In serious situations, you may need to consider adolescent residential treatment, but don’t send your teen anywhere before you go through this warning-sign checklist to spot and avoid dangerous or ineffective programs.
As a last resort, parents sometimes consider adolescent
residential treatment as a preferable alternative to hospitalization,
incarceration, serious injury or worse.
This can be the right choice, but it’s not something to take
lightly - and it’s not something to consider until exhausting all
interventions that would keep your child in the family home.
Should you decide on residential treatment (after consulting
with other professionals) you need to find a
program that:
Can likely help your teen
Won’t worsen the situation
Protects your child's safety and
well-being
In this article you’ll find some information on picking the right teen program (get qualified professional help for this) and more information on how to avoid a program that won’t help and
could hurt.
Learn:
Why you need to worry about residential treatment safety
A check-list of points of concern and potential red-flags to
consider
The basic rights you should demand for your child
Private Teen Treatment – An Unregulated Industry
The Federal Trade Commission (FTC) cautions consumers that
no federal regulations cover private adolescent residential treatment programs - and
many run as unlicensed and unregulated operations. Examples of private
adolescent residential treatment programs include:
Therapeutic wilderness programs
Therapeutic boarding schools
Boot-camp programs
Behavior modification programs
Emotional growth academies
And programs under other names
Of course, a residential program can be unregulated and
still safe and effective, but without any significant oversight or
standardization, it’s really up to parents to thoroughly investigate any
program before signing on. Before sending any child away, the FTC recommends
that parents:
Visit the residential program site
Research the program on the internet (looking for negatives,
as well as positives)
Ask many questions
Get all agreements and promises in writing
Ask for documented proof of staff credentials and facility
licensing and accreditation1
To help you spot potential problems, consider the list
of 16 red-flag warning signs below for any program under consideration.
Residential Programs: Points of Concern
Here is a checklist of potential points of concern, or in
some cases, red-flag warning signs. Do not send a child off before going
through this list and feeling satisfied on every count; no program is perfect but you should never compromise on safety. Reviewing programs
carefully will take some time and effort, but you need to invest the time now
to avoid mistakes you can’t undo later.
A warning sign doesn’t necessarily indicate a serious
problem – though it might.
Take your time when selecting a program. Things are almost
never so drastic as to preclude a few days/weeks of careful consideration, and in
fact, you should consider any undue attempt to rush your decision a cause for concern (you are not buying a used car here; strong sales tactics
are unethical.)
1. Check for an Appropriate State License and Any
Accreditation
If the program is licensed, be sure to ask what agency
issued the license, and then confirm with that agency that the license remains
valid and is appropriate to the situation you are considering.
In some cases, a program may have licensure or accreditation
for one aspect of their program, but not another. If a program offers
educational services, residential care and therapeutic services, their
licensing should reflect this.
2. Check for Consumer Complaints
Past problems may indicate present challenges. Contact your
state Attorney General, the Better Business Bureau and your local Consumer
Protection office and ask for:
Any publicly available information on complaints or
actions filed against the program
Copies of site visit evaluations
Violation reports
Corrective actions mandated
Be very concerned if
you find reports of past problems with:
Insufficient staff supervision
Medical neglect
Violations of youth or family rights
Any physical or sexual abuse, either between residents or
involving staff
Poor diet
Unsanitary or unsafe living conditions
Forced exposure to extreme physical situations
3. Check Staff Credentials
If a program advertises a psychiatrist on staff and that
professional checks in for a few hours once a month to ‘assess’ a large group
of clients, is this a deception?
You can answer that question for yourself, but it’s a good idea to spend some time investigating the experience
level of the staff who’ll be spending the most time working with your child.
Ask:
Who will spend the most time in direct contact with my
child? What credentials and experience do they have? Are they licensed in this
state? What agency provided licensure? Can I see copies of relevant licensing
documents?
