Residential Treatment, Therapeutic Boarding, and other Services: A Guide to Terminology

The terminology in use to describe services of interest to FamilyLight is confusing even to those of us who have been involved in this work for over forty years.  It can be much more so to people inquiring for the first time regarding services for a family member in a time of stress. This is a problem because there are no standard definitions for many of these terms. We use these terms on this website consistent with our intuitive understanding of what they mean.  But we caution people that not everyone understands these in in the same way.  Each state defines these their own way according to their own licensing standards.

  • Boot Camp -- This is a simulation of military basic training.  The methods have been applied to troubled adolescents with some serious political backing.  Note that when this is applied to people entering the military, we are considering a method applied to generally healthy, responsible, stable young adults.  Effective behavioral change with disturbed youth depends in part on quality relationships between the young person and the adults reaching out -- an element missing in pure boot camp  programming.  Applied to adolescents with behavioral issues, it is generally intended as a punitive approach. We think when the juvenile justice system uses some of these methods with adolescents convicted who are screened by mental health professionals to screen out those who have emotional disturbance this may be beneficial, although we are ambivalent about that.  We are appalled by the use of this kind of thing for juveniles awaiting trial and when it used in private programs instead of a clinical therapeutic approach.   We are equally appalled by politicians demagoging proposals for increasing federal regulation on quality programs by referring to all mental health and behavior change programming for adolescents as boot camps.
  • Boarding School or Conventional Boarding School -- These are the schools that students attend for academic purposes. Many of these have supportive services including therapists meeting with students on campus.  These differ from therapeutic schools and most transitional schools because the therapeutic support is generally a private relationship between the student and the therapist;  what happens between the  student and the therapist is confidential from the school faculty and administration. Some conventional boarding schools willingly admit students who are clearly candidates for Transitional Schools and do a fine job with them. By contrast, in therapeutic boarding schools and most transitional schools the therapist along with all other staff of the schools are on a team working together for common goals.
  • Emotional Growth School/ Program  -- This  broadly refers to a school or program with behavioral change goals that does not involve use of traditional mental health clinicians.  A narrower understanding of the term comes applies to schools that based their method of impacting behavior on traditions that originated at the now defunct Cedu organization, and was then with some variation incorporated into the Cascade School in California, Mount Bachelor Academy in Oregon, the Rocky Mountain Academy in Idaho, and others. This terminology has fallen into disfavor because of the methods used by the Cedu organization and others that were widely accepted in the 1980s when these schools were in their growth phase but in 2015 tend to be thought of as abusive.
  • Inpatient -- This word is often applied to any therapeutic school or program that provides 24 hour care.  If we are being precise, it really is a correct term only for hospital care.
  • Residential Treatment Center (RTC) -- This is usually a highly clinical treatment program providing 24 hour care but less intensive and restrictive than a hospital. Where child and adolescent care is involved, some effort will be made to meet educational needs at least minimally, but the emphasis is traditionally on clinical service. However state licensing regulations cause this terminology to mean different things in different states. In New York, an RTC is a facility specifically for children and adolescents who are "in the system" due to issues related to family disruption and/or protective services. These programs provide services that may still be highly clinical, but are part of a totally separate bureaucracy. New York responds to mental health needs for people recognized as needing the care that we generally associate with the term "Residential Treatment Center" in programs they call "Residential Treatment Facilities."
  • Residential Treatment Facility (RTF) --  We encounter this designation in New York and Pennsylvania. In both states these are facilities that we normally would think of as RTCs. In New York this is simply a designation to separate these programs from treatment programs children and adolescents in the social service system; in Pennsylvania these are the facilities that care for Medical Assistance patients with severe Mental Health needs who are not in need of acute care hospitalization.  We mention it only to demonstrate how state bureaucracies can really add confusion.
  • Therapeutic Boarding School (TBS)--  Where RTCs and RTFs put their emphasis on clinical care and in many cases do just the legal minimum  to get by with education for school age children, a TBS is an educational institution that has therapeutic support integrated into the program. In a typical TBS the faculty and clinical professionals work as a team, as distinct from a the situation in a conventional boarding school where a student might see a therapist on campus but that is a private arrangement where the therapist maintains the student's confidentiality where faculty and staff are concerned. The line between a TBS and an RTC is increasingly blurred.  In the state of Utah, for example, many facilities are licensed as RTC although they function more like a TBS.  Some of those have very strong and intensive therapeutic programs AND very strong academic programs. Utah, which probably has more programs of interest to FamilyLight than any other state has very odd laws that create an incentive for programs that better fit the definition of therapeutic schools to obtain RTC licenses.
  • Transitional School -- A transitional school is a school that functions for the specific purpose of educating children or adolescents (usually high school aged teens) who have recently been to therapeutic program, have resolved their issues for the most part but are not ready to jump into the social climate of a conventional school or back living with parents.  These schools almost always have the majority of their students transitioning on to a conventional school for graduation, although most can issue a high school diploma to those for whom that is appropriate.   Licensing again confuses things. Mountain Springs Preparatory Academy in Utah is licensed simply as a boarding school -- not mental health licensed.  Families make their own arrangements with a therapist in town to work with their son or daughter in the school (usually from a lists supplied by the school). However the therapists are normally authorized to discuss the case with the school. Teamwork applies even with the therapist not being an employee of the school.
  • Wilderness Program -- This is a program taking advantage of the non-negotiable realities of nature for therapeutic purposes.  The details of how the wilderness programs work are very different from one to another. They range from a program of rigorous backpacking and camping, continuously living under primitive conditions for two months or more without encountering civilization (at one extreme) to maintaining an organic farm at the other end of the range of possibilities.
    • Adventure -- refers to programming that is based upon challenging activities that teenagers are likely to enjoy when not in a therapeutic program, like rock climbing,rappelling, whitewater rafting, etc.
    • Expedition -- refers to a program where the program participants travel by hiking from place to place setting up camp and living under primitive conditions.
    • Base Camp Model -- A camp location is available for participants to return to periodically.  However there is tremendous differences from one Base Camp Model program to another.  In some cases participants return to the base camp every night; in other cases they do so only once per week. In some cases the base camp is very primitive; in other cases it provides such luxuries as hot and cold running water, real beds, etc.
    • Full Immersion --  This refers to a program in which the participants remain in primitive conditions away from "civilization" for the duration of their time in the program. This may include use of a primitive base camp.
    • Hard Skills --  Primitive survival skills such as starting a campfire without matches.

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Last Updated January 2, 2018

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