Tag: boarding schools

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not a reliable way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team? There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  What are the safety and security plans in the facility?  Staff must be able to safely manage anything that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must know what to establish back home when they return.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.
  • Last and most important: when your child leaves, there should be a discharge meeting and a discharge plan.  What this means:  all staff who worked with your child get together with you and discuss what treatment should continue once they go home.  Medication management and therapy is identified in advance, appropriate school accommodations are discussed, changes in the home environment are discussed if needed…  You should never leave without knowing what comes next in the months following care.

Body health is brain health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority for healthcare facilities is The Joint Commission.

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that staff observations and advice help you and your child with insight and skills for managing his or her unique symptoms, and for communicating effectively.

Good luck.

 

What was your experience when your child was in residential care?  Please share your comment so others can learn.

The Troubled Teen Industry – A warning about boarding schools and outdoor camps

The Troubled Teen Industry – A warning about boarding schools and outdoor camps

This is a troubled teen in a military-style camp, not an adult military recruit who’s there by choice.

There is a troubled teen industry out there—boarding schools, outdoor programs, and “boot camps” that are not licensed, not certified, and not experienced with youth with disorders.  Maybe you’ve seen the ads that promise to improve your teen’s behavior in the back of some magazines.  They promise that their program will “fix” your child.  They promise that your teen will learn important lessons about respect and about following your rules.  There are quotes from satisfied parents about how the program saved their teen’s life, but you can’t contact them.  The ads claim that staff are highly trained, strict, and caring.  The location is usually too far to check out easily, an airline flight away from home, often in a rural area.  The cost is outlandish.  To help with payment, the program provides financial advice to parents about getting loans and 2nd mortgages.

It’s a red flag if they –>promise<– to ‘correct’ your child.

You’re a desperate parent and you’ll do anything you can to stop the craziness and get a break.  You tell yourself it must be a nice place, especially if it advertises a religious approach*, even though you haven’t seen it in person.  The representative on the phone seems to know exactly how you feel and what your teen needs.  If you’re desperate, you may not think to ask if the organization is a legitimate behavioral health treatment facility.  Many are not!

*Claiming a religious affiliation is no guarantee of a genuine, effective faith-based program.

 What to ask:

 

What is the training and licensure of staff?  You want to know if they have therapists with MSW degrees, registered nurses, psychiatrists or doctors, and if a professional is available on site 24/7.  Mental health programs are about treatment and stability through medication or therapy, and positive activities with lots of emotional support.  Safety must be paramount.  Staff must be aware of the types of things that can go wrong and how crises should be handled.

 

Does the camp or school have a business license in their state?  Are staff licensed to practice behavioral health?  Do they have grievance procedures?

 

Is the camp or school accredited as a treatment facility, and by whom?  Does it have mental health agency oversight?  Are emergency services (hospital, law enforcement) a phone call away?  If your child’s mental health is a concern, read “What to know about psychiatric residential treatment.”

 

punish boy in boarding school
It’s understandable if you’ve “had enough!” and want your child punished, but excessive punishment does not work.  (Quote of camp counselor, “If I can’t make a kid puke or piss in his pants on his first day, I’m not doing my job.”)

Can you call and talk to your child when you request?  Can you visit?  Can your child call you when they request it?  Some of these programs limit or disallow parental contact. Why? According to a testimonial at a children’s mental health conference, a young man was used as slave labor at a camp. The staff kept communicating to his mother that he was misbehaving, that he hated her and didn’t want to talk, and that they recommended he stay another 6 months.  In this way, they drew out his stay for 3 years.

I’ve heard personal testimony from parents and troubled young people whose condition was worsened by the camp or school, or who felt betrayed by their families.  On rare occasions, children have died at the hands of young, untrained staff who thought they were just disciplining the child.  Other stories included teens being offered drugs by staff or other campers, or sexual relationships with staff or campers.

 

Check out the article below.  The problems in the “troubled teen industry” are significant enough such that an advocacy group has formed to change state laws to protect youth.


 

Unlicensed residential programs: The next challenge in protecting youth. –excerpt-

By Friedman, Robert M.; Pinto, Allison; Behar, Lenore; Bush, Nicki; Chirolla, Amberly; Epstein, Monica; Green, Amy; Hawkins, Pamela; Huff, Barbara; Huffine, Charles; Mohr, Wanda; Seltzer, Tammy; Vaughn, Christine; Whitehead, Kathryn; Young, Christina Kloker

American Journal of Orthopsychiatry. Vol 76(3), Jul 2006, 295-303.

 

According to this article, many private residential facilities are neither licensed as mental health programs nor accredited by respected national accrediting organizations.  The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families, and journalists describing mistreatment in the unregulated programs.  There is a range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death.