Residential Treatment

Sometimes children who are experiencing severe symptoms with their mental health condition may need a higher level of care than outpatient programs can provide. They may require services that require observation and structured activities around the clock, which they are unable to receive living at home. Residential treatment facilities are one way to meet these needs.

Usually, children requiring this level of care have repeatedly demonstrated behaviors that have been difficult to manage and proven unsafe to themselves or others. In a residential treatment facility, they can receive intense comprehensive treatment and the necessary structure and supervision to keep them safe.

Residential facilities provide security and restricted access to ensure the safety of the child, staff and visitors. Children can remain in these programs for several months, with the ultimate goal of returning home and reuniting with their families.

Most programs have:

• Structured treatment plans and schedules that promote and reinforce healthy behavior
• Individual and group therapies
• Family involvement, including family therapy, which can increase the chances of a successful return to the home environment
• An academic component where children attend school either within the facility or nearby

Knowing the signs that it may be time to consider residential treatment for your child can give you more confidence and reassurance when making such a difficult decision. As the expert on your child, it’s important to trust your instincts.

Let’s explore some of the signs that it may be time to consider whether your child will benefit from a residential placement, how to evaluate different placement options and some of the relevant barriers and factors that may affect your decision.

Making The Decision

Residential treatment may be an appropriate treatment decision for many reasons, including assessment to clarify a diagnosis, crisis intervention, intensive treatment for psychiatric symptoms, or substance use.

When making such a complex decision, you want to feel confident that you have explored all other options — due to the intense nature of the program and the associated costs, residential treatment is often described as a “last resort.” It may be helpful to reframe this decision as one that offers the best option possible to provide necessary social, emotional and academic support when all other options have proven to be insufficient.

Indicators That Residential Treatment May Be Appropriate For Your Child:

• They pose a danger to themselves or others due to:
  • Self-harm or self-destructive behaviors
  • Violent or aggressive behaviors
  • Suicidal thoughts and behaviors
• They show signs of substance use problems
• They struggle with eating disorders
• They often run away
• They are having problems at school that have not improved with other interventions (refusal to attend, academic decline, conflict with peers and disciplinary actions)
• They exhibit behavior changes that are causing them difficulty, and these changes haven’t responded to traditional treatment
• They experience severe mood changes that are causing them difficulty, and these changes haven’t’ responded to traditional treatment

When you reach the point of considering residential treatment for your child, it can feel quite defeating. You have likely gone through many different types of treatment and various levels of care to support your child, while living in a state of enormous stress and disruption at home and school.

Many parents also experience stigma and struggle with the potential of facing judgment and criticism of themselves and their child if they send them to a residential program. All of these issues can make an already tough decision that much harder. However, it’s important to keep in mind that your child’s needs motivate your choices to keep them safe while providing them with the necessary tools and strategies to manage their illness.

Evaluating A Program

Given the many different types of programs that exist, selecting the right program can be an overwhelming process. Choosing the program best suited to meet the needs of your child is important, so try to gather as much information as possible to help you make an informed decision.

Here are some suggestions to help determine what the right program may be to best fit your child’s needs.

1. Seek consultation with your child’s mental health providers for recommendations and input.
2. Do your research. Ensure that the facilities are licensed by the state and in good standing — that there are no sanctions with any licensing entities in your state. Also ask about accreditation from national organizations such as Commission on Accreditation of Rehabilitation Facilities (CARF) or Joint Commission on Accreditation of Health care Organizations (JCAHO).

You also want to know about the details of the program: what modalities of therapies they use, that they use proven treatments and that the practitioners have experience treating children with similar diagnoses. Also, it’s important to know how the program manages problem behavior, how they incorporate the family into the treatment and how you will be updated on treatment and progress. Ask about a typical daily schedule and about the educational curriculum offered.

1. Go see the program. Schedule a tour, visit the campus, talk to the director and other members of the staff. Get a feel for the place — and remember, trust your gut. Inquire about the staff-to-child ratio, their philosophy and their approach to supporting the children through this transition. Avoid programs that withhold family contact and engagement in the treatment.
2. Speak with families who have had children treated at the facility. In addition to visiting the facility and talking to staff, testimonials and feedback from parents can be invaluable. You can contact families online through the various support groups or ask the program for contact information of former families.

Accessing And Paying For A Program

Residential programs can be expensive, and frequently are not covered by private insurance or Medicaid. Keep in mind that insurance companies that do cover costs of residential treatment, will only do so if the placement is deemed medically necessary. Another possible option is through the school district (and their special education programs as part of the IEP process), which can fund placement if they determine that your child’s needs cannot be adequately met at regular school facilities.

Seeking and securing residential placement for your child can be quite a logistical ordeal, and you may need to seek the support of an attorney or advocate to help you navigate the process successfully. You will likely experience a range of very intense feelings throughout this process and, as always, you are better able to support and care for your child when you have the space to process and manage your own emotions. Find your local NAMI for support and resources.

While the decision to place a child in a residential facility is an intense and emotional one, this type of program may provide the much-needed, and often long-awaited, treatment and support that your child needs to flourish.