Confirm:
For peace of mind, take 2 minutes to confirm the accuracy
and validity of licenses by contacting the issuing body. This is a very normal
and routine request to make of these agencies.
Obviously, any misrepresentation of staff qualifications is
a huge red flag.
4. Ask about Background Checks
Are background checks performed on all staff that will be in
contact with your child? If so, what is the name of the agency that conducts
these checks? Consider contacting the agency that did the checks to confirm
that checks are up to date. Have all employees been cleared by your state’s
child abuse registry?
5. Check If You’ll Be Asked to Give up Your Rights
As a parent, you should have reasonable access
to your child at any time and you should be the person to make important decisions. Be wary of any program that would restrict your ability to
communicate with your child or that asks you to relinquish – even temporarily –
any of your normal custodial rights.
6. Will You Have Open Access to Your Child?
Quality programs relish family involvement, knowing
that caregivers play an essential role in the therapeutic process.
Ask:
How often can you visit? Can you visit whenever
you want to? If you can’t, why not?
Do children ever lose family contact ‘privileges’ for rule
violations?
Will staff listen in to phone calls or read letters? You do not want to
put your child in a position where they are geographically isolated and unable
to communicate with you about problems or abuses.
7. Check Specific Treatment Practices
You child has a completely unique history and personality,
faces unique challenges and needs personalized treatment, not cookie-cutter
solutions.
You send a child to residential treatment to work on a specific problem. There is little point in sending a child away unless
you feel confident they will benefit from the experience.
To make sure you get appropriate benefit, confirm that the program uses effective therapies that are suitable to your
child’s unique situation. Ask:
What therapies will you use to treat my child?
What research evidence supports the use of these therapies?
Is there research evidence to support the use of these therapies
for my child’s key challenge?
How will you measure whether these therapies are working for
my child?
Learn more about evidence based therapies
8. Check Disciplinary Practices
How do staff discipline? Ask for specifics. Ask if staff,
under any circumstances, make use of any of the following corrective techniques:
Humiliation – ‘breaking down to build back up’
Isolation (solitary confinement or forced silence or
ostracizing)
Restraint (other than in very extreme cases to protect the
safety of the child or others, and always in a manner that is compliant with
federal law and best practices)
The withholding of food, water or medical care
Denying contact with family members as punishment
According to The Community Alliance for the Ethical
Treatment of Youth (a residential treatment safety group) restraint or
seclusion indicate dangerous treatment breakdown – these should
never occur as normal disciplinary practices.2
Likewise, it is inappropriate and unethical to deny a child
contact with his or her family as a disciplinary technique.
The best programs use positive reinforcement and build on strengths,
rather than tearing down weaknesses. If a child doesn’t feel ready or willing to share
personal information, how is this handled? Is this a rule violation that’s met
with discipline?
9. Ask about the Use of Escort Services
Only you can decide if your situation warrants the use of an
escort service, but do not agree to the use of an escort service before
considering the possible consequences.
Escort services come into your house (at your invitation) in
the middle of the night, restrain your son or daughter (if necessary), and force them into
transportation to a facility.
Before agreeing to such an intervention, think carefully
about the potential long-term consequences, such as loss of trust, humiliation, trauma and PTSD, etc.
Before agreeing to an escort service, find out what type of
background checks the escort company performs on their employees.
10. Check for Trauma Sensitivity
Some children develop emotional or behavioral problems after
experiencing trauma, such as abuse, the death of a parent, violence, foster
care, neglect and others.
Children struggling with trauma fear a loss of control.
These children can be further traumatized by:
Confrontational tactics
Interventions designed to bring out an extreme emotional
reaction
Being pushed to reveal their story before they are ready to
do so
If trauma is an issue for your child, be sure to ask about
the program’s trauma-sensitive adolescent treatment practices.
11. Medication Issues
Many teens with behavioral or emotional issues severe
enough to require residential treatment are on one or more medications. Some of
these children are likely over-medicated and some are likely under-medicated. Given
this, the program shouldn’t have an extreme philosophy on medication
(for example…"We need to wean kids off too much medication.")
