When you are considering a residential treatment or outdoor therapeutic program for your child or young adult – you probably have many concerns and questions. I have taken great care in evaluating every program I recommend to my clients. It is my intention that the families I am honored to serve get the best care and treatment for their child / young adult who may be struggling with addiction, adoption / attachment, eating disorder, educational, emotional, behavioral, sexual misconduct, and trauma challenges.
Outdoor therapeutic programs and short-term clinical programs are designed to assess and stabilize children and young adults.
Residential treatment programs are longer term – anywhere from 6 months to a year.
All programs I recommend have the intention of re-uniting families as quickly as possible.
The best programs work with and for families and children: they collaborate and help families discover what works to help their child or young adult flourish.
Depending on your situation, there may be limits to how much choice you have about where your child or young adult receives services.
Factors include clinical needs, family, finances, health insurance coverage, location, IEP services, etc.
Remember that you have the right to have a voice in the decision-making about where your child or young adult receives treatment.
I evaluate and have an on-site visit with every program I recommend. I am not afraid to ask questions or challenge policies that don’t make sense or don’t seem right. Many programs are very open to my ideas and understand that I am acting in my client’s best interest. Many excellent programs will not meet all the criteria I search for during my on-site evaluations, and there are differences in programs – depending on how they are structured and what they specialize in.
Outdoor therapeutic programs will be very different than a residential treatment center.
I take that into consideration and will address some of those differences along the way.
When a program, however, is not family friendly or the answer to any of the questions about academics, medication, safety or whether the treatment is right for my clients, I may not accept them as part of my referral list. Also I will not tolerate any unsafe, inappropriate or disrespectful treatment to my clients and their children or young adults.
1. HOME OR AWAY?
Is a residential program really the best place for your child or young adult to receive treatment right now? Are there services in the community that would work?
Being away from home is hard for everyone — especially children and even young adults.
Although outdoor therapeutic and residential treatment programs can appear to be safe, I evaluate every program to see if it is well-run, and the staff has been properly screened and trained.
Outdoor therapeutic programs can be used to achieve a specific goal like respite and assessment.
Residential treatment centers are used to achieve education, medication stabilization, or learning particular skills in preparation for return to the community.
2. RIGHT PLACE NOT JUST ANY PLACE
I research and visits every program to ensure it is offering the best available academic, clinical, family, nurturing, professional expertise for your child or young adult.
I make sure their specific needs and challenges are going to be addressed as a part of their treatment plan and reunification plan.
Just because there is an opening at a particular program — doesn’t mean that program is right for your child.
I research to discover whether the program can demonstrate that it has the specific expertise needed to help what my client is searching for.
Every child and young adult is unique and I want a successful experience.
When your child or young adult needs academic or clinical / psychological assessments, I also search for the best expert I can find.
I have connections with experts in the field of Aspergers and autism, eating disorders, family dysfunctions, learning disabilities such as ADHD and NLD, medical conditions such as OCD and ODD, and other more serious psychiatric disorders. These experts help guide my decision on a placement at times, however, the final decision is always up to the family. I have no affiliation with any program or school. I accept no compensation, in any form, from any program or school – ever.
I understand that ideally, the outdoor therapeutic or residential program needs to be located as close to home as possible to make visiting easier.
I do all I can to accommodate this desire, knowing that is not always possible.
3. A START TO SOME OF THE QUESTIONS WE ASK DURING OUR ON-SITE EVALUATIONS AND VISITS
- What type of academic, emotional and behavioral concerns does the outdoor or residential program treat most often?
- Does the program have expertise with any specialties such as ADHD, Asperger, autism, adopted children with attachment disorders, adolescent bipolar, eating disorders, etc.
- What is involved in the treatment of each client?
- What are the different therapies that will be used?
- What goals will the child need to meet in order to finish / graduate?
- How will the child or young adult be able to function differently after treatment?
- How long do staff think it will take for a child or young adult to return home or back to college?
4. SAFE PROGRAM QUESTIONS
- Is the program licensed and accredited?
- Have all staff had criminal background checks and have they been cleared through the state’s child abuse registry?
There are no federal regulations for residential treatment programs for children with emotional and behavioral problems. State regulation varies widely and some programs advertise that they can help such children even though they are not licensed to do so.
Some states send children out-of-state to residential programs that are not appropriately licensed in the state in which they are located.
Consequently, it’s important for me to check licensing and regulation information thoroughly.
Programs need to be licensed by the state where they are located to provide each of the specific services they are offering.
I look for accreditation either by JCAHO, COA or CARF. when they are not licensed, parents are notified.
(NOTE: Being licensed does not guarantee that a program is safe or appropriate).
To learn about possible problems with any program, I research online for news accounts relating to the facility and contact the Better Business Bureau and the state attorney general’s office to learn if there have been any serious, ongoing issues.
I also check with the local fire department and police department to see how many / if any calls / have been made to the program.
Other questions I ask during my in-site evaluation:
- Which state agency licenses the residential program?
- What state agency licenses the educational services at the program?
- Is the program accredited? By which agency?
- What training is provided to the staff members who work day-to-day and evening shifts with the children?
- What kind of supervision does the staff have, especially those that work holidays and weekends?
- Have all the employees been subject to background checks? By which organization and what kind of screening has been done?
- Are all employees and staff subject to drug testing?
- Does the program take children’s and young adult’s medical complaints seriously, with a “better safe than sorry” approach, rather than assuming that this children or young adult with behavioral challenges is “faking”?
- How does the program communicate with the parents and the advocate / educational consultant about any serious incidents?
5. EFFECTIVE SERVICES QUESTIONS
- Are the techniques used by the program supported by research studies on children or young adults with similar needs?
The best programs base their care on scientific evidence, ideally using techniques that have been shown by research to be safe and effective with particular types of children and young adults.
Quality programs also tend to have the most highly educated staff, particularly among those working day-to-day with the children.
Claims about “success rates” that aren’t backed by research published in medical journals may need to be viewed skeptically. Quality programs have processes in place to learn what works and what doesn’t work, overall, and for each child and young adult they have adopted approaches that others have found effective.
Other questions I ask:
- What kind of research supports the techniques you are using?
- What did that research show about success rates?
- How will you communicate with the family and the advocate / educational consultant about the outcomes of treatment?
- How are programs reviewed and adjusted to work better?
6. FAMILIES ARE EQUAL PARTNERS QUESTIONS
- Does the program make families feel like their ideas and opinions are important?
- Does the program involve the family in decisions about their child or young adult during care?
You know your child better than anyone else does. Consequently, the best programs involve family members in as many ways as possible. I search for programs where family members’ perspectives are sought out and valued. I want to see that letters and phone calls are encouraged, not used to reward or punish children.
I want to see that visits are encouraged. I want to see programs that creatively involve family members in many aspects of the program. I want to see that when a child or young adult is not doing well, family contact is increased, when desired– and families are not treated as the problem, rather as part of the solution. A family advocate or educational consultant as a parent partner can help make this partnership work.
Other questions I may ask:
- How does the program involve family members in treatment?
- What is the letter writing, visiting and phone contact policy?
- What suggestions can the program offer to help parents aid in their child’s recovery?
- Will the program teach parents the strategies they need to help their child at home?
- Can the program provide the names of other family members that parents we refer can talk to about their experience?
- How will the program work with us as the family advocate or educational consultant?
- How is transpiration from and to the airport as well as to and from other off camps appointments handled? Who are the drivers?
7 . YOUTH HAVE A VOICE QUESTIONS
- Does the program empower a youth to guide their own recovery?
Being sent to an outdoor therapeutic or residential program can be a frightening experience even in the best of circumstances.
Research shows that increasing the sense of control children and young adults have over their own treatment improves the odds of success. The more control people feel they have, the safer they feel — and the safer they feel, the easier it is for them to learn.
Consequently, children and young adults need to be given meaningful choices and allowed to set goals for themselves.
To make sure that youth voices are heard, many high quality programs have a “peer to peer ” committee who can help with conflicts. Some of the best programs actively involve children and youth in their own recovery.
Other questions I ask:
- What does the program do to help children and young adults set goals and guide their own recovery?
- Is there a “peer to peer” group that children and young adults can speak with when they have concerns or questions?
- Can parents visit the program in advance to learn what to expect?
8. COMMUNICATION COUNTS QUESTIONS
- Does the program communicate well with parents and have a clear plan to consult with them about important questions and decisions?
The best outdoor therapeutic and residential programs collaborate closely with your family and communicate clearly and openly about how your child or young adult is doing. This is crucial to treatment success. It need never be difficult to contact staff and they need to be in touch with parents and advocates / educational consultants regularly. Communication is the key to avoiding problems. Many good programs link new families with family members of children or young adults who are already in the program to help them navigate the system and get the most out of it.
Programs may have family members or youth who have been through the program on their staff to be a resource to new families. This can help families communicate and feel empowered. With good communication, everyone involved is able to discuss even difficult issues, which might arise during treatment.
Other questions I may ask:
- How will the program communicate with the family? How often?
- Who specifically do they speak with to discuss issues or raise concerns and questions?
- How do you help families mentor each other?
9. STRENGTHS MATTER QUESTIONS
- Does the program consider the strengths of each family and help them discover and build on their strengths and those of their child or young adult?
When a family is faced with a child’s academic, emotional and behavioral challenges, it’s often hard for them to recognize their own strengths. High quality outdoor therapeutic and therapeutic residential programs help families find and build on these strengths.
Other questions I at times ask:
- How will the program help families identify their strengths?
- How will the program use children’s or young adult’s strengths to motivate them?
- Does the program have a way to help children and young adults stay involved in or start community activities that allow them to develop hobbies and talents or pursue special interests?
10. POSITIVE POWER QUESTIONS
- Does the program build children and young adults up, not break them down?
Some people believe that children and young adults with behavioral problems need “tough love.”
Research shows that the best therapies and types of care focus on building kids up, not breaking them down.
High quality programs focus on children’s positive qualities, not on getting them to accept stigmatizing labels. They do not force kids to “open up” when they are not ready to do so.
Research shows that compassionate, empathetic and caring relationships between children and their therapists and other staff are most likely to be helpful and that confrontational or humiliating approaches are harmful.
Other questions I ask:
- How does the program view bullying and confrontation?
- What does the program do when a child or young adult does not feel safe sharing personal information?
- How are conflicts between children and staff handled?
- Who is at the program to mediate conflicts?
11. DISCIPLINE, SECLUSION AND RESTRAINT QUESTIONS
- Are restraints used only when a child truly endangers themselves or others?
- Is the staff trained to reduce the need for restraints, apply restraints safely, and avoid the use of seclusion?
Unsafe use of restraint is one of the biggest risks children face in outdoor therapeutic and residential programs. Restraint and seclusion have no therapeutic purpose and can severely harm children when used inappropriately or for lengthy periods of time. Consequently, seclusion need never be used and restraint need only be used when a child is an immediate danger to themselves or others.
Face-down restraints are the most dangerous.
Quality programs do not use any kind of corporal punishment. They don’t use disciplinary measures that reduce access to education, food or communication with parents and they never use restraint or seclusion as punishment. Restraint is avoided as much as possible and there is a debriefing for the child and the staff after every use of restraint to see if another technique could have defused the situation and to prevent recurrence.
Other questions I do ask:
- What are the program’s policies on seclusion and restraint?
- How often is restraint used? Is the program engaged in a process to reduce the use of restraint and seclusion? Has the use of these procedures been reduced?
- What kind of training is provided to staff members who apply restraints?
- Is face-down restraint ever used?
12. CHILD AND FAMILY TEAM QUESTIONS
- Will all the people working with the child or young adult meet or speak regularly with the parents as a team to talk about the child’s plan and how things are working?
A Child and Family Team (CFT) is the group of advocates, educational consultants, providers, educators, family members and others who know the child and who are working with the family.
Everyone on this team collaborates to ensure that all necessary services are received in a coordinated way at the appropriate time.
Until recently, outdoor therapeutic programs and residential programs were isolated from the outside world and disconnected from advocates, educational consultants, therapists or other providers that work with a family before and after placement. Now, we know that integrating all the services a family receives into a “system of care” is much more effective.
Other questions I ask:
- Do you work with Child and Family Teams?
- How will the outdoor therapeutic or residential program work with the Child and Family Team?
- Which staff member(s) will attend CFT meetings or conference calls?
13. EDUCATION QUESTIONS
- Does the program offer children appropriate educational opportunities while they are in care?
- What steps will be taken to be sure the child has a smooth transition back to a school in the community afterwards?
Education is crucial to life success and this is especially true for children with academic, emotional or behavioral challenges.
While some programs provide education on-site, others use local schools or other providers to meet the educational needs of participants.
High quality residential programs ensure that children have access to the best educational resources including certified teachers and special education teachers.
Even outdoor programs have now started adding academics, although limited, to their treatment plan.
Other questions I eventually ask:
- How does the program provide education?
- Are the teachers certified?
- When education is not provided on-site, how do you coordinate with teachers and other educators to ensure school success?
- Who will be on the CFT with regard to the child’s education while in residential care?
- How do you coordinate with at home school districts to be sure each child has needed school support services in place when they are discharged?
14. CULTURE AND LANGUAGE QUESTIONS
- Are the staff members interested in and respectful of different cultures?
Although it is obvious that a child who doesn’t speak English won’t benefit from a program that literally does not “speak their language,” there are many other cultural issues that are not so immediately visible.
These can have a huge impact on how a child or young adult fares in an outdoor therapeutic or residential program. The best programs are “culturally competent”– that is, they recognize that different cultures have different approaches to child-rearing, different norms for family roles, and different understandings of mental health. These programs work with families to ensure that cultural differences are recognized and valued, not dismissed or misunderstood.
Other questions I find beneficial to ask:
- How does your program work to understand cultural differences and address them?
- How much experience do you have working with children and young adults from other backgrounds?
- What training has your staff had in addressing these issues?
- Does the program hire staff members from different cultures?
- When a child or young adult is a “minority” in the program, how do you address that?
15. CONNECTED TO HOME AND COMMUNITY QUESTIONS
- Is the program going to support the parents when their child or young adult comes home?
- Does the program keep children or young adults involved in community activities even when they are in care?
- Does the program prepare young adults to live independently?
Among the most difficult times for children and young adults as well as their families are the transitions into and out of outdoor or residential care. The best providers ensure that your child or young adult and your family have the educational, vocational, family, and community supports needed during and after discharge.
These connections produce the best outcomes. As much as possible, high quality programs involve children and young adults in the community and use approaches that carry over into life back home. They teach families how to use these techniques to maintain their gains. All children and young adults need to be learning skills that will help them be successful in the community.
In contrast, some programs use “phase, point and level” systems (where a child has to earn a certain number of points to progress to a higher level of privileges and at times can be set back for failures).
These do not prepare children to cope outside of residential care and there is no evidence that these systems aid recovery. For children who are leaving residential care as young adults, quality programs ensure that they have a place to go that will support them and that there is appropriate aftercare, education, and job training or placement arranged in advance.
Other questions we ask:
- How will you prepare each child or young adult for transitions?
- What techniques will you use with each child and young adult that parents can use at home to help?
- How will you be sure each child or young adult has the life skills they need to function in the world?
- What can be done to support my young adults who want to live on their own after discharge?
16. TRAUMA ISSUE QUESTIONS
- Does the program understand that many children and young adults have experienced overwhelming stress and/or trauma?
- Does the program work to avoid situations that can re-traumatize children, teens and young adults?
Many children and young adults with behavioral or developmental needs serious enough to require residential treatment have experienced some form of trauma and/or overwhelming stress.
This can include losing a parent to abandonment, death or divorce, being placed in juvenile hall, suffering neglect, physical or sexual abuse, witnessing violence or being involved or witnessing a serious accident. For some children and young adults, ordinary experiences that would not be traumatic for others can be perceived and reacted to as traumatic. Trauma is an experience of overwhelming fear and powerlessness and those who have suffered trauma are often exquisitely sensitive to situations that they feel they cannot control.
High quality outdoor therapeutic and residential programs recognize this and do everything possible to make children and young adults feel safe and in control.
Confrontational therapies, approaches that push children or young adults to discuss traumatic experiences when they aren’t ready to do so or that elicit extreme emotions can re-traumatize these children or young adults.
Other questions found beneficial to ask:
- How does the program deal with trauma issues?
- What does the program do to ensure that children or young adults who have experienced trauma feel safe in therapy?
- What other trauma-informed practices does the program use?
17. MEDICATION QUESTIONS
- Is the program using medications safely and appropriately?
Many children and young adults with emotional and behavioral challenges need medication, even if just for a short period of time. The best outdoor therapeutic programs and residential programs will accept those on medication, however, medication is not changed for anyone in an outdoor setting.
Medication may need to be evaluated once in a residential setting. Often, residential treatment is used to eliminate those medications which are unnecessary or that have problematic side effects.
High quality programs work with families and their educational consultants to obtain a thorough medication history by the time of admission so that medications which have previously been tried and failed are not used again in the same way.
These programs also notify parents of any medication changes, concerns or issues. Programs vary in their philosophies on the use of medication. Research finds that some children and young adults are overmedicated and some are under-medicated—so the best programs don’t take extreme positions favoring or opposing medication. They work to find the best solution for each child or young adult.
Prescribing practices are based on the best available current research. Medication is distributed by nurses or other medical staff—not by children.
Other questions we ask:
- What is the program’s philosophy on medication?
- How is medication distributed to the children or young adult?
- How will a parent be notified of changes, concerns or problems with medication?
18. ARE WE THERE YET QUESTIONS
- Does the program track whether a child or young adult is making progress towards their goals and make changes when needed?
- Can the program clearly describe what the criteria are for discharge and graduation?
- What will happen if there is a disagreement about my child’s readiness for discharge / graduation?
In collaboration with families, quality programs track children’s progress and set clear goals.
Programs need to be able to show through assessments and specific, measurable outcomes how your child or young adult is doing in language that you can understand. You need to be able to monitor this progress and discuss what can be learned from setbacks. Don’t be afraid to speak up when you feel that something isn’t clear or that progress isn’t being made.
Other questions we ask:
- How can we be sure that a child or young adult is making progress?
- What is your idea of what a child or young adult needs to accomplish to be ready for discharge / graduation?
- What can you do to help prepare a family for their child’s or young adults homecoming?
As you can see, there are many elements that go into evaluating a program when I have an on-site visit. Consequently, even the best programs won’t be the best in every single area—and that doesn’t mean your child or young adult won’t benefit.
Again, the most important elements are safety and a nurturing environment; when these are present, and the program is willing to work with us and you on the issues that you feel are important, that is a great place to start.
I focus on the aspects of the program that matter the most to families.