So You are Considering Residential Treatment for Your Teen: Questions to Ask

"Larry's counselor recommends residential treatment for his substance abuse problems. We've been in family therapy for months but Larry continues to drink and use drugs. I feel sad that our 15-year-old son has such a severe addiction problem but I also feel relieved that he will soon be getting more intensive help. The question now is how do we choose a good facility?"
~ Mrs. Laurie S. ~

Mrs. S. is not alone in her situation. An estimated 1.1 million youths ages 12 to 17 meet the diagnostic criteria for dependence on illicit drugs -- a history of regular and chronic use -- and approximately 915,000 are dependent on alcohol.

Not all these adolescents require out-of-home placement. The twin therapeutic goals of stopping alcohol/drug use (abstinence) and improving communications among family members can often be achieved on an outpatient basis.

But what should a parent do when inpatient treatment is recommended?

First, know that there is a bright side to such a recommendation. A significant gap exists between the number of adolescents who need treatment and those who receive it. Only one-fourth of youths ages 14 to 17 needing such care actually obtain it.

Your child is fortunate that you are supporting his or her substance abuse rehabilitation. The adolescent brain and psyche are still maturing and proper addiction treatment will significantly improve your teen's quality of life, both now and as an adult.

How then can you best choose an effective and affordable residential treatment facility?

Start by asking your counselor for several recommendations. Many facilities have a website containing basic information - location, cost, accreditation, philosophy of treatment, duration of treatment, admission process, and a contact person - as well as photos.

Arrange to visit the facility in person and, finally, contact parents of alumni.

The Basics: Location, Cost, Accreditation
* The location of a residential facility is critical since you will not simply be dropping your teen off and picking him or her up a few weeks or months later. Parents play an integral part in adolescent treatment and visit the facility on a regular basis. In fact, many programs will refuse to admit a youth without parental commitment to on-site participation.

Your child also will be able to spend weekends at home as treatment progresses. Unless you don't mind the cost or inconvenience of long trips, the facility should be close to home or easily accessible by bus or train.

* The cost of treatment should be affordable and covered by insurance (managed care or Medicaid). Many programs have scholarships that cover any difference between fees and pocketbook. Ask what financial assistance is available. Get a list of costs that are covered and those that are not.

* Do not even consider a facility that lacks basic accreditation. Ask if it is state licensed (usually by the Department of Health) and currently accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Philosophy of Treatment
* Look for a statement of philosophy of treatment. Does the program treat adolescents only, or are adults housed in the same location? Research shows that the most effective teen treatment is totally separated from adult programs.

* Is the program it based on a self-help model with 12-Step programs being emphasized? What if your child rejects the spiritual basis of such programs? Are there alternative recovery styles available also?

* What is the average length of a residential stay? This can range from a month to a year, depending on the facility. How many teens are in treatment at any one time? How big are therapeutic groups? What are the grounds for dismissal from the program?

* Will educational and emotional needs also be addressed? How will your child's educational needs and learning style be determined? What are the goals and frequency of psychological therapy if such treatment is needed?

* Is parental participation required throughout the duration of your child's stay and what form does it take? Is there a Family Day set aside and are there support and educational groups for families?

* How does the program handle aftercare? Although there will be many changes in your child during his or her time in residential treatment, aftercare - support after leaving an inpatient program -- is the heart of maintaining recovery.

Expect that there will be at least a year of aftercare, some form of outpatient therapy and recommended attendance at self-help groups. Are aftercare services easily accessible and near your house? If not, the likelihood of your teen continuing to recover is lessened.

Admission Process and Staff Qualification
* Ask what the admissions process entails. Many facilities offer a free initial screening with a nominal charge for urine screening. If you are uncomfortable with the amount, consult with your insurance carrier on whether this cost is covered.

* An assessment will be made to determine the severity of addiction and whether a less intensive mode of treatment - intensive outpatient or day treatment through partial hospitalization - might be indicated. Sometimes a psychological, medical or psychiatric consultation will also be made. Find out what the least restrictive option is for your child.

* Ask what the basic qualifications are for being on staff with regard to education, work experience and their personal recovery from substance abuse. Are there nurses and medical staff available in case of injury? What is the ratio of staff to residents? What is the staff turnover rate?

* What is the composition of staff with regard to such demographics as age, sex, ethnicity, and sexual orientation? It is important that staff be culturally competent and sensitive to cultural issues. What staff training is offered to ensure such diversity?

Make Sure to Visit
Websites and brochures are helpful to rule out those programs that do not meet your basic needs but only an on-site visit can give a true sense of the program. Look at all aspects of the site through both adult and adolescent eyes.

* Are the rooms and grounds well kept? Is there room for teens to be active both in nice and inclement weather?

* Observe the schedule from wake-up until bedtime, if possible. This will give you a sense of how your child will spend a typical day, as well as a feeling for the adult-teen interactions. Are meals attractively served and are classrooms well equipped?

* Is there a "level system" in operation that will encourage your child to achieve self-control and leadership? You can ask to attend a group community meeting but don't be surprised if this request is refused because of confidentiality.

Talk to Other Parents
* Ask the prospective facility for "graduates" in your area that you can contact. Spend time talking with these parents about their experience. Ask the hard questions such as whether their child has experienced relapse and whether they were satisfied with the residential program.

* Share your concerns about any aspect of the program relative to the special needs of your child. Are learning disabilities addressed? If your child is gay or lesbian will he or she find peers, and understanding of gender issues from counselors?

The task of choosing a residential treatment center takes time and requires a parent to become educated about substance abuse. But it is this process that will allow you to participate effectively in your child's recovery. It is an investment worth making.

Copyright 2003 Judy Shepps Battle