There are no strict guidelines as to when parents should choose residential treatment as a placement option for their teen. Generally speaking, teens enter residential treatment when their needs are too intense to be managed with outpatient treatment.
When we receive referrals from an outpatient counselor, usually one or more of the following issues is taking place:
- Outpatient treatment has failed to contain the symptoms and increasing the intensity and/or the frequency of counseling contacts has not stemmed the tide of distress and dysfunction.
- Available emotional resources for support from friends and family have become depleted or drained, leaving the teen with a lack of support during periods of heightened symptomatology.
- There is no clear indication for acute inpatient hospitalization.
- There is considerable diagnostic ambiguity that may be clarified or eliminated by regular or round-the-clock observations in a safe environment—for example, to determine whether a behavioral disturbance is the result of a rapid-cycling mood disorder or concealed substance abuse.
- There are safety issues, such as escalating levels of substance abuse, disordered eating or purging behaviors, or self-injurious behaviors, that may be reduced in a controlled (but not necessarily locked) treatment milieu that features round-the-clock behavioral observations.
Therapeutic boarding schools fill a gap between outpatient treatment and inpatient hospitalization. But often the medical environment is simply not an effective intervention for most adolescent development issues. A hospital can feel impersonal, short, detached, expensive, and create a label for your teen that will be difficult for them to move past. Outpatient counseling can also feel impersonal to your teen as they tolerate it in an effort to simply get by each week. Unless your teen is motivated to change, outpatient counseling does not have sufficient structure and oversight to require a teen to ‘try change.’ The mere attendance in a weekly session can lull you as a parent into believing something is happening even though no real progress is being made.
Many teens confess when they arrive at Shelterwood that they are desperate for this kind of inpatient therapeutic help. While they might not admit it to their parents, most students realize that without a firm intervention that removes them from their environment, they had no ability to ‘self heal.’ As long as it was possible to avoid change, they were committed to avoiding it. But once they felt the warmth, support, and duration of a therapeutic boarding school, they let their guard down and tried on new ways to live.