 5

their home and placed in a residential program, hindering their chances of treatment success. In 

addition, the costs of placing youths in residential programs such as RTCs can be substantial to the 

juvenile justice system (Bettman and Jasperson 2009). A report from the Justice Policy Institute (2009) 

estimates that reporting States spend an average of $7.1 million a day keeping youths in residential 

facilities. Thus, many jurisdictions across the country have implemented alternative options to secure 

residential placements and confinement for youths who could be served better in community-based 

treatment programs, instead of receiving treatment in residential settings such as RTCs (though these 

alternatives may not be appropriate for all youths).

Alternatives to secure corrections or confinement, including residential placements, are special 

programming approaches designed to prevent youths from being placed out of the home environment 

for any significant length of time. The concept follows from the premise that time spent in out-of-home 

placement may do more harm than good for these youths. Further, these alternatives give such youths 

the benefit of remaining in their communities with greater access to needed resources (i.e., necessary 

treatment and medical services) without endangering the community and at much less expense then 

secure residential placement (OJJDP 2001). In addition, the many problems associated with reentry are 

avoided because the youth is never entirely estranged from the community for a lengthy period of time. 

Finally, this approach keeps less serious or nonviolent offenders at home or in their home communities, 

thus increasing the availability of secure beds for the most serious and violent offenders (OJJDP 2001).

There are several different types of secure confinement and placement alternatives, including home 

confinement or house arrest, day or evening reporting centers, shelter care, specialized foster care, and 

intensive supervision programs. Wraparound/case management is another program type designed to 

keep youth at home and out of institutions or residential placements whenever possible. The strategy 

involves “wrapping” a comprehensive array of individualized services and support networks 

“around” young people, rather than forcing them to enroll in inflexible treatment programs. Many of 

the wraparound initiatives and programs that have been evaluated, including Wraparound Milwaukee 

and Connections, have concentrated on youths with mental health needs. The research on these 

programs finds that youths who receive wraparound/case management services show improvements 

in behavior and everyday functioning, as well as reduced risks of delinquency, compared with youths 

who do not receive those services.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 6

References

(AACRC) American Association of Residential Treatment Centers. 1999. Outcomes in Children’s 

Residential Treatment Centers: A National Survey. Washington, D.C. 

Baker, Amy J.L., Caryn Ashare, and Benjamin J. Charvat. 2009. “Substance Use and Dependency 

Disorders in Adolescent Girls in Group Living Programs: Prevalence and Associations With 

Milieu Factors.” Residential Treatment for Children & Youth 26(1):42–57.

Baker, Amy J.L., Darren Fulmore, and Julie Collins. 2008. “A Survey of Mental Health Service Provision 

in New York State Residential Treatment Centers.” Residential Treatment for Children & Youth 

25(4):333–57.

Bates, Brady C., Diana J. English, and Sophia Kouidou–Giles. 1997. “Residential Treatment and Its 

Alternatives: A Review of the Literature.” Child & Youth Care Forum 26(1):7–51.

Bettmann, Joanna E., and Rachael A. Jasperson. 2009. “Adolescents in Residential and Inpatient 

Treatment: A Review of the Outcome Literature.” Child & Youth Care Forum 38(4):161–83.

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