Ask:
Will program staff get in touch with my child’s doctor to
discuss medication needs?
Who hands out medication to children? What qualifications
does this person have?
Do other children ever hand out medications?
12. Watch for Pressure Sales Tactics
According to the Alliance for the Safe, Therapeutic and
Appropriate Use of Residential Treatment (ASTART) deceptive marketing and
pressure sales practices are unfortunately common within the
industry.
Parents don’t usually consider residential options until
the family situation reaches a crisis point. From this position of great
stress, it’s normal for parents to struggle with a mix of negative emotions,
like:
Anger and frustration
Anxiety about your child’s future
Worry about the well-being of others in the household
Exhaustion and a need for the ‘drama’ to
end
It's hard to make calm analytic decisions from an emotional position - and what’s worse,
unscrupulous admissions ‘counselors’ may stoke fear to make a sale.
Be skeptical about the true motivations of anyone
who urges a quick decision on residential treatment,
especially if they present worst-case scenario outcomes as likely if you delay.3
13. Quick Assessment over the Phone or Internet
Programs that will diagnose and admit a child after a brief
conversation about behaviors and symptoms cannot be
considered ethical healthcare providers.
Cookie-cutter solutions don't work and you
should only consider treatment after your child receives a comprehensive
evaluation and diagnosis/recommendation from a licensed professional. According to the Building Bridges Initiative, a national
treatment policy group, to increase your chances of finding an appropriate and
effective program:
Get in touch with a professional who truly specializes in
your teen's challenges and request a thorough
evaluation and recommendation. An example could be a psychologist who publishes
research on conduct disorder, or a psychiatrist who researches and specializes
in the treatment of ADHD.
Make sure that any professional you approach has no
financial or professional relationship with any organization under
consideration.
Remember that all things being equal, the closer program is
the better program – families should be a part of the process and proximity
allows for more frequent visitation.4
14. One-Size-Fits-All Treatment
If your child has a serious mental illness or substance
abuse problem, you need to send them to a specialized program that’s designed
and staffed to meet the challenges inherent in this type of treatment. If the
program claims to treat an A to Z list of problems and mental illnesses, you
should proceed with caution.
15. Ask about Education
If academics play a role in the program, ask:
Are teachers certified, and if so, by what agency?
Does learning occur via classroom teaching or through
independent study?
Are credits earned transferable to your local school? (You
may want to double check this.)
16. Ask about Undisclosed Financial Relationships
If a professional or agency has referred you to a program,
be sure to ask about the existence of any business relationship. If an agency
is paid to refer students, can they be impartial?
When to Consider a Residential Treatment Program
In some situations, adolescent residential treatment makes
sense, but according to the National Alliance on Mental Illness (NAMI), in the vast
majority of situations, you should only consider sending your teen away after ‘utterly exhausting community mental health care
resources.”
Additionally, any residential phase of treatment should:
Be as short as possible
Be focused on achieving a very specific goal – such as
assessment, stabilization or respite
Be centered on a goal of having the adolescent return to the
home with as little stress and disruption as possible.5
Your Child’s Rights
Programs that respect your child’s basic rights are less
likely to be abusive or neglectful. Check to make sure that:
Your son or daughter will have regular access to a phone and
to unsupervised phone calls.
You and your son or daughter are provided with hotline phone
numbers to call to report any program abuses.
Program staff never use abusive disciplinary techniques,
such as forced seclusion or restraint, denying medical care, food or water,
sedation with medications, inducing fear, humiliation or any form of corporal
punishment.
Parents or caregivers should be notified promptly after
sickness or injury.
Parents or caregivers should be notified with 24 hours about medication regimen changes or missed dosages.
Parents or caregivers should receive notification within 2
days of any investigation into allegations of child abuse or neglect,
violations in health or safety standards of violations of licensing standards.
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