When do I consider residential treatment for my child who is neurodiverse, struggles with mental health issues or suffers from complex trauma (Reactive Attachment Disorder)?
For caregivers, this is an incredibly difficult and complex question that comes with so many complicated emotions.
The decision to send a child to residential treatment is never an easy one and comes with many consequences for all involved.
So how does one make such a decision?
Over the years my husband and I have come up with a checklist of sorts that we go through when life seems impossible with Sunshine.
This list has been compiled after our daughter experienced multiple mental health crises and four residential placements.
It includes advice and counsel from mental health professionals, psychiatrists, pediatricians, and law enforcement that we've met along the way. It has also helped that my husband was an emergency mental health screener for years and has applied that training.
When Do I Consider Residential Treatment for My Child?
1. My child has received as many in-home supports from the community as are available, and circumstances are not improving.
Before considering residential treatment for our daughter we exhausted all resources available in our community.
These resources included:
- ABA Based Day Program Placement
- Respite
- Intensive In-Home Therapy
- Case Management
- Short-term Inpatient Psychiatric Care
- Regular Psychiatrist Appointments
These resources were used after we had already participated in the following opportunities.
- Occupational Therapy
- Physical Therapy
- Speech Therapy
- Parent Training Courses
- Regular Developmental Pediatrician Appointments
Residential treatment is the last resort or end of the line when it comes to obtaining services and supports for your child.
Even if nothing works, it's still important to try for documentation purposes, especially when that documentation is from professionals.
If you have utilized all your community has to offer and there is still no improvement, it may be time to consider residential, so long as you understand the realities that come with the decision.
2. My child has received treatment in a pediatric psychiatric inpatient hospital, and circumstances are not improving.
When a child is having an emergency mental health crisis or behaviors are becoming too extreme, professionals advise to take the child to the local ER or to call local law enforcement.
Depending on the circumstances, local law enforcement may take the child to the ER.
Once a child arrives in the local ER for mental health struggles, she will be screened. A screening will determine if she needs to be sent to a short-term psychiatric inpatient hospital for treatment.
In some circumstances, time in a short-term psychiatric inpatient hospital may be mandated. Other times it may not.
The goal of short-term psychiatric inpatient treatment is to stabilize the child through the use of or discontinued use of medications.
There is only so much that can be done during short-term psychiatric stays. If after a couple stays, your child is still not showing improvement, it may be time to consider residential treatment.
3. A child is a danger to herself and/or others continuously.
There may come a time when your child experiences a mental health emergency. It's a one time thing that is addressed with community supports, possibly an inpatient psychiatric hospital stay, and continued support at home and in the community.
But, then there are circumstances where a child may remain in a constant state of wanting to harm herself or others. Or perhaps the same dangers continue to cycle.
If you have a child who remains in a constant state of wanting to harm herself or others, or she continues to cycle in and out of those cycles regularly in your home, it is time to consider residential treatment.
Caregivers can be charged with endangering the welfare of other children for keeping a child in the home who is a danger to herself and/or others without the proper safety plans in place, approved by professionals in the community.
Always seek help immediately when a child is a danger to herself or others.
4. A child is unsafe in the home, even with safety plans in place.
It's always a hope that with the proper safety plans, a child can remain in the home without being a danger to herself or to others.
Unfortunately, there are times when a child chooses not to follow the safety plans and will not commit or follow through with safety.
In these cases, after exhausting community resources and trying short-term psychiatric inpatient care, it is time to consider residential treatment.
5. A child is creating an unsafe environment for others in the home.
There are circumstances where a child may not be a danger to herself or to others, but is still creating an unsafe environment in the home, refusing to follow safety plans put in place.
Some of these circumstances include:
- Continuous destruction of property
- Constant verbal abuse and defiance
- Continuous eloping
In these situations, after all other options are exhausted, it is time to consider residential.
So often caretakers wait until circumstances are severe before seeking treatment for their child.
They think they can handle circumstances in the home on their own, and then something even more horrible happens, destroying the family unit.
Often times hesitation on the caregiver's behalf is a result of negative experiences with law enforcement and professionals who are supposed to help, but don't.
Hesitation may also be about hope. A caregiver may think, if I can just hold on a little bit longer, things will get better.
In other situations, the process of finding a residential placement that accepts a child and is covered by insurance or community supports is extremely complicated and seemingly impossible.
No matter what circumstances you find yourself in as a caregiver, if your child meets the criteria above, it is time to find a way to obtain residential treatment for the sake and safety of all members of the family unit.
Will Residential Treatment Help My Child?
When considering residential treatment, it is very important to understand the realities of what treatment is like and that it may not help your child.
Residential treatment is a way to keep those who are left at home safe.
In many cases, your child will learn more unsafe and negative behaviors that she will bring home with her when she returns.
There is a significant chance that your child will also be harmed by other children in residential. There will be marks and bruises.
You will have very little input if any as to how behaviors are handled and what techniques are used to change behavioral patterns.
When a child goes to residential, you are no longer the caretaker of your child.
Most therapists in a residential setting are working on receiving their licensure for counseling. You will not be receiving the best of the best, nor do you have much of a choice of who you work with.
Therapists change often as retention of professionals as residential facilities is low.
Staff working with your child on the unit and throughout the day have very little training in how to "parent" children with such high needs.
Residential facilities hire those who are willing to be put in dangerous situations time and time again. Again, the retention of staff is low. Staff fluctuates often providing a lack of stability and structure.
If you exhausted every resource, taken every course, and worked with a therapist who is experienced and knowledgeable, you will struggle to adjust with the reality that staff and professionals in residential most often do not follow the same protocol.
What was not okay to do at home, as a parent, can often be justified by staff as necessary due to your child's behaviors. This can be extremely confusing.
There are some places and cases where residential can help a child heal. Most often in these instances a child is coming from an abusive and neglectful home or other setting.
Residential provides the structure and care that they never had.
But, for a child who comes from a safe, stable home, a residential treatment center is a horrific and scary place to be.
There are bullies.
More trauma occurs.
Behaviors can increase.
The more time a child spends in residential placements the more likely it is for her to return to residential again.
Why Should I Send My Child to Residential Treatment?
Despite all of the pitfalls of residential, the number one goal of placement is safety for an entire family unit.
The reason you send your child away is all about safety.
The reason a child stays in residential for any given period of time is all about safety.
When the residential team, local community leaders, and family feel the child is safe enough to return to home, the reunification process will begin.
The goal of residential treatment is always to return home and reunify with family.
Unless a caregiver's rights have been surrendered or taken away, your child will return to you.
Making the choice to send a child to a residential placement is one of the HARDEST decisions a caregiver will ever have to make.
Most often the decision does not have to be one that is made alone.
Utilize your team.
Use documentation from professionals.
Ask for help.
Residential may not yield the results you most desire, but it does give time for safety, healing, and planning, AND time for a child's brain to develop.
For those who are looking for more information about handling challenging behaviors as a caregiver, be sure to subscribe to our free newsletter by clicking the link below.
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