Evidence-Based Alternatives to Residential Treatment, Therapeutic Boarding Schools, and Wilderness Programs
Disturbed by what you’ve learned on our website? We strongly encourage parents to seek out community-based alternatives to RTCs, as this industry is not regulated enough to provide a safe environment for your child. Some of the adult survivors Cedar Ridge, or “Makana, Formerly Cedar Ridge,” confirm that juvenile detention and foster care were actually much better experiences (and totally free for parents). This is very telling. As one explained:
“I had no understanding of how bad it was in Roosevelt until I ran away, and was put in juvie for stealing a car. In juvie, we were allowed to play cards. We were allowed to talk to each other. We played basketball. We were very free in comparison. There wasn’t any of this violence, child abuse, pedophilia, restraints, level systems, being placed on silence, nothing. They were not trying to ‘break us down’ to remold us into program robots or something. I would much rather have spent my entire adolescence in juvie than a moment in a not-so-therapeutic boarding school.”
Please check out the list of alternatives to RTCs, wilderness, and therapeutic boarding schools meticulously compiled from the researchers and clinicians affiliated with #BreakingCodeSilence:
https://www.breakingcodesilence.net/parents
The following is from their website:
“There is no shortage of options for evidence-based, community and professional care for struggling youth. Our goal is that by supporting these evidence based treatments, and creating reform to hold inpatient facilities to safe standards, children will receive real help today and onward.”
“We understand that families need to seek treatment for adolescent behavioral, trauma, and mental health issues. That is why we believe in evidence-based therapy and approaches to treatment. What do we mean by "evidence-based"? We mean that researchers have conducted studies to determine whether a treatment has:
- Demonstrated effectiveness in scientific evaluations and randomized control trials.
- Been assessed in large studies with diverse populations, or through multiple replications by independent researchers. Not the by developer of the model (aka someone who gains or profits from it).
- Resulted in significant and sustained effects for a minimum of 6 months post-treatment.
See the following list of evidence-based treatment methods and programs to serve a wide array of adolescents and children with a variety of issues. Some programs and treatments will be more effective for certain issues than others so please take the time to read into each program/model to understand where their strengths lie.
- 1) Wraparound - Wraparound is a method of engaging with children and youth with the highest levels of mental health needs, and their families, so that they can live in their homes and communities and realize their dreams.
- 2) Cognitive Behavioral Therapy (CBT) for Anger-Related Problems in Children and Adolescents - Cognitive behavioral therapy (CBT) is a problem-focused, therapeutic approach that attempts to help people identify and change dysfunctional beliefs, thoughts, and patterns that contribute to their problem behaviors. This variant of CBT focuses specifically on children and adolescents who have anger-related problems. The practice is rated Effective for reducing aggression and anger expression, and improving self-control, problem-solving, and social competencies.
- 3) Dialectic Behavior Therapy (DBT) was originally developed to treat chronically suicidal individuals, and has since been adapted for youth with serious emotional problems. This cognitive-behavioral treatment focuses on four functions, three of them to directly help the youth (enhance behavioral skills to handle difficulties, find motivation to change dysfunctional behaviors, ensure use of the skills in daily life) and the fourth to train and consult with counselors to improve their skills in working with the young people. Studies of DBT have shown reductions in suicidality, depression, self-harm, and drug abuse.
- 4) Dropout Prevention Programs - School- or community-based programs targeting frequently absent students or students at risk of dropping out of school. These programs are aimed at increasing school engagement, school attachment, and the academic performance of students, with the main objective of increasing graduation rates. The practice is rated Effective for reducing rates of school dropouts, and rated Promising for improving test scores/grades, graduation rates, and attendance.
- 5) Adults in the Making (AIM) - A family-centered preventive intervention designed to enhance the family protective process and self-regulatory competence to deter escalation of alcohol use and development of substance use problems. The program is rated Effective. Overall, the preponderance of evidence indicates that the program has a positive impact on deterring the use of alcohol, drugs, and involvement in other risky behaviors among participants.
