By Jennifer L. Shoenfelt, MD
Board Certified Child, Adolescent, and Adult Psychiatrist, Lindner Center of HOPE
Assistant Professor, University of Cincinnati, College of Medicine, Department of Psychiatry and Behavioral Neuroscience
Assistant Professor, Wright State University, Boonshoft School of Medicine, Department of Psychiatry
There are several levels of psychiatric care for children and adolescents. These are separated by the acuity of the clinical scenario, past care, and the goals of treatment. The least restrictive type of care is the outpatient setting. Higher levels of care include intensive outpatient, partial hospitalization, inpatient hospitalization, and residential treatment centers. Residential care exists in different settings or types of environments. Residential care is often considered when a child has “failed” other less restrictive interventions, such as having repeated inpatient stays in a short span of time. Residential care is also considered when the adolescent‘s family feels unable to assure the teen’s safety or the safety of other family members in any other environment. The following outlines advantages to pursuing or choosing residential treatment options.
- Residential treatment programs are longer in duration than most other levels of care. These programs range from 10-14 days for a diagnostic program to 3 months or longer for long term therapeutic interventions. In residential settings, the patient is away from home, living at the facility. Often, this means that the adolescent is a significant distance away from their family. They are removed from their daily stressors and the environment that is likely contributing to their current mental, physical and behavioral state.
- Residential treatment affords diagnostic clarification which includes in-depth testing, observational analysis, formalized testing, concentrated, in –depth, historical information gathering, and observation of family dynamics and social interaction. Professionals in multiple areas of expertise interact with the patient and then collectively formulate a differential diagnosis over time. Most programs are staffed with physicians, psychologists, social workers, teachers, chemical dependency counselors, nurses, family therapists, dieticians, and other specialty area professionals.
- Residential programs offer a vast array of therapies and approaches that are not commonly available in other treatment programs. Utilizing a combination of therapies or approaches may be what the adolescent needs to achieve success they could not find in other limited programming. For instance, a partial hospitalization program may be able to offer, dialectical behavioral therapy, group therapy, and recreational therapy among their regimen of daily activities. However, a residential program may be able to combine this with family systems therapy, cognitive behavioral therapy, acceptance and commitment therapy, eye movement desensitization and reprocessing, yoga, equine therapy, holistic approaches, martial arts, community service, academic planning and testing, etc. Of course, these do not come without a significant price.
- Residential programming allows the adolescent time to practice and strengthen skills they are learning. Many programs are based on the adolescent achieving certain levels of competency and progressing step-wise through a customized program that encourages improved self-esteem, acknowledgement of accomplishments, recognition of effort and gentle re-integration to their family dynamic.
- Educational planning if often another advantage to residential treatment. Adolescents can undergo detailed educational and neuropsychological testing. While in treatment, a plan can be devised and implemented to address any deficits or challenges the teen is facing. The educational team can make recommendations for placement and interventions for post discharge.
- Residential treatment comes in many different settings. There are programs focused on wilderness, arts, education, addictions and many others. While the teen is being treated in these novel environments, family members at home can be focusing on improving the home setting and engaging in their own specific therapies to prepare for re-integration of the child. This break for the family has its own healing effect and enables other family members to focus on their issues and concerns while their family member is away. Likewise, the adolescent may find new interests and strengths to build upon after discharge.
- Although residential treatment is costly and sometimes not covered by commercial insurance, in the long-term it can be cost effective by saving the family from multiple hospitalizations, partial hospitalization or expensive intensive outpatient care.
- Lastly, residential treatment is often more successful in addressing or treating co-occurring disorders. The comprehensive nature of residential and the duration of treatment allow the team to focus on all aspects of the clinical picture and to thoroughly attack each facet of the adolescent’s needs.
Overall, there are many advantages to residential care, though it is often the least used avenue in adolescent psychiatry. The drawbacks of cost and availability often preclude the neediest of adolescents from obtaining the comprehensive treatment benefits that could help them most.