Exploring Residential Treatment for Kids and Teens

In most cases, the best place for children and teens to live is with their families. But when a child seems to be struggling for a long time, despite family support and community services, an out-of-home placement may be considered. Here's what parents need to know about residential treatment.

What Is a Residential Treatment Center(RTC) For Children Or Teens?

Residential Treatment Centers, also known as “RTC’s” or “rehabs” provide therapeutic (treatment) or rehabilitative services for children and adolescents who are struggling. The child lives at the facility 24/7 and receives on-site care and support by a multi-disciplinary team that often includes therapy, psychiatric support, and psychoeducation in a peer-positive treatment environment. Generally this setting is highly structured and intensely supervised. 

However, other options, that are safe and the least restrictive, should first be explored. 

When Should Residential Treatment Be Considered For Your Child or Teen?

A Residential Treatment Center is geared to help children and teens address issues such as:

• Serious mental health issues
• Rage and aggression
• Substance abuse 
• Other addictions (gaming, internet, etc.)
• Trauma
• Abuse
• Attachment challenges
• Eating disorders
• Gender identity and expression
• Family conflict 
• Peer issues
• Significant and/or repetitive behavioral concerns (running away or elopement, self-harm or suicidal gestures, and fire starting)
• Sexual behavioral issues
• Violent or criminal behavior(s)

How Do I Know If My Child Needs Residential Treatment? 

Sometimes children needing out-of-home placement services are referred to as “troubled kids”, “troubled teens” or “at-risk youth.” Residential Treatment Centers serve youth who would benefit from a more intensive level of care than they might receive in outpatient family, group or individual therapy. Families usually begin to consider a Residential Treatment Program when they are:

• Frequently worried about their child or teen 
• Afraid for their child’s safety as a result of the child’s behaviors or choices
• Concerned that their son or daughter seems to be spiraling into unhealthy or even dangerous behavior patterns and choices
• Parenting a child or teen who is experiencing mental health challenges and struggling to make progress in their regular home and school environments
• Experiencing repetitive inpatient psychiatric stays for their child only to return home and readmitted
• Receiving feedback from community providers that their child may need a more intensive level of care
• Involved with law enforcement due to the youth’s truancy, fighting, running away, theft or other criminal behaviors
• Addressing addictive behaviors related to drinking, drug use, gaming, internet use, or sexual behaviors with their child or teen
• Worried about their child’s eating related behaviors

Usually by the time out-of-home placement is considered, parents have tried many other outpatient or inpatient programs and feel stressed out, defeated and helpless. They feel like nothing they do is working and no one has been able to reach their child.  They’ve likely tried various interventions and met with many providers in hopes of helping their child or teen-psychiatrists, psychologists, counselors, group therapy and more. 

Despite all their effort, it’s common for parents to feel guilt, and sometimes shame, for even considering a Residential Treatment Center for their youth. But deep down, they know your child or teen needs something more. 

They long for their home to be more peaceful. They want to feel more connected to their child or teen.   They desire for their child to be happy, healthy and confident and able to make positive choices to prevent self-destructive, unsafe or criminal behavior.

How Long Is Residential Treatment?

Residential treatment is generally not meant to be permanent, meaning discharge planning should begin at day one and influence the youth’s treatment plan.  Most programs do not keep a child until adulthood as the goal.

The length of time at the facility is generally driven by one or more of the following:

1. The financial investment the family is able to make, if paying out of pocket or supplementing insurance
2. The time that insurance will cover services
3. Whether the goal is stabilization or treatment
4. The program’s model for treatment
5. The child’s Treatment Plan

Residential Treatment varies in length, from short-term, which may be just a few days or several months, and long-term, more than 90 days. In rare cases, treatment stays may last more than a year. 

How Does Residential Treatment Work?

Residential Treatment generally begins with a referral from the child’s community provider, such as a therapist, psychiatrist, or other helping professional. 

Families may use a Therapeutic Consultant to guide them through this process or they may contact the Admissions or Intake department directly at the facility in which they are inquiring about out-of-home placement.  The appropriate program personnel will gather relevant information, including demographic information, insurance information, history, parental concerns, and any relevant documentation. 

The facility’s intake or admissions staff will review all the information and determine if the child or teen is appropriate for their program and notify the parent. This usually takes several days.  

Once it has been determined that the youth meets the program’s requirements, and date for admissions will be agreed upon with the parent, who will be responsible for bringing the child to the facility.  

Each state has their own licensing program that set standards of care for treatment centers, including treatment planning, and each facility has their own policies and procedures and curriculum for their program.  Ask any questions you have about this during the intake process about treatment planning, state standards and licensing and monitoring visit reports by state authorities.

The American Academy of Child and Adolescent Psychiatry (AACAP), has developed the following guidelines for Residential Treatment Centers for best-practice.

