Behavior modification facility

Last updated

A behavior modification facility (or youth residential program) is a residential educational and treatment institution enrolling adolescents who are perceived as displaying antisocial behavior, in an attempt to alter their conduct.

Contents

Due to irregular licensing rules across countries and states, as well as ambiguity regarding the labels that facilities use themselves, it is hard to gauge how widespread the facilities are. [1] The facilities are part of what has been called the Troubled Teen Industry. [1] Programs in the United States have been controversial due to widespread allegations of abuse and trauma imposed on the adolescents who are enrolled, as well as deceptive marketing practices aimed at parents. [1] Critics say the facilities do not use evidence-based treatments. [1]

Methodologies used in such programs

Practices and service quality in such program vary greatly. The behavior modification methodologies used vary, but a combination of positive and negative reinforcement is typically used. [2] Often these methods are delivered in a contingency management format such as a point system or level system. [3] Such methodology has been found to be highly effective in the treatment of disruptive disorders (see meta-analysis of Chen & Ma (2007). [4]

Positive reinforcement mechanisms include points, rewards and signs of status, [5] while punishment procedures may include time-outs, [6] point deductions, reversal of status, prolonged stays at a facility, physical restraint, or even corporal punishment. Research showed that time out length was not a factor and suggestions were made to limit time out to five minute durations. [6] A newer approach uses graduated sanctions. [7] Staff appear easily trained in behavioral intervention, such training is maintained and does lead to improved consumer outcomes, as well as reduce turn over. [8] More restrictive punishment procedures in general are less appealing to staff and administrators. [9]

Behavioral programs were found to lessen the need for medication. [10] Several studies have found that gains made in residential treatment programs are maintained from 1–5 years post discharge. [11] Therapeutic boarding schools are boarding schools based on the therapeutic community model that offers an educational program together with specialized structure and supervision for students with emotional and behavioral problems, substance abuse problems, or learning difficulties. Some schools are accredited as Residential treatment centers.

Behavioral residential treatment became so popular in the 1970s and 1980s that a journal was formed called Behavioral Residential Treatment, which later changed its name to Behavioral Interventions . The journal continues to be published today.

History

In the late 1960s, behavior modification or practice referred to as applied behavior analysis began to move rapidly into residential treatment facilities. [12] [13] The goal was to redesign the behavioral architecture around delinquent teens to lessen chances of recidivism [14] and improve academics. [15] Harold Cohen and James Filipczak (1971) published a book hailing the successes of such programs in doubling learning rates and reducing recidivism. [16] This book even contained an introduction from the leading behaviorist at the time, B.F. Skinner hailing the achievements. Independent analysis of multiple sites with thousands of adolescents found behavior modification to be more effective than treatment as usual, a therapeutic milieu, and as effective as more psychologically intense programs such as transactional analysis with better outcomes on behavioral measures; [17] however, these authors found that behavior modification was more prone to leading to poor relationships with the clients. [18] Over time, interest faded in Cohen's CASE project. [19] Other studies found that in proper supervision of staff in behavior modification facilities could lead to greater use of punishment procedures. [20]

Under the leadership of Montrose Wolf, Achievement place, the first Teaching Family Home became the prototype for behavioral programs. [21] Achievement place opened in 1967. Each home has from 6-8 boys in it with two "parents" trained in behavior modification principles. The token system for the program was divided into 3 levels. Outcome studies have found that Achievement place and other teaching family homes reduce recidivism and increase pro-social behavior, as well as self-esteem. [22] [23] While initial research suggested the effects of the program only lasted for one year post discharge, recent review of the data suggests the program lasts longer in effect. [24]

Gradually, behavior modification /applied behavior analysis within the penal system including residential facilities for delinquent youth lost popularity in the 1970s-1980s due to a large number of abuses (see Cautilli & Weinberg (2007) [25] ), but recent trends in the increase in U.S. crime and recent focus on reduction of recidivism have given such programs a second look . [26] [27] Indeed, because of societal needs the number of youth residential facilities has grown over recent years to close to 39,950 in 2000. [28] The use of functional analysis has been shown to be teachable to staff and able to reduce use of punishment procedures. [29] Rutherford's (2009) review from interviews and archival materials documents the decline from treatment of behavior analysis with criminal justice populations. [19]

These facilities are part of what has been described as the Troubled Teen Industry. [1]

Some model programs

Some journalists[ by whom? ] claim that boot camp type programs have not been shown to be successful; however, many successful graduates[ by whom? ] openly disagree, stating that the claim that "they represent punishment devoid of context" (unlike in the military, where passing boot camp initiates one into the service) is in fact untrue[ citation needed ]. Often, the graduates[ by whom? ] say, the reward for graduation is the removal of a life altering felony conviction and a vocational or formal university education offered free of charge to graduates by state-funded programs[ citation needed ]. As well, they[ by whom? ] argue that the negative claims are biased as supporting data was gathered by examining private religious and reform school boot camp programs, as opposed to well designed programs that offer structured rehabilitation[ citation needed ]. In addition, proponents of boot camp programs[ by whom? ] claim that some studies were designed by those with financial interest in alternative options and those who in general have no military experience, supported in their arguments only by claims from students who have been discharged from the programs unsuccessfully[ citation needed ].

Studies of successful graduates have shown that boot camp programs as an alternative to prison time are particularly successful in reducing criminality, but these studies are limited to successful graduates of state correctional and prison-alternative programs managed by current and former military service members. [30] Programs such as teaching family homes based on the Teaching-Family Model have been researched by industry funded organizations and show positive gains. Research shows that they can be used to reduce delinquency while adolescents are in the home and post release {see Kingsley (2006) [31] . In general, these types of programs take a behavioral engineering approach to reducing problem behavior and building skills.

In general, behavior modification programs, including military style boot camps that follow modern curriculum, that are used in facilities or in the natural environment have a large effect size and lead to an estimated 15 to 40 %0reduction in recidivism. [32] While this reduction appears to be modest, it holds potention[ check spelling ] in the U.S. given the large number of people in the prison system. Increasingly, behavior modification models based on the principles of applied behavior analysis, cognitave behavioral therapy, and dialectic behavioral therapy are being developed to model and reduce delinquency and are being integrated into programs of all types. [33]

Controversy

This industry is not without controversy, however. The U.S. Surgeon General (1999) discussed the need to clarify admission criteria to residential treatment programs. [34] Included in the same report was the call for more updated research as most of the residential research had been completed in the 1960s and 1970s. [34] [ dead link ]. Disability rights organizations, such as the Bazelon Center for Mental Health Law, oppose placement in such programs and call into question the appropriateness and efficacy of such group placements, the failure of such programs to address problems in the child's home and community environment, the limited or no mental health services offered and substandard educational programs.

Bazelon promotes community-based services on the basis that it considers more effective and less costly than residential placement. [35] While the behavior modification programs can be delivered as easily in residential programs as in community-based programs [36] [37] overall community-based programs continue to lack empirical support especially with respect to long term outcomes for severe cases [38] with the notable exception of Hinckley and Ellis (1985). [39] Even with this said, in 1999 the surgeon general clearly stated "...it is premature to endorse the effectiveness of residential treatment for adolescents.". [34] [ dead link ]

From late 2007 through 2008, a broad coalition of grass roots efforts, prominent medical and psychological organizations that including members of Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART) and the Community Alliance for the Ethical Treatment of Youth (CAFETY), provided testimony and support that led to the creation of the Stop Child Abuse in Residential Programs for Teens Act of 2008 by the United States Congress Committee on Education and Labor. [40]

Jon Martin-Crawford and Kathryn Whitehead of CAFETY testified at a hearing of the United States Congress Committee on Education and Labor on April 24, 2008, [41] where they described abusive practices they had experienced at the Family Foundation School and Mission Mountain School, both therapeutic boarding schools. [42] [43]

One recent acknowledgement has been that long term care does not equate with better outcomes. [28] To reduce the tendency for abuse, a strong push has occurred to certify or license behavior modifiers [44] [45] or to have such practices limited to licensed psychologists.[ dead link ] In particular psychologists with behavioral training [46] American psychological association offers a diplomat (post Ph.D. and licensed certification) in behavioral psychology. [47]

Often the practice of behavior modification in facilities comes into question (see recent interest in Judge Rotenberg Educational Center, Aspen Education Group and the World Wide Association of Specialty Programs and Schools). Often these types of restrictive issues are discussed as part of ethical and legal standards (see Professional practice of behavior analysis). Recent research has identified some best practices for use in such facilities [28] In general policies in such facilities require the presence of a treatment team to ensure that abuses do not occur especially if facilities are attempting to use punishment programs. [48]

Regulations

In the U.S. residential treatment programs are all monitored at the state level and many are JACHO accredited. States vary in requirements to open such centers. Due to the absence of regulation of these programs by the federal government and because many are not subject to state licensing or monitoring, [49] the Federal Trade Commission has issued a guide for parents considering such placement. [50] Due to irregular licensing practices and differences in the kinds of labels that facilities use themselves, it is unclear how many facilities exist in the United States. [1]

Organizations

Residential therapist who are behavior modifiers should join professional organizations and be professionally affiliated. Many organizations exist for behavior therapists around the world. The World Association for Behavior Analysis offers a certification in behavior therapy In the United States, the American Psychological Association's Division 25 is the division for behavior analysis. The Association for Contextual Behavior Therapy is another professional organization. ACBS is home to many clinicians with specific interest in third generation behavior therapy. The Association for Behavioral and Cognitive Therapies (formerly the Association for the Advancement of Behavior Therapy) is for those with a more cognitive orientation. Internationally, most behavior therapists find a core intellectual home in the International Association for Behavior Analysis (ABA:I) .

See also

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. It was originally designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.

Ole Ivar Løvaas was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well-known for his research on early behavior modification to teach autistic children through prompts, modeling, and positive reinforcement. It is also noted for its use of aversives to reduce undesired behavior. He is also known for his experiments on gender-variant children in developing the practice of conversion therapy.

Applied Behavior Analysis (ABA), also called behavioral engineering, is a scientific technique concerned with applying empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on learning theory, such as respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

Youth detention center Type of prison for people under the age of majority

In criminal justice systems a youth detention center, known as a juvenile detention center (JDC), juvenile detention, juvenile hall, or more colloquially as juvie/juvy, also sometimes referred as observation home or remand home is a prison for people under the age of 21, often termed juvenile delinquents, to which they have been sentenced and committed for a period of time, or detained on a short-term basis while awaiting trial or placement in a long-term care program. Juveniles go through a separate court system, the juvenile court, which sentences or commits juveniles to a certain program or facility.

Behavior modification is a treatment approach that replaces undesirable behaviors with more desirable ones by using the principles of operant conditioning. Based on methodological behaviorism, overt behavior is modified with consequences, including positive and negative reinforcement contingencies to increase desirable behavior, or administering positive and negative punishment and/or extinction to reduce problematic behavior.

Adventure therapy Type of psychotherapy

Adventure therapy is a form of psychotherapy created as early as the 1960s. It is influenced by a variety of learning and psychological theories. Experiential education is the underlying philosophy. Existing research in adventure therapy reports positive outcomes in improving self-concept and self-esteem, help-seeking behavior, increased mutual aid, pro-social behavior, trust behavior, and more. There is some disagreement about the underlying process that creates these positive outcomes.

Wilderness therapy

Wilderness therapy is an adventure-based therapy treatment modality for behavior modification and interpersonal self-improvement, combining experiential education, individual and group therapy in a wilderness setting. The success of the Outward Bound outdoor education program in the 1940s inspired the approach taken by many current-day wilderness therapy programs, though some adopted a survivalist methodology. Young individuals aged 12–17 are the most frequent clients.

Boot camps are part of the correctional and penal system of some countries. Modeled after military recruit training camps, these programs are based on shock incarceration grounded on military techniques. The aggressive training used has resulted in deaths in a variety of circumstances. Boot camps are also criticized around the world for their lack of behavioral change and for the way extreme force can traumatize children and teenagers.

The Idaho Department of Juvenile Corrections (IDJC) is a state agency of Idaho that operates three juvenile correction centers and works closely with county probation departments to provide accountability, community protection, and rehabilitation to justice involved juveniles in Idaho. The three facilities are: Juvenile Corrections Center Lewiston (JCC-L), Juvenile Corrections Center Nampa (JCC-N), & Juvenile Corrections Center St. Anthony (JCC-SA). The agency has its headquarters in Boise.

Residential treatment center

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.

The professional practice of behavior analysis is one domain of behavior analysis: the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The professional practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both the experimental analysis of behavior and applied behavior analysis. Professional practice seeks maximum precision to change behavior most effectively in specific instances. Behavior analysts are mental health professionals and, in some states, may hold a license, certificate or registration as a behavior analyst. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as Behavior Analysts are becoming more and more common.

Community Alliance for the Ethical Treatment of Youth

The Community Alliance For the Ethical Treatment of Youth (CAFETY) is an advocacy group for people enrolled in residential treatment programs for at-risk teenagers. The group's mission includes advocating for access to advocates, due process, alternatives to aversive behavioral interventions, and alternatives to restraints and seclusion for young people in treatment programs. They have also called for the routine reporting of abuse in residential treatment programs, as well as federal government oversight and regulation of residential treatment programs.

A therapeutic boarding school is a residential school offering therapy for students with emotional or behavioral issues.

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems. According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness". In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate". Common factors is one route by which psychotherapy researchers have attempted to integrate psychotherapies.

Clinical behavior analysis is the clinical application of behavior analysis (ABA). CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism and the use of functional analytic models of verbal behavior—particularly, relational frame theory (RFT).

Multisystemic therapy (MST) is an intense, family-focused and community-based treatment program for juveniles with serious criminal offenses who are possibly abusing substances. It is also a therapy strategy to teach their families how to foster their success in recovery.

Vernon Lewis Quinsey is a Canadian psychologist. He has studied violent crime offenders, sex offenders, sexually violent predators, juvenile delinquency, and ways to predict, assess, and manage individuals with these tendencies. He testified in court that a rapist, Allen Edward Bullock, was "erotically attracted to that kind of behavior".

Gender responsive approach for girls in the juvenile justice system

Gender responsive approach for girls in the juvenile justice system represents an emerging trend in communities and courts throughout the United States, Australia and Latin America, as an increasing number of girls are entering the juvenile justice system. A gender responsive approach within the juvenile justice system emphasizes considering the unique circumstances and needs of females when designing juvenile justice system structures, policies, and procedures.

References

  1. 1 2 3 4 5 6 "Troubled US teens left traumatised by tough love camps". BBC News. 2021-06-18. Retrieved 2021-06-19.
  2. Martin, G.; Pear, J. (2007). Behavior modification: What it is and how to do it (8th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
  3. McKee, John M. (1971). "Contingency Management in a Correctional Institution". Educational Technology. 11 (4): 51–54. JSTOR   44417185.
  4. Chen, Chiu-Wen; Ma, Hsen-Hsing (2007). "Effects of treatment on disruptive behaviors: A quantitative synthesis of single-subject researches using the PEM approach". The Behavior Analyst Today. 8 (4): 380–397. doi:10.1037/h0100629.
  5. Cancio, Edward J.; Johnson, Jesse W. (2007). "Level systems revisited: An important tool for educating students with emotional and behavioral disorders". International Journal of Behavioral Consultation and Therapy. 3 (4): 512–527. doi:10.1037/h0100820.
  6. 1 2 McGuffin, Patrick W. (1991). "The effect of timeout duration on frequency of aggression in hospitalized children with conduct disorders". Behavioral Interventions. 6 (4): 279–288. doi:10.1002/bin.2360060405.
  7. Howell, J. C. (1998). "A new approach to juvenile crime: The promise of graduated sanctions in a juvenile justice system". Corrections Compendium. 23 (9).
  8. Rosen, Howard S.; Yerushalmi, Cydney J.; Walker, Jane C. (1986). "Training community residential staff: Evaluation and follow-up". Behavioral Interventions. 1: 15–38. doi:10.1002/bin.2360010104.
  9. Lindeman, David P.; Miltenberger, Raymond G.; Lennox, David B. (1992). "Acceptability of behavioral interventions: Perceptions of superintendents of public residential facilities". Behavioral Interventions. 7: 35–44. doi:10.1002/bin.2360070105.
  10. Foxx, R. M. (1998). "A comprehensive treatment program for inpatient adolescents". Behavioral Interventions. 13: 67–77. doi:10.1002/(SICI)1099-078X(199802)13:1<67::AID-BIN5>3.0.CO;2-I.
  11. "U.S. Surgeon General (1999). Mental Health. Chapter 3". Archived from the original on 2010-05-28. Retrieved 2010-07-08.
  12. Cohen, H. L.; Filipczak, J.; Bis, J.; Cohen, J.; Golddiamond, I.; Larkin, P. (1968). Case II- Model: A contingency oriented twenty-four-hour learning environment in a juvenile correctional institution. Silver Spring, Md: IBR Press.
  13. Milan, M. A.; McKee, J. M. (1974). "Behavior modification: Principles and applications in corrections". In Glasser, D. (ed.). Handbook of Criminology. Chicago: Rand McNally.
  14. Cohen, H. L. (1964). "Behavioral architecture". Architectural Association Journal.
  15. Tyler, Vernon O.; Brown, G. Duane (1968). "Token reinforcement of academic performance with institutionalized delinquent boys". Journal of Educational Psychology. 59 (3): 164–168. doi:10.1037/h0025874. PMID   5662684.
  16. Cohen, H. L.; Filipczak, J. (1971). A new learning environment. Jossey Bass.
  17. Jeness, Carl F. (1975). "Comparative Effectiveness of Behavior Modification and Transactional Analysis Programs for Delinquents". Journal of Consulting and Clinical Psychology. 43 (6): 758–779. doi:10.1037/h0078109. PMID   1194473.
  18. Jeness, Carl F. (1975). "Comparative Effectiveness of Behavior Modification and Transactional Analysis Programs for Delinquents". Journal of Consulting and Clinical Psychology. 43 (6): 758–779. doi:10.1037/h0078109. PMID   1194473.
  19. 1 2 Rutherford, A. (2009). Beyond the Box: B. F. Skinner's Technology of behavior from laboratory to life, 1950s-1970s. Toronto: University of Toronto Press.
  20. Bassett, John E.; Blanchard, Edward B. (1977). "The Effect of the Absence of Close Supervision on the Use of Response Cost in a Prison Token Economy 1". Journal of Applied Behavior Analysis. 10 (3): 375–379. doi:10.1901/jaba.1977.10-375. PMC   1311200 . PMID   924912.
  21. Phillips, Elery L. (1968). "Achievement Place: Token reinforcement procedures in a home-style rehabilitation setting for "pre-delinquent" boys1". Journal of Applied Behavior Analysis. 1 (3): 213–223. doi:10.1901/jaba.1968.1-213. PMC   1311003 . PMID   16795179.
  22. Braukenmann, C. J.; Wolf, M. M.; Kirgin-Ramp, K. A (1985). Follow up of group home youth into young adulthood (Report). Achievement Place Research Project.
  23. Maloney, Dennis M.; Fixsen, Dean L.; Phillips, Elery L. (1981). "The teaching-family model: Research and dissemination in a service program". Children and Youth Services Review. 3 (4): 343–355. doi:10.1016/0190-7409(81)90017-7.
  24. Kingsley, David E. (2006). "The teaching-family model and post-treatment recidivism: A critical review of the conventional wisdom". International Journal of Behavioral Consultation and Therapy. 2 (4): 481–497. doi:10.1037/h0101002.
  25. Cautilli, Joseph; Weinberg, Michael (2007). "Editorial: To license or not to license? That is the question: Or, if we make a profession, will they come?". The Behavior Analyst Today. 8: 1–8. doi:10.1037/h0100100.
  26. Redding, R.E. "Characteristics of Effective Treatments and Interventions for Juvenile Offenders". Juvenile Justice Fact Sheet. Institute of Law, Psychiatry & Public Policy.
  27. Lipsey, M.; Wilson, D. (1998). "Effective intervention for serious juvenile offenders: A synthesis of research". In Loeber, R.; Farrington, D. (eds.). Serious and Violent Juvenile Offenders. Thousand Oaks, CA: Sage Publications.
  28. 1 2 3 Underwood, Lee A.; Talbott, Leana Baggett; Mosholder, Eleanor; von Dresner, Kara Sandor (2008). "Methodological concerns of residential treatment and recidivism for juvenile offenders with disruptive behavioral disorders". The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention. 1 (2): 222–236. doi:10.1037/h0100467.
  29. Phillips, Katrina J.; Mudford, Oliver C. (2008). "Functional analysis skills training for residential caregivers". Behavioral Interventions. 23: 1–12. doi:10.1002/bin.252.
  30. Daly, D. L. (1994). "Do boot camps work". Caring. 10: 7–9.
  31. Kingsley, David E. (2006). "The teaching-family model and post-treatment recidivism: A critical review of the conventional wisdom". International Journal of Behavioral Consultation and Therapy. 2 (4): 481–497. doi:10.1037/h0101002.
  32. Itlescas, S. R.; Sánchez-Meca, J.; Genovés, V. G. (2001). "Treatment of offenders and recidivism: Assessment of the effectiveness of programmes applied in Europe" (PDF). Psychology in Spain. 5 (1): 47–62.
  33. Morris, Edward K. (1987). "Introductory Comments: Applied Behavior Analysis in Crime and Delinquency: Focus on Prevention". The Behavior Analyst. 10 (1): 67–68. doi:10.1007/BF03392407. PMC   2741939 . PMID   22477961.
  34. 1 2 3 U.S. Surgeon General (1999). Mental Health. Chapter 3 Archived May 28, 2010, at the Wayback Machine
  35. U.S. Supreme Court to Decide Forest Grove v. T.A.: Parents Should Win, But Bazelon Center Opposes Therapeutic Boarding Schools Archived 2009-05-21 at the Wayback Machine , Bazelon Center for Mental Health Law, Retrieved May 1, 2009
  36. Thoder, Vincent J.; Hesky, James G.; Cautilli, Joseph D. (2010). "Using reliable change to calculate clinically significant progress in children with EBD: A BHRS program evaluation". International Journal of Behavioral Consultation and Therapy. 6: 45–66. doi:10.1037/h0100897.
  37. Fuoco, Frederick J. (1993). "Behavioral interventions: Theory and practice in residential and community-based clinical programs". Behavioral Interventions. 8 (4): 227–228. doi:10.1002/bin.2360080402.
  38. Wells, Kathleen (1991). "Placement of emotionally disturbed children in residential treatment: A review of placement criteria". American Journal of Orthopsychiatry. 61 (3): 339–347. doi:10.1037/h0079274. PMID   1951641.
  39. Hinckley, Edward C.; Ellis, W. Frank (1985). "An Effective Alternative to Residential Placement: Home-based Services". Journal of Clinical Child Psychology. 14 (3): 209–213. doi:10.1207/s15374424jccp1403_7.
  40. "Stop Child Abuse in Residential Programs for Teens Act of 2008." Archived 2008-12-29 at the Wayback Machine Official bill language from the U.S. Congress. Retrieved May 1, 2009.
  41. "Child Abuse and Deceptive Marketing by Residential Programs for Teens." Archived 2008-12-12 at the Wayback Machine Official testimony to the U.S. Congress. Retrieved May 1, 2009.
  42. "Transcript of testimony of Jon Martin-Crawford." Archived 2009-04-30 at the Wayback Machine Official transcript from the U.S. Congress. Retrieved May 1, 2009.
  43. "Transcript of testimony of Kathryn Whitehead." Archived 2009-04-30 at the Wayback Machine Official transcript from the U.S. Congress. Retrieved May 1, 2009.
  44. BACB Archived January 7, 2008, at the Wayback Machine
  45. Hunter, Richard H. (2001). "Improving outcomes requires more, not less, from psychology". The Behavior Analyst Today. 2: 4–13. doi:10.1037/h0099908.
  46. Dowd, E. Thomas (2001). "Board certification (Diplomate) in behavioral psychology". The Behavior Analyst Today. 2: 15–17. doi:10.1037/h0099904.
  47. Spreat, Scott; Lipinski, David P. (1986). "A survey of state policies regarding the use of restrictive/Aversive behavior modification procedures". Behavioral Interventions. 1 (2): 137–152. doi:10.1002/bin.2360010205.
  48. Evaluating Private Residential Treatment Programs for Troubled Teens, FTC Urges Caution When Considering 'Boot Camps', FTC Federal Trade Commission, Retrieved May 1, 2009
  49. Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask, FTC Federal Trade Commission, Retrieved May 1, 2009