16-Point Safety Checklist before Sending Your Teen to Residential Treatment

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:

1. Can likely help your teen
2. Won’t worsen the situation
3. 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:

1. Why you need to worry about residential treatment safety
   
2. A check-list of points of concern and potential red-flags to consider
3. 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 Checklist: 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.

1. A warning sign doesn’t necessarily indicate a serious problem – though it might.
2. 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.

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.²

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:

1. 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.
2. Make sure that any professional you approach has no financial or professional relationship with any organization under consideration.
3. 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.³

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:

1. Be as short as possible
2. Be focused on achieving a very specific goal – such as assessment, stabilization or respite
3. Be centered on a goal of having the adolescent return to the home with as little stress and disruption as possible.⁴

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.