Selection Criteria – Federal Trade Commission

My original thought for Angels in the Rough was that it would be a support mechanism for parents whose son or daughter was already attending a therapeutic treatment program.  What has actually happened is that parents considering placement are also looking at this blog.  Given this, I would be doing these families a disservice if I did not address problems in this industry.

Simply stated the industry is not unscathed.  Although there are excellent legitimate therapeutic treatment programs there have also been cases of abuse, even, sadly, negligent deaths at some programs.  In addition, there have been cases where the program simply did not deliver the services they said they would.  If you wonder why, these issues are due to a variety of reasons including: unfortunately, and as seen in many industries, there are people who are simply unethical, people who will take advantage of people’s fears and moments of crisis, and simply people who just don’t have the appropriate training and background to provide the services they advertise they offer.  In addition, the reality is that today not all states have licensing requirements for these programs nor do all states require monitoring of these programs as mental health or educational facilities.  Furthermore, the federal government has yet to require regulation of these programs.  The good news is that various groups have mobilized and are working to pass legislation (there is an act in Congress pending approval – more on this in another blog).  In addition, there are other groups  helping educate parents in the interim(I will also follow up more on this in another blog).

So what does a parent do now?  In my opinion, you surround yourself with a strong local team that includes someone who is knowledgeable and has an unbiased relationship with different residential and local programs.  In addition, you do your own independent research, you make phone calls.  Simply stated you educate yourself as much as possible and as quickly as possible (unfortunately, many families are in crisis when they’re looking at programs) to the options that are available.  With this team and information in hand, you make the best decision for your family.  Whether your son or daughter goes to a therapeutic residential program  or not, it is important that you follow up to make sure that everything is going according to plan as adjustments may be needed.

With this background, over the next few blogs I will provide additional sources of information for parents to consider when looking at a residential treatment centers so as to better enable to make the best decision for their family.  The first of these sources is the Federal Trade Commission (FTC ).  In posting the FTC’s questions to ask prospective programs, some results from the Government Accountability Office’s (GAO) Report to Congress (October 2007) will be addressed (more on this report in another blog).

Please note that although it is my goal to consolidate these multiple sources in a summary page, for now, I thought I would share this information independently so parents could at least have an opportunity to peruse this data at their discreition.  I will follow up with other sources shortly.

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Federal Trade Commission

Per their website,

“The Federal Trade Commission (FTC), the nation’s consumer protection agency, cautions that before you enroll a youngster in a private residential treatment program, check it out: ask questions; ask for proof or support for claims about staff credentials, program accreditation, and endorsements; do a site visit; and get all policies and promises in writing.”

The FTC provides the following set of questions to ask prospective programs (from http://www.ftc.gov/bcp/edu/pubs/consumer/products/pro27.shtm).  You will note that some of these questions are almost identical to those provided in the blog Selection Criteria while other questions are more detailed  (e.g. licensing requirements details), etc..  Hopefully the specifics noted here will help explain the reasons for these questions.

Questions for Prospective Programs

1.  Are you licensed by the state? If the answer is yes, find out what aspects of the program the license covers: educational, mental/behavioral health, and/or residential? If the program claims to be licensed, get the name of the state agency that issued the license and contact the agency to verify that the license is current. Often, the licensing will be through a state Department of Health and Human Services or its equivalent. If the program’s representative can’t provide the name of the licensing agency, consider it a red flag.If the program is unlicensed and you still want to consider it, contact the state Attorney General (via the National Association of Attorney Generals – www.naag.org), the Better Business Bureau (www.bbb.org), and the local consumer protection office (www.consumeraction.gov/state.shtml) where the program is located. Regardless of whether a program is licensed, when contacting any of these groups:

• Ask for copies of all publicly available information, including any complaints or actions filed against the program, site visit evaluations, violations, and corrective actions.
• Pay particular attention to any reports of unsanitary or unsafe living conditions, nutritionally compromised diets, exposure to extreme environmental conditions or extreme physical exertion, inadequate staff supervision or a low ratio of staff to residents, medical neglect, physical or sexual abuse of youth by program staff or other residents, and any violation of youth or family rights.

2.  Do you provide an academic curriculum? If so, is it available to all program participants? Do you have teachers who are certified or licensed by your state? Some programs may offer only self-study or distance education. Sometimes, educational options are not made available until a resident has reached an advanced phase of the program. In addition, some programs may claim that academic credits will transfer to the resident’s home school and count toward a high school diploma. Check with the board of education in the state where the program operates – and with your state board if you live out-of-state – to verify that academic credits will transfer.

3.  What about accreditation? Several independent nonprofit organizations, like the Joint Commission (JACHO), the Council on Accreditation (COA), and the Commission on Accreditation of Rehabilitation Facilities (CARF), accredit mental health programs and providers.

