What Is Therapeutic Respite Care? (This Is a Serious Question)

Can anyone define for me what “therapeutic respite care” is, either from a practical or from a legal/licensing viewpoint? I understand respite care, a service provided by foster families or agencies that provide care for a few days for children or adults with special needs, whose families are exhausted with caring for them. I also understand the concept of therapeutic foster care and of special training for resource parents who want to provide a supportive environment for children with physical, cognitive, or emotional disabilities. Organizations or individuals who provide either of these kinds of care are normally licensed by their states, and 

staff  have been subjected to criminal background checks and evaluation of their educational qualifications.

It’s also possible for states to license residential treatment facilities for children and adolescents with chronic emotional, behavioral, or mental health issues. These facilities care for larger numbers of children than would be possible in a foster home, they must have trained professional staff, and they provide educational services as appropriate for each child. They are required to establish treatment plans and goals, rather than simply to “warehouse” children and adolescents whose parents are having difficulty coping.

But therapeutic respite care? Google shows one use of the term to refer to actual brief respite for families with special needs children (www.nvfs.org). Otherwise,  I am not sure there is any such animal under discussion in the conventional world of child and adolescent mental health care. 

When I Google this term, here’s what I see: raisinamazin.com/therapeutic-respite-services, an Oregon outfit that claims to deal with “deep seeded” [sic] problems through the use of chores, journaling (or coloring for younger children), “affirmations and I-statement work”, while keeping the child in the caregiver’s line of sight at all times except when under the surveillance of a video monitor at night. Raisinamazin states that one of the trainers for their staff is Nancy Thomas, of dog-training and holding therapy fame, the lady who has stated that she can tell when parents are good to foster or adopted children because the children still have their heads and arms and legs on. Thomas also advises withholding quantities or varieties of food in response to undesired child behavior--  for example, providing only peanut butter sandwiches and milk rather than regular meals.

Google also shows a 2007 page by the Attachment Therapy/Holding Therapy advocate Deborah Hage, deborahhage.com/articles/respt2rescu.html. In her discussion of therapeutic respite and therapeutic motivational respite ( her term for  a treatment “set up when the child has regressed to such a level that a change of venue is needed in order to motivate him to ‘shift gears’ “), Hage  references practices like those mentioned by the raisinamazin organization and Nancy Thomas, including the use of journaling, chores, and exercise, which “gets oxygen to the brain and enables it to think more clearly”. In addition, the therapeutic respite provider must be eternally vigilant, and “her attention must be so excruciating for the child that he gets the message loud and clear that he never wants to return and be subject to such scrutiny again”. These methods are recommended for use with children whose behaviors Hage attributes to disorders of attachment.

 Google lists a series of providers of therapeutic respite care, including Nancy Thomas, at attachmenttraumanetwork.com/respite.html. This organization attributes unwanted behavior to Reactive Attachment Disorder, and presumably that is the diagnosis considered treatable through therapeutic respite care.

One more: Google shows home4healinghearts.com/about-us/the-support-we-offer/what-is-therapeutic-respite as an entity that offers therapeutic respite care. Such care is intended to make “your child… respectful, responsible, and fun to be around. Your child is expected to work hard to get a strong heart so that he or she can return to the family that loves them. Of course, the duration of the stay will be determined by the adults and specialists involved, but your child will be under the impression [! JM] that they’re earning their way home by exhibiting positive changes in behavior.” Once again, home4healinghearts cites Reactive Attachment Disorder as a major reason for this treatment, but (rather terrifyingly) proposes that children with PTSD and even autism should be subjected to the regimen. This apparently undated site does not describe its founder’s educational background.

I’m not wanting to jump to any conclusions, but it looks to me as if “therapeutic respite care” is a term used almost exclusively by advocates of Attachment Therapy/Holding Therapy and by proponents of the authoritarian practices of Nancy Thomas, Foster Cline, and others. I can see that small groups of this kind could be run under the radar of the law if the caregivers are licensed as foster parents--  or, in fact, if all payment is private, and no complaint is ever brought, whether they are licensed or not. But what about larger facilities, which I know exist? Are these not residential treatment facilities and required to be licensed as such in most states?

Perhaps readers can fill me in on this issue. How often is the term “therapeutic respite care” used in a legitimate way rather than as a description of a small, unmonitored, facility for a very concerning form of treatment? Is there any reader who has experienced such treatment either as a child or as a parent who placed a child?