- 6) Adolescent Community Reinforcement Approach - An outpatient program targeting 13 to 25 year olds that aims to replace activities supporting alcohol and drug use with positive behaviors that support recovery. The program is rated Effective. Participants were more likely to seek out and continue care services, abstain from substance use (in particular, marijuana), had less reported depression and internalized behaviors problems, and more social stability (i.e., working, receiving education, in a home or shelter, or receiving medical care). ·
- 7) Adolescent Diversion Project (Michigan State University) - This is a strengths-based, university-led program that diverts arrested youth from formal processing in the juvenile justice system and provides them with community-based services. The program is rated Effective. Participants in the program had statistically significant lower rates of official delinquency, compared with control group youth. However, there was no statistically significant difference between groups in self-reported delinquency.
- 8) Aggression Replacement Training (ART) - A multidimensional psychoeducational intervention designed to promote prosocial behavior in chronically aggressive and violent adolescents using techniques to develop social skills, emotional control, and moral reasoning. The program is rated Effective. Among adolescents taking part in the intervention there was a statistically significant reduction in felony recidivism, improved social skills and a reduction in problem behavior among participants.
- 9) Behavioral, Emotional, and Social Training: Competent Learners Achieving School Success (BEST in CLASS) - A classroom-based intervention, delivered by teachers, designed to prevent emotional and behavioral disorders in high-risk children. The program is rated Effective. Intervention group children showed statistically significant improvement in behaviors, social and behavioral competence, and student-teacher relationships, compared with control group children. Intervention group teachers showed statistically significant improvements in instructional practices, compared with control group teachers.
- 10) Big Brothers Big Sisters (BBBS) Community-Based Mentoring (CBM) Program - This program offers one-to-one mentoring in a community setting for at-risk youth between the ages of 6 and 18. This program is rated Effective. It was associated with a statistically significant reduction in initiating drug and alcohol use and antisocial behavior among mentored youth, compared with non-mentored youth. Mentored youth also showed statistically significant improvement in relationships with parents and academic performance (i.e., better grades and fewer absences)
- Children with Problematic Sexual Behavior-Cognitive Behavioral Therapy (PSB-CBT) - This is a cognitive–behavioral therapy (CBT) program for children that is designed to eliminate problematic sexual behavior. The program is rated Effective. Children in the CBT treatment group who demonstrated problematic sexual behavior displayed no statistically significant differences, compared with control group children, in sexual and nonsexual offenses at the 10-year follow up, indicating that the treatment was effective at reducing these behaviors.
- Children’s Advocacy Center Model - This program is a multidisciplinary, victim-focused approach designed to improve forensic interviewing and the continuity of care for youth who are victims of sexual abuse and assault. The program is rated Effective. The program showed a statistically significant increase in the receipt of physical health examinations and counseling referrals for treatment group youth, compared with youth in the community comparison group.
- Cognitive Behavioral Intervention for Trauma in Schools (CBITS) - A cognitive and behavioral therapy group intervention for reducing children’s symptoms of posttraumatic stress disorder and depression caused by exposure to violence. The program is rated Effective. The study found significantly lower scores of self-reported PTSD, depressive symptoms and psychosocial dysfunction than the comparison group.
- Cognitive-Processing Therapy for Female Victims of Sexual Assault - This is a cognitive therapeutic program that is intended to assist female victims of sexual assault with posttraumatic stress disorder (PTSD). The program is rated Promising. Both PTSD and depression symptoms decreased with cognitive treatment, when compared with the control group.
- Criando con Amor: Promoviendo Armonía y Superación (CAPAS) - This program includes two versions of a culturally adapted parenting intervention for immigrant Latino populations. The program is rated Effective. Both versions of the intervention were found to have a statistically significant impact on improving parenting practices, compared with the control group. Only the enhanced intervention had a positive, statistically significant effect on child internalizing behaviors. Neither had a statistically significant effect on externalizing behavior.
- Families And Schools Together (FAST) - A multifamily group intervention program designed to build protective factors for children, empower parents to be primary prevention agents, and to build supportive parent-to-parent groups. The program is rated Effective. Two studies found participants had fewer problem behaviors than their controls. There were mixed study results on social skills and academic competency. Other study findings were higher academic performance, improved family functioning and lower special education placement.
- First Step to Success - An early intervention program designed to identify children with antisocial behavior and introduce adaptive behavioral strategies to prevent antisocial behavior in school. The program is rated Effective. Participants showed improvements in adaptive behavior, less maladaptive behavior and aggression, and more attention to the teacher. There were no differences between groups on teacher ratings of withdrawn behavior and significant gains in functional impairment and academic competence.
