What Does a Good Program Look Like?

Matching of Facility Resources and Family Needs
Once the difficult decision is made that residential treatment will be required parents face the formidable task of selecting among the myriad programs that advertise nationwide.

Like therapists, residential programs vary widely in their goals, their theoretical orientation and treatment paradigms, and the specific features of their treatment settings. Parents may gravitate toward the relative intimacy of four- to six-bed facilities housed within single-family residences or they may lean toward larger institutional facilities housing dozens of students on larger more complete campuses.

Residential treatment centers also vary widely in their geographic distribution, cost, emphasis on amenities, emphasis on group cohesiveness within the milieu, and length of stay. The expected or typical length of stay also varies widely among residential treatment programs. Many programs recommend minimum lengths of stay of between one and three months and some have lengths of stay that range from six months to two years or more.

We strongly encourage parents to seek out markers of quality and to ask many questions before committing to a particular program. There are no standardized or nationwide ratings of residential programs, and the process of evaluating programs is complicated by the fact that many facilities compete for the same pool of clients. Generally speaking, high-quality residential treatment programs will have in common the following characteristics:

Accreditation and/or licensure: High-quality residential facilities tend to subject themselves to scrutiny and oversight by state licensing authorities or other entities providing accreditation for healthcare organizations. Such licensing and accrediting authorities tend to require strict standards for evidence-based care, documentation, medication storage and handling, and other key aspects of residential care.

Fully credentialed staff: Practitioners who work in residential facilities must be sensitive not only to the dynamics of each individual client but also to group dynamics, the dynamics of conflicts between staff and clients and, perhaps most importantly, the often-subtle indications that a client may be struggling and in need of more intensive monitoring or even acute hospitalization. Less qualified programs will not only fail to recognize their inability to help the client but may be reluctant to release the teen to other levels of care due to the loss of financial stability. Be very wary of programs that are unwilling to refer clients to other programs and require long-term financial commitments.

High staffing ratio’s: Residential facilities with high staffing ratio’s respond well to the fluctuating levels of anxiety within the treatment milieu. Effective treatment programs have the ability provide more intensive monitoring (e.g., on a schedule of wellness checks every 30 minutes, every 15 minutes, or even continuous one-to-one observation) without disrupting the campus culture. Quality staff coverage not only protects the individual client but also helps ensure that the affective environment of the treatment milieu can be modulated and other clients can continue on safely and uninterrupted.

Ready access to urgent and emergency care facilities: Accidents happen and so do intentional acts of self-harm. Residential facilities that have working relationships with local hospitals and urgent care facilities are well positioned to transition clients in crisis to a higher level of care with a minimum of disruption to the milieu.

Actively participating in outcome studies:  The programs of highest quality will want to use scientifically based assessment tools to understand what aspects of their treatment are effective for various presenting problems.  Building an evidence based program is not easy and demonstrates a commitment to client feedback and growth.  Shelterwood is currently participating in a nation wide study that is sponsored by the National Association of Schools and Programs (NATSAP) and are in the process of receiving an endorsement for being an Evidence Based Program.

An aftercare strategy: Excellent programs begin planning for aftercare soon after admission, although in some cases this will be delayed by the need for diagnostic clarification. Outpatient therapists should always be included in the aftercare-planning process, and usually this inclusion can be accomplished by phone or e-mail without the need for therapists to attend meetings in person. According to research a small minority of clients elect to remain in contact with the therapists who treated them during their residential stay, but most patients do not. At Shelterwood, we are very proud of our life-long connection with former clients. Most students remain connected through social media and seek out support years after their stay with us.