When reviewing options for residential behavioral healthcare parents often ask questions and share concerns about not only the programs which are currently available but also about the history of the industry as a whole. Like all histories, the history of behavioral health is not universally favorable - and so it can be difficult for a family to differentiate between the various options which currently exist and the historical problems or shortcomings of the past. Some of those historical problems - addressed through litigation, increased state oversight, and the widespread adoption of standards in accreditation and clinical best practices - continue to adversely color current perceptions of the field despite significant advances and improvements.
This blog is intended to:
- provide additional historical perspective
- assist parents in recognizing not all treatment programs and interventions are created equal
- highlight the differentiation between historical and current options.
The history of behavioral healthcare is rich with evolution, innovation, and reinvention - and is both broad and long enough to include both visionaries and charlatans. Too often, the current advances and practices in the field of behavioral healthcare are haphazardly lumped in with references to long-ago closed programs, defunct business, and business practices and practitioners well-removed from the landscape of current options. This confusion and conflation only serves to make an already difficult family decision more complex - until some additional context is provided.
One scary chapter in the history is The Worldwide Association of Specialty Programs and Schools (also referred to as WWASPS). These were a collection of troubled teen treatment programs owned by Richard Lichfield, founded in 1998. There have been many lawsuits filed, and many settled out of court, against the WWASPs. According to an article written in The Hill in 2007, there were 133 different plaintiffs in one case against WWASPS. Then another case with 25 plaintiffs in July of 2007 “in the U.S. District Court of the Northern District of New York alleges that Lichfield and several partners entered into a scheme to defraud them by operating an unlicensed boarding school in upstate New York. The suit does not allege physical or emotional abuse,” said The Hill. Some of these cases were thrown out for procedural reasons and others were settled out of court.
While I am not an investigative journalist, nor is my goal to denigrate, debate, or re-litigate the efficacy of the WWASPs, it is important to highlight that the history of the WWASPs is not the universal history of the field, nor is it indicative of the typical care families can expect from the reputable and state-licensed and nationally accredited treatment programs of today’s landscape.*
Why do the WWASPS ‘treatment’ programs matter?
At their largest, WWASPs operated Behavior Modification programs in Missouri, Iowa, Utah, Samoa, Mexico, Jamaica, Costa Rica, Nevada, Montana, Colorado, California and South Carolina. Each of these programs served 100 - 300 students at a time, and were marketed as Therapeutic Boarding Schoolsor Residential Treatment Centers. During the years they operated, there was limited licensing in most of the places WWASP programs were operating, so those designations were purely self-identified, often not related to formal licensure. There is a website created and dedicated to “Survivors” of these programs. I am sure there are students who attended, who found success and there are a lot of former students who do not feel that way.
Change has happened and is happening since the 1990’s for adolescent treatment. Many states now have licensing systems that indicate and dictate levels of care. Many of the WWASP horror story programs did not have clinically-trained, licensed therapists or counselors who worked with clients - or if they did, the caseloads were often significantly larger than what we recognize as standard today.
Understanding the ripple effects and legacy of the WWASPs is important because they often get put in the same descriptors as treatment programs today. These historical programs are often mentioned, usually by the specific program’s name, in the media when a currently-operating program is in the news. By mentioning WWASPs in the same story as a currently-available option, journalists may be either intentionally or inadvertently implying a relationship between the two - where any similarities may not exist at all .
For instance, the WWASPs were classified as therapeutic boarding schools - yet, the “school” aspect was often a questionable element. Programs often did not offer formal classrooms, and the students completed school via unsupported or unsupervised packet work. Additionally, the WWASP programs did not always hire licensed teachers, and there were few, if any, licensed therapists on treatment teams. Staffing ratios at WWASP programs were much higher than most states requirements for this level of care, if the state today even licenses this level of care. Today, outcome-based treatment modalities, formal treatment plans, national or state accreditation - all the features that any consumer of teen treatment today should expect from treatment programs today - were absent from the WWASP programs.
The WWASPs minimalist services, intended to maximize profits, are exactly what reputable organizations of today strive to differentiate from - and significant strides have been made in programmatic and clinical efficacy. At this point in time, if a treatment program does not have a licensed therapist(s) or licensed teachers or accredited school, or is not accredited either by a state licensing division, or a national organization (CARF, COA, NIPSA, AEE, Joint Commission, etc) - ASK MORE QUESTIONS.
In addition to providing relevant information and suggested questions to families who are seeking treatment options, the advertisements listings on allkindsoftherapy.com require the program to answer questions, be transparent in a way that is not in typical online treatment directories. The reason for this is that the facts about treatment and interventions can be hidden or glossed over. In order to be an advertiser on All Kinds of Therapy, treatment and intervention programs, professionals must maintain transparency and be willing to answer over 30 specific questions which drill down into the specifics of clinical caseloads, accreditation, treatment modalities, and other specifics which can help families get a more transparent window through which to evaluate treatment options. If a treatment program is not listed on the website, use the facts that advertisers provide here as a springboard to your questions to a treatment program you are investigating. Additionally, the side-by-side comparison feature allows families to compare treatment options in an apples-to-apples format, which also increases family awareness and informed decision making. By understanding the significant differences between today’s Family Choice Behavioral Healthcare options and options like the WWASPs, families can make more informed decisions and feel confident in the care and support their family member will receive.
(* Historical context, NATSAP did not exist and some say it was formed because of what the WWASPS programs did. There is so much more to all of these stories, as you can see from the image from the blog.)
About the Author
Jenney Wilder, M.S.Ed launched All Kinds of Therapy in 2015, as the only independent online directory. With an impressive case of ADHD and her starter career in the 90's in Silicon Valley, the idea for creating an easy to filter online directory and feature-rich treatment programs & interventions germinated from her own needs. Jenney has a Masters in Special Education from Bank Street College (NY) and a Bachelor of Arts focused on History from Wheaton College (MA).