This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Wednesday, March 21, 2012

Residential Treatment

Am I A Failure For Placing My Child in Residential Treatment? 
"We once told a person, who questioned our decision to place our son in residential treatment, that if he had a terrible illness or disease and we were told the only cure for him was to drain our savings account, fly to Australia, and see a specialist who could give us a cure, we would. In a heartbeat, no questions asked!
Why? Because we love our son. Our heart to help him heal, leads us to fight tooth and nail for him. We envision a day where he leads others, helps others, and gives back to the world in some amazing way. In order to help him get to that place tomorrow, we must fight today.
I’ve seen it in the eyes of a thousand parents I’ve talked to over the past few years- passion for their child. A belief that their current choices are not the end of their story. We’ve read it in the millions of words some of you have written in the comments on our blog or on our Facebook Page- a hopeless, empty, even terrified feeling over your child’s extreme behavior. But a willingness to fight. A belief in tomorrow. An “I’m not quitting” mentality.
Was the choice to take our son to residential treatment difficult? Absolutely! Did his choices lead him there? You bet! Does it mean we are failures for making that choice? Not in a million years! ~ Mike Berry

Is Residential Psychiatric Treatment (RTC) what your child needs? This is a great post about what RTC can't do (I don't necessarily agree with all of it. I do believe RTC can provide some solutions, but in general it is NOT going to solve all your child's problems).

How Do I Find Residential Treatment?
We've had quite a bit of experience with RTC's for our two children who are severely mentally ill and adopted with lots of trauma issues. The main thing to remember is that you have the right to "shop around."  for a provider and you have the right to work closely with them.  Here's what we do:

Prequel: Before you start the RTC process, you need to have documentation showing that your child NEEDS this level of care. For us, this meant repeated psych hospitalization, psychiatrist recommendations, therapist recommendations... The best thing you can do is Document! Document! Document! and keep it organized and easy to access.

1) Check with your insurance to see what they'll cover and their requirements. Our kids were on state Medicaid and our state doesn't cover RTC, but we were able to get funding from the state we adopted through (because a friend had warned me to have it written in to our adoptions subsidy). We had private insurance at one point and they had a bunch of hoops to jump through first (getting our child declared to have an SMI - serious mental illness; repeated psych hospitalizations and other outpatient stuff first... they would only pay for 4 days of RTC for my son because we didn't do all their steps.

2) RECOMMENDATIONS! Ask your therapists, psych hospital social worker, psychiatrist, post on places like this... every RTC is different in what they provide and what they're good at, and of course your child's needs are individual too. Insurance company will sometimes give you a list, but be sure to check it out yourself.

3) Check the REVIEWS Check the State Licensing Board. In our state it's called the Department of Family, Protective and Regulatory Services (or something like that). They have an ONLINE evaluation of ALL places they regulate (I use it for child care facilities too). They record ALL deficiencies (this can be injury or even death of a child, cleanliness of the facility, record keeping...). I also enter the name of the facility online with the word review. I've found some things that way that didn't make it to the licensing reports.

4) Contact several providers, and ask if you can see their facilities. Have a written list of questions to ask of each facility. Some of our questions:
  • Do you take our insurance?
  • What age children do you take?
  • What is the average length of stay?
  • What does the typical client there look like (aggressive, mostly male, most of the kids are there for substance abuse, kids with primarily behavior problems....)?
  • What type of therapy do you provide?
  • How familiar are the therapists/ psychiatrists/ staff with trauma issues (PTSD, RAD/ attachment issues, Borderline Personality Disorder...)  Will they try to facilitate attachment to the family, or to themselves?
  • My child has unusual or special modifications/ accommodations _________ (blind, uses a wheelchair, sexually reactive, afraid of the dark, intellectually disabled, needs to be in small groups...), how would you handle these?
  • What are the education/ experience/ training requirements for staff?  What is the staff turn-over rate?
  • What happens if my child becomes violent or non-compliant?
  • What happens if my child's behavior, health, or other issues change or escalate?
  • Do the kids attend the local public school or is there a charter school on campus?
  • How receptive are the therapist, staff psychiatrist to communicating with me?
  • How do you keep us (family) informed about what's going on with my child?
  • What type of communication and visitation policy do you have?  What does that look like?
  • In what areas are family expected to be involved (family therapy, part of the treatment team, staffings... ?)  In what areas are parents allowed to be involved?  
  • What kind of testing/ evaluations do you do?
  • What type of health care providers do you have on staff?  (psychiatrists, therapists, nurses, doctors...) 
  • Is the psychiatrist conservative or progressive with medications?
  • Can you accommodate my child's food/ seasonal allergies or other health issues?
  • What happens if my child gets sick or injured?  Where do they go if they need medical care not provided by the facility?
  • Can you get me a copy of the manual about how things work there (usually has info on visitation, dress code, level systems...) before we commit?

5) Check out the facility yourself. I went to a facility that during the interview process actually asked me these questions:
First question: Our facility has a large minority population. Are you OK with that? (answer: Yes, my son prefers this.)
SECOND Question (I kid you not!): Your son will be on a ward with aggressive boys (he was very aggressive due to his undiagosed bipolar disorder among other severe issues). Are you OK with him getting beaten up every day? (answer was NO!! by the way, and we did NOT take him to this facility, which has since closed it's doors).

Find a Residential Treatment Center (RTC)
A free resource to match RTC's with funding options and children's needs. I have not used their services but it came from a good source
Texas based - Youth for Tomorrow

Info about what makes an RTC a good place.

Getting Funding for RTC

Where is your child adopted from? (International, Private Adoption, Domestic Foster Care, Out of State Foster Care...)

  • Be prepared for a fight. 
  • Your child's School District may help. If it is residential, the school system must pay the cost to educate them, but this is expensive, so getting them to admit your child needs care they cannot provide is often a battle that requires a special education advocate/ attorney.  
  • Private health insurance generally covers the therapy part, as long as you meet their requirements. For this I highly recommend you document, document, document. Generally your child must have a diagnosed Severe Mental Illness (SMI), and have stepped up through repeated psychiatric hospitalizations, intensive outpatient (IOP) aka partial day hospitalization(PDH), and of course have an RTC recommendation from psychiatrist. Don't be surprised if insurance will only pay for a short period of hospitalization
    {We had a child hospitalized 6 times in a 3 month period, did 2 months in an IOP (Intensive Outpatient Program/ Partial Day Hospitalization), but was only covered for 8 days of RTC - even though she was still suicidal and the extensive neuropsychiatric testing (that this RTC specialized in) took 2 weeks! In our case, the RTC actually covered the remaining week it took to get the testing done. I know they hoped to win an appeal to the insurance to be reimbursed, but they lost. Luckily for us (but unluckily for them), we were not required to reimburse them.} 
  • Medicaid. If your child has Medicaid, some state's Medicaid covers RTC - many do not. In Texas, RTC is covered for children in foster care, but not for children who have been adopted from foster care, even if they are still on Medicaid. This is why many families are forced to do Joint Conservatorship.
  • Joint Conservatorship. Putting a child into foster care so the state will pay for mental health services. Second Time Foster Child by Toni Hoy gives a little more info on this. -  It is not an easy road, but a lot of states are working on improving the legislation that make it legal. (Ex. currently, many states might pursue you for child abandonment if you refuse to pick up an unsafe child from the hospital). You may be responsible for paying for the child to be in foster care (ex. if you receive an adoption subsidy from that state, this may be suspended while the child is receiving support outside your home).
  • Other Programs. Every state is different. Ask around. Start making phone calls. Get online. Talk to your school district, adoption support groups, National Alliance on Mental Illness (NAMI), your government representatives, psychiatric hospitals, community support programs...  
  • State Representatives. Try contacting your state representative for help.
  • Private pay. Unfortunately, sometimes this is the only option. If you work directly with the RTC, they may be willing to work with you on discounted rates and/or financing for out-of-pocket treatment.
Foster Care Adoption:
  •  Adoption Agreement. When drafting an adoption agreement, you can request adding a clause to cover RTC if you are unable to find alternate funding. {We adopted children from another state's foster care and went this route.}
  •  Post Adoption Services.  Contact your adoption caseworker and keep calling up the chain until you get someone who can help you. Sometimes saying you have no choice but to relinquish (even if untrue) might help get someone to listen.
If you have any suggestions or clarifications for funding sources - please comment and I'll add them to the list!


Sophie said...

Great post. I hope I never need this info but when I am realistic I think I may. Thank you for sharing.

GB's Mom said...

So difficult! Sorry.

Jackie said...

You can also seek the counsel of an education consultant. Find a reputable consultant through IECA at
They are not cheap, but what part of this process has been?!
Good luck,