- Functional Family Therapy (FFT) - This is a family-based prevention and intervention program for dysfunctional youth, ages 11 to 18, who are justice-involved or at risk for delinquency, violence, substance use, or other behavioral problems. The program is rated Effective. Program participants showed a statistically significant reduction in general recidivism and risky behavior, compared with control group participants. However, there were no differences between groups on felony recidivism or caregiver strengths and needs.
- Great Life Mentoring - This is a one-on-one mentoring program in which youth referred from a community mental health agency receive support from adult volunteers with whom they spend 2 to 3 hours weekly on positive community activities. The program is rated Effective. The intervention was shown to be associated with a statistically significant increase in global functioning and a lower likelihood of an unplanned and client-initiated ending of treatment.
- Guiding Good Choices - This is a family-competency training program to promote healthy parent-child interactions and address children’s risk for early substance use. The program is rated Promising. Parent participants had a statistically significant improvement in intervention-targeted parenting behaviors, at 1-year posttest. Child participants had a statistically significant lower likelihood of alcohol-related problems and cigarette use, after 10 years, but there was no effect on being drunk and using illicit drugs.
- HOMEBUILDERS - This is an in-home, family preservation service and reunification program for families with children returning from or at risk for out-of-home placement. The program is rated Effective. The treatment group had a statistically significant greater number of reunifications and reduced rates of out-of-home placement, compared with the control group. However, there were no significant differences between groups in successful reunification (i.e., whether the children returned to foster care).
- INSIGHTS into Children's Temperament - A school-based intervention program delivered to urban elementary students, with the participation of parents and teachers, to address disruptive behaviors. The program was rated Effective. In both studies, authors found that the intervention had a marginal-to-moderate effect on behavior problems exhibited by children.
- JobCorps- Youth receive free vocational training while being placed in a public program.
- LifeSkills Training - This is a classroom-based, drug abuse–prevention program for upper elementary and junior high school students. This program is rated Effective. Students who participated in the program reported a statistically significant decrease in prevalence of cigarette, alcohol, and polydrug use; and slower growth in initiation of substance use, compared with control students. However, there were no significant differences between groups on self-reported marijuana use.
- Linking the Interests of Families and Teachers (LIFT) - This is a program designed to prevent the development of aggressive and antisocial behaviors in children in elementary school. The program is rated Effective. Youth who participated in the intervention demonstrated statistically significant reductions in physical aggression; in initiation of alcohol and tobacco; and in use over time of alcohol, tobacco, and illicit drugs; compared with control youth. However, there were no significant differences between groups in initiation of illicit drugs.
- Mentoring - This practice provides at-risk youth with positive and consistent adult or older peer contact to promote healthy development and functioning by reducing risk factors. The practice is rated Effective in reducing delinquency outcomes; and Promising in reducing the use of alcohol and drugs; improving school attendance, grades, academic achievement test scores, social skills and peer relationships.
- Midwestern Prevention Project (MPP) - A school-based comprehensive program intended to promote an antidrug message throughout communities and prevent substance use (alcohol, tobacco, and marijuana) among middle school students. The program is rated Effective. The program significantly reduced cigarette smoking prevalence among treatment youths relative to the control group. There was no significant sustained effect for alcohol or marijuana use at follow-up.
- Motivational Interviewing - A client-centered, semidirective psychological treatment approach that concentrates on improving and strengthening individuals’ motivations to change. The practice is rated Effective. Individuals in the treatment groups significantly reduced their use of substances compared to those in the no-treatment control groups.
- Multidimensional Family Therapy - A manualized family-based treatment and substance abuse prevention program developed for adolescents with drug and behavior problems. The program is typically delivered in an outpatient setting, but it can also be used in inpatient settings. The program is rated Effective. The program resulted in the greatest and most consistent improvements in adolescent substance abuse and associated behavior problems.
- Multidimensional Treatment Foster Care-Adolescents - A behavioral treatment alternative to residential placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. This program is rated Effective. It was associated with a significant drop in official criminal referral rates, involvement in criminal activities, and days spent in lock up among MTFC-A boys. Similarly, the program was associated with a significant reduction in delinquency and days spent in lock up among MTFC-A girls.
