By Brenda Wychulis

A full-scale residential treatment center is designed to treat and educate children and adolescents who are not succeeding in school or in life in general. The primary reason for a child being placed in one shouldn't be driven solely by a school-based problem, but rather by behaviors and mental health issues that are impairing his or her ability to function appropriately in most or all aspects of daily life. In other words, a child may be failing miserably in school, but it should not be the only criteria for residential placement. For other students, the school setting may be the only place they function well, but their behavior and problems outside the school setting are severe enough that a 24-hour care facility is the best way to keep them supervised, supported, and safe.

Put simply, the driving force behind putting a child in a residential treatment center should be the need for treatment.

Who goes to a residential treatment center?
In today's world, clinical knowledge and trends in child and adolescent mental health treatment have led to an increase in the number of out-patient or home-based treatment programs. It is commonly accepted that many young people are better served when kept in their homes and provided services with as little disruption to the family unit as possible. In layman's terms, this means that many residential treatment centers treat and educate children whose problems are so severe that their needs cannot be adequately managed at home, and/or that they are a risk to themselves or to others and must be carefully supervised at all times.

Hospital settings serve this purpose, but are more short-term and usually require an acute episode (such as a suicide attempt) for admission. Residential treatment is a setting where your child might go when they are discharged from the hospital. In this environment, work can be done to help prevent another episode and to help your child and family learn to understand precipitating factors and behaviors so that intervention can begin before your child ends up hospitalized again. The role of the hospital is simply to stabilize the immediate symptoms, which they usually do by administering medication and setting up a treatment plan for follow-up after discharge. They aren't really designed to promote long-term internalized change, unless they are a specialized hospital that keeps their clients longer than 3 to 4 days.

Why clinical needs have to come first
The clinical realm uses multiple forms of therapy, psychiatry, individualized interventions, and targeted interactions to address the underlying mental health issues that usually lead to a child being placed in a treatment center. Some children who fail in school due to ADHD may require residential treatment if their case is so severe that they are impulsive to the point that they place themselves or others in precarious situations and require 24-hour supervision. In cases like this, it's important to keep in mind that without proper medication, clinical orders, and adequate supervision, class work will suffer until the ADHD is sufficiently addressed — even in a very structured school environment.

This is a mild example, however. Most children in residential treatment have problems that extend far beyond a case of ADHD — they may suffer from it, but it's usually compounded by other factors such as additional mental health diagnoses, family problems, peer conflicts, legal trouble, and/or other nuances of emotional and behavioral health that are observable, but not easily defined. Diagnosing a problem is not always an exact science, but it's a big step towards creating a targeted approach to your child's clinical AND educational needs.

Getting started
If you're considering residential treatment for your child, and try to use your private health insurance to help pay for it, you'll likely find that your insurance company will either adhere to the idea that your child can be treated in what they may refer to as a "less-structured" setting, or they will consider residential treatment relatively equal to hospital treatment and will not pay for much more than a week or so.

If you plan to pay out of pocket, the treatment centers you look into will (or should, if they don't) evaluate your child first, either in person or through a variety of paper reviews and phone conversations. The process will depend on the facility. The center will then determine if it is appropriate for your child to be admitted, just as a private school determines who meets their entrance criteria. A good facility will give you recommendations for alternative treatment if they are unable to admit your child, and should also let you know if residential treatment (at least in their center) is more than what your child appears to need.

Brenda Wychulis is the former Admission Director of a residential treatment center for adolescent boys and holds a Master's in Public Administration from the University of Colorado. She has 16 years of experience working with  mental health, child welfare, and juvenile corrections systems throughout the United States.