Published in Children’s Voice, Volume 29, Number 1

by Mark Chatfield

Each year in the United States, tens of thousands of young people are placed in residential programs— in which youth temporarily live outside of their homes in facilities where they can be supervised and monitored—to receive treatment for substance abuse, behavioral problems, or psychological issues. Many treatment recipients may report that they are helped, or even “saved” by these programs, while others in the same cohort may report harm or a mix of positive and negative effects.. Some youth who are placed in restrictive, intrusive, and insular settings may have problems accessing the psychosocial resources necessary for positive development. One obstacle to preventing such effects may be the disagreement among professionals on how to identify the program features that will be problematic.

It would be inaccurate to say that highly restrictive, intrusive, and insular settings are inherently harmful. It is perhaps more helpful to think of them as “totalistic,” a more neutral concept that might help child welfare advocates and professionals resist binary terminology that assumes a treatment setting is either harmful or helpful.With these considerations in mind, I developed a qualitative research project to understand the lived experiences, immediate effects, and long-term impacts of highly totalistic programs.

In the study, each participant rated “how totalistic” their program’s features were. Seven items were developed to measure key features that characterize totalistic teen treatment programs: (1) peer policing; (2) communication restrictions; (3) centralized authority of program staff; (4) hierarchical social status levels, typically beginning with a probationary period of minimal privileges; (5) confessions and confrontations in group therapy; (6) strict rules and punishments; and (7) a philosophy of total personal transformation.

The invitation to participate in research described the study and an online questionnaire. I shared it with authors and treatment professionals affiliated with residential youth programs across the United States who in turn agreed to share it among their contacts. A total of 223 people completed the questionnaire; 212 of them rated their respective programs as “highly totalistic.” Thirty adults aged 19 to 53, who had resided in highly totalistic programs when they were youths, were selected from this group and interviewed by phone. Twenty-five different programs located in 12 states across the nation, and one American-owned program located in Mexico, were represented in this sample. They included therapeutic boarding schools, residential treatment centers, wilderness or outdoor programs, and intensive outpatient programs.

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Mark Chatfield received his master of science degree in the Department of Family, Youth and Community Sciences at the University of Florida, where he is now is a PhD student in U.S. History. His masterʼs thesis, “Adult Perspectives on Totalistic Teen Treatment: Experiences and Impact,” is available online. An essay about his research is featured in Child Maltreatment in Insular & Isolated Communities, a collection published in 2018 by the Child Welfare League of America and the Field Center at the University of Pennsylvania. A peer-reviewed article summarizing his thesis also is available online in the Journal of Extreme Anthropology.