• JACHO accredits and certifies more than 15,000 health care organizations and programs in the U.S. (www.jointcommission.org)
• COA is an international child- and family-service and behavioral healthcare organization that accredits 38 different service areas, including substance abuse treatment, and more than 60 types of programs. (www.coanet.org)
• CARF International is an independent accreditor of human services providers in areas including behavioral health, child and youth services, and employment and community services. (www.carf.org)

Ask whether all components of the program are accredited, for example, the base program, the drug and alcohol component, and the wilderness program. Then contact the accrediting organization for confirmation.

The GAO’s Report noted that one program claimed to be accredited by the JACHO, but in fact, only the base program was accredited. Neither the wilderness program nor the drug and alcohol component was accredited.

The organizations above grant accreditation and certification after evaluating the quality of services provided by a treatment program. Parents and guardians should be aware that some other organizations that claim to accredit schools may serve merely as membership organizations, and may not conduct site inspections or otherwise evaluate the quality of the programs they certify. If a treatment program claims to be certified or accredited, parents and guardians should contact the accrediting organization and ask about the standards the organization uses when issuing a certification.

4.  Do you have a clinical director? What are his/her credentials?Typically, a clinical director is responsible for overseeing, supporting, and maintaining the quality of care for the program. A clinical director may have an advanced degree in a related field, like clinical psychology, and may be involved in providing individual therapy, assessment and consultation, staff training and development, and managing or supervising the components of the program.

5.  What are the credentials of the staff, especially the counselors and therapists, who will be working with my child?Do they have appropriate and relevant advanced degrees like a Masters in Social Work, a license to do clinical social work (LCSW), a Ph.D., or an M.D.? Are they certified or licensed within the state? If they are, by what agency or organization?Ask to see copies of relevant documents, and consider contacting the certifying or licensing organization to confirm the staff credentials. The GAO found that some program leaders falsely claimed to have credentials in therapy or medicine, which led some parents to trust them with teens who had serious mental or physical disabilities requiring different levels of treatment.

6.  How experienced is your staff?  Have they worked at other residential treatment programs?  If yes, where and for how long?  Ask to see current certifications in CPR and other emergency medicine. For wilderness programs, also ask for proof of relevant training and expertise.

7.  Do you conduct background checks on your employees?  If the answer is yes, find out who does the background check and how extensive it is. Call the company to confirm that it provides background check services for the treatment program.  If the answer is no or the program does not conduct background checks, consider it a red flag.

8.  What are the criteria for admission ?  Do you conduct pre-admission assessments?  Are they in person, by phone, or over the Internet?  Who conducts them?  If your child has serious addiction problems or psychological issues, take special care to ensure that the program is equipped to deal with them.  Discuss the appropriateness of the program with your child’s psychologist, psychiatrist, or other healthcare provider.

9.  Will you provide an individualized program with a detailed explanation of the therapies, interventions, and supports that will address my child’s needs?  When is this done?  How often will my child be reassessed?  Ask whether your child will have group or individual therapy sessions. If the answer is yes, ask how often the sessions will take place and who will conduct them. Once enrolled, confirm with your child that the promised level of care is being received.

10.  How do you handle medical issues like illness or injury?  Is there a nurse or doctor on staff?  On the premises?   Will you contact me?  Will I be notified or consulted if there’s a change in treatment or medication? Ask for copies of procedures the program follows on dealing with medical emergencies.

11.  How do you define success?  What is your success rate?  How is it measured?  Some programs make specific success claims in their advertising materials.  To date, there is no systematic, independently collected descriptive or outcome data on these programs.

12.  How do you discipline program participants? Ask about policies and procedures for discipline.

13.  Can I contact/speak with my child when I want?  Can my child contact me when he wants?  Some programs prohibit, monitor, or otherwise restrict verbal or written communication between you and your child. Find out what is allowed and prohibited before you enroll your child.

14.  What are the costs?  What do they cover?  What is your refund policy if the program doesn’t work out?  Private residential treatment programs often charge hundreds of dollars per day.  While health insurance sometimes may pay a limited amount, for the most part, the youngster’s family is responsible for paying the fees and bills.

15.  Do you have relationships with companies and individuals that provide educational and referral services?  Some companies may provide services, claiming to match troubled kids with an appropriate treatment program.  Be aware that although some of these services represent themselves as independent, they may not be.  They may actually be operated or paid by one or more of the treatment programs.  Ask the service if it receives commissions from the treatment programs.

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The Federal Trade Commission also provides additional information sources.  These include:

• The Government Accountability Office’s (GAO) Report to Congress: “Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth” (October 2007) – www.gao.gov
• The U.S. Department of Health and Human Services, Centers for Disease Control and Prevention’s list of state mental health agencies – www.cdc.gov/mentalhealth/state_orgs.htm
• The U.S. Department of State Fact Sheet: “Behavior Modification Facilities” – www.state.gov
• The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) – http://astart.fmhi.usf.edu. A START is sponsored by the Department of Child and Family Studies of the University of South Florida. The Alliance includes leaders in psychology, psychiatry, nursing, mental health law, policy and family advocacy, as well as individuals with direct program experience as director, evaluator, parent, or participant in such programs.

My hope is to address these sources in individual blogs.

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As always, I hope that this has been of use.