Troubled students diagnosed with mood and behavior disorders, substance abuse, academic problems or family difficulties represent an at-risk population with special needs. The brief sampling of research literature review outlined here is intended to explore how high school dropout rates and trends in mental health care support the need for private market, parent-choice therapeutic residential programs and schools. Recent and future studies that demonstrate the effectiveness of these programs are explored.
Increasing Dropout Rates
Twenty-five to thirty percent of American teenagers, including recent immigrants, fail to graduate from high school with a regular high school diploma, and dropout rates have not diminished over the past twenty years (Sum et al., 2003). For the 1995-96 school year, Louisiana had the highest dropout rate in the nation of 11.6% with a median dropout rate of 5.3% (Sum et al., 2003). Research shows that dropping out of school results in negative adulthood outcomes for former students (Kotering & Braziel, 2002).
Teen School Failure Has a Lifelong Effect
Chen and Kaplan use a life-course perspective and thirty-year longitudinal panel data set collected at three developmental stages with structural equation analyses to specify how early school failure influenced status attainment at midlife. Lower levels of mental health and higher rates of deviant behaviors in early adulthood are additional mediating processes (Chen & Kaplan, 2003). A modest residual direct effect of school failure in adolescence on status attainment at midlife is interpretable in terms of inherited or acquired cognitive abilities and motivational dispositions manifested in early adolescence (Chen & Kaplan, 2003).
A Desire for Alternative Learning Environments
Kotering and Braziel's study illustrates how youth with learning disabilities perceived various aspects of their high school program. Students participate in an interview that addressed the best and worst parts of school and recommend school, family or personal changes that would improve their success in school. Those interviewed provide examples of how a teacher helped them to learn and offered general recommendations for improving school (Kotering & Braziel, 2002). This information offers insight into how educators might better tailor high school interventions to help more youth with learning disabilities complete high school. The factors reported in this study support the case for an alternative classroom structure designed to reach at-risk students on an individual level.
Reduced Availability of Traditional Inpatient Treatment with Few Community Resources
There has been a decline in inpatient treatment availability for adolescents (Glied & Evans Cueller, 2003). In the late 1990s lengths-of-stay fell from an average of eighteen days in the mid-1980s to eight days in the late 1990s (Glied & Evans Cueller, 2003). Rather than serving as treatment modalities, inpatient units are increasingly providing crisis care and discharging seriously ill children for community follow-up (Glied & Evans Cueller, 2003). Institutional alternatives to long-term hospitalization are also lacking in many communities (Glied & Evans Cueller, 2003). While inpatient units discharge troubled teens with a plan for community follow-up, the real community options available to troubled students remain limited.
Increased Use of Psychotropic Medications
A trend in mental healthcare is an increase in prescribing psychotropic medications for teens (Glied & Evans Cuellar, 2003). Pharmacological and psychotherapeutic treatments are used to manage depression in children and adolescents with evidence from different trials that support benefit for both approaches (Varley, 2006). It can be concluded that the best practice combines treatment with both medication and psychotherapy, and that important safety issues must be monitored carefully when children and adolescents are treated for depression (Varley, 2006).
Comorbidity Requires Long-Term Solutions
Comorbidity in adolescents with mental health disorders and poly-drug use is best resolved in a multidisciplinary setting (Crome, 2004). Psychosocial interventions, such as motivational enhancement techniques and cognitive behavioral treatment as well as appropriate short-term use of a range of pharmacological agents, are the best options for treatment (Crome, 2004). Thus the need for a longitudinal and multidisciplinary approach (with appropriate assessment instruments in young people) is required to further explore diagnostic classification, which will classify the degrees and patterns of relationships between disorders (Crome, 2004).
The Juvenile Justice System is Overwhelmed with Mentally Ill Teens
Teplin, Abram, McClelland, Dulcan and Mericle used the Diagnostic Interview Schedule for Children to assess a randomly selected, stratified sample of youth who were arrested and detained in a juvenile detention center. They presented six-month prevalence estimates by demographic subgroups for affective, anxiety, psychosis, attention-deficit/hyperactivity, disruptive behavior and substance abuse disorders (Teplin et al., 2002). This study shows that youth with psychiatric disorders pose a challenge for the juvenile justice system and for the larger mental health system (Teplin et al., 2002). Nearly 60% of male detainees and more than two thirds of females met diagnostic criteria and had a diagnosis-specific impairment for one or more psychiatric disorders (Teplin et al., 2002).
Private Parent-Choice Therapeutic Residential Programs and Schools Are Meeting the Needs of Troubled Teens with Unique Solutions
Behrens and Satterfield (2006) used a longitudinal, multi-center study of outcomes in private residential treatment. It appears that private residential treatment clients are equally likely to be male or female, unlikely to be from ethnic minority backgrounds and are placed in treatment by their parents (Behrens and Satterfield, 2006). Analyses of variance indicated that both adolescents and parents reported a significant reduction in problems from admission to discharge, on each aggregate measure psycho-social functioning (Behrens and Satterfield, 2006). These suggested that adolescent problems improve significantly during private residential treatment and that, with only a few exceptions, discharge functioning and in-treatment change are relatively similar, regardless of adolescent background, history, problems and treatment factors (Behrens and Satterfield, 2006)
More Research to Come
The emerging field of private, parent-choice therapeutic residential programs and schools present new approaches to the unmet needs of troubled teens. There is an industry awareness of the need for more outcome studies that prove their effectiveness. There are more studies underway. The National Association of Therapeutic Schools and Programs (NATSAP) leads the these efforts. Currently, there are five concurrent research projects at work. Their studies are outlined on their website at www.NATSAP.org. These studies cover a wide range of topics and have involved both single programs efforts as well as collaborative projects.
The trends in education, mental health and juvenile justice in the sampling of studies listed are serious indicators. The need for new ideas and innovations in residential treatment options for teens is evident. As this book outlines, there are, in fact, innovations and new ideas currently being offered and developed by the private market, parent-choice therapeutic residential programs and schools. The newly emerged industry provides multiple alternative approaches to education that are adaptable to the needs of teens.
Behrens, E. & Satterfield, K. (2006, August). Report of findings from a multi-center study of youth outcomes in private residential treatment. Paper presented at the 114th Annual Convention of the American Psychological Association, New Orleans, Louisiana.
Chen, Z. & Kaplan, H.B. (2003). School failure in early adolescence and status attainment in middle adulthood: A longitudinal study. Sociology of Education, 76, 110-127.
Crome, I.B. (2004). Co-morbidity in young people: Perspectives and challenges. Acta Neuropsychiatrica, 16, 47-53.
Giled, S. & Evans Cuellar, A. (2003). Trends and issues in child and adolescent mental health. Health Affairs, 22, 39-50.
Kortering, L & Braziel, P. (2002). A look at high school programs as perceived by youth with learning disabilities. Learning Disability Quarterly, 25,177-187.
Sum, A., Harrington, P., Bartishevich, C., Fogg, N., Khatiwada, I.,& Motoroni, J., et al. (2003). The hidden crisis in the high school dropout problems of young adults in the us: Recent trends in overall school dropout rates and gender differences in dropout behavior. The Business Roundtable.
Teplin, L.A., Abram, K.M., McClelland, G.M., Dulcan, M.K. & Mericle, A.A. (2002). Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry, 59, 1133-1143.
Varley, C.K. (2006). Treating depression in children and adolescents: What options now? CNS Drugs, 20, 1-13.