The progressive past of residential treatment of emotionally disturbed children.

In January 1949, 9-year-old Betty stepped through the doors of the Cincinnati Child Guidance Home. For the next 2 years, the Home would attempt to treat her severe emotional and behavioral problems in an experimental approach called residential treatment. After 4 years of child welfare and child guidance interventions, the Home was a last resort. Betty’s home life was a mess. When she was 3, her “promiscuous” mother had deserted the family, and her father, an alcoholic, was gone most of the time. The house was so messy that the family was evicted over and over.1 Two foster homes later, Betty arrived at a local child guidance clinic, where the staff noted her “extreme stubbornness, destructive behavior, vomiting, soiling, and diurnal and nocturnal enuresis.”1 Betty ’s third foster mother, Mrs F, resented having to care for this “defective” child. She regularly beat Betty, who had blank staring spells and skipped school. Fed up with this behavior, Mrs F begged the child guidance clinic to admit the girl to a psychiatric hospital.1 Looking back, we might imagine that Betty would have been sent away to a state mental hospital or a punitive custodial institution for delinquent girls. Twenty years earlier, this might have been the case,2 but, in fact, Betty had a very different experience than what we might expect. The Cincinnati Child Guidance Home, where Betty was admitted, was a new, radical alternative for children like her. One of a small number of new inpatient treatment facilities for emotionally disturbed children called residential treatment centers, it was intended to treat difficult children for whom outpatient interventions had failed. Today, the early years of residential treatment have largely been forgotten. But a look back at Betty’s experience reveals a progressive experiment to provide integrated, intensive treatment of children otherwise deemed hopeless. At the Home, Betty encountered a new model of care. Residential treatment, on the rise in dozens of centers all over the country, adopted a child-centered, nonpunitive approach to help children develop healthy ways of interacting with others. Ultimately, staff members hoped to reintegrate children into the larger community by providing corrective and educational experiences in a homelike setting. They believed that the children’s problems, which they called “emotional disturbances,” had resulted from growing up in a pathologic home environment. Residential treatment would give the child relief from this environment and an opportunity for a “corrective living experience,” as child psychiatrist and Home director Othilda Krug explained.3 To treat these incredibly challenging children, the Cincinnati Child Guidance Home employed three psychiatrists, two psychiatry residents, several case workers, and three residential workers to work with the children around the clock.4 The Home’s therapeutic milieu was a carefully designed environment intended to help each child experience