Commentary:Recognizing the value of the milieu in therapeutic residential care for children and youth

Therapeutic residential care differs markedly from other forms of out-of-home care for children and youth. Support for the view that therapeutic residential care needs to be a milieu approach that leverages all interactions in the living environment to achieve a beneficial emotional and behavioral experience for children and youth is presented. A therapeutic milieu has the advantage of maintaining focus on what is in the best clinical interest for a child by aligning and coordinating all interactions and activities. We provide a rationale for a milieu-based foundation for therapeutic residential care that consists of five elements: care, treatment, nurturing, teaching, and order. Attending to milieu as defined will provide a sound foundation upon which effective and well-implemented treatment can be fully expressed.