When a child or teen is admitted to a Residential Treatment Facility, they are evaluated or assessed by the Treatment Team and a Treatment Plan is subsequently completed. The Residential Treatment Center admissions process should:

• Include a comprehensive evaluation prior to admission by a licensed graduate-level provider.
• Include a documented current DSM diagnosis and evidence of significant distress/impairment.
• Include a discharge plan.
• Include a medical assessment and a physical examination within the first 24 hours of admission, unless a physician determines that an examination within the week prior to transfer to the facility is sufficient.
• Include a review and approval of the admission by a psychiatrist for appropriateness and safety of the program.
• Identify family resources and family participation in treatment.

An initial comprehensive Treatment Plan is usually completed with 7 days of admission. AACAP recommends that a treatment plan should:

• Be developed jointly with the family and youth.
• Include multidisciplinary assessments.
• Establish measurable goals and objectives.
• Be reviewed every 4 weeks.
• Include appropriate monitoring of medications.
• Include treatment modalities that are appropriate to the clinical needs of the child.
• Include the family in at least weekly therapy or, if the family lives greater than 3 hours from the facility, weekly telephone contact for family therapy must be conducted with monthly face-to-face family therapy sessions.
• Include supportive services such as religious services when requested.
• Be an extension of treatment plans formulated in previous clinical settings.

According to AACAP, discharge planning should:

• Begin at admission.
• Include coordination of follow-up and ongoing involvement with family and/or guardians.
• Take advantage of all community services.
• Reflect specific discharge criteria.
• Ensure that the child has a place to go at the time of discharge and that person or agency actively participated in the treatment. If a biological parent or extended family member is not available or appropriate, the designated foster parent must actively participate in the child’s treatment.
• Provide families with the strategies to help their child adopt to “family life” when they return home.
• Involve coordination with community-based services to ensure a continuum of care.

The Residential Treatment Center’s curriculum and youth’s needs, and typically utilizes evidence-based treatment through a combination of individual therapy and group sessions. Family therapy sessions are also carefully weaved through the process, either in-person or virtually, to address issues identified in the Treatment Plan. Most programs also provide parent support through mandatory involvement in parent counseling sessions and/or parent psychoeducation to teach the parent new strategies for connecting with their child and identify and overcome barriers to maintaining the child or teen’s therapeutic gains while in the program 

Based on the reason for treatment, the child or youth’s strengths and preferences, and the options offered by the facility therapeutic interventions may include guided activities such as: 

• Art therapy
• Music Therapy
• Sand Tray Therapy
• Yoga
• Equine Therapy
• Meditation
• Structured physical activity

Residential Treatment Center programs are facilitated by a clinical team that includes therapists who use the group, individual and family sessions to gain insight into the life of their patient and facilitate growth and healing, based on the youth’s treatment goals. Trained staff also eat meals and go outdoors with patients/clients to understand how they relate in varying settings. Some Residential Treatment Centers may also use off-campus activities, which remove the youth from their environment, usually as an earned privilege. All of these encounters help the staff better understand the child or teen patient/client and provide support in real-life situations related to their specific struggles.

As the child or teen settles in to the program and/or moves closer to discharge, there will be more family contact through letters, family therapy sessions, family visits (virtual or in-person). In some cases, the child may go home for short visits and then come back to the facility where the parents and child process with staff what went well, and what is still needed to facilitate a successful discharge and reunification.

After discharge, some programs provide staff support by checking in with parents and youth to help them through challenges and encourage success to prevent readmission.

Are Residential Treatment Centers Effective?

The effectiveness and success of Residential Treatment Centers vary by program and are based on many different factors, including:

• The child and family’s commitment and involvement in treatment
• The type and quality of the program offered
• The training and experience of the staff to meet the child or teen’s identified needs
• An accurate assessment of the youth’s needs
• Planning and services identified to offer support for the family after the child returns home

Quality programs will likely administer standardized assessments, at intake and at discharge, and even several months post-discharge to measure treatment progress. This information can also be utilized by facilities to determine the effectiveness of their program.  Programs may share their success rate, based on these assessments and other criteria, such as repeating admissions or criminal involvement post-discharge.

How Do I Choose The Best Residential Treatment Center For My Child?

With so many treatment programs in the United States, it can seem like a daunting task to choose the best one for your child. To get started:

1. Check out their profile on KIDStherapyfinder.com, including their program description, videos and endorsements or testimonials from others.
2. Thoroughly review the treatment center’s website.
3. Read reviews on the internet.
4. Visit the treatment center as part of the intake process. Take advantage of options to tour the school in-person or virtually. This is a great time to ask questions. Make a list of questions  ahead of time that you would like to ask during your meeting(s). Take advantage of any opportunites to meet staff, administration and observe daily life.
5. Verify any claims about staff credentials, accreditation, licenses, awards, etc.
6. Review any reports from state monitoring visits which may be available online on the state’s website or by asking the facility.

 It can also be helpful to discuss your list with your child’s therapist, school counselor or other helping professional involved with your family.  Some families also hire an Educational Consultant to help them navigate this process.  They help identify the best choices for your child based on their needs, assist you with the application and intake processes and even support you before, during and after placement. 

How Should I Prepare My Child For Residential Treatment?

Many parents are nervous about talking to their child about Residential Treatment. However, by the time this is a consideration, most children and teens are very aware that what the family has been doing is not working and in some cases, they are ready for a break. However, there are other cases, in which talk about out-of-home placement may take the child by surprise or they may be resistant to the idea of going away for help. 

The best way to have this discussion is to start by connection.  In a non-threatening, non-blaming, calm manner, truthfully acknowledge how hard it has been for them and the family. Give them opportunities to talk about their feelings and choices. Reflect their feelings and use joining language (us, we), instead of accusations (you never, you always). 

For example, 

“I know things have been really hard for us lately. I can tell you are angry and sad, and you do things that you later regret that cause you harm. We have met with a psychiatrist, psychologist and therapist, but it doesn’t seem like this is working for us right now.  I love you and I’m concerned about you.  I think it’s time we try something else.” 

Next, share with the child the resources you have found and the process.  Be direct and honest.  

“Tomorrow we are going to meet with some people that can help us.  They will talk with us so we can decide if we are a good match for their program.  If we are, then they will let us know when you will begin.”  

In some cases, you will have already made the arrangements for the child to go, without an interview.   In this case, you will again use the same approach above-connection, honesty, calmness and positivity, but your message will be different. It’s usually best to not have too much time before telling the child and the time you leave, so they don’t have as much time to worry or try to bargain. 

When it has been decided that your child or teen is to become enrolled in a Residential Treatment Center program you will be expected to pack necessities – such as casual comfortable clothes and shoes.  Each program will have a list of acceptable items and non-acceptable items.

Are All Residential Treatment Centers All The Same?

Although all Residential Treatment Centers are out-of-home placements, there are some differences between each facility, including:

• Length of stay
• Payment methods (many do not accept insurance)
• Policies and procedures
• Treatment model.  For example, some are Wilderness Programs, in which treatment strategy incorporates outdoor living in a wilderness environment without the comforts of a indoor living environment.
• Ages accepted. They may focus on a specific age group, such as younger children, teens or transition-age or young adults.  For example, Failure to Launch Programs are geared to youth who are having a difficulty moving towards independence and transitioning into early adulthood. 
• Levels of care
• Some are single-gender programs and some are co-ed programs.
• Some are LGBTQ+ affirming programs and others are not
• Specializations

• Gaming or Tech Addictions - The residential therapy for this option is often coupled with at least a three-week digital detox which involves the removal of digital screens or internet.  In this time, individuals are reintroduced to natural reward systems of real-life living.  There is a strong emphasis on rebalancing adequate sleep, nutrition, exercise, and social interaction.
• Sexual Behavior - The focus is placed on providing treatment for sexual behavior that is deemed problematic. The therapy involves the use of medical, behavioral, psycho-educational, and cognitive treatment plans weaved within individual sessions to encourage improved sexual boundaries and maladaptive behaviors.
• Substance Abuse Treatment - The focus is to remove the client from opportunities and ability to use substances (detox), and help them to reconnect with themselves while learning to appreciate and practice more healthy habits and better coping mechanisms.  They also receive therapy to work through past traumas and prepare to re-enter their community.
• Eating Disorder Treatment - The aim is to decrease eating disorder symptoms and practices while addressing the reasons or causes for the unhealthy behaviors.  The center works to also educate the individual about body image, health, exercise, nutrition, preventing relapse, and understanding family dynamics.  Residential treatment for eating disorders may be necessary if the person is suffering with severe, intense, or prolonged symptoms of anorexia, bulimia or other unhealthy eating patterns.
• Faith vs. Non-Faith Based Facilities - Faith-based facilities weave a particular spiritual approach into their program, such as Christianity, and often times, these spiritual aspects influence admissions, values, polices, and curriculum. 

Final Thoughts

Initially, before enrolling your child into a Residential Treatment Center you might be hesitant, but consider the benefits to the well-being of your child and family if they truly need the specialized therapy and support to overcome their substance abuse, mental illness, or other behavioral issues. Be sure and find support for yourself during this process.  There are online support groups as well as counselors in the KIDStherapyfinder.com directory who can provide parent counseling.

https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/principles_of_care_for_children_in_residential_treatment_centers.pdf