- Multisystemic Therapy (MST) - A family and community-based treatment program for adolescent offenders who have exhibited serious antisocial, problem, and delinquent behaviors. The program is rated Effective. The treatment group had fewer rearrests and spent fewer days incarcerated than a comparison group that received usual services The program had a positive impact on family cohesion and social skills for the intervention group; but over time did not show better substance use outcomes than the comparison.
- Multisystemic Therapy - Substance Abuse - This version of multisystemic therapy is for adolescents with substance abuse and dependency issues. This program is rated Effective. Treatment youth showed statistically significant reductions in marijuana use and in aggressive behavior and convictions for aggressive behavior, compared with control group youth. However, no significant differences between groups were found for symptoms of mental health, criminal behavior, or alcohol or cocaine use.
- Parent–Child Interaction Therapy (PCIT) - The program teaches parents new interaction and discipline skills to reduce child problem behaviors and child abuse by improving relationships and responses to difficult behavior. The program is rated Effective. Program children were more compliant with less behavior problems than the wait list group. The treatment group parents gave more praise and fewer criticisms and improved negative aspects of their parenting. There were fewer re-reports of physical abuse.
- Parent Management Training - Oregon model (PMTO™) is an evidence-based structured intervention to help parents and caregivers manage the behavior of their children. The PMTO method is designed to promote prosocial skills and cooperation and to prevent, reduce and reverse the development and maintenance of mild to moderate to severe conduct problems in children age 4 - 18. PMTO empowers parents as primary treatment agents to promote and sustain positive change in families.
- Positive Action - The program uses a curriculum-based approach to improve youth academics, behavior, and character. The program is rated Effective. Treatment group students reported less substance use, sexual activity, violent behavior, serious violence-related behavior, and bullying behavior than did the control group students. There were no significant differences in measures of disruptive behaviors.
- Positive Family Support (PFS) - This is a family-centered intervention, which addresses family dynamics to prevent substance use and problem behaviors in adolescents. The program is rated Effective. Students in the treatment group were found to report less substance use, including alcohol, tobacco, and marijuana; and demonstrate less antisocial behavior, compared with students in the control group. These differences were all statistically significant.
- Positive Parenting Program (Triple P System) - The Positive Parenting Program is a comprehensive system of parenting and family support for families with children. The program consists of five levels of intervention, which increases with intensity, and progressively narrows the reach at each increasing level. The program incorporates a media and communication strategy, which pronounces the challenges of parenting and encourages parents to break down parenting isolation barriers and seek out help and support. Ultimately, the program is designed to prevent poor parenting practices, and reduce family risk factors as they related to maltreatment and behavioral and emotional problems.
- Prolonged Exposure Therapy - A cognitive–behavioral treatment program for individuals suffering from posttraumatic stress disorder. The program is rated Effective. The program reduced the severity of PTSD and depression; anxiety; trauma-related guilt; and improved social functioning.
- Promoting Alternative THinking Strategies (PATHS®) - This prevention program promotes emotional and social competencies and reduces aggression and behavior problems in children. The program is rated Effective. Statistically significant findings included lower peer-ratings for aggressive, hyperactive, or disruptive behavior for intervention children, compared with control children. Further, intervention classrooms showed higher quality climate, levels of interest and enthusiasm, and ability to stay focused, compared with control classrooms.
- School-Based Bullying Prevention Programs - The practice includes programs that aim to reduce bullying and victimization (being bullied) in school settings. Some interventions aim to increase positive involvement in the bullying situation from bystanders or witnesses. The practice is rated Effective for reducing bullying, bullying victimization, and for increasing the likelihood of a bystander to intervene. The practice is rated No Effects for increasing bystander empathy for victims of bullying.
- School-wide Positive Behavioral Interventions and Supports (SWPBIS) - A universal, school-wide prevention strategy aimed at reducing behavior problems that lead to office discipline referrals and suspensions, and change perceptions of school safety. The program is rated Effective. Students in the SWPBIS schools received significantly fewer school suspensions than students in schools that did not receive SWPBIS training. Perceptions of safety improved in the schools that implemented SWPBIS, but declined in the schools that did not implement SWPBIS.
- SNAP Under 12 Outreach Project - This is a multisystemic intervention for boys younger than 12 who display aggression and antisocial behavior problems. This program is rated Effective. Boys who participated in the program showed a statistically significant decrease in delinquency and aggression scores and in behaviors such as rule-breaking, aggression, and conduct problems, compared with control group boys.
- Solution Focused Brief Therapy (SFBT) is a strengths-based approach to working with children and families. It emphasizes positive attributes and behaviors and how these can be applied to overcome difficulties. SFBT focuses on “life without the problem” rather than a detailed analysis of the problem itself.
- Speechkids.com - Useful services for parents of children on the autism spectrum. Helps parents teach their children how to learn and communicate more effectively.
- Steps to Respect - A school-based antibullying program that teaches social and emotional management skills to elementary school students. The goal is to help improve relationships and buffer the detrimental effects of bullying. The program is rated Effective. There were lower levels of bullying outcomes in the intervention group relative to the control group (e.g., observed bullying behavior, nonbullying aggression, destructive bystander behavior and students involved in malicious gossip).
- Strengthening Families Program: For Parents and Youth 10-14 - This adaptation of the Strengthening Families Program is designed to reduce substance use and behavior problems among youth ages 10–14. The program is rated Effective. Intervention students showed a statistically significant improvement in youth intervention-targeted behaviors, and delays in substance use initiation and growth rates, compared with control students. Intervention parents showed statistically significant improvements in parenting competencies, compared with control parents.
- Strong African American Families (SAAF) - This is a parental training and family therapy program targeted at rural African American families designed to reduce youths’ substance use and sexual activity. The program is rated Effective. SAAF group youth showed statistically significantly less increase of alcohol use and lower levels of alcohol initiation compared with the control group youth. SAAF group parents experienced a statistically significantly greater change in parenting behaviors targeted by the intervention.
- Success for All (SFA) - This is a schoolwide, intensive educational intervention to detect and resolve literacy problems for school children in preschool through sixth grade who are mostly in high-poverty schools. The program is rated Effective. Letter-Word recognition, Word Attack scores and oral reading results were statistically significant for grades across the five program schools with positive effects for the lowest-achieving students.
- Targeted Truancy Interventions - These interventions are designed to increase attendance for elementary and secondary school students with chronic attendance problems. The practice is rated Effective for improving attendance.
- The Blues Program - The Blues Program is a school-based prevention program for adolescents with depressive symptoms or adolescents who are at risk of onset of major depression. The program is delivered by 1 or 2 Facilitators who are familiar with cognitive behavioral methods of prevention and treating depression. The program is delivered to groups of 4-8 adolescents, in one-hour sessions over 6 weeks with home practice assignments included.
- The Incredible Years–Child Training Program - This is a program that aims to reduce behavior problems in children and increase their social and problem-solving skills. The program is rated Effective. Treatment group children demonstrated statistically significant improvements in conduct problems, social competence, and problem-solving skills, compared with control group children, at the post test.
- Therapeutic Approaches for Sexually Abused Children and Adolescents - Interventions designed to reduce the negative effects of child sexual abuse, which can include PTSD, internalizing behaviors, and externalizing behaviors. The practice is rated Effective for reducing PTSD symptoms, internalizing behaviors, and externalizing behaviors.
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) - A treatment intervention designed to help children and their parents overcome the negative effects of traumatic life events such as child sexual or physical abuse. The program is rated Effective. The treatment group had fewer PTSD symptoms, scored lower on the internalizing behavior and total behavior profile, sexualized behavior and problem behaviors. Treatment group parents scored lower in depression, emotional response and higher on parenting practices and support
- Trauma Affect Regulation: Guide for Education and Therapy (TARGET) - This is a trauma-focused psychotherapy program for those suffering from posttraumatic stress disorder (PTSD). The program is rated Effective. Treated adults showed statistically significant lower PTSD symptoms, depression, and anxiety than comparison group adults. Treated youth showed statistically significant higher levels of hope and lower levels of the PTSD criterion of intrusive re-experiencing than comparison group youth, but there were no impacts in other mental health outcomes.
- Universal School-Based Prevention and Intervention Programs for Aggressive and Disruptive Behavior - Universal school-based prevention and intervention programs for aggressive and disruptive behavior target elementary, middle, and high school students in a universal setting, rather than focusing on only a selective group of students, with the intention of preventing or reducing violent, aggressive, or disruptive behaviors. The practice is rated Effective in reducing violent, aggressive, and/or disruptive